{
    "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 Pelvis into a concise conclusion."
    ],
    "Reasoning": [],
    "Input_language": [
        "English"
    ],
    "Output_language": [
        "English"
    ],
    "Instruction_language": [
        "English"
    ],
    "Domains": [
        "Medicine",
        "Clinical Reports",
        "CT",
        "Pelvis"
    ],
    "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 homogeneous attenuation throughout. \nThere is a 1.3 cm cyst or biliary hamartoma in the right hepatic lobe, as well\nas additional scattered hypodensities, too small to characterize, likely also\nrepresenting 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 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.  There are multiple\nhypodensities in the left kidney which are similar to prior, including a 4.9\ncm intermediate density lesion in the upper pole (2:39).  A previously seen\ncluster of cysts along the anterior aspect of the interpolar region have\ndecreased in size, now measuring up to 1.1 cm, previously 3.1 cm (2:70). \nThere is mild hydroureteronephrosis extending along the entire course of the\nleft ureter.  There is a punctate calculus in the lower pole of the left\nkidney, similar to prior.  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 collapsed around a Foley catheter.  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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPosterior fixation hardware at L4-5 is similar in appearance.  There are\nsevere degenerative changes of the right hip joint, with substantial joint\nspace narrowing and subchondral cystic change.\n\nSOFT TISSUES: Mild subcutaneous edema is seen in the pelvis and to a lesser\nextent along the abdomen.",
            "output": "1. Mild left hydroureteronephrosis including the entire length the ureter,\nwithout obstructing process demonstrated.  Mild left perinephric stranding,\ncorrelate with urinalysis to assess for infection.\n2. Interval decrease in size of previously seen cluster of hypodensities in\nthe interpolar region of the left kidney.  Additional hypodensities in\nintermediate density lesions are unchanged.  These can be further evaluated\nwith nonurgent renal MRI if clinically indicated.\n3. Prostatomegaly.\n4. Status post right nephrectomy\n5. Severe degenerative changes of the right hip with substantial joint space\nnarrowing."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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\n1.3 cm right hepatic lobe cyst or biliary hamartoma is redemonstrated. \nAdditional subcentimeter hypodense lesions within the liver are too small to\ncharacterize but likely represent cysts or biliary hamartomas.  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: Status post right nephrectomy.  Multiple intermediate density left\nrenal lesions are redemonstrated, measuring up to 4.9 cm.  There is an\nexophytic lesion arising from the anterior aspect of the left midpole (2:76 ,\n601:53) that measures approximately 1.6 x 3 cm, and demonstrates\nhypoenhancement relative to the renal cortex and is unchanged in size when\ncomparing to baseline noncontrast study of ___.  This corresponds to\npreviously visualized simple cyst on CTU of ___.\nA nonobstructive punctate left lower pole renal calculus is redemonstrated. \nStreak artifact from lumbar spinal fixation hardware, degrades evaluation of\nthe mid ureter, within this limitation there is no evidence of gross focal\nlesion.  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 or fat\nstranding. The appendix is normal.\n\nPELVIS: A Foley balloon terminates in the bladder, which contains locules of\nair.  The bladder wall is substantially thickened.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is substantially 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. \nL4-L5 pedicle screws are redemonstrated.  Severe right hip degenerative\nchanges are noted, with superior joint space narrowing, subchondral cysts and\nsclerosis, and acetabular spurring.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal or intrapelvic process.\n2. Nonobstructive left nephrolithiasis. No substantial hydroureteronephrosis.\n3. Substantial bladder wall thickening in the setting of prostatomegaly,\nconsistent with obstructive uropathy.\n4. Redemonstrated intermediate density left renal lesions.  Including a 1.6 x\n3 cm exophytic left midpole lesion, that demonstrates mild enhancement, which\nrepresents a collapsed hemorrhagic/proteinaceous cyst.  These can be further\nevaluated with renal MRI as clinically indicated.\n5. Additional findings are 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 are 2 hypodense lesions within the dome of the liver measuring up to 13\nmm, unchanged compared to prior, and likely representing a hepatic cysts or\nbiliary hamartomas.  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 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: Patient is post right nephrectomy without suspicious soft tissue\nlesions or nodularity noted within the resection bed.  Multiple indeterminate\ncysts are again re-demonstrated of the left kidney measuring up to 4.7 cm. \nNone are new or growing when compared to the most recent CT of ___,\nhowever when compared to earlier studies from ___, some are decreased in\nsize.  Punctate nonobstructing 3 mm left lower pole renal calculus is seen.\n\nThere is diffuse thickening of the urinary bladder likely representing chronic\nbladder outlet obstruction.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Colonic diverticulosis\nwithout diverticulitis is noted.  Otherwise, the colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.8 cm with protrusion\nof the median lobe into the base of the bladder.  Seminal vesicles are\nsymmetric and normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Patient is post L4-L5 transpedicle screw fixation.  No periprosthetic\ncomplications.  There is no evidence of worrisome osseous lesions or acute\nfracture.  Severe degenerative changes are seen involving the right hip with\nsubchondral cysts and sclerosis as well as joint space narrowing.\n\nSOFT TISSUES: Small fat containing umbilical hernia is noted.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal pathology.\n2. Prostatomegaly and diffuse thickening of the urinary bladder favors chronic\nbladder outlet obstruction.  However, given abdominal pain, recommend\ncorrelation with UA.\n3. Post right nephrectomy.\n4. Multiple indeterminate left renal cysts measuring up to 4.7 cm are stable\ncompared to most recent prior, with interval decrease in size of some cysts\nwhen compared to earlier ___ studies.  If further characterization of the\ncysts are desired, this can be performed with renal ultrasound.\n5. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S):  Nonemergent 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 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 is decompressed, with soft tissue stranding in the\nprevesical space, possibly adhesions in the setting of prior hernia repair. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland 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 small fat containing umbilical hernia.  Postoperative\nchanges following bilateral inguinal hernia repair are noted.  No recurrent\nhernia.",
            "output": "1. Status post bilateral inguinal hernia repair without evidence of hernia\nrecurrence.\n2. Mild soft tissue stranding in the prevesical fat, could reflect prior\nhernia repair, difficult to exclude surgical adhesions.  Correlate clinically."
        },
        {
            "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 liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  No change in the hypodensity adjacent\nto the falciform ligament, consistent with focal perfusional change.  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Again seen is focal thickening near the gastric cardia,\nslightly worsened compared to the prior study from ___ (series 5:58).\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Apparent thickening of the sigmoid colon is probably due to under\ndistension given the lack of significant pericolonic fat stranding.  However\ncorrelation with clinical symptoms of colitis is recommended.\n\nPELVIS: The urinary bladder is under distended but unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are surgically absent.  No\nresidual adnexal mass is visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  The 4 mm left gastric lymph node is\nunchanged compared to the immediate prior study from ___.\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.  A\nlucent area in the left iliac bone adjacent to the sacroiliac joint is\nconsistent with degenerative change and stable compared to prior exams.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post interval bilateral salpingo-oophorectomy without evidence of\nresidual mass.\n2. Redemonstration of thickening at the gastric cardia, correlate with\nprevious EGD findings.\n3. No new suspicious mass or lymphadenopathy.\n4. Apparent thickening of the sigmoid colon is probably due to underdistension\ngiven the lack of significant pericolonic fat stranding. However correlation\nwith clinical symptoms of colitis is recommended.\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\n___ for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is re-demonstration of an area of\nhypodensity near the falciform ligament likely due to perfusional change. \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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: There is again seen thickening of the wall of the stomach\nnear the gastric cardia, slightly increased when compared to prior (series 5\nimage 53).  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement. There is mild thickening of the rectosigmoid colon but it is\nincompletely distended.  The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Bilateral ovaries and uterus are surgically absent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic 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. Patient is status post bilateral salpingo-oophorectomy, no evidence of\nmetastatic disease.\n2. There has been slight interval increase in thickening of the region of\nknown adenocarcinoma in the gastric wall near the cardia when compared to\nprior CT.\n3. Mild thickening of the incompletely distended rectosigmoid colon similar to\nprior CT, may represent colitis in the appropriate clinical setting."
        },
        {
            "input": "LOWER 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 IV B,\nmeasuring approximately 1.5 x 1.7 x 2.4 cm (AP by TV by CC), similar in size\nto ___.  A solitary vessel appears to run through this lesion with no\ndistortion of the vessel.  This finding together with the characteristic\nlocation adjacent to the falciform ligament favors perfusional/focal fatty\nchange.  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: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 focal thickening and enhancement of the\ngastric cardia (series 6, image 53), slightly decreased since ___.  Please\nnote that gastric tumors may be better characterized with PET-CT.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThe colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: There is a right adnexal mass measuring approximately 3.8\nx 4.2 x 5.4 cm (AP by TV by CC) similar in size to ___.  The\nvisualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no lymphadenopathy.  The left gastric lymph node is\nsimilar in size compared to prior imaging.  There is no pelvic or inguinal\nlymphadenopathy.\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": "1. No lumbar spine metastasis visualized.  No radiological finding explaining\nthe patient's back pain.\n2. There is gastric thickening at the cardia which could represent the region\nof gastric adenocarcinoma seen on EGD on ___.\n3.  Subcentimeter left gastric lymph node is indeterminate.  Please note the\ngastric mass as well as lymph nodes could be better assessed with PET-CT\n4. Right adnexal mass appears similar in size to ___.  Adnexal\nmetastasis cannot be excluded.\n5. Hypoattenuating liver lesion is favored to represent perfusional/focal\nfatty change as described above.\n6. Please refer to dedicated CT chest for further characterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 small accessory spleen (2:33).\n\nADRENALS: The 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 8 mm left upper pole hypodensity is too small to characterize by CT, but\nstatistically likely a cyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is sigmoid\ndiverticulosis with a 9.4 cm segment of sigmoid colonic wall thickening,\nadjacent fat stranding, and mucosal hyperemia, compatible with acute\nmicroperforated diverticulitis.  The degree of colonic wall thickening is\nsevere (601b:24).  No drainable fluid collection.  The appendix is not\ndirectly 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall bone islands in the bilateral acetabula.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Findings compatible with acute, microperforated sigmoid diverticulitis,\nwithout drainable fluid collection.  Significant associated bowel wall edema.\n\nRECOMMENDATION(S):  Consider direct visualization with colonoscopy, given the\nseverity of the colonic wall thickening.\n\nNOTIFICATION:  The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 11:15 pm on ___, 5 min after\ndiscovery."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 a subcentimeter hypodensity in the left upper pole which is too small\nto characterize, but likely represents a simple cyst.  Small peripelvic cysts\nare noted in the left kidney.  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. Diverticulosis of\nthe sigmoid colon is again 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: 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. \nSclerotic foci in the bilateral acetabula likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to explain the patient's\npain.\n2.  Redemonstration of colonic diverticulosis without definite evidence of\nacute diverticulitis."
        },
        {
            "input": "ABDOMEN: There is a small, possibly loculated right pleural effusion along the\nmedial pleural aspect. There is bilateral compressive atelectasis, right\ngreater than left.  In the anterior right lower patchy opacities may be due to\naspiration or atelectasis. The heart is enlarged. Mitral valve replacement is\npresent. The liver is shrunken and nodular compatible with known history of\ncirrhosis. No focal lesions are identified.  The main portal vein is patent. \nThe pancreas is unremarkable. Patient has had a splenectomy.  The adrenal\nglands are unremarkable. The kidneys enhance and excrete contrast\nsymmetrically without any focal lesions or hydronephrosis. There is a large\namount of intra-abdominal ascites.  Simple in nature.\n\nAgain seen are multiple dilated loops of small bowel involving the majority of\nthe bowel with some distal loops which are collapsed. This is similar in\nappearance to ___.  ___ although some loops appear slightly decreased\nin caliber. No definite transition point is identified.  A air and retained\ncontrast is present within the colon. These findings are most consistent with\nan ileus.  There is no free air within the abdomen. The aorta is of normal\ncaliber without evidence of aneurysm. There is mild atherosclerotic extending\ninto the iliac arteries.\n\nPELVIS: The bladder is distended unremarkable. The rectum and sigmoid colon\nare unremarkable.  The endometrial cavity is distended.  This may reflect\nendometrial thickening or possibly fluid within the endometrial canal.  There\nis a Ill large amount of pelvic ascites. There is no free air lymphadenopathy\nP\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.  There are\nmild degenerative changes within the spine. There is generalized soft tissue\nedema compatible with anasarca..  A small fluid containing ventral hernia in\nthe upper abdomen superior to the umbilicus is noted (602b:39).",
            "output": "1. No evidence of intra-abdominal infection.\n2. Cirrhosis with massive ascites and anasarca.\n3. Dilated loops of small bowel with air and oral contrast within the colon\nmost compatible with ileus and similar to the prior exam from ___\nwith possible slight improvement in extent of bowel dilation.\n4. Distended endometrial cavity. Recommend correlation with presence of\nvaginal bleeding and pelvic ultrasound for evaluation of endometrial\nthickening.\n5. Small right pleural effusion, possibly loculated with bilateral compressive\natelectasis, right greater than left. Opacities in the anterior right lower\nlobe may represent aspiration or atelectasis.\n6. Small fluid containing ventral hernia.\n\nNOTIFICATION:  These findings were discussed with Dr. ___ by Dr. ___\n___ telephone at 16:45 on ___."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions and left-sided pleural\nthickening are decreased in extent compared with the immediate prior study of\n___. Multiple round masses scattered throughout both lungs are\nessentially unchanged from the prior study, compatible with known metastatic\ndisease. Please see separately submitted report of Chest CT for full\ndescription of the lungs.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation.  The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\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: The stomach is decompressed without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction. The appendix is not definitively\nvisualized, but there is no fat stranding or free fluid in the right lower\nquadrant to suggest acute appendicitis. There is a moderate colonic fecal\nload.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with no atherosclerotic\ncalcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS:   The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nOSSEOUS STRUCTURES:  A single lytic lesion in the right iliac bone measures\n1.4 by 1.0 cm, unchanged from the prior study of ___.  No new lytic\nlesions are identified.",
            "output": "1. Unchanged lytic lesion in the right iliac bone. No new osseous metastases. \nNo evidence of new metastatic disease within the abdomen or pelvis.\n2. Moderate colonic fecal load.\n3. Please see separately submitted report of CT chest for full description of\nthe intrathoracic findings."
        },
        {
            "input": "VASCULAR:\n\n Pre EVAR Angiogram of the Abdominal Aorta\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal:  2.1 x 2.2 cm\nAt lowest renal artery right: 1.8 x 1.9 cm\n5 mm below lowest renal artery: 1.9 x 1.9 cm\n10 mm below lowest renal artery:  1.9 x 1.8 cm\n15 mm below lowest renal artery:  1.9 x 1.8 cm\n\nANEURYSM Infrarenal, fusiform with eccentric clot\nDiameter (Cross-sectional): 4.4 x 4.3 cm\nLength: 7.7 cm\n\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 1.6 x 1.7 cm; Left: normal 1.5 x 1.8 cm.\nExternal Iliacs: Right: normal 0.9 cm; Left: normal 1.0 cm.\nInternal Iliacs: Right: normal 0.8 cm; Left: normal 0.7 cm.\nFemoral: Right: normal 0.7 cm; Left: normal 0.5 cm.\n\nTortuosity Iliacs:  Right: mild; Left:  mild.\nFemoral Calcifications: Right: none; Left: none.\n\nThere is a focal dissection of the right common iliac artery (axial series 3,\nimage 111).  There is narrowing involving the origin of the right internal\niliac artery (axial series 3, image 117).  Moderate narrowing with plaque\nright internal iliac.  Focal dissection distal abdominal aorta.\n\nLOWER CHEST: The lung bases are clear.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  Focal fatty deposition adjacent to the\nfalciform ligament.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor 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: 1.0 cm right adrenal nodule measuring less than 10 ___ on the\nprecontrast images in keeping with a benign adenoma.  The left adrenal gland\nis unremarkable.\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.  Uncomplicated sigmoid diverticulosis.  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\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: Mild to moderate prostatomegaly.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing paraumbilical hernia.",
            "output": "1. Infrarenal abdominal aortic aneurysm as described above.\n2. 1.0 cm adrenal nodule with attenuation in keeping with benign adenoma.\n3. Mild to moderate prostatomegaly."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Cardiomegaly\nsecondary to enlargement of the right atrium.  There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates mildly heterogeneous attenuation\nthroughout.  2.6 x 1.1 cm irregularly enhancing lesion at the tip of the\nliver.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder decompressed.  Small amount of perihepatic\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout 5 mm hypodensity in\nthe tail of the pancreas could represent 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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Thickening of the\nsigmoid in relation to the pelvic mass without obstruction (03:57).  Remainder\nof the colon and rectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small amount\nof fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Irregular endometrial hypodense mass has not\nsignificantly changed since prior.  Bilateral adnexa heterogeneously enhancing\nhypodense masses again noted.  The overall ___ are 8.4 x 8 cm,\npreviously 9 x 8.4 cm, not significantly changed allowing for differences in\nmeasurement technique.  This masses abut the rectosigmoid colon with loss of\nfat plane.\n\nLYMPH NODES/OMENTUM/RETROPERITONEUM: 1.3 cm portacaval lymph node, series 2,\nimage 20, grossly stable.  Additional prominent upper abdominal lymph nodes\nappear stable.  Multiple mesenteric, retroperitoneal, bilateral iliac lymph\nnodes up to 1 cm in diameter are suspicious for involvement.  There is\nnodularity and thickening of the omentum with adjacent collapsed loops of\nsmall bowel concerning for omental caking.\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. Redemonstrated endometrial and adnexal heterogeneous hypodense masses with\nan overall measurement of 8.4 x 8 cm concerning for malignancy.  Probable\ninvolvement of the rectosigmoid junction, without evidence of obstruction.\n2. Ascites, presumably malignant from likely ovarian, less likely uterine\norigin, has worsened since ___.  Redemonstration of omental caking\nconsistent with carcinomatosis, and portacaval, mesenteric, retroperitoneal\nand bilateral iliac involved adenopathy.\n3. Focal 2.6 cm lesion in the tip of the liver is concerning for metastasis."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.  The\nappendix is normal.  The urinary bladder and distal ureters are 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: Moderate degenerative changes are visualized about the bilateral hips\nand lower lumbar spine without evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No fracture identified."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  There is diffuse decreased attenuation of the hepatic\nparenchyma compatible with steatosis.  2.2 x 2.0 cm cyst in segment ___ of the\nliver (09:46) is unchanged in size dating back to ___.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement with no main duct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY:  No hydronephrosis on either side.  A partly exophytic cyst arising\nfrom the superior pole of the left kidney and measuring 5.8 x 6.1 x 6.1 cm\nwith thin rim calcification is unchanged compared to the prior exam from ___.  This cyst demonstrates a 1.6 cm lobulated component which also\ndemonstrates rim calcification within it as before.\nSmaller bilateral simple renal cortical cysts are unchanged compared to the\nprior exam.  No solid enhancing renal masses.  No hydronephrosis.\nGASTROINTESTINAL:  There is no bowel obstruction.  A moderate amount of stool\nburden is seen throughout the colon.\nLYMPH NODES: The patient has a history of bladder cancer.  Again identified\nare bilateral external iliac, up to greater, common iliac, aortocaval lymph\nnodes measuring up to 8 mm in short axis.  The aortocaval node (9:69) is\nslightly smaller in size compared to the exam dated ___.  However\nthe right external iliac lymph node (9:108) measures 10 mm in short axis\ncompared to a prior measurement of 6 mm.\nVASCULAR: Abdominal aorta is normal in caliber.  There is a moderate amount of\ncalcified atherosclerotic plaque throughout the abdominal aorta and its\nbranches without aneurysmal dilation.\n\nPELVIS:\nThe bladder is minimally distended and demonstrates wall thickening in the\nregion of the bladder dome (13:41) that has progressed compared to the prior\nCT dated ___.  Coarse calcification is noted within a nonenlarged\nprostate.\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes of the lumbar spine with no osteolytic or\nblastic bone lesions noted.  .",
            "output": "1. Minimal interval increase in size of a right external iliac lymph node with\ndecrease in size of aortocaval lymph node as described in detail above. \nNumerous subcentimeter lymph nodes along bilateral external iliac, common\niliac, aortocaval region are unchanged in size.\n2. Bladder wall thickening in the region of the dome with stranding of\nsurrounding perivesicular fat has progressed compared to the prior CT from ___, in this patient with known bladder cancer.\n3. Hepatic steatosis.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "8 mm hypodensity in segment 7 of the liver demonstrates nodular enhancement\nwith filling on 3 minute delayed phase imaging and is in keeping with a\nhemangioma. 6mm hypodensity in segment ___ (series 5, image 62) is too small\nto accurately characterize. The portal vein is patent. There is no intra or\nextrahepatic biliary dilatation. The gallbladder is unremarkable. The spleen\nis normal size.\n\nThere is no pancreatic ductal dilatation or mass. The adrenal glands are\nunremarkable.  There is no hydronephrosis involving either kidney.\n\nT-shaped intrauterine device is noted.  There is inward convexity of the\ncontour of the left uterine cavity thought to be on the basis of a 2.1 cm\nsubmucosal fibroid. The bladder is unremarkable. There is no free\nintraperitoneal fluid.  No small or large bowel dilatation is present. There\nis no abdominal or pelvic lymphadenopathy.\n\nPostsurgical changes are noted along the left chest wall/abdominal wall from\nbreast surgery with myocutaneous flap reconstruction.\n\nThe bones are unremarkable. Minor linear atelectasis is seen involving the\nleft lower lobe. The lung bases are otherwise clear.",
            "output": "1. No definite evidence of metastatic disease within the abdomen or pelvis.\n2. Postsurgical changes along the left chest/abdominal wall related to the\nbreast surgery with reconstruction."
        },
        {
            "input": "LOWER 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 subcentimeter hypoattenuating lesions in the kidneys bilaterally, too\nsmall to characterize.  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 moderate\nfecal loading; the colon and rectum are otherwise 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 within normal\nlimits.  An IUD is seen within the endometrial cavity.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: At the T12 vertebral body, there is a 0.9 cm sclerotic focus.  At the\nL1 vertebral body extending into the right pedicle, there is a 4.2 x 3.6 cm\nlytic lesion with soft tissue extension into the anterior and right lateral\nspinal canal and subsequent moderate spinal canal narrowing.  At the L3\nvertebral body, there is a sclerotic lesion.  The right iliac, there is a 0.8\ncm lytic lesion.\n\nSOFT TISSUES: Postsurgical changes are noted along the left chest and\nabdominal wall.  An umbilical hernia containing fat is noted.",
            "output": "1. 4.2 cm L1 vertebral body lytic lesion with soft tissue extension into the\nanterior and right lateral spinal canal.  Moderate spinal canal narrowing.\n2. Additional sclerotic and lytic lesions are noted along the vertebra and\npelvis, concerning for bone metastasis."
        },
        {
            "input": "LOWER 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: Subcentimeter hypodense lesion is seen in the lower pole of the left\nkidney and is too small to further characterize (series 2, image 78).  The\nkidneys are of normal and symmetric size with normal nephrogram.  There is no\nevidence of suspicious focal renal lesions 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 wall thickening or 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: Intrauterine device seen within the endometrial cavity. \nThe 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: The known sclerotic lesions in T7 and T8 are again seen but are\nslightly less conspicuous compared to prior exam.  The previously noted\nexophytic lytic lesion seen extending from the L1 vertebral body into the\nspinal canal is no longer visualized; however, within the vertebral body there\nis redemonstration of sclerotic and lytic changes.  The previously noted right\niliac lesion is not seen on today's exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of progression of disease.  There has been interval improvement\nin bone metastasis.\n2. The known T7 and T8 vertebral body sclerotic lesions persist but are\nslightly less conspicuous compared to prior.\n3. The previously noted exophytic lesion extending from the L1 vertebral body\ninto the spinal canal is no longer seen.  However, within the L1 vertebral\nbody, there is persistent sclerotic and lytic changes.\n4. The previously noted right iliac lesion is not 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: 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 redemonstration of multiple subcentimeter hypodense lesions in the\nbilateral kidneys, unchanged from prior study and too small to characterize. \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 minimal\ncolonic diverticulosis without evidence of diverticulitis.  Otherwise, 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.  An\nintrauterine device is again visualized within the endometrial cavity.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  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 sclerotic and lytic changes to the L1\nvertebral body, unchanged from prior study.  The known sclerotic lesions in T7\nand T8 are again seen and unchanged.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of postsurgical changes to the anterior\nabdominal wall, unchanged.  There is a small left spigelian hernia with a neck\nmeasuring approximately 10 mm (602:59), containing a loop of small bowel\nwithout evidence of bowel dilation, wall thickening, or adjacent stranding.",
            "output": "1. No evidence of disease progression.  Unchanged osseous metastatic lesions,\nas described above.\n2. Small left spigelian hernia containing a loop of small bowel without\nevidence of incarceration or obstruction.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Please see report of CT chest from same day.\n\nABDOMEN:\n\nHEPATOBILIARY: An 8 mm hyperenhancing lesion in segment 7 of the liver has\nremained stable in size  and appearances since ___.  The appearances are\nconsistent with a hemangioma.  No focal liver lesions suspicious for\nmetastases.  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: There are subcentimeter renal lesions bilaterally consistent with\nsimple cysts.  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. 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 uterus and adnexa appear normal.  There is an ICD\nin-situ.\n\nLYMPH NODES: There is no retroperitoneal or 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 lytic and sclerotic lesions are re-demonstrated in the lumbar\nspine and pelvis.\nThe mixed lytic sclerotic lesion involving the L1 vertebral body appears more\nsclerotic compared to prior.  Sclerotic lesions of the posterior aspect of the\nL2 and L3 vertebral bodies are stable.  A predominant lytic lesion with\nsurrounding area of sclerosis in the S1 vertebrae has increased in size  from\n8 mm to 14 mm.\nSubcentimeter sclerotic foci within the right and left iliac bones are\nunchanged (series 6, image 93).\nA lucent lesion in the left sacral ala appears more sclerotic (series 6, image\n97).\nA mixed lytic sclerotic lesion in the right anterior acetabulum is more\nsclerotic (series 6 image 117).\nA lucent lesion in the right acetabulum is marginally larger in  size (series\n6, image 111).\nNo evidence of vertebral collapse, spinal stenosis or pathological fracture .\n\nSOFT TISSUES: Evidence of prior ventral abdominal wall hernia repair.",
            "output": "1. Redemonstration of multiple bone metastases in the lumbar spine and pelvis.\n2. There has been mixed interval change in these lesion as demonstrated by\ninterval increase in size of 2 predominantly lytic lesions (in S1 and right\nacetabulum) concerning for enlarging metastatic lesions.  The other mixed\nlytic sclerotic lesions have become more sclerotic (suggesting treatment\nresponse).  Other smaller sclerotic lesions are unchanged.\n3. No visceral metastases in the abdomen or pelvis.\n4. Stable segment 7 hepatic hemangioma\n5.  For chest findings reference is made to CT chest report of 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. \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: There is simple appearing hypoattenuating cystic lesions within the\nkidneys bilaterally which are similar in size dimension to ___.  There is\nnow 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: There is a retroverted uterus.  The visualized\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There are multiple hyperenhancing, enlarged, round left inguinal\nlymph nodes measuring up to 1.7 cm in diameter.  There is a round enhancing\nright inguinal lymph node that is 6 mm in diameter (series 2, image 108).\nThere are multiple enlarged left external iliac lymph nodes measuring up to\n1.4 cm in diameter (series 2, image 104).\nThere is a left common iliac lymph node measuring 0.9 cm in diameter (series\n2, image 78).\nThere is a 0.6 cm periaortic lymph node at the bifurcation which is also\nsuspicious.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is a stable Tarlov/perineural cyst within the sacrum.  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. There are multiple enlarged, left iliac and inguinal lymph nodes which are\nsuspicious and consistent with biopsy proven lymphoproliferative disorder. \nThe left inguinal lymph nodes may be amenable to biopsy/excision if indicated.\n2.   No splenomegaly.\n3.   Reference is made to CT chest report of the same day for chest findings."
        },
        {
            "input": "LOWER CHEST: Postsurgical changes noted at the right lung base.  Mild\ndependent bibasilar atelectasis.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears shrunken and nodular, compatible with\ncirrhosis.  There is no evidence of concerning focal lesions within the\nlimitations of an unenhanced scan.  A tiny punctate calcification is noted\nwithin the right hepatic lobe, likely compatible with calcified granuloma\n(02:18).  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 appears mildly atrophic, 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Numerous hypodense\nlesions within the bilateral kidneys are compatible with simple cysts, with\nthe largest in the right interpolar region measuring 4.2 cm (02:29).  Multiple\nadditional subcentimeter hypodensities are too small to characterize, though\nlikely compatible with simple cysts.  There is no evidence of concerning focal\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is a punctate nonobstructive stone within the right\nupper pole (02:26).\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\ninflammation 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 mild aneurysmal dilatation of the lower thoracic aorta,\nmeasuring up to 4.3 cm (02:11).  Extensive atherosclerotic disease is noted. \nThere is an IVC filter in place.\n\nBONES: There is no evidence of worrisome osseous lesions.  Severe degenerative\nchange of the lumbar spine, including mild to moderate multilevel compression\ndeformities most notably involving L2, L3, and L4.  There is grade 1\nanterolisthesis of L5 on S1.  Moderate to severe degenerative change involving\nthe bilateral femoral heads, left greater than right, with moderate sclerosis\nof the left femoral head and mild sclerosis of the right femoral head,\nsuggestive of osteonecrosis.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No acute intraperitoneal or retroperitoneal bleed.\n2. Severe degenerative change involving the bilateral hip joints, with\nmoderate sclerosis and flattening of the left femoral head and mild sclerosis\nacross the right femoral head, most compatible with osteonecrosis.\n3. Severe degenerative change of the lumbar spine, most notably including\nmultilevel compression deformities worst at L2 through L4, and mild\nanterolisthesis of L5 on S1.\n4. Cirrhotic liver morphology without evidence of concerning focal lesions\nwithin the limitations of an unenhanced scan.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. Punctate nonobstructive stone within the right upper renal pole.\n7. Mild aneurysmal dilatation of the lower thoracic aorta measures up to 4.3\ncm."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 is\npredominantly fluid-filled throughout with diffuse mild mural wall thickening\nand hyperemia.  No drainable fluid collection is seen.  No pneumoperitoneum or\nascites.\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: The infrarenal abdominal aorta is mildly ectatic measuring up to 2.7\nx 2.5 cm (02:41), stable compared to ___.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Compression deformity of the T12 vertebral body appears similar to\nprior exam performed ___.  No aggressive osseous lesions are\nidentified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Diffusely fluid-filled colon with mild mural wall thickening and\nenhancement compatible with provided history of diarrhea.  Findings may\nreflect a mild pancolitis.\n2. Stable ectatic infrarenal abdominal aorta.\n3. Unchanged T12 compression deformity."
        },
        {
            "input": "Soft tissues:  There is a small intramuscular hematoma measuring 2.4 x 2.3 cm\nwithin the left iliacus muscle.  There is no associated fracture. The osseous\nstructures are osteopenic. Skin thickening of the posterior proximal left\nthigh is noted, possibly correlating with skin findings of ecchymosis.\n\nThe visualized lower abdomen demonstrates a large gallstone within the\ndependent portion of the gallbladder from of the right extrarenal pelvis, and\nmoderate severe vascular calcifications of the inferior abdominal aorta and\niliac vessels.  There is no free fluid in the lower abdomen or pelvis. The\nbladder is well distended. There is no pelvic lymphadenopathy. Visualized\nbowel is not obstructed with significant colonic fecal load.  A calcified\nlymph node is noted in the right lower quadrant, of uncertain etiology.\n\nBones:  There is grade 2 anterolisthesis of L4 on L5, with pars defects\nbilaterally.  Significant facet arthropathy is noted at L4-L5 and L5-S1. \nModerate degenerative changes of the left hip were noted.There is a right hip\ntotal hemi arthroplasty, with no evidence of perihardware fracture.",
            "output": "1.  Small hematoma within the left iliacus muscle. No fracture.\n2.  Grade 2 anterolisthesis of L4 on L5 with bilateral pars defects.\n3. Cholelithiasis"
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  The partially visualized left\nand right cardiac atria are dilated.\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 minimal\ncolonic diverticulosis.  The appendix is normal.\n\nPELVIS: The urinary bladder is under distended but grossly unremarkable. \nThere 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are bilateral L5 pars defects associated with mild grade 1 L5-S1\nanterolisthesis.\n\nSOFT TISSUES: There is prominent fat within the left inguinal canal, likely\nrepresenting a 4.7 x 3.4 x 3.0 cm spermatic cord lipoma.",
            "output": "No evidence of malignancy in the abdomen or pelvis.  Minimal sigmoid\ndiverticulosis and left spermatic cord lipoma noted."
        },
        {
            "input": "LOWER CHEST: There are severe calcifications at the coronaries and aortic\nvalve.  Visualized lung fields 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 are multiple hyperdense lesions\ncompatible with choledocholithiasis within the common bile duct.  The stones\nwithin the common bile duct measure up to 11 mm in greatest diameter.  The CBD\nmeasures 10 mm.  There is diffuse intrahepatic biliary dilatation with subtle\nwall enhancement.  The gallbladder is surgically absent with surgical clips in\nthe 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 adrenal glands are normal in shape and size.\n\nURINARY: There are multiple subcentimeter hypodensities throughout the\nbilateral kidneys too small to fully characterize on CT though statistically\ncysts.  The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: Fibroid uterus with multiple calcified fibroids.  The\nbilateral adnexal are unremarkable.\n\nLYMPH NODES: Enlarged 1.1 cm aortocaval lymph node is identified.  There are\nmultiple additional retroperitoneal lymph nodes that do not meet CT criteria\nfor lymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Visualized osseous structures are diffusely demineralized.  Several\nvertebral body hemangiomas are identified, specifically at L 2, L3 and T8. \nThere is levoscoliosis of the lumbar spine.  No acute fracture.  There is\nsevere degenerative changes at the left hip.  There is moderate degenerative\nchanges at the right hip.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  There is also fat\ncontaining spigelian hernia on the left (2:61).",
            "output": "Choledocholithiasis with diffuse intrahepatic dilatation.  Intrahepatic wall\nenhancement raises possibility for ascending cholangitis.\nSlightly enlarged aortocaval lymph node."
        },
        {
            "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 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.  Few tiny\nsubcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, though likely compatible with simple renal cysts.  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.  Numerous diverticula are seen scattered throughout the colon, with a\nshort segment of descending colon in the left lower quadrant demonstrating\nbowel wall thickening with surrounding fat stranding, compatible with acute\ndiverticulitis.  No focal fluid collection or free intraperitoneal air is\nidentified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  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: The abdominal and pelvic wall is within normal limits.",
            "output": "Acute uncomplicated diverticulitis involving a short segment of the distal\ndescending colon in the left lower abdominal quadrant.  No focal fluid\ncollection or free intraperitoneal air identified.\n\nExtensive diverticulosis 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 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 hydronephrosis.  Tiny bilateral subcentimeter hypodense lesions\nare again seen which are too small to characterize but may represent renal\ncysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Numerous\ndiverticula are again seen throughout the colon with a short segment of\ndescending colon noted to have mild surrounding mesenteric fat stranding. \nWall thickening is difficult to access due to collapse of the bowel at this\nlevel.  There is no organizing fluid collection, free air, or abscess\nidentified.  The appendix is mildly dilated up to 7 mm with no adjacent\nmesenteric fat stranding, not substantially changed compared 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 unremarkable.\n\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 are small bilateral fat containing inguinal hernias.",
            "output": "Extensive colonic diverticulosis with mesenteric fat stranding involving a\nshort segment of the descending colon without definite bowel wall thickening\nis concerning for mild acute diverticulitis or colitis.  No evidence of\nperforation or abscess."
        },
        {
            "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:  126 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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:\nStatus post cystectomy of the antral mass with postoperative changes and mesh\nplacement in the anterior abdominal wall.  There is no leak.  No\nlymphadenopathy seen around the stomach.\nPost colectomy and ileostomy in the right lower quadrant\nRETROPERITONEUM & MESENTERY with no interval change since the in ___\noutside study\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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe left renal vein is dilated to the level where it passes behind the SMA and\nanterior to the aorta.  In addition there is a large varix extending from the\nrenal vein to of the left common iliac vein just behind the aorta.  These\nfindings indicate nutcracker syndrome due to compression of the renal vein\nbetween the SMA and aorta\nABDOMINAL WALL AND SOFT TISSUES:\nIleostomy in the right lower quadrant is seen with air parastomal hernia\ncontaining small bowel\n.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nProstate is normal status post colectomy and rectal resection\n\nSKELETAL:\nThere is no evidence of worrisome lesions.",
            "output": "1. Status post recent resection of a gastric tumor.\n2. Not likely left renal vein we large renal-iliac vein collateral/varix.\n3. No renal tumour\n4. Post colectomy with a ileostomy in the right lower quadrant and parastomal\nhernia containing small bowel, nonobstructing"
        },
        {
            "input": "LOWER CHEST: Please see separate report for intrathoracic findings from\nsame-day CT chest.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates an unremarkable noncontrast appearance\nwithout obvious focal lesions.  There is no intrahepatic biliary ductal\ndilation.  Lack of IV contrast precludes evaluation of the portal vein.  A 4\nmm gallstone layers dependently within the gallbladder lumen (series 2, image\n42).  The gallbladder is otherwise unremarkable.\n\nPANCREAS: The pancreas demonstrates homogeneous attenuation. There is no\nperipancreatic stranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The kidneys demonstrate a normal noncontrast appearance.  There is no\nevidence of renal, ureteral, or bladder calculi.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Postoperative changes are noted along the anterior midline\nabdominal wall near the gastric antrum from prior resection, unchanged.  The\nduodenum is unremarkable.  Non-dilated small bowel loops are normal in course\nand caliber without evidence of obstruction.  Again seen in the right lower\nabdominal quadrant is a parastomal hernia containing a few loops of\nunremarkable appearing small bowel (series 2, image 54), also unchanged in\nappearance.  The patient is status post colectomy.\n\nRETROPERITONEUM: Moderate to severe atherosclerotic calcification is most\nprominent in the infrarenal abdominal aorta.  The abdominal aorta is normal in\ncaliber without evidence of aneurysm or dilation.  There is no retroperitoneal\nfluid collection.  There is no mesenteric or retroperitoneal lymphadenopathy\nby CT size criteria.  There is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs, including the bladder and terminal ureters, are\nunremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL: Postsurgical changes along the midline abdominal wall are\nsimilar to prior exams, with evidence of midline incision as well as surgical\nmesh placement.  An abnormal appearance to the lumbosacral spine at L5-S1 is\nunchanged from prior exams, chronic and degenerative in nature, with evidence\nof vacuum disc phenomenon of the L5-S1 intervertebral disc.  No concerning\nfocal lytic or sclerotic osseous lesions are seen.",
            "output": "1. No retroperitoneal hematoma.\n2. No evidence of acute intra-abdominal or intrapelvic process.\n3. Status post colectomy.  Unremarkable small bowel.  Unchanged small\nparastomal hernia at the right lower quadrant end ileostomy.\n4. Cholelithiasis.\n5. Unchanged postsurgical appearance of the anterior abdominal wall adjacent\nto the site of prior antral gastric resection.\n6. Moderate to severe atherosclerotic abnormal aortic calcification.  No\naneurysm or dilation.\n7. Please see separate report for intrathoracic findings from same-day CT\nchest."
        },
        {
            "input": "VASCULAR:\n\nThe abdominal aorta and its branches are patent with normal caliber.   There\nis mild calcium burden in the abdominal aorta and great abdominal arteries. \nNote is made of replaced left hepatic artery arising from the left gastric\nartery.\n\nLOWER CHEST: Please refer to the separate report of cardiac CT performed on\nthe same day 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 a gallstone in the\ngallbladder fundus without evidence of 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. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post total colectomy with end\nileostomy in the right lower quadrant.  No bowel obstruction.  There is a\nparastomal hernia containing nonobstructed small bowel loops and free-fluid. \nThe appendix is surgically absent.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder wall appears thickened most likely due to\ndecompression.  There is a 0.4 cm nonobstructing stone within the urinary\nbladder (series 4, image 225) as on prior study.  The distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of the lumbar spine are unchanged.\n\nSOFT TISSUES: Post hernia repair mesh are noted in the anterior abdominal\nwall.  Small fat containing umbilical hernia on the left.",
            "output": "1. No acute process within the abdomen or pelvis.\n2. For detailed evaluation of the chest and vascular diameters, please see\nseparate report performed separately with the cardiac CT.\n3. Cholelithiasis without cholecystitis.  Unchanged 0.4 cm nonobstructing\nstone in the urinary bladder."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is marked calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe visualized portions of the liver, spleen, kidneys, pancreas and bowel are\nunchanged from the CT scan of the abdomen and pelvis performed 4 hours prior. \nAgain noted is a right lower quadrant ileostomy with an adjacent parastomal\nhernia containing nonobstructed small bowel loops.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and prostate are unremarkable.  There is a left\nfat containing hernia as well as a small bowel containing right inguinal\nhernia.\n\nBONES: Anterolisthesis of L5 over S1 is unchanged.  Echo oasis at L4-L5.  No\nacute osseous abnormality.\n\nSOFT TISSUES: Re-demonstrated is expansion of the right adductor musculature\ncompatible with the previously described hematoma.  The size of the hematoma\nhas not changed.  Postcontrast there is no evidence of active extravasation. \nNo retroperitoneal hematoma.  Unchanged fat stranding along the medial right\nupper thigh and low pelvis.",
            "output": "1. Right adductor musculature hematoma, unchanged in size since 4 hours prior,\nwith no evidence of active hemorrhage.  The remainder of the examination is\nunchanged when compared to the immediate prior CT."
        },
        {
            "input": "LOWER CHEST: Minimal compressive atelectasis of the left lower lobe. \nPartially imaged cardiomegaly with similar leftward deviation of the heart\napex.  Pacer lead is visualized within the right ventricle.  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 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 suspicious\nrenal 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 collapsed.  No bowel obstruction is seen. \nPatient is status post right lower quadrant ileostomy.  The right lower\nquadrant osteoma site is normal appearance without evidence of bowel\nobstruction.  Status post total colectomy.\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: Redemonstrated chronic anterolisthesis of L5 over S1, similar in\nappearance.\n\nSOFT TISSUES: Midline anterior abdominal wall ventral hernia repair is\nredemonstrated.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Cholelithiasis without evidence of acute cholecystitis.\n2. Status post colectomy and right lower quadrant ileostomy.  No bowel\nobstruction.  No acute findings within the abdomen and pelvis.\n3. No renal, ureteral, or bladder calculus.  No hydronephrosis bilaterally.\n4. Partially imaged cardiomegaly."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported.\n\nABDOMEN:\n\nHEPATOBILIARY: Mild diffuse low-attenuation of the liver parenchyma,\nconsistent with liver steatosis.  No morphologic features of cirrhosis.  No\nfocal parenchymal lesions.  Portal and hepatic veins patent.  Unremarkable\ngallbladder.  No intrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreas is normal in bulk and attenuation.  No focal parenchymal\nlesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (9 cm).  There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Normal kidneys.  No concerning renal parenchymal lesions.  No\nhydronephrosis.\n\nGASTROINTESTINAL: Normal stomach and small bowel.  Moderate volume stool\nburden.  Large-bowel otherwise unremarkable.  The appendix in the right lower\nquadrant normal.\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nPELVIS: Unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: The prostate gland is enlarged.  There is median lobe\nhypertrophy, with protrusion into the bladder lumen.  Seminal vesicles are\nnormal.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber.  Origins of the celiac axis,\nSMA, renal arteries, and ___ are patent.  Portal vein, portal confluence, SMV,\nand splenic vein patent.\n\nBONES: No acute or focal destructive osseous lesions.  Mild degenerative\nremodeling lumbar spine.  In TS of fat surround the bony pelvis.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.",
            "output": "1. No CT evidence of malignancy within the abdomen or pelvis.\n2. Mild diffuse low attenuation of the liver, consistent with liver steatosis.\nNo gross morphologic features of cirrhosis.\n3. Note that findings pertaining to the chest will be reported separately."
        },
        {
            "input": "CHEST:\nThe visualized bases of lungs are clear.\n\nABDOMEN:\nThe liver is normal without evidence of focal lesions or intrahepatic biliary\nductal dilatation. The patient is status post cholecystectomy. The spleen is\nhomogeneous, and normal in size. The adrenal glands bilaterally are normal.\nThe kidneys bilaterally are normal without evidence of focal solid or cystic\nlesions concerning for malignancy. The pancreas is normal without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nThe stomach, duodenum, and small bowel are normal without evidence of wall\nthickening or obstruction. The colon appears to demonstrate moderate fecal\nloading, with evidence of a redundant colon.\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.\n\nBONES AND SOFT TISSUES:\nDegenerative changes are seen throughout the spine. No focal lytic or\nsclerotic lesions concerning for malignancy are seen.",
            "output": "Moderate fecal loading with the redundant colon. Moderately distended cecum\nwhich lies in the midline.  No other abnormalities identified."
        },
        {
            "input": "LOWER CHEST: There is 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 common bile duct measures 1 cm in\ndiameter, and tapers smoothly to the ampulla.  A small focus of subcapsular\nair is noted as well as air along the anterior abdominal wall, likely related\nto recent intervention.  The patient is 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 not definitively visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace\nintrapelvic free fluid is within physiologic limits.\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": "Post cholecystectomy with expected postoperative changes.  Mild intra and\nextrahepatic biliary ductal dilatation, without radiopaque stone.  No fluid\ncollections."
        },
        {
            "input": "LOWER CHEST:  Emphysema is noted at the imaged lung bases with mild scarring\nand nodularity.  A left lower lobe nodule is seen on series 2 image 7\nmeasuring 4 mm.  Also noted in the right lower lobe on series 2, image 13 is a\n6 mm nodule.  No pleural or pericardial effusion seen.  Pacemaker wires are\nnoted.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver is unremarkable.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY:  There are multiple bilateral simple renal cysts.  Subcentimeter\nhypodensities in bilateral kidneys are too small to be characterized.  There\nis no hydronephrosis.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.  Small bowel is\nunremarkable without signs of ileus or obstruction.\nColonic diverticulosis is noted without diverticulitis.  While E appendix is\nnot seen, there are no secondary signs of appendicitis.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:  Uterus is unremarkable.  No adnexal mass is seen.  Distal ureters\nopacify normally.  The urinary bladder appears well distended and normal.\n\nBONES AND SOFT TISSUES:  There is no evidence of worrisome lesions.  There is\ngrade 1 anterolisthesis of L4 over 5 with associated degenerative disc disease\nat this level and no pars defects.",
            "output": "1.  No evidence of colitis.  Diverticulosis noted without diverticulitis.\n2.  Lung base emphysema with subtle nodules measuring 4 and 6 mm for which\nfollowup CT is recommended in ___ months."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes. \nCoronary artery calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 sub-centimeter hypodensities too small to characterize in\nboth kidneys. There is no perinephric abnormality.  There is no hydronephrosis\nor hydroureter. The bladder is partially decompressed but demonstrates\ncircumferential wall thickening.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. There is a moderate stool burden in the rectum and\nsigmoid colon.  The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged, measuring 6.4 cm in largest axial\ndiameter.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no aortic aneurysm. There is a moderate atherosclerotic\nburden in the abdominal aorta.  There is a mild atherosclerotic plaque burden\nin the iliac arteries. The celiac trunk, SMA and ___ are patent. Vascular\ncalcifications are noted in the right greater than left renal arteries. The\nSMV measures 1.6 cm at its proximal aspect.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue densities overlying the abdominal wall\nlikely reflect sequelae of injections. There is a small fat containing\nsupra-umbilical hernia. There is also a small fat containing umbilical hernia.\nThe abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Moderate atherosclerotic burden in the abdominal aorta with a mild\natherosclerotic burden in the iliac arteries. The SMV measures 1.6 cm at its\nproximal aspect.\n2. Circumferential bladder wall thickening is likely related to chronic outlet\nobstruction in the setting of enlarged prostate.\n3. Coronary artery calcifications are partially visualized."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  Cardiomegaly.  Coronary calcifications. \nNo pericardial or pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensity in segment 6 is too small to characterize.  There is\nno evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is fatty infiltration of the pancreatic head and uncinate\nprocess.  No focal lesions.  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. \nSimple cysts in the lower pole and interpolar region of the right kidney\nmeasures 2.3 and 2.7 cm respectively.  There is no evidence of solid renal\nlesions or hydronephrosis.  There is small amount of fluid in the right\nperinephric space.\n\nGASTROINTESTINAL: The stomach is 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 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 atherosclerotic\ndisease is noted.  Incidentally noted a retroaortic left renal vein.\n\nBONES: Patient is status post right total arthroplasty.  No areas of lucency\nconcerning for loosening or infection.  No periprosthetic fractures.  L1\ncompression fracture.  Degenerative changes of the lumbar spine.\n\nSOFT TISSUES: In the right iliacus muscle extending to the ileus psoas is a\nfairly homogeneous hyperdense collection spanning the muscle bulk measuring\n7.4 x 4.8 x 8.5 cm (AP, transverse, cc).  The collection extents to the level\nof the prosthesis.  Apparent hypodense focus in the distal iliopsoas, in close\nto the insertion at the lesser trochanter is likely streak artifact from the\nright hip arthroplasty.",
            "output": "1. 7 x 5 x 9 cm hematoma centered in the right iliacus muscle.\n2. Total right hip arthroplasty.  No evidence of fracture.\n3. Age indeterminate L1 compression deformity."
        },
        {
            "input": "LOWER CHEST: Probable small filling defect in a left lower lobe lateral basal\nsegment pulmonary artery, compatible with provided history of bilateral\npulmonary emboli. The partially imaged lung bases are otherwise unremarkable.\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 contains stones, without\nevidence of gallbladder 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 and attenuation throughout, without\nevidence of focal lesions.  Small accessory spleen.\n\nADRENALS: Small, nodular right adrenal gland measuring 1 Hounsfield unit,\ncompatible with an adrenal adenoma.  The left adrenal gland is normal in size\nand shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nHypoattenuating renal lesions are too small to completely characterize, but\nstatistically likely reflect simple cysts.No hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. Colon and rectum are\nwithin normal limits. there is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There are few locules of gas in the urinary bladder, correlate with\nrecent instrumentation.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\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.  Incidental\nduplicated inferior vena cava with the left inferior vena cava draining into\nthe left renal vein.  There is a suprarenal inferior vena cava filter.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A large oblique musculature intramuscular hematoma is increased\nin size in the craniocaudal direction since 4 days prior, measuring\napproximately 26 x 17 x 12 cm, previously 18 x 19 x 11 cm.  No evidence of\nactive extravasation or pseudoaneurysm formation.  There is significant\nadjacent fat stranding, increased since the prior examination.  There is a\nsmall, fat containing umbilical hernia.",
            "output": "1. A large left oblique musculature intramuscular hematoma has increased in\nsize since 4 days prior in the craniocaudal direction, measuring approximately\n26 x 17 x 12 cm, previously 18 x 19 x 11 cm.  No evidence of active\nextravasation or pseudoaneurysm formation.\n2. Probable small left lower lobe lateral basal segment pulmonary artery,\ncompatible with provided history of bilateral pulmonary emboli.\n3. Cholelithiasis.\n4. Small, 2.0 x 0.6 cm right adrenal adenoma.\n5. Few locules of gas in the urinary bladder.  Recommend correlation with\nrecent instrumentation."
        },
        {
            "input": "CHEST:  Dependent atelectasis is in the postero-basilar segments of the lower\nlobes.  There are no lung nodules or consolidation suspicious for malignancy\nor infection. There is no pericardial pleural effusion.\n\nABDOMEN:  Unchanged the 1.2 cm hypodense lesion in segment 4, otherwise the\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. The adrenals glands\nare unremarkable bilaterally.\n\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones  or hydronephrosis.  Smaller than 4 mm bilateral kidney\nhypodensities are unchanged since ___ and too small to be\ncharacterized.\n\nThere is no evidence of pathologically enlarged retroperitoneal and mesenteric\nlymph nodes.\n\nThe abdominal aorta demonstrates mild atherosclerosis.\n\nPELVIS:  The urinary bladder is empty after Foley catheter placement. Distal\nureters are unremarkable. Stable dual fluid collection adjacent to the sigmoid\ncolon is now more displaced anteriorly of tear urinary bladder and ablation,\nand with the nasion of 4.4 x 5.8 cm (series 2: Image 73). Smaller than 1 cm\nsatellite lymph nodes of the left iliac chain are likely reactive. There is no\nevidence of inguinal lymphadenopathy. Small amount of free fluid is anterior\nto the pelvic abscess previously described (2:77).\n\nBONES AND SOFT TISSUES:  There are no bone lesions suspicious for malignancy\nor infection.",
            "output": "1. 4.4 X 5.8 cm left pelvic abscess is more displaced anteriorly since CT\nperformed same day after urinary bladder depletion with Foley catheter\n2. Small amount of free abdominal fluid is anterior to the pelvic abscess\n3. Unchanged 1.2 cm hypodense lesion in segment 4\n4. Smaller than 4 mm bilaterally kidney hypodense lesion are too small to be\ncharacterize but stable since in ___"
        },
        {
            "input": "There is deformity of the posterior iliac bones bilaterally, these appear to\nbe post surgical or post traumatic changes, possibly related to prior bone\ngraft donor sites (03:37).  This appearance is unchanged compared to multiple\nprior studies dating back to ___.  There has been prior posterior\nfusion at L4-L5 with grade 1 anterolisthesis of L4 on L5, this is unchanged in\nappearance when compared to the prior studies.\n\nThere is no convincing evidence of a sacral insufficiency fracture.  On 1\nimage only, there is a linear lucency through the right iliac bone close to\nthe sacroiliac joint (03:30).  This was not definitely seen on the earlier\nstudies however there was a cortical irregularity in this area and this is\nunlikely to represent acute fracture.  If the patient has pain in this area,\nthis could reflect an undisplaced fracture.  MRI may be better able to\nclarify.\n\nThere are moderate degenerative changes in the bilateral hip joints, more\nprominent on the left than the right.  Degenerative changes also noted in the\nsymphysis pubis and bilateral sacroiliac joints.  A small sclerotic focus in\nthe right parasymphyseal region is likely a bone island.\n\nAssessment of the pelvic parenchymal structures is limited.  There is\nextensive atherosclerotic calcification.  Extensive colonic diverticulosis\nwithout evidence of diverticulitis.  There is a fat containing ventral hernia\n(04:13).  No pelvic lymphadenopathy seen.  Calcifications noted in the right\nadnexal region.",
            "output": "1. Subtle linear lucency the posterior right iliac bone is likely a nutrient\nforamen however given the provided history, undisplaced insufficiency fracture\ncannot be excluded.  MRI may be helpful to clarify.\n2. New deformity and irregularity of the bilateral posterior iliac bones\nconsistent with bone graft donor site.\n3. Degenerative changes in the bilateral hip joints and sacroiliac joints.\n4. Small fat containing ventral hernia.\n5. Calcifications in the right adnexal region, likely in the right ovary but\nincompletely evaluated on this study.\n6. Diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nNo active contrast extravasation is identified to suggest active\ngastrointestinal bleeding.  There is no abdominal aortic aneurysm.  There is\nminimal calcium burden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  Trace bilateral\npleural effusions.   There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nSeveral hepatic hypodensities measure up to 9 mm and are nonenhancing,\nconsistent with simple cysts or biliary hamartomas. There is no evidence of\nconcerning focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Mild gallbladder wall thickening the fundus suggest\nadenomyomatosis.  The gallbladder is otherwise within normal limits, without\nstones or gallbladder wall edema.  Pericholecystic fluid is likely secondary\nto underlying ascites.\n\nPANCREAS: Normal attenuation throughout the pancreas, however there is the\nsuggestion of mild diffuse enlargement and edema of the pancreas, most\npronounced at the pancreatic head.  No main ductal dilatation.  Peripancreatic\nfluid is seen diffusely about the pancreas without evidence of organization.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, 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. Several subcentimeter cortical\nhypodensities too small to characterize by CT likely represent simple cysts. \nThere is no evidence of stones, concerning focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There are prominent gastric rugae throughout, however there\nis relatively increased wall edema seen at the distal stomach near the antrum\nand pylorus (series 5, image 67).  The level of the duodenal bulb, there is a\nradiopaque density (series 5, image 62), likely reflective of known clip. \nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.  There is mild circumferential mural thickening of the right\ncolon, otherwise the colon and rectum are within normal limits. There is no\nevidence of mesenteric lymphadenopathy.  The appendix is normal.  No evidence\nof active extravasation within the colon or rectum.\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 moderate volume,\nsimple abdominopelvic ascites.  A left lower quadrant approach approach\nperitoneal dialysis catheter terminates in the right lower quadrant.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.  There are bilateral vasectomy clips.\n\nBONES: There 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 active contrast extravasation within the gastrointestinal\ntract.\n2. Marked circumferential mural edema involving the gastric antrum and pylorus\nwhich may be due to third spacing, but can also be seen with gastritis.\n3. Mildly enlarged and somewhat edematous appearance of the pancreas with\nperipancreatic fluid findings suggestive of mild acute interstitial edematous\npancreatitis.  No evidence for pancreatic necrosis.  Correlation with serum\nlipase levels suggested.\n4. Mild mural thickening of the right colon may be secondary to third spacing.\n5. Moderate volume low-density abdominopelvic ascites.  Left lower quadrant\napproach peritoneal dialysis catheter terminates in the right lower quadrant\nand appears intact.  Trace bilateral pleural effusions.\n6. Atrophic kidneys bilaterally consistent with known medical renal disease."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  There is focal fat\ndeposition at the falciform ligament.  An additional tiny hypoattenuating\nfocus is identified in the left lobe of the liver and is unchanged from the\nstudy performed ___.  Portal and hepatic veins are patent.  The\ngallbladder is decompressed.  There is no intrahepatic or extrahepatic bile\nduct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen measures at the upper limits of normal at 13 cm in\ndiameter.  There are no focal splenic lesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: There is a hyperdense 13 mm lesion at the upper pole of the right\nkidney (103 Hounsfield units) on the portal venous phase.  On the 3 minutes\ndelay, it appears to washout to 70 ___ units.  On the study performed\nin ___, a small hypodense cystic lesion was seen in this location,\nmeasuring approximately 8 mm in diameter.  There are bilateral non-obstructing\nrenal calculi.  A calculus at the interpolar region of the right kidney\nmeasures approximately 3 mm in diameter (series 8, image 28).  A calculus at\nthe upper pole of the left kidney measures 4 cm in diameter (series 8, image\n30).  No hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: Normal stomach and small bowel.  No mural thickening or\nluminal distention.  Normal rectum and large bowel.  Appendix in the right\nlower quadrant normal.\n\nPERITONEUM: No free air or free fluid.\n\nPELVIS: Normal appearance of the urinary bladder\n\nREPRODUCTIVE ORGANS: Unremarkable prostate gland and seminal vesicles.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta is normal in caliber.  Major branch vessels are\npatent.  Incidental note is made of a retroaortic left renal vein, a normal\nvariant.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Abdominal and pelvic wall are unremarkable.",
            "output": "1. Findings pertaining to known metastatic disease to the chest will be\nreported separately.\n2. No evidence of metastatic disease to the abdomen or pelvis.\n3. Indeterminate hyperdense 13 mm lesion at the upper pole of the right\nkidney, which appears to washout on the 3 minutes delay.  A smaller simple\ncystic lesion was noted in this location on the study performed in ___.  This warrants further investigation with an MRI (with and without\ncontrast.\n4. Bilateral non-obstructing renal calculi.\n\nRECOMMENDATION(S):  Renal mass MRI with and without 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 a stable subcentimeter hypoattenuating focus in the left lobe.  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 (12 cm) and 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 with normal nephrogram. \nThere are bilateral nonobstructive subcentimeter renal calculi that appear\nunchanged compared to most recent study.  A previously seen hyperdense lesion\nin the upper pole of the right kidney was better evaluated on the previous\nstudy perhaps secondary to phase of contrast administration.  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 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Right renal lesion was better evaluated on the previous study and at that\ntime, an MRI was recommended for further evaluation.\n3. Bilateral nonobstructing renal calculi."
        },
        {
            "input": "LOWER CHEST: For chest findings reference is made to CT chest report of the\nsame day\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Subcentimeter biliary hamartoma\n(series 2, image 47) is again noted.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is normal in morphology.  A\nsmall linear hyperdensity measuring 4 mm likely represents a gallbladder polyp\nappear similar compared to prior MRI done ___, this could be better\nassessed with dedicated ultrasound.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Previously seen lesion at the posterior upper pole of the right\nkidney has largely undergone involution.  Bilateral punctate, milli metric\nnonobstructing renal calculi noted bilateral.  There is no evidence of solid\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. Appendix 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.  Incidental note is made of a retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic bony lesions appear similar compared to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The abnormality seen on recent MR spine correlates to a lesion/collection\nin the left pleural space and reference is made to CT chest for a description\nof this finding.\n2. There is no evidence of metastatic disease in the abdomen or pelvis.\n3. A small linear hyperdensity noted in the gallbladder could represent a\ngallbladder polyp, this could be better assessed with dedicated ultrasound.\n4. Bilateral punctate, milli metric nonobstructing renal ___\nplaques appear similar compared to prior imaging.  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 or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones and\nsludge without wall thickening or surrounding inflammation.\n\nPANCREAS: There is new mild peripancreatic stranding adjacent to the\npancreatic head and uncinate process (02:26, 601:34, 602:44).  Otherwise, the\npancreas demonstrates fatty atrophy but normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is persistently enlarged measuring approximately 14 cm. \nThere is interval enlargement of a 5.4 cm peripherally hyperenhancing,\ncentrally hypoenhancing, splenic lesion, previously measuring 4.9 cm in\n___.  Addition, there is a similar appearing lesion more anteriorly\nwhich appears new measuring approximately 3.4 cm (02:19).  Otherwise, there\nare stable scattered calcified granulomas.\n\nADRENALS: The right adrenal gland is normal in size and shape.  The left\nadrenal gland again demonstrates a unchanged 1.6 x 2.1 cm nodule, stable\ncompared to ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a stable exophytic 2.0 cm lesion arising from the upper pole of the\nleft kidney with bulk fat likely representing angiomyolipoma (02:28). \nAdditionally, there is a stable sized 2.0 cm right cortical simple cyst\n(02:39).  There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia otherwise, the stomach is\nunremarkable.  A misty mesentery appearance is stable compared to ___.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Patient status post right colectomy without evidence\nof complications.  Diverticulosis of the 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: There is an partially calcified 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: A right femoral vein stent is visualized.  A partially visualized\nright femoral artery graft demonstrates relative abrupt decreased\nopacification (2:75, 77).  There is no abdominal aortic aneurysm.  Extensive\natherosclerotic disease is 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 a right lower abdominal scar and mild soft tissue\nstranding in the right groin, likely postprocedural/postsurgical.  There is a\ntiny fat containing umbilical hernia.  The remaining abdominal and pelvic wall\nis within normal limits.",
            "output": "1. Findings compatible with early acute interstitial pancreatitis. \nCorrelation with clinical findings and serum lipase levels is recommended.\n2. Partially imaged right femoral artery graft demonstrates relative decreased\nopacification, which may represent occlusion.  Correlation with prior surgical\nhistory and vascular surgery consultation is recommended.\n3. Enlarging and new splenic lesions may represent hemangiomas.  However,\ngiven history of reported colon cancer, MRI abdomen with intravenous contrast\nis recommended.\n4. 2.0 cm indeterminate left adrenal nodule, stable compared ___. \nThis can be reassessed on follow-up imaging.\n\nRECOMMENDATION(S):  Vascular surgery consultation.\n\nMRI abdomen with and without contrast, on a non emergent basis\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:50 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Again demonstrated, are fibrotic lung changes at the bases in\nkeeping with history of interstitial lung disease.  Otherwise, 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. 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 bilateral cortical hypodensities some of which are too small to\ncharacterize but likely represent cysts statistically.  Otherwise, there is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small fluid-filled hiatal hernia.  Otherwise, the\nstomach is fluid-filled and slightly distended.  There is a fluid-filled\ndistal esophagus.  There is a small-bowel obstruction with a transition point\nin the right mid abdomen quadrant where there is a short segment of thickened\nsmall bowel with a targetoid appearance  (2:44, 601:24).  There is\nfecalization of small bowel loop immediately proximal to the abnormal\nappearing short-segment of small bowel, which is after near a transition in\ncaliber, the site of suspected obstruction (02:38).  Small quantities of fluid\ndo pass the point of suspected obstruction, however.  More distal small bowel\nis decompressed.  There is segment of mid sigmoid with equivocal wall\nthickening and hyperenhancement, although assessment is difficult due to under\ndistension (2:64).  The terminal ileum appears normal.  Colonic diverticulosis\nwithout evidence of acute diverticulitis. The colon and rectum are overall\ndecompressed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.  The seminal vesicles\nare 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.\n\nSOFT TISSUES: There is a moderate sized fat containing umbilical hernia. \nOtherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. Small-bowel obstruction with transition point in the right mid abdomen,\nwhere there is a short segment of hyperemic/thickened small bowel.  The short\nsegment has a targetoid appearance with intramural edema or inflammation. \nPossibilities include that this is due to congestion associated with small\nbowel obstruction, including the possibility of early ischemic change, versus\nintrinsic small-bowel abnormality such as a short-segment of inflammatory\nbowel disease.  The latter possibility seems less likely, however.  This\nappearance is not suspicious for a tumor but it may be appropriate,\nparticularly to exclude a background inflammatory process, to consider\nfollow-up imaging within a few months.\n2. Hyperemic sigmoid colon may represent a skip lesion in the setting of\ninflammatory bowel disease.  However, this apparent hyperenhancement may be\ndue to under distension and is an equivocal abnormality.\n3. No evidence of free intraperitoneal air.\n4. Colonic diverticulosis without evidence of acute diverticulitis.\n5. Small to moderate sized fat containing umbilical hernia without significant\nsecondary inflammatory changes.\n6. Small hiatal hernia.\n\nRECOMMENDATION(S):  Follow-up cross-sectional imaging, CT or MR, may be\nappropriate within 3 months in order to assess for any possibility of an\nunderlying small-bowel process to explain obstruction.  However, obstruction\ndue to adhesion is favored as the most likely etiology.\n\nNOTIFICATION:  Findings and recommendations discussed with Dr. ___ at\napproximately 12:45 by telephone."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A few subcentimeter scattered hypodensities are seen in the\nliver, incompletely characterized but unchanged since prior exams dating back\nto ___.  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: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 mm nonobstructive renal stone is noted in the left 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.  Mild scattered\ncolonic diverticulosis is noted without evidence of acute diverticulitis. \nOtherwise, the colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is distended.  There is no distal hydroureter. \nThere is no free 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is again an L4 vertebral body hemangioma.  No acute fractures are\nseen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute process seen in the abdomen or pelvis.\n2. Mild scattered colonic diverticulosis without evidence of acute\ndiverticulitis.\n3. 2 mm nonobstructive left lower renal pole stone."
        },
        {
            "input": "LOWER CHEST: Multiple bilateral pulmonary nodules are again noted and are\nunchanged in size and distribution in this patient with known sarcoidosis.\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.  2 mm new nonobstructive stone in the upper pole of the\nleft kidney is noted (series 3, image 76).  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 unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 mm nonobstructive kidney stone in the upper pole of the left kidney.  No\nhydronephrosis.\n2. Multiple micronodules in both lower lobe of the lung are unchanged in size\nand distribution from prior CT of ___."
        },
        {
            "input": "VASCULAR:\n\nThere is a saccular 3.4 x 3.1 cm (in the axial plane) pseudoaneurysm abutting\nand likely arising from the SMA.  There components of arterial contrast\nopacification within the pseudoaneurysm which is otherwise thrombosed.  \nThough no active extravasation is visualized, the wall of the pseudoaneurysm\nis hazy with adjacent fatty stranding raising concern for impending rupture.\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Linear atelectasis/scarring is visualized at the right lung base.\nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.2 cm right hepatic lobe hypodensity likely compatible with\nhepatic cyst versus biliary hamartoma.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is contains sludge versus\nvicarious excretion of contrast as well as stones, without evidence of\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 and attenuation throughout, 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 though symmetric in size with normal\nnephrogram.  Multiple bilateral renal hypodensities are visualized measuring\nup to 3.5 cm with an exophytic left upper pole lesion compatible with simple\nrenal cysts.  Additionally there is an intermediate density nonenhancing\nexophytic right upper pole lesion that measures 3 cm and is compatible with\nhemorrhagic or proteinaceous cyst.  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.  Diverticulosis visualized without evidence of\nbowel wall thickening or adjacent fatty stranding.  Appendix is not seen. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Contour abnormality of the right ventral aspect of the bladder near\nthe base is again seen though without frank herniation into the now fat\ncontaining right inguinal hernia.  The distal ureters are unremarkable.  There\nis no evidence of pelvic or inguinal lymphadenopathy.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged with fiducials visualized\nbilaterally.\n\nBONES: Degenerative changes are seen in the lumbar spine without evidence of\nworrisome osseous lesions.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.  Fat containing\numbilical hernia is also noted.",
            "output": "1. A partially thrombosed pseudoaneurysm measuring up to 3.4 cm which appears\nto arise from the SMA.  Subtle adjacent fat stranding raising possibility of\nimpending rupture, though no active extravasation is visualized.  This\nappearance has not changed since yesterday's exam.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Diverticulosis without diverticulitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:45 pm."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nPatient is status post resection and repair of a SMA aneurysm with surgical\nstaples in the resection bed (03:56).  Soft tissue stranding at the site of\nprior SMA pseudoaneurysm extends to the first SMA branch point and is likely\npostsurgical (3:51, 58, 59).  No evidence of residual pseudoaneurysm.\n\nOtherwise the celiac axis, ___, renal, and iliac arteries and their major\nbranches are patent with no signs of occlusive or aneurysmal disease.\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.  A\n1.8 x 1.5 cm hypodense lesion in segment V is unchanged compared to ___ (03:39).  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is contains stones, without evidence of\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 and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere no hydronephrosis.  A hyperdense right interpolar lesion measures 2.7 x\n2.4 cm, which is grossly similar compared to prior exam and does not\ndemonstrate postcontrast enhancement.  This likely represents a hemorrhagic\ncyst (02:28).  An exophytic 3.7 x 3.6 cm left interpolar renal cyst is\nunchanged compared to prior.  Multiple other renal hypodensities are too small\nto fully characterize but appear in similar size and configuration compared to\nprior exam and likely represent simple renal cysts.  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.  Diverticulosis in the sigmoid colon is noted. \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 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: Fiducial markers are again demonstrated in the prostate.\n\nBONES: Mild degenerative changes of thoracolumbar spine.  There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias, right greater than\nleft.",
            "output": "Previously demonstrated SMA pseudoaneurysm is no longer visualized.  Soft\ntissue density surrounding the SMA and extending into the first SMA branch\npoint is likely secondary to postoperative changes and is associated with two\nsurgical clips.  No evidence of residual pseudoaneurysm."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  0.7 cm hypodensity in segment 2, is too\nsmall to characterize, likely represents a simple cyst.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions.  There\nis no 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: 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.  3.1 cm simple cyst\nin the left inter pole is unchanged in size.  Additional hypodensities are too\nsmall to characterize.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. Marked\nappendiceal distention with surrounding stranding in keeping with\nappendicitis. Along the mid aspect of the appendix the wall appears thin and\nthere is an associated air-fluid level suggesting a prior rupture and\ncontained perforation/abscess formation. Surrounding stranding as well as\nreactive lymph nodes are noted.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A incompletely distended penile implant reservoir is\nnoted in the pelvis.  No evidence of complications is noted.  The prostate is\nenlarged measuring 6 cm.\n\nLYMPH NODES: Prominent inguinal, retroperitoneal and pelvic sidewall lymph\nnodes are noted, overall unchanged compared to prior study.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Marked appendiceal distention with surrounding stranding in keeping with\nappendicitis. Along the mid aspect of the appendix the wall appears thin and\nthere is an associated air-fluid level suggesting a prior rupture and\ncontained perforation/abscess formation.\n2. Prominent inguinal, retroperitoneal and pelvic sidewalls lymph nodes are\noverall unchanged compared to prior, however a possible lymphoproliferative\ndisorder should be excluded if not done previously.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 130 pm, 5 minutes after discovery\nof the 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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There are multiple scattered hepatic hypodensities measuring up\nto 9 mm in size, likely cysts.\nThe gallbladder is partially distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation no focal pancreatic lesions.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses noted\nGASTROINTESTINAL: There is no bowel obstruction.  None no bowel wall\nthickening noted.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The prostate has a\nhomogeneously hypodense appearance, and is not enlarged.  No free fluid in the\npelvis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\nMild body wall edema noted.",
            "output": "1. No abdominal/pelvic lymphadenopathy or splenomegaly noted.\n2. Scattered hepatic hypodensities measuring up to 9 mm in maximum dimension,\nlikely cysts."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.  No\npleural pericardial effusion.  Coronary artery calcifications are partially\nvisualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  Mild intrahepatic ductal dilatation. \nThe gallbladder is surgically absent.\n\nPANCREAS: Status post pancreaticoduodenectomy.  The remainder of the pancreas\ndemonstrates normal enhancement without evidence of focal lesion or pancreatic\nductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Accessory spleen is seen at the distal tip of the\nspleen (series 2, image 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis underdistended, limiting its evaluation.\n\nGASTROINTESTINAL: Post surgical changes related to interval\npancreaticoduodenectomyare seen.  Enteric contrast is seen within the stomach\nand small bowel without evidence of contrast extravasation to suggest a leak\nor perforation.  Tiny foci of intraperitoneal air is likely related to recent\nsurgery (series 2, image 30).  Visualized small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening or fat stranding.  The ascending\nand transverse colon is under distended.  There is an oblong fluid and air\ncontaining collection along the anterior wall of the peritoneum measuring\napproximately 14.1 x 2.3 x 8.7 cm (SI by AP by TRV; series 602, image 56,\nseries 601, image 17).\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Again demonstrated is a focal calcification in the\nuterine myometrial wall.  A hypoattenuating cystic structure near the cervical\nos measures 1.1 x 1.0 cm, possibly a nabothian cyst, and unchanged compared to\nthe prior examination (series 602, image 53).\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: Degenerative changes are seen in the lumbar spine.  No aggressive\nosseous lesions are identified.\n\nSOFT TISSUES: There is a large skin and subcutaneous defect along the right\nupper anterior abdominal wall extending to but not insert passing the\nperitoneum.  Findings are compatible with recent debridement.  Heterogeneous\nmaterial within the defect may reflect packing material.  Scattered foci of\nair and fluid along the midline anterior abdominal wall may be related to\nrecent debridement versus phlegmonous change.  Surgical staples are seen\noverlying the upper abdominal wall.  There is moderate body wall anasarca.  No\ndefinite organized collection is seen in the subcutaneous soft tissues.",
            "output": "1. Status post radical pancreaticoduodenectomy with an oblong fluid and air\ncontaining collection abutting the anterior peritoneum measuring approximately\n14.1 x 2.3 x 8.7 cm (SI by AP by TRV).\n2. Large skin and subcutaneous defect along the right upper anterior abdominal\nwall compatible with recent debridement and packing.  Scattered areas of air\nand fluid along the midline anterior abdominal wall may be related to recent\ndebridement versus phlegmonous change.  No identifiable drainable fluid\ncollection in the subcutaneous soft tissues of the abdominal wall.\n3. Mild intrahepatic ductal dilatation.\n4. Tiny foci of intraperitoneal air is likely related to recent surgery."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Note is made of bibasilar\natelectasis as well as minimal left pleural thickening posteriorly.  A venous\ncatheter tip terminates at the cavoatrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild intrahepatic biliary\ndilatation, similar from prior. The gallbladder is surgically absent. There is\nan unchanged tubular focus just medial to the inferior right hepatic lobe,\nnonspecific (2:48).\n\nPANCREAS: The patient is status post pancreaticoduodenectomy.  The residual\npancreas is normal in bulk with a normal enhancement pattern and no evidence\nof focal lesion or main 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes related to pancreaticoduodenectomy are\nnoted. Evaluation of the postoperative anatomy is limited in the absence of\noral contrast media. There is no evidence of bowel obstruction. Oral contrast\nmedia is seen within the rectum as well as in multiple colonic diverticula,\nlikely representing residual oral contrast from the prior exam.\n\nThere is re-demonstration of a fluid collection along the anterior abdominal\nwall.  A pigtail drainage catheter is noted within the superior component of\nthis collection which is substantially smaller on the current exam and\ndifficult to discretely measure.  The more inferior component of this\ncollection measures approximately 6.9 x 1.6 x 1.7 cm, previously 9.1 x 1.4 x\n6.9 cm (TV by AP by CC) (2:38, 602:45). Anterior to the greater curvature of\nthe stomach abutting the peritoneum there is re-demonstration of a 1.5 x 1.5 x\n1.4 cm rim enhancing collection slightly changed in morphology from prior but\nprobably slightly larger (2:39). There is unchanged nonspecific soft tissue\nnodularity within the anterior superior mesenteric fat could reflect\npostsurgical change or omental disease (2:42).\n\nPELVIS: The urinary is distended but unremarkable in appearance.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Unchanged 1 cm cystic focus adjacent to the cervical os,\npossibly a nabothian cyst (2:77).  A focus of calcification in the uterine\nmyometrium is unchanged.\n\nLYMPH NODES: No abdominopelvic 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: There is extensive body wall anasarca with a slightly\nconglomerate appearance in the right anterior wall pannus without evidence of\nrim enhancement (2:62).  Presumed post debridement changes are noted along the\nanterior abdominal wall with a slightly heterogeneous appearance which may\nreflect packing material.",
            "output": "1. Status post pancreaticoduodenectomy, suboptimally evaluated in the absence\nof oral contrast media.  Unchanged mild intrahepatic biliary ductal\ndilatation.\n2. Interval decrease in size of an anterior abdominal wall fluid collection\nstatus post pigtail catheter placement as described above.\n3. A 1.5 cm rim enhancing collection anterior to the greater curvature of the\nstomach is slightly changed in morphology from prior and slightly larger,\nlikely below size threshold for drainage.\n4. No definite new focal fluid collections, however evaluation is limited\nwithout oral contrast.\n5. Nodular soft tissue deposits within the anterior superior mesenteric fat\nmay reflect postsurgical change or omental disease.\n6. Nonspecific tubular structure just medial to the inferior right hepatic\nlobe is unchanged from prior and may reflect sequelae of cholecystectomy. \nAttention on follow-up is recommended.\n7. Diffuse body wall stranding and anasarca with evidence of an anterior\nabdominal wall wound defect status post packing."
        },
        {
            "input": "NOTE: History of malignant biliary obstruction status post pylorus preserving\npancreaticoduodenal ectomy.\n\n\nLOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nThere is nodular soft tissue within the mesentery in the midline (series 5,\nimage 22) a, slightly smaller in size compared to ___, together\nmeasuring 2.2 x 0.6 cm in size.  Persistent 4 mm soft tissue nodule along the\ninferior margin of the liver (series 5, image 31) also noted.\n\nHEPATOBILIARY:  The liver enhances homogeneously with no focal liver lesions.\nThe gallbladder is surgically absent.\nPANCREAS: The patient is post pylorus preserving pancreaticoduodenectomy.  The\nremnant pancreas enhances homogeneously with mild prominence of the main\npancreatic duct.\nSPLEEN:  No splenomegaly or focal splenic lesions..\nADRENALS:  There is a right adrenal nodule measuring 1.3 x 0.8 cm in size\n(series 5, image 12) that was not seen on the MRI from ___, and\nis more conspicuous compared to ___ concerning for a metastatic\nlesion in the given clinical scenario.\nThere is new uniform thickening of the left adrenal gland (series 5, image\n14), close attention on follow-up recommended.\n\nURINARY: No hydronephrosis or solid enhancing renal masses noted.\nGASTROINTESTINAL: There is no bowel obstruction.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears unremarkable.  The uterus and\nadnexae are unremarkable..\n\nBONES AND SOFT TISSUES:\nMild degenerative changes of the thoracolumbar spine noted.  No worrisome\nosseous lesions identified.\n\nThere is interval resolution of the previously noted fluid collection located\nbetween the stomach, left lobe of the liver and the anterior abdominal wall.\n\nPostsurgical changes of the upper anterior abdominal wall noted.\nSubcutaneous hypodense nodules in the right anterior pelvic wall measuring up\nto 1.6 cm in size may be related to injections (5:64).",
            "output": "1. Interval resolution of previously visualized fluid collection located\nbetween the liver, stomach and the anterior abdominal wall.  There has been\ninterval removal of the percutaneous drain noted on the prior scan.  No new\nintra-abdominal fluid collections seen.\n2. Decrease in size of nodular soft tissue thickening within the upper\nabdominal midline mesentery.  Continued attention on follow-up.\n3. New/more conspicuous right adrenal nodule measuring 1.3 cm in size, and\nthickening of the left adrenal gland-close attention on follow-up 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.  No\nfluid collections at the gallbladder fossa.  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. \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. Fluid filled\ncolon, appears otherwise 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 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.\n2. Fluid-filled colon with otherwise normal wall appearance.  Correlate with\ndiarrhea.\n3. Status post cholecystectomy with no fluid collections at the gallbladder\nfossa."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  In\nthe subhepatic space abutting the inferior border of the right hepatic lobe\nand adjacent duodenum is a heterogenously enhancing mass measuring 5.8 x 4.7\ncm, (series 2, image 57) and previously measured 10.5 x 8.7 cm on most recent\nprior.  The solid homogeneous enhancing mass, anterior to the large subhepatic\nheterogenously enhancing lesion, (seen on prior imaging; series 2, image 37)\nis no longer demonstrated on current study.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreatic parenchyma demonstrates mild fatty replaced.  There\nis no evidence of focal lesion or pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen remains posteriorly displaced by the mass extending from\nthe stomach.  The spleen demonstrates normal size and 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 with normal nephrogram. \nThere are bilateral non there is no evidence of focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Extending from the greater curvature of the stomach is a\nheterogenously enhancing, complex cystic and solid mass with a centrally\nnecrotic component measuring 9.8 x 6.8 x 10.3 cm and previously measured up to\n18.1 cm.  There is a small hiatus 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.  There has been interval resolution\npreviously demonstrated hyperdense ascitic fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Moderate prostatomegaly.  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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel degenerative changes of the lower thoracic and\nlumbar spine including intervertebral disc space narrowing osteophytosis and\nvacuum phenomena.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. There has been significant interval decrease in size of of the GIST tumor\nextending from the greater curvature of the stomach and the metastatic mass in\nthe subhepatic space.\n2. Interval resolution of previously demonstrated solid homogeneous enhancing\nmass, anterior to the subhepatic lesion.\n3. Interval resolution of small volume hyperdense ascites.\n4. Cholelithiasis and diverticulosis are incidental findings."
        },
        {
            "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.\n\nIn the subhepatic space abutting the inferior border of the right hepatic lobe\nand adjacent to the duodenum, there is redemonstration of the hypodense mass\nmeasuring 5.2 cm x 4.0 cm x 2.6 cm, previously 5.8 cm x 4.7 cm x 3.6 cm,\nmildly decreased in size.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder contains a stone as before.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Mild fatty replacement as before.  There is no pancreatic duct\ndilatation.\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: Colonic diverticula are seen. Stable duodenal diverticulum.\n\nThere is no evidence of bowel dilatation or obstruction.\n\nThere is redemonstration of the mass extending from the greater curvature of\nthe stomach, abutting the spleen. It measures 6.6 cm x 10.1 cm x 4.6 cm,\npreviously 6.8 cm x 10.3 cm x 5.6 cm, mildly decreased in size.\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. Moderate\ndegenerative disc disease is seen in the lumbar spine. Fat-containing\numbilical hernia again seen.",
            "output": "1. Mild decrease in size of the mass extending from the greater curvature of\nstomach and the subhepatic mass.\n\n2.  Uncomplicated cholelithiasis.\n\n3. Please see the report of the CT chest performed on the same day for more\ndetails."
        },
        {
            "input": "LOWER CHEST:\nPlease refer to same day chest CT report for subdiaphragmatic findings.\n\nABDOMEN AND 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 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 shows normal size and attenuation throughout, 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 with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGastrointestinal: Unchanged appearance of a hypodense mass adjacent to the\nduodenum in proximity to the gall bladder and right hepatic lobe (05:56)\nmeasuring 5.2 x 4.0 cm.  Also relatively unchanged is a hypodense mass along\nthe greater curvature of the stomach and close proximity to the spleen (05:43)\nmeasuring 10.8 x 6.3 cm.  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 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 are unremarkable.  The prostate is\nmildly 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. Stable masses along the greater curvature of the stomach and duodenum, in\nkeeping with the known primary malignancy.  No other lesions concerning for\nnew metastatic disease.\n2. Uncomplicated 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\nGIST LESIONS: Well-defined low-density soft tissue just inferior to the porta\nhepatis, contacting the gastric pylorus, medial margins of hepatic segments 5\nand 6, and the colonic flexure is stable in size and appearance, measuring up\nto 4.7 x 4.1 cm.\nSimilarly, the well-defined irregular soft tissue mass abutting the greater\ncurvature of the gastric fundus 10.1 by 6.6 cm in maximum ___, similar\nto previous examination.  This lesion blends with the gastric surface, and\nabuts the anterior spleen.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There is cholelithiasis without evidence of\ngallbladder wall thickening or adjacent fluid.\n\nPANCREAS: The pancreas shows fatty replacement, otherwise is normal in\nattenuation without evidence of focal lesion.  There is no MPD dilatation.\n\nSPLEEN: Closely associated with the left upper quadrant mass, otherwise shows\nnormal parenchymal attenuation 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Left upper quadrant mass is inseparable from the gastric\nfundal wall, most likely serosal in origin.  The porta hepatis mass similarly\nis closely associated with the gastric pylorus serosa.  There is no gastric\nmucosal thickening.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement.  The colon and rectum are within normal limits.\nThe appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are present, most severe between L2\nand S1.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia is noted.",
            "output": "1. Stable size and appearance of low-density masses in the left upper quadrant\nand porta hepatis, closely associated with gastric serosa.  No lymphadenopathy\nor evidence of other metastatic disease.\n2. Uncomplicated cholelithiasis."
        },
        {
            "input": "LOWER CHEST: There is bibasilar linear atelectasis.  There is a 3 mm right\nlower lobe ground-glass nodule (series 2, image 7).  There is no evidence of\npleural or pericardial effusion.\n\n\n\nABDOMEN:\n\nThere is small volume free fluid in the abdomen and pelvis.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nWithin the subhepatic space, abutting the inferior aspect of the right lobe of\nthe liver, is a 10.5 x 8.7 x 7.1 cm  heterogeneous cystic and solid mass\n(series 2, image 35), with loss of intervening being fat plane between the\nliver and the mass, without evidence of hepatic invasion.  The mass abuts the\npylorus and duodenum, also with loss of intervening fat planes as seen on\nseries 601, image 27.  There is central necrosis within this mass.\nAnother solid homogeneously enhancing mass measuring 7.6 x 3.2 x 4.0 cm\n(602:36/02:37) is located anterior to this necrotic mass in the right\nhemiabdomen.\n\nPANCREAS: 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 displaced posteriorly by the large mass.  The spleen\nshows normal size and 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: There is a large exophytic heterogeneously enhancing cystic\nand solid mass measuring up to 18.1 cm possibly arising from the greater\ncurvature of the stomach (series 601, image 40).  There are areas of central\nnecrosis.  The lesion displaces the spleen posteriorly with no discrete\ninvasion of the spleen.\n\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nThe hepatic flexure passes near the smaller subhepatic mass, with intact\nintervening fat plane.  There is focal colonic wall thickening and mesenteric\nstranding (series 2, image 42), likely reactive.\nThere is diverticulosis.  No bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nmoderate intermediate density ascites.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: No enlarged lymph nodes 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: Small fat containing umbilical hernia noted.",
            "output": "1. Two large heterogeneously enhancing, mixed solid and cystic intraperitoneal\nmasses noted.  The larger mass measuring up to 18.1 cm is likely arising from\nthe greater curvature of the stomach, extending exophytically into the left\nupper quadrant of the abdomen, displacing the spleen posteriorly. \nDifferential includes a cystic GIST.  The second, smaller similar appearing\nmass measuring up to 10.5 cm in maximum dimension may represent a peritoneal\nmetastasis.\n2. A more solid homogeneously hyperdense/enhancing mass, discrete from the\nsmaller subhepatic mass is located anterior to the smaller subhepatic mass and\ngiven the ___ of ___ represent a hematoma.\n3. Small volume hyperdense ascites, concerning for hemoperitoneum. \nCholelithiasis and diverticulosis are additional incidental findings.\n4. Recommend tissue biopsy, either percutaneously or via endoscopy.\n\nRECOMMENDATION(S):  Please see impression 4."
        },
        {
            "input": "VASCULAR:\n\nThe patient is status post EVAR.  The abdominal aorta is ectatic, measuring up\nto 3.3 cm at the esophageal hiatus.  And aorto bi-iliac stent is in situ. \nType 2 endoleak appreciated in the distal aorta, likely from a supplying\nlumbar artery.  The native aneurysm sac has not changed in size and measures\n5.3 x 4.8 cm.\n\nFocal short segment narrowing of the celiac caliber at the diaphragmatic crus.\nThere is an accessory left hepatic artery arising from the left gastric\nartery.  The common hepatic artery is replaced, arising from the SMA.  The\nsingle right and single left renal arteries are patent.  There is slight\nsuprarenal extension of the aorto bi-iliac stent.  There is contrast\nopacification of the right stent did common iliac artery, external iliac\nartery, CFA, SFA, and profunda femoris.\n\nThere is contrast opacification of the internal iliac artery, though there is\nmild attenuation of the obturator branch.  On the left side, there is contrast\nopacification of the external iliac artery, with evidence of mural calcific\nand noncalcific plaque.  The CFA, SFA, and profunda femoris are patent.  The\ninternal iliac artery is patent.\n\nLOWER CHEST: Lung bases are clear.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are a few tiny hypodensities within the liver, incompletely\ncharacterize, but statistically representing cysts.  Small area of focal fat\nis seen adjacent the falciform ligament.  .  The gallbladder is within normal\nlimits, without 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 right and left adrenal glands are normal in size and shape.\n\nURINARY: Small cysts within the left kidney is noted.  There is evidence of\nparenchymal scarring and cortical thinning in bilateral kidneys.  No evidence\nof hydronephrosis.  The bladder is unremarkable.  Large fluid collection is\nseen in the right scrotal sac which is incompletely imaged, which may\nrepresent a hydrocele.\n\nGASTROINTESTINAL: There has been prior APR.  A right lower quadrant ileostomy\nis in situ.  There is no evidence of mesenteric or retroperitoneal\nlymphadenopathy.\n\nBONES: Degenerative changes within the thoracolumbar spine.  No worrisome\nosseous findings.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Aorto bi-iliac stent with type 2 endoleak likely from supine lumbar artery.\nNo interval change in the size of the native aneurysm sac."
        },
        {
            "input": "VASCULAR:\n\nAgain seen are postsurgical changes status post endovascular repair of an\ninfrarenal abdominal aortic aneurysm.  Aneurysm graft extends from the just\nsuperior to the renal arteries, into the bilateral common iliac arteries, as\non the prior examination.  Type 2 endoleak at the inferior aspect of the graft\nis similar in appearance to the prior examination, and appears to arise from a\nlumbar artery.\n\nThe aneurysm sac measures 5.0 cm AP x 5.6 cm transverse, increased in size\nfrom prior examination, where it measured 4.6 cm AP x 5.1 cm transverse, using\nsimilar measurements.\n\nAccessory left hepatic artery again noted arising from the left gastric. \nCommon hepatic artery is again noted to arise from the SMA.\n\nThe celiac and superior mesenteric arteries are patent.\n\nThe renal arteries remain patent.  The inferior mesenteric artery is\nnon-opacified, and excluded by the graft.\n\nThe internal iliac arteries are well opacified and remain patent.\n\nThe external iliac arteries are patent.\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. \nArterially enhancing lesions in segment 3 and segment 7 are unchanged, and\nlikely represent hemangiomas.  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. \nNo stones. 1 cm cyst noted projecting from the upper pole of the left kidney.\nAdditional subcentimeter renal lesions are too small to completely\ncharacterize and statistically most likely to represent simple cysts.  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.  Right lower quadrant ileostomy noted. The colon\nand rectum are surgically absent. 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: The prostate is enlarged. Right hydrocele noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Re-demonstration of a type 2 endoleak status post endovascular repair of an\ninfrarenal abdominal aortic aneurysm. Aneurysm sac size has increased in size\nfrom the prior examination, now measuring 5.0 x 5.6 cm, previously 4.6 x 5.1\ncm."
        },
        {
            "input": "VASCULAR: Postsurgical changes status post endovascular repair of infrarenal\nabdominal aortic aneurysm with graft extending from the level of the renal\narteries through the common iliac arteries.  Seen on prior, there is a type 2\nendoleak with contrast seen within the excluded aneurysm sac likely from\npatent lumbar branches.  Currently, aneurysm measures 5.1 x 6.0, previously\n5.0 x 5.9 cm.  There is no evidence of rupture.  Otherwise, no change from\nprior.  Atherosclerotic burden is unchanged.\n\nLOWER CHEST: Emphysema at the lung bases noted with areas of atelectasis in\nthe left lower lobe and lingula.  The heart is mildly enlarged as on prior.\n\nABDOMEN:\n\nHEPATOBILIARY: Arterially enhancing lesions again seen within segment 3,\nseries 3, image 40 measuring 10 mm and segment 7, series 3, image 18 measuring\n3 mm are unchanged and likely represent hemangiomas.  No new or worrisome\nliver lesion.  Main portal vein is patent.  The gallbladder is unremarkable.\n\nPANCREAS: The pancreas appears normal without focal concerning lesion, ductal\ndilation or signs of inflammation.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: Adrenals are unremarkable.\n\nURINARY: The kidneys enhance symmetrically.  No hydronephrosis.  A hypodensity\narising from the left renal upper pole is likely a cyst though too small to\ncharacterize.  A lobular contour of the kidneys is unchanged with slight\natrophy of the left kidney again noted.  No signs of pyelonephritis.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal.  Small bowel loops\ndemonstrate no signs of ileus or obstruction.  An ileostomy is again noted in\nthe right mid abdomen appearing uncomplicated.  The colon and rectum are\nsurgically absent.  No free air or free fluid is seen.  No mesenteric\nadenopathy or fluid collection.\n\nRETROPERITONEUM: No retroperitoneal hematoma or adenopathy.\n\nPELVIS: The urinary bladder is moderately distended appearing normal.  The\nprostate is not enlarged.  Fluid in the right hemiscrotum is partially\nvisualized.  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": "Re-demonstration of a type 2 endoleak status post endovascular repair of an\ninfrarenal AAA.  Minimal interval increase in sac size, previously 5.0 x 5.9\ncm, currently 5.1 x 6.0 cm."
        },
        {
            "input": "Study is limited by motion degradation.\n\nVASCULAR:\n\nSince the prior CTA of the abdomen/pelvis from ___, has been interval\nembolization of a left lumbar artery coursing from the region of the left\nL5-S1 neural foramen to the left internal iliac artery.\n\nAgain seen is an aorto bi-iliac stent graft.  There is an aneurysm of the\ninfrarenal aorta measuring 5.5 x 5.9 cm (series 6:73), unchanged in size and\npreviously 5.4 x 5.9 cm on CTA abdomen pelvis ___.  Again noted are\nfoci of enhancement within the excluded aneurysm sac, compatible with a\npersistent type 2 endoleak.  There is no stranding surrounding the aneurysm\nsac.\n\nModerate atherosclerotic burden is again noted.  The celiac artery and SMA are\nwidely patent.  The bilateral renal arteries arise from the superior aspect of\nthe stent graft and are widely patent.  The ___ is not visualized.\n\nIncidental note is made of a circumaortic left renal vein.\n\nLOWER CHEST: There is mild dependent subsegmental atelectasis in the bilateral\nlung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a segment III hypodensity measuring 8 mm (series 6:37) which is\nunchanged from prior and too small to characterize but statistically likely\nrepresents a simple cyst or biliary hamartoma.  7 mm hyperattenuating focus in\nsegment III (series 6:35) and punctate hyperattenuating focus at the hepatic\ndome (series 6:15) are unchanged and likely represent capillary hemangiomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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 diffuse cortical thinning of the left kidney, slightly more\nprominent compared to the right side.  A 1.3 cm hypoattenuating focus in the\nupper pole of the left kidney (series 6:32) likely represents a simple cyst. \nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The colon and rectum are surgically absent.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThe right lower quadrant ileostomy is unremarkable.  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: The prostate does not appear enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\na right-sided hydrocele.",
            "output": "Interval embolization of a left lumbar artery coursing from the region of the\nleft L5-S1 neural foramen to the left internal iliac artery.  Aorto bi-iliac\nstent graft with the infrarenal abdominal aortic aneurysm sac measuring 5.5 x\n5.9 cm, unchanged compared to prior CTA of the abdomen/pelvis from ___, with a persistent type 2 endoleak."
        },
        {
            "input": "VASCULAR:\n\nAorto bi-iliac stent graft traversing a large infrarenal abdominal aortic\naneurysm is again seen.  This measures up to 5.5 x 6.1 cm, not significantly\nchanged compared to prior exam.  Foci of enhancement within the aneurysm sac\nin a similar distribution compared to prior exam is again compatible with type\n2 endoleak supplied by at least two vessels, one of which is a lumbar artery. \nThe celiac axis and SMA are patent.  The bilateral common, external, and\ninternal iliac arteries are patent.  Bilateral renal arteries are patent.\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 5.5 x 6.1 cm\nDiameter (Center-line): 6.3 cm\nVolume:\n\n1. Aneurysm: 176 ml\n2. Renal to Aortic bifurcation: 218 ml\n3. Renal to Iliac bifurcation: 240 ml\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.3 cm.\nLength distal graft to iliac bifurcation:  Right: 1.7 cm; Left: 3.0 cm\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. \nSubcentimeter hypodense lesion in segment 3 is stable from prior and too small\nto characterize, but likely represents a simple cyst or biliary hamartoma. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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 or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality. \nIndeterminate hypodense lesion measuring 0.3 cm arises from the interpolar\nregion of the right kidney, but stable since at least ___.  1.3 cm cyst\narising from the upper pole of the left kidney is poorly assessed on this exam\ndue to motion artifact.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Status post total colectomy.  There is no\nevidence of mesenteric 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. Prostate and seminal vesicles are unremarkable.  Right-sided hydrocele\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Right upper quadrant ileostomy is noted.",
            "output": "Status post EVAR of infrarenal abdominal aortic aneurysm measuring 5.5 x 6.1\ncm, not significantly changed compared to prior exam with persistent type 2\nendoleaks."
        },
        {
            "input": "POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.2 x 5.7 cm, previously 6.1 x 5.5 cm.\nDiameter (Center-line): 6.4 cm, previously 6.3 cm.\nVolume:\n\n1. AAA diameter (largest centerline axis):\n2. AAA diameter (largest axial view):\n3. AAA volume:  185 cc, previously 176 cc.\n4. Lowest renal artery to aortic bifurcation volume:  222 cc, previously 218\ncc.\n5. Lowest renal artery to the iliac bifurcation volume:  269 cc, previously\n240 cc.\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.5 cm; compared to 1.3 cm.\nLength distal graft to iliac bifurcation:  Right: 1.9 cm, compared to 1.7 cm;\nLeft: 0.6 cm, compared to 0.3 cm.\n\nAorto bi-iliac stent graft within an infrarenal abdominal aortic aneurysm is\ngrossly similar when compared to prior exam on ___.  The largest\naxial dimension measures 6.3 x 5.6 cm, previously 6.1 x 5.3 cm on ___ (3:81).  There is persistent foci of enhancement within the aneurysmal\nsac, similar in appearance compared to prior exam, likely due to a type 2\nendoleak, most likely supplied by lumbar arteries (3:80).\nOtherwise, the major abdominal vasculature remain patent, specifically the\nceliac axis, SMA, and bilateral renal arteries.\n\n LOWER CHEST: Atelectasis of the bilateral lung bases are mild.  There is no\npericardial or pleural effusion.  The descending thoracic aorta is mildly\ndilated measuring 3.5 cm.\n\nABDOMEN: The liver, spleen, pancreas, adrenal glands and kidneys are\nunremarkable, aside from a subcentimeter hypodensity in segment III (03:30),\nlikely a simple cyst or biliary hamartoma, and subcentimeter hypodensities in\nbilateral kidneys, that are too small to characterize by CT (03:33).\n\nGASTROINTESTINAL: Patient is status post total colectomy and end ileostomy. \nThere is no intestinal obstruction or ascites.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.  There is persistent right hydrocele.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen.",
            "output": "Status post TEVAR of infrarenal abdominal aortic aneurysm with persistent type\n2 endoleak measuring 6.2 x 5.7 cm, previously 6.1 x 5.5 cm in ___.  The volume has increased minimally from 176 cc to 185 cc."
        },
        {
            "input": "VASCULAR:\n\n POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.7 x 5.7 cm (previously 6.3 x 5.6 cm)\nDiameter (Center-line): 6.6 x 6.1 cm (previously 6.2 x 5.7 cm)\nVolume:\n\n1. Aneurysm: 201 ml (previously 185 mL)\n2. Renal to Aortic bifurcation: 215 ml (previously 222 mL)\n3. Renal to Iliac bifurcation: 272 ml (previously 269 mL)\nENDOLEAK: Type IIB (aneurysm sac is filling via multiple branch vessels\nsimilar to prior).\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.6 cm; compared to 1.5 cm.\nLength distal graft to iliac bifurcation:  Right: 1.5 cm, compared to 1.9 cm;\nLeft: 0.3 cm, compared to 0.6 cm.\n\nThe aorto bi-iliac stent graft is in stable position.  Type IIB endoleak is\nagain demonstrated.  There is slight increase in sac size since the previous\nCTA.  The descending thoracic aorta is diffusely dilated at up to 3.4 cm,\npreviously 3.3 cm.  The celiac and SMA are widely patent.  There is a replaced\ncommon hepatic artery from the SMA.  The bilateral renal arteries also appear\nwidely patent and there is symmetric enhancement of the kidneys.  Circumaortic\nleft renal vein is noted.  There is no new iliac/common femoral stenosis below\nthe graft.\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.  A\nstable 9 mm arterially enhancing focus in segment 4B is consistent with a\nflash hemangioma and a stable 6 mm hypodensity in 4B is consistent with a cyst\nor biliary hamartoma.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor 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, solid masses, or hydronephrosis.  A few small\ncortical hypodensities are incompletely characterized due to size but likely\ncysts.\n\nGASTROINTESTINAL: The patient is status post colectomy and end ileostomy\nformation.\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.  A\npartially visualized chronic large right hydrocele is noted.",
            "output": "Ongoing Type IIB endoleak with slight increase in aneurysm sac size.  Aneurysm\nvolume is calculated at 201 mL, previously 185 mL."
        },
        {
            "input": "VASCULAR:\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.7 x 6.0 cm, previously 6.7 x 5.7 cm\nDiameter (Center-line): 6.6 cm, previously 6.6 cm\nVolume:\n\n-Aneurysm: 214 ml, 201 and 185 ml on the previous 2 studies\n-Renal to Aortic bifurcation: 239 ml, 215 and 222 mL on the previous 2 studies\n-Renal to Iliac bifurcation: 294 ml, 272 and 2 cc 9 on the previous 2 studies\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.6 cm; compared to 1.6 cm.\n Length distal graft to iliac bifurcation:  Right: 3.6 cm, compared to 1.5 cm;\nLeft: 2.0 cm, compared to 0.3 cm.\n\nThe patient is status post right iliac limb extension into the external iliac\nartery and coil embolization of the right internal iliac artery.  The aorta\nbi-iliac stent graft is in a stable position.  Type II B endoleak is again\ndemonstrated with numerous hyperenhancing foci along the periphery of the\naneurysmal sac (for example 03:57, 61, 64).  There has been slight interval\nincrease in the aneurysmal sac size since the previous CTA.  The celiac, SMA,\nand bilateral renal arteries are widely patent.  There is a replaced common\nhepatic artery from the SMA.  There is a circumaortic left renal vein.\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. \nKnown arterially enhancing 9 mm focus within segment IV B, previously\ncharacterized as a flash hemangioma, is not seen.  A stable 6 mm hypodensity\nin segment IVb (03:34) likely represents a cyst or biliary hamartoma.  No new\nfocal lesions.  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 with normal nephrogram. \nA 1.2 cm exophytic simple cyst arising from the upper pole of the left kidney\nis stable.  Few other cortical hypodensities are too small to characterize but\nlikely represent cysts.  There is no evidence of stones or hydronephrosis.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post colectomy and end ileostomy\nformation.  No evidence of obstruction.\n\nLYMPH NODES: There is no evidence of mesenteric or retroperitoneal\nlymphadenopathy.\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.  The seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A partially visualized chronic large right hydrocele is again\nseen.  The abdominal and pelvic wall is within normal limits.",
            "output": "-Continued aneurysmal sac enlargement with evidence of ongoing, apparent\nmultifocal type II endoleak.  Aneurysm volume is calculated at 214 mL,\npreviously 201 mL.\n-Status post right iliac artery limb extension into the right external iliac\nartery and coil embolization of the right internal iliac artery."
        },
        {
            "input": "POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 7.1 x 6.3 cm, previously 7.0 x 5.6 cm in ___, and 6.7 x 6.0 cm in ___\nDiameter (Center-line): 7.1 cm, previously 6.6 cm in ___\nVolume:\n\n1. Aneurysm: 222 ml, previously 214 mL\n2. Renal to Aortic bifurcation: 262 ml, previously 239 mL\n3. Renal to Iliac bifurcation: 307 ml, previously 294 mL\nENDOLEAK: type IIB: aneurysm sac filling via branch vessel (multiple vessels)\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.2 cm; compared to 1.6 cm.\nLength distal graft to iliac bifurcation:  Right: 4.2 cm, compared to 3.6 cm;\nLeft: 4.0 cm, compared to 2.0 cm.\n\nAgain seen is the aorto bi-iliac stent graft, with measurements as above.  The\npatient is status post right iliac limb extension into the external iliac\nartery and coil embolization of the right internal iliac artery.  Multiple\nhyperdense foci along the peripheral aneurysm sac are compatible with known\ntype IIB endoleak, possibly from lumbar arteries (for example, 2:81).  Focal\nhyperdensity anterior to the superior aspect of the right iliac limb graft, at\nthe level of overlapping segments (for example, 2:85) may possibly reflect a\nsmall type III endoleak.\n\nThe celiac, SMA, and bilateral renal arteries are patent.  Again seen is a\nreplaced common hepatic artery from the SMA, along with a circumaortic left\nrenal vein.  Mild-to-moderate atherosclerotic disease.\n\nLOWER CHEST: Mild, bibasilar atelectasis.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nsubcentimeter hypodense focus within segment IV B (02:33) appears unchanged,\nlikely a cyst or biliary hamartoma.  An ill-defined hypodensity, at the\nperiphery of segment IVB (02:41), likely reflects focal fat.  No other lesions\nare identified.  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 mildly atrophic, but are of symmetric size with normal\nnephrogram.  A simple appearing cyst within the upper pole of the left kidney\nmeasures 1.2 cm, unchanged.  Other, subcentimeter renal hypodensities are too\nsmall to characterize.  There is no evidence of stones or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\ncolectomy and end ileostomy, with the ostomy site located within the right\nhemiabdomen.  No evidence of bowel obstruction.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A right hydrocele is partially imaged.  The prostate is\nmildly enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Aside from the right hemiabdomen ostomy, the abdominal and\npelvic soft tissues are normal.",
            "output": "1. Interval increase in size of the infrarenal abdominal aortic aneurysm sac,\nwith total aneurysm volume measuring 222 mm, previously 214 mm in the\ndedicated study from ___.   No substantial change in configuration\nor position of the aorto bi-iliac stent graft with right iliac limb extension.\n2. Redemonstrated findings compatible with type II endoleak, with a focal\nhyperdensity anterior to the superior aspect of the right iliac limb graft, at\nthe level of overlapping segments, possibly reflecting a small type III\nendoleak."
        },
        {
            "input": "LOWER CHEST: There is subsegmental basilar atelectasis.  4 mm solid nodule\nwithin the right middle lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable.  Mild biliary dilatation is likely\ndue to post cholecystectomy.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Splenomegaly measuring 13.7 cm in craniocaudal ___.  No focal\nlesions.\n\nADRENALS: Unremarkable.\n\nURINARY: Simple cyst within the upper pole the right kidney.  Otherwise,\nunremarkable.\n\nGASTROINTESTINAL: There is no intestinal obstruction.  The appendix is within\nnormal limits.  No free air..\n\nPELVIS:Patient is again noted to be post hysterectomy.  The right ovary is\nmildly enlarged, however there are multiple cysts measuring up to 3 cm and two\ncorpora lutea.  On the same date ultrasound, there was no peripheral\ndisplacement of the follicles.  Moderate amount of intermediate density fluid\nwithin the pelvis, likely reflects a ruptured cyst or hemorrhagic cyst.\n\nLYMPH NODES: No lymphadenopathy.\n\nVASCULAR: .  Moderate narrowing at the origin of the celiac artery, likely due\nto compression from the median arcuate ligament.\n\nBONES: Unremarkable.\n\nSOFT TISSUES: Unremarkable.",
            "output": "1. Corpora lutea within the right adnexa with high-density fluid in the pelvis\nlikely secondary to a ruptured hemorrhagic corpus luteum.\n2. No acute appendicitis.\n3. The spleen is at the upper limit of normal for size which is of uncertain\netiology or clinical significance.\n4. 4 mm solid nodule within the right middle lobe, for which no specific\nfollow up is recommended in a low risk patient.\n\nRECOMMENDATION(S):  Consider CT chest within 12 months."
        },
        {
            "input": "Evaluation is somewhat limited given the lack of images of the abdomen and\nenteric contrast\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There are\nlikely fluid filled loops of small bowel in the pelvis.  In addition, there\nare two apparently noncommunicating, incompletely rim enhancing collections in\nthe pelvis measuring 3.5 x 3.0 and 3.2 x 2.4 cm (2: 23, 601:21, 30).  Further\nevaluation after the administration of enteric contrast is advised\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  The ovaries are not\ndefinitely identified.\n\nLYMPH NODES: 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": "Suggestion of incompletely rim enhancing fluid in the deep pelvis may\nrepresent developing collections, though the lack of enteric contrast limits\nevaluation and it is difficult to separate these areas from adjacent loops of\nsmall bowel.  If further evaluation is required, CT of the abdomen and pelvis\nwith enteric contrast (delayed scanning) is recommended for optimal\nassessment."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  A 2.5 x 2.7 x\n2.6 cm simple cyst is seen in the upper pole of the left kidney.  No\nnephrolithiasis noted in 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.\n\nREPRODUCTIVE ORGANS: Uterus and adnexa are unremarkable.  There is trace fluid\nin the cul-de-sac, within physiological range.\n\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 nephrolithiasis or hydronephrosis.\n2. No acute findings 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. \nSubcentimeter hypodensity in segment 2 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 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: There is mild thickening of the left adrenal gland without discrete\nnodularity.  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 a 1.1\ncm simple cyst in the lower pole of the left kidney.  Additional subcentimeter\nhypodensities bilaterally are too small to characterize, but also likely\nrepresent simple cysts.\n\nGASTROINTESTINAL: Small hiatal hernia.  Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the transverse, descending, and sigmoid colons\nare noted.\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. \nCoxa valga deformity of bilateral hips is noted.\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.  A\nsubcentimeter left hepatic hypodensity (04:47) is too small to characterize,\nbut appears unchanged.  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. \nA simple cyst within the lower pole of the left kidney measures 1.2 cm. \nOther, bilateral renal hypodensities are too small to characterize.  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. Colonic\ndiverticulosis, without evidence of acute diverticulitis.\n\nPELVIS: The bladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.  Small bilateral hydroceles are 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.  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. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization."
        },
        {
            "input": "LOWER CHEST: Please refer to dedicated CT chest report from the same day for\ndetails of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of 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.  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 glands is normal in size and shape.  The left\nadrenal gland is mildly thickened without discrete nodules, unchanged since\n___.\n\nURINARY: The kidneys are of normal and symmetric size and nephrogram. \nMultiple subcentimeter hypodensities scattered throughout the kidneys are too\nsmall to characterize, but likely represent renal cysts.  11 mm exophytic\nhypodense lesion of the left lower pole averaging 29 ___ units likely\nrepresents a hemorrhagic or proteinaceous cyst which is unchanged since\n___.  No evidence of solid renal lesions or hydronephrosis.  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 normal.\n\nPELVIS: The urinary bladder is decompressed.  Distal ureters are unremarkable.\nNo free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\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: There is a new 14 mm lucent within the L2 vertebral body with an\nexpansile soft tissue component (10:29, 5:68).  Compared to the CT of ___ there are new lucent lesions within the T3 and T4 vertebral bodies\nwhich display FDG avidity on the PET-CT of ___.\nNo evidence of acute fracture.  Sclerosis at the T11 inferior endplate is\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There is a new 14 mm L2 vertebral body lucent lesion with an expansile soft\ntissue component.  Additional lucent lesions of T3 and T4 displaying FDG\navidity on the PET-CT of ___, are concerning for metastatic\ndisease.\n2. Please refer to the dedicated CT chest report from the same day for details\nof intrathoracic findings."
        },
        {
            "input": "CHEST:  There is bibasilar dependent atelectasis and minimal septal\nthickening.  There is no pleural effusion.  A small to moderate hiatal hernia\nis present.\n\nABDOMEN:\n\nGENERAL:  There is a large upper abdominal midline fat and fluid containing\nventral hernia. There is a small volume of ascites, predominantly in the\nperihepatic and mesenteric distribution.  There is no intra- or\nretroperitoneal fluid collection.  There is no peritoneal thickening.\nHEPATOBILIARY:  The liver enhances homogeneously. There are no concerning\nfocal hepatic lesions.  The intrahepatic and extrahepatic bile ducts are\nmildly prominent, likely secondary to cholecystectomy. The gallbladder is\nsurgically absent.  There are dropped surgical clips inferior to the gastric\nantrum.\nPANCREAS:  The pancreas appears normal.  There are no concerning focal\npancreatic lesions.  No peripancreatic fluid collection is present.  There are\nno signs of inflammation.\nSPLEEN:  The spleen enhances normally.  There is no concerning focal\nabnormality.  There is no splenomegaly.  There are several coarse\ncalcifications consistent with exposure to granulomatous disease.\nADRENALS:  There are no adrenal nodules.\nKIDNEYS:  Renal corticomedullary enhancement is normal bilaterally.  There is\ndelayed renal excretion of contrast.  There are no concerning solid lesions. \nThere are no stones.  There is no hydronephrosis or hydroureter.  There is a\n3.7 cm simple right renal cyst\nGASTROINTESTINAL:  There is marked edema of the gastric antral wall.  There is\nno evidence of bowel obstruction.  The small and large bowel enhance normally.\nThere is diffuse, minimal wall thickening in the small and large bowel.  There\nis no mass.  There is no intraperitoneal fluid collection. The appendix is\nnormal in caliber, without mass or evidence of inflammation.\nLYMPH NODES:  There is no lymphadenopathy identified in the abdomen or pelvis.\nVASCULAR:  The abdominal aorta and its main branches are patent, with moderate\ncalcified plaques.  There is no aneurysm or dissection.  The IVC is minimally\nflattened but there are no overt signs of shock.  The main portal vein and its\nfirst order intrahepatic branches are patent.\n\nPELVIS: There is no pelvic or inguinal lymphadenopathy.  There is no free\nfluid in the pelvis.\nGENITOURINARY:  The urinary bladder and distal ureters are unremarkable. There\nis a Foley catheter balloon within the collapsed bladder.  The reproductive\norgans are within normal limits.\n\nBONES AND SOFT TISSUES: There is no acute fracture.  There are no destructive\nosseous lesions concerning for malignancy or infection.  There are no soft\ntissue masses.",
            "output": "Edema of the gastric antrum most consistent with gastritis.  Possible mild\nsmall bowel edema, which can be seen in gastroenteritis.  No free air to\nsuggest perforation.  No evidence of bowel obstruction or ischemia.\n\nNOTIFICATION:  Preliminary findings were communicated to Dr. ___ by Dr.\n___, in person on ___ at 5:00 ___, at the time of interpretation.  Wet\nread updated to reflect that perforated ulcer is unlikely.  Update\ncommunicated to Dr. ___ at 17:46."
        },
        {
            "input": "LOWER CHEST: There is atelectasis at the bilateral lung bases.  Otherwise\nvisualized lung bases are clearer.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are tiny hypodensities throughout the liver that are too small to\ncharacterize however likely to be cysts (for example 5; 61).  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ndecompressed without 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 adrenal gland is normal in size and shape.  There is a\nheterogeneous 3 x 2 cm lesion in the left adrenal gland (5; 66).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Prominent lymph nodes are not pathologically enlarged by imaging\ncriteria.\n\nBONES: No evidence of worrisome bony lesions.  Posterior spinal fusion\nhardware is noted.  Compression deformity of L2 and L3 is likely chronic.\n\nSOFT TISSUES: Heterogeneously enhancing right iliacus muscle lesion measuring\n4.6 x 4.3 x 4.7 cm (5; 101 and 8; 31).  Additional left gluteus minimus/medius\nlesion with dominant part measuring 4.7 x 2.6 x 4.9 cm and additional\nposterior 2.6 cm extension (5; 105 and 106).",
            "output": "1. 3 cm left adrenal gland mass, for which in the setting of primary lung\ncancer is concerning for metastasis.\n2. 5 cm right iliacus and 5 cm left gluteal muscle lesions suspicious for soft\ntissue metastasis."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions with subjacent atelectasis is\npresent.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hepatic lesions, some of which are new or\nlarger compared to prior.  For example 2 lesions at the dome each measure 1 cm\n(08:14).  A segment VII lesion measures 1.7 cm, previously 0.6 cm.  There also\nmultiple new segment VI lesions, the largest measuring 2 cm (08:40).\n\nNo biliary dilation.  The gallbladder is distended with no gallstones. \nPericholecystic ascites is likely related to small volume generalized 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: A left adrenal mass is larger, measuring 3.8 x 2.7 cm, previously\n2.9 x 1.9 cm.  There is a new right adrenal nodule measuring 2.2 x 1.1 cm.\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.  Bilateral perinephric\nstranding is nonspecific.\n\nGASTROINTESTINAL: Enhancing, near circumferential mass in the second portion\nof the duodenum is in keeping with the known ampullary metastasis (8:63). \nThere are multiple additional sites of curvilinear enhancing masses involving\nthe jejunal wall, many of which are nearly circumferential (for example 10:35,\n8:100).  In the left upper quadrant, there is a defect in the posterolateral\njejunal wall at the site of a mass (8:66, 11:105).  Additionally, there is\nsmall volume pneumoperitoneum and ascites.  There is also air in a branch of\nthe superior mesenteric vein (8:82).\n\nSmall hiatal hernia.  The lesions in the gastric fundus seen on endoscopy are\nnot well appreciated on CT.  The colon is unremarkable.\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 free fluid in\nthe pelvis.\n\nVASCULAR:\nThere is severe calcified and noncalcified atherosclerotic plaque, including\nareas of plaque ulceration in the infrarenal aorta.  The infrarenal aorta is\nectatic but not frankly aneurysmal.  Near occlusion is noted at the origin of\nthe right common iliac artery.\n\nThere is severe stenosis at the origin of the celiac artery.  The superior\nmesenteric artery is patent.  The inferior mesenteric artery is diminutive,\nbut patent.\n\nThe SMA and main portal vein are patent.\n\nREPRODUCTIVE ORGANS: The prostate gland is mildly enlarged.\n\nBONES: L4-5 laminectomy and posterior fusion is re-demonstrated.  Sclerotic\nendplate changes of L2 and L3 are similar to prior, probably degenerative.\n\nSOFT TISSUES: Re-demonstrated enhancing masses in the right iliacus and left\ngluteus musculature, which of each significantly increased in size.  The right\niliacus mass now measures 8.0 x 6.8 cm, previously 4.3 x 4.6 cm.  The left\ngluteus mass measures 8.0 x 4.6 cm, previously 4.7 x 2.6 cm.\n\nSmall bilateral fat containing inguinal hernias.",
            "output": "1. Focal perforation of the jejunum at the site of an enhancing jejunal lesion\n(likely metastasis) with small volume pneumoperitoneum and portal venous gas.\n2. Overall worsening metastatic disease, with small bowel metastases,\nincreasing size of liver lesions, bilateral adrenal masses, and soft tissue\nmasses in the right iliacus and left gluteus musculature.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:45 Pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "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. There\nis no evidence of focal lesions.  Pneumobilia is noted likely postprocedural. \nThere is a common bile stent in place.\n\nPANCREAS: Again noted is an infiltrative locally advanced pancreatic tumor\noriginating from the uncinate process.  The tumor is ill-defined,\napproximately measures 4.1 cm in AP dimension (series 7, image 98).  There is\nmild dilatation of the pancreatic duct.  There is marked infiltration of\nadjacent soft tissues and mesentery.  The tumor extends to the root of\nmesentery and invades the third portion of duodenum as well as few small bowel\nloops with no evidence of obstruction.  The tumor encases the SMA and narrows\nthe SMV.  Overall the findings are stable from recent MRI dated ___.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hyperattenuating\nSize (maximal axial dimension in cm): Ill-defined infiltrative\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\n___ 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 ___ branch: present\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: present\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: 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\n___ 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: present invading the mesentery, no definite\nnodule.\nAscites: present\nSuspicious lymph nodes: porta hepatis\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 right and left adrenal glands 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 duodenal stent in place which is patent.  Some\ndebris is noted in the duodenal stent.  The tumor involves several loops of\njejunum, however there is no evidence of obstruction.  The remaining of the\nsmall bowel is normal.  The colon is normal in caliber.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.  A\nporta hepatis lymph node is seen measuring 1 cm (series 7, image 84).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is a small volume\nascites (series 7, image 163).\n\nREPRODUCTIVE ORGANS: There is a heterogeneously enhancing lobulated subserosal\nfibroid measuring 9.7 x 7.8 cm\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  1\ncm anterolisthesis of L5 on S1 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Locally advanced infiltrative pancreatic tumor arising from the uncinate\nprocess extending to the root of mesentery, duodenum and several loops of\njejunum as well as encasing the SMA and narrowing the SMV as described. \nOverall the tumor is stable from prior MRI of ___.\n2. Recently placed duodenal stent is patent."
        },
        {
            "input": "LOWER 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.\n\nA metallic CBD stent is again noted, with pneumobilia seen, compatible with\nstent patency.  The gallbladder is within normal limits.\n\nPANCREAS: Known mass in the pancreas uncinate process is not well delineated\non the current study, making measurement difficult.  Soft tissue haziness and\nstranding encasing the superior mesenteric artery and vein (4:54-58) and\ncontacting the caudal aspect of the third portion of duodenum (4:64) (spanning\napproximately 3.8 cm) appear similar.  Redemonstration of mild narrowing of\nthe SMV near the portal venous confluence, however the vessel remains patent. \nProminence of the main pancreatic duct up to 4 mm is unchanged.\n\nSPLEEN: The spleen is mildly enlarged 14.1 cm, previously 13.6 cm.  No focal\nlesions 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 grossly unremarkable.  A stent in the third\nportion of the duodenum is again noted and appears patent.  Small and large\nbowel loops are normal in caliber.  The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Redemonstration of an enlarged uterus containing multiple\nfibroids measuring up to 5.8 cm.  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. \nBilateral L5 pars defects associated with grade 2 anterolisthesis of L5 on S1\nis unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Known mass in the pancreas uncinate process is not well delineated on the\ncurrent study.  Soft tissue haziness and stranding encasing the superior\nmesenteric vessels and contacting the caudal aspect of the third portion of\nthe duodenum appear similar.\n2. Patent CBD and duodenal stents in situ.\n3. No evidence of new lymphadenopathy or new distant metastatic disease in the\nabdomen or pelvis.\n4. 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 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There is redemonstration of a metallic CBD\nstent, with pneumobilia seen, compatible with stent patency.  The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of a mass in the pancreas uncinate process,\nwhich is ill-defined and difficult to measure on today's exam; however, within\nthese limitations, the mass measures 1.4 x 1.9 cm (series 5, image 95)\n(previously measured up to 3.5 cm on CT dated ___.  Soft tissue\nhaziness and fat stranding is seen encasing the superior mesenteric artery and\npartially encasing the superior mesenteric vein.  Additionally, the fat\nstranding is seen contacting the third portion of the duodenum but is\nunchanged in appearance.  There is redemonstration of mild narrowing of the\nsuperior mesenteric vein near the portal venous confluence; however, the vein\nremains patent.  The main pancreatic duct measures up to 3 mm (series 5, image\n80).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Fibroid uterus measuring up to 5.9 cm.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: No evidence of worrisome osseous lesions or acute fractures. \nRedemonstration of bilateral L5 pars defects and stable L5 on S1\nanterolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.",
            "output": "1.  The known mass at the pancreatic uncinate process is again seen but appear\nsmaller compared to prior CT dated ___.\n2.  Redemonstration of soft tissue haziness and stranding encasing the\nsuperior mesenteric vessels and contacting the caudal aspect of the third\nportion of the duodenum.\n3.  No evidence of new lymphadenopathy or new distant metastatic disease in\nthe abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Tip of a central venous\nterminates in the SVC/right atrial junction.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Re-demonstrated is mild central\nintrahepatic biliary ductal dilatation as well as left lobe predominant\npneumobilia.  There is air within the gallbladder lumen, likely secondary to a\npatent biliary stent.  The gallbladder is otherwise within normal limits.\n\nPANCREAS: The known mass in the pancreatic uncinate process is not well\nvisualized on the current study.  There has been interval increase in\nperipancreatic soft tissue density which encases the SMA and partially encases\nthe SMV (601:17, 2:29, 33, 35).  There is also increased attenuation of the\nSMV by the mass (02:33).  Soft tissue density extends around the third portion\nof the duodenum which contains a duodenal stent (02:38, 601: 23, 24). \nIncreased soft tissue within the lumen of the duodenal stent is also noted,\nalthough it is difficult to determine how much of this is due to tumor\nextension versus ingested contents.  However, this result in near complete\nocclusion of the duodenal lumen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and 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 proximal duodenum are distended with air and\nfluid secondary to a nearly completely occluded duodenal stent (602:44). \nDuodenal stent remains in similar position.  There is increased soft tissue\ndensity encasing the third portion of the duodenum.  Distal loops of small\nbowel are largely collapsed.  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: There are multiple uterine masses consistent with\nfibroids.  There has been interval increase in size in a 7.6 cm hypodense\ncystic structure arising from the left adnexa (2:69).  There is also a new,\n2.7 cm hypoattenuating cystic structure arising from the right adnexa (2:63). \nThere are multiple prominent vessels in the pelvis bilaterally as well as\ndilated gonadal veins.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 L5 on S1 is unchanged with bilateral L5 pars\ndefects.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Gastric outlet obstruction secondary to a nearly occluded duodenal stent.\n2. Interval increase in peripancreatic soft tissue density which encases the\nSMA and SMV causing severe attenuation of the SMV, as well as involving the\nthird portion of the duodenum concerning for worsening pancreatic malignancy.\n3. Interval increase in size in a hypoattenuating left adnexal cystic lesion\nas well as a new cystic lesion in the right adnexa.  Findings are concerning\nfor ovarian metastases.  This can be further evaluated with a nonurgent pelvic\nultrasound if clinically indicated.\n4. Prominent vessels in the pelvis as well as a dilated gonadal veins\nbilaterally can be seen with chronic pelvic congestion syndrome, but clinical\ncorrelation is needed.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:53pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "VASCULAR:\nThe abdominal aorta is non-aneurysmal.  Minimal atherosclerotic burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the dedicated CT chest report for intrathoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. No\nevidence of focal lesions.  There is a similar, moderate degree of pneumobilia\npredominantly within the left lobe of the liver with unchanged mild central\nbiliary ductal dilatation.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.  Again demonstrated is a stent spanning\nthe common bile duct and terminates within the duodenum.\n\nPANCREAS: The pancreas has normal attenuation throughout. There is similar\nmild pancreatic duct dilatation measuring up to 4 mm.  Again there is a poorly\ndefined soft tissue density in the region of the uncinate process of the\npancreas with unchanged encasement of the SMA and SMV.  There is unchanged\nnarrowing of the SMV at the confluence with the portal vein (4: 95-97). \nUnchanged partial encasement of the third part of the duodenum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 stones,\nsolid renal lesions, or hydronephrosis.  No urothelial lesions in the kidneys\nor ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is unchanged positioning\nof 2 telescoping duodenal stents spanning the ___ to ___ part of the duodenum.\nThere is similar diffuse small bowel wall edema more prominent proximally and\nwithout associated fat stranding which can be seen in chronic portal venous\ncongestion.  Compared to the CT dated ___, there is an area of mild\njejunal dilatation within the left lower quadrant measuring up to 4.2 cm. \nThere are several foci of intraluminal air, but no evidence pneumatosis or\ndefinite transition points.\n\nThe colon and rectum are within normal limits. The appendix is normal.\n\nRETROPERITONEUM: New subtle foci of peritoneal hyperdensity within the left\npericolic gutter and a 1 cm nodule in descending colon mesentery are \nconcerning for peritoneal studding (4:114; 4:110).  No evidence of\nretroperitoneal lymphadenopathy.\n\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No evidence\nof pelvic or inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus with punctate calcifications. \nPreviously mentioned bilateral ovarian cysts are surgically absent in keeping\nwith history of bilateral salpingo oophorectomy.\n\nBONES: Unchanged mild multilevel degenerative changes with similar grade 1\nanterolisthesis of L5 over S1.  Unchanged foci of heterotopic ossification\nalong the posterior aspect of the proximal right femur.  No evidence of\nworrisome 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. New foci of peritoneal hyperdensity within the left lateral mid abdomen\nconcerning for peritoneal studding (4: 110; 4: 114).\n2. No significant change in poorly defined uncinate process pancreatic mass\nwith similar encasement of the SMA, SMV and partial encasement of the third\npart of the duodenum.\n3. Similar diffuse small bowel edema which is likely related to chronic venous\ncongestion from known SMV narrowing.\n4. Stable positioning of the common bile duct and duodenal stents.\n5. Please refer to the dedicated CT chest report for intrathoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no substantial calcium burden\nin the abdominal 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Left sided pneumobilia is similar to the\nprior study.  A CBD stent is demonstrated within the extrahepatic biliary\ntree, stable in position compared to the prior study and terminating at the\nlevel of the duodenum.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of a hypoenhancing ill defined mass arising\nfrom the uncinate process corresponding to known infiltrative locally advanced\npancreatic neoplasm.  Stable low density soft tissue surrounding the\nmesenteric root measures approximately 4.1 cm in the AP diameter (series 2,\nimage 116), with close involvement of the third portion of the duodenum, few\nsmall bowel loops as well as the SMA and SMV.  The SMA is circumferentially\nencased.  The SMV is narrowed and attenuated at the level of the uncinate\nprocess (series 2, image 118), with patent tributaries.  The pancreatic duct\nis mildly dilated measuring 4 mm, unchanged from prior study.  The soft tissue\ndensity extends to the mid to distal SMA, unchanged from the prior study from\n___, measuring approximately 1.4 x 1.0 cm (series 2, image 137).\n\nSlow flow and venous mixing is demonstrated within the portal vein at the\nconfluence of the SMV and splenic vein without discrete intraluminal thrombus.\n\nSPLEEN: No discrete splenic lesions are demonstrated.  The spleen is mildly\nenlarged, measuring 13.3 cm, unchanged from the prior 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 stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There's redemonstration of 2\ntelescoping duodenal stents spanning the ___ to ___ part of the duodenum. \nThere's diffuse small bowel edema along the proximal small bowel similar in\nextent compared to multiple prior studies.  The pancreatic lesion\ninterdigitates along the central left proximal small bowel mesentery in\nsimilar extent compared to the prior study (series 2, image 129).  No evidence\nof bowel obstruction.  Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening or fat stranding. The appendix is normal.\n\nRETROPERITONEUM: There is redemonstration of diffuse peritoneal haziness and\nnodularity with slightly more prominent discrete nodules, including a 0.6 cm\nsoft tissue nodule in the right lower quadrant (series 2, image 133), and\nanterior mesenteric nodule (series 2, image 115).   Soft tissue density within\nthe left perirenal fat in close proximity to the descending colon measures 1.7\nx 1.5 cm, previously 1.7 x 1.6 cm (series 2, image 117) more inferiorly along\nthe mesentery of the descending colon there is additional soft tissue density\nmeasuring approximately 1.1  cm, which is unchanged.  Previously demonstrated\nleft pericolic stranding is not as well visualized compared to the prior\nstudy.  Some interloop fluid along the perirectal mesentery is not\nsubstantially changed compared to the prior study.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: Redemonstration of a fibroid uterus with punctate\ncalcifications.  Patient is status post bilateral salpingo-oophorectomy.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Grade 2\nanterolisthesis of L5 over S1 is unchanged, with bilateral pars defects noted.\nNo suspicious osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable ill-defined uncinate process infiltrative pancreatic lesion with\nunchanged encasement of the SMA, SMV and third portion of the duodenum, with\nextension into the mesentery of loops of proximal small bowel.\n2. CBD and duodenal stents are grossly unchanged in position.\n3. Similar to slightly increased diffuse stranding and nodularity throughout\nthe peritoneum.\n4. Unchanged proximal small bowel edema without obstruction likely related to\nchronic venous congestion.  No bowel obstruction.\n5. Please refer to separately dictated same day CT chest for full description\nof thoracic findings."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is no significant calcium burden\nin the abdominal 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Predominantly left-sided pneumobilia is\nsimilar to prior studies.  Similar position of a CBD stent, which is seen\nterminating at the level of the duodenum.  The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: There is overall similar appearance of a hypoenhancing, ill-defined\nmass arising from the pancreatic uncinate process corresponding to the known\ninfiltrative pancreatic neoplasm.  Low-density soft tissue surrounding the\nmesenteric root measures approximately 4.1 cm in the greatest axial dimension\n(4:96), with close involvement of the third portion of the duodenum and few\nloops of small bowel, similar to prior study.  There is similar involvement of\nthe SMA and SMV, with complete circumferential encasement of the SMA.  The\nsoft tissue density extends to the mid to distal SMA, unchanged from multiple\nprior studies, measuring approximately 1.5 x 1.0 cm (4:111).  The SMV appears\nnarrowed and attenuated at the level of the uncinate process with patent\ntributaries (4:97).  The main pancreatic duct is mildly dilated measuring 4\nmm, unchanged from prior study.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 14.5 cm.  The spleen\nshows 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 stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is similar appearance\nand position of two telescoping duodenal stents spanning the ___ and ___\nportion of the duodenum.  Diffuse small bowel edema involving the proximal\nsmall bowel appears similar in extent to multiple prior studies.  The\npancreatic lesion interdigitates along the central left proximal small-bowel\nmesentery in similar extent compared to the previous studies (4:99).  No\nevidence of bowel obstruction.  Mild sigmoid diverticulosis is noted, without\nevidence of diverticulitis.  The colon and rectum are otherwise within normal\nlimits. The appendix is normal.\n\nRETROPERITONEUM: There is overall similar appearance of diffuse peritoneal\nhaziness and nodularity with few prominent discrete nodules.  For instance,\nthere is a 6 mm soft tissue nodule in the right lower quadrant (4:109), and a\n5 mm soft tissue nodule in the anterior mesentery (4:101), both unchanged from\nprior study.  There is stable soft tissue density within the left perirenal\nfat in close proximity to the descending colon measuring approximately 1.7 x\n1.5 cm (4:100), unchanged from prior study.  Additional soft tissue density\nmeasuring approximately 1.1 cm is seen along the mesentery of the descending\ncolon (4:110).  A small amount of interloop fluid along the perirectal\nmesentery is not substantially changed compared to prior studies.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: There is an enlarged fibroid uterus containing multiple\ncalcifications.  No adnexal abnormality identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative change of the lumbar spine.  Stable\nappearance of grade 2 anterolisthesis of L5 over S1 with associated bilateral\npars defects, unchanged from prior study.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia.  The abdominal and pelvic\nwall is otherwise within normal limits.",
            "output": "1. Stable appearance of the ill-defined infiltrative pancreatic lesion within\nthe uncinate process, with similar encasement of the SMA, SMV, and third\nportion of the duodenum, as well as extension into the mesentery as described\nabove, overall unchanged compared to prior study from ___.\n2. Overall similar appearance of diffuse peritoneal stranding and nodularity\nas described above, also unchanged from prior study.\n3. Unchanged proximal small bowel edema, likely related to chronic venous\ncongestion.  No evidence of bowel obstruction.\n4. Unchanged position and appearance of the CBD stent and duodenal stents.\n5. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day."
        },
        {
            "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 mild intrahepatic bile duct dilation with pneumobilia reflecting the\npresence of a CBD stent.  No radiopaque ductal stones are seen.  The\ngallbladder is collapsed, and appears normal.\n\nThe pancreas is mildly atrophic.  The main pancreatic duct is mildly\nprominent, measuring up to 4 mm, unchanged from prior.  Again seen is an\ninfiltrative uncinate process mass, measuring up to 4.1 cm, unchanged since\nthe prior CT examination, with continued encasement of the SMA and upper SMV\n(series 4, image 106).  The portal SMV confluence and splenic vein remain\npatent.\n\nThe spleen size is within normal limits.  There are no focal splenic lesions.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is a duodenal stent in situ (series 4, image\n110), without upstream dilation.\n\nThe bladder is moderately distended, and appears normal.  A fibroid uterus is\nagain demonstrated (series 8, image 65).  No concerning adnexal lesions are\ndetected.\n\nA 6 mm anterior omental nodule is unchanged (series 4, image 99).  A 2.0 x 2.0\ncm left pararenal soft tissue is unchanged (series 4 image 111).  An inferior\nleft pararenal soft tissue is also unchanged, measuring 1.0 cm (series 4,\nimage 120).  A 6 mm right pericolic node is unchanged (series 4 image 119).\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches remain patent and normal in caliber.  The intrahepatic portal and\nhepatic veins are patent.\n\nThere are no osseous lesions concerning for malignancy or infection.  There is\ngrade 1 anterolisthesis of L5 over S1 (series 8 image 64).",
            "output": "1. Unchanged infiltrative pancreatic uncinate process mass, measuring up to\n4.1 cm, with continued encasement of the SMA and upper SMV.\n2. Unchanged 6 mm anterior mesenteric and right pericolic nodes.  Unchanged\n2.2 cm and 1.0 cm left pararenal metastases.\n3. Duodenal and CBD stents in situ, without obstruction.\n4. No new abdominopelvic metastasis or lymphadenopathy.\n5. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "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: Punctate pleural based left lower lobe pulmonary nodule is\nunchanged compared to prior exam (series 2, image 6).  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is persistent mild intrahepatic biliary\ndilatation and pneumobilia, predominantly in the left lobe of the liver,\nlikely due to the CBD stent placement.  The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: Similar to prior exam, there is a 4.1 cm uncinate process mass\n(series 5, image 55), which is unchanged compared to prior exam.  As before,\nthis mass encases the SMA, SMV, and duodenum (series 5, image 59.  There is\npersistent prominence of the pancreatic duct measuring up to 4 mm (series 5,\nimage 44).\n\nSPLEEN: The spleen is enlarged measuring up to 15 cm (series 601, image 72). \nNo focal lesions 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 stones, solid renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\nduodenal stent placement, which is similar in appearance and positioning\ncompared to prior exam.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.  No active colonic contrast extravasation identified.  There is\nredemonstration of a 6 mm anterior mesenteric lymph node (series 5, image 65)\nand a prominent 7 mm right pericolic lymph node (series 5, image 72),\nunchanged compared to prior.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is redemonstration of two similar-appearing left perinephric soft tissue\nlesions measuring 2.5 x 1.5 cm (series 5, image 61) and 1.9 x 0.8 cm more\ninferiorly (series 5, image 72).\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, and contains\nmultiple known fibroids, as seen on prior studies, further characterized on\nultrasound dated ___.\n\nBONES: Grade 1 spondylolisthesis of L5 over S1 is again seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No active contrast extravasation seen in the abdomen or pelvis.\n2. Redemonstration of a 4.1 cm ill-defined uncinate process mass with\nencasement of the SMA, SMV, and duodenum.\n3. The duodenal stent and CBD stent are unchanged in position.\n4. Similar-appearing mesenteric lymph nodes and left perinephric soft tissue\nmetastases.  No n"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe superior mesenteric vein is markedly narrowed by the focally enlarged\npancreas and surrounding soft tissue abnormality.\n\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.  There remains mild bilobar intrahepatic\nbiliary dilatation and pneumobilia in the left lobe of the liver.  There is a\nbiliary stent in-situ.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: There is redemonstration of an infiltrative locally advanced tumor\nat the uncinate process of the pancreas.. The margins are difficult to\ndelineate however it appears grossly similar in size when compared with the\nprevious study.  The mass extends into the root of the mesentery.  The mass\nencases the SMA and SMV.  The SMV is severely narrowed and attenuated by the\nmass.  The pancreatic duct is dilated measuring up to 0.5 cm in the body of\nthe pancreas.\n\nSPLEEN: The spleen measures 14.3 cm in long axis, previously 15 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: 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: The stomach is unremarkable.  There is a stent within the\nsecond and third parts of the duodenum.  There is in growth of soft tissue\nthrough the stent but there is no evidence of bowel obstruction (2:121).  A\ncluster of small bowel in the proximal jejunum appears tethered together and\nto the infiltrative mass extending from the pancreas. The colon and rectum are\nwithin normal limits.\n\nRETROPERITONEUM: There is redemonstration of 2 soft tissue masses abutting the\nleft anterior pararenal fascia.  The larger of these masses (2:84) abuts the\nadjacent descending colon.  It demonstrates interval increase in size now\nmeasuring 2.6 x 2.4 cm compared with 2.1 x 1.5 cm of the previous study. \nSlightly caudal to this, the second nodule measures 1.5 x 0.7 cm and is stable\nin size when compared with the previous study.\n\nPeritoneum: Peritoneal nodularity along the anterior pelvis is more\nconspicuous than on prior study (2:190\n\nLYMPH NODES : No significantly enlarged retroperitoneal or mesenteric nodes. \nA 1 cm nodule anterior to the left gonadal artery may represent a lymph node\nor peritoneal deposit it is stable in size when compared with the previous\nstudy.\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 an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nBONES: There is grade 1 anterolisthesis of L5 on S1.  No evidence of bone\nmetastases.\n\nSOFT TISSUES: There is nodular enhancement of the lower confluence of the\nrectus abdominus muscle measuring up to 1.7 cm in AP dimension (2:187),\nincreased compared to prior where it measured 1.4 cm.",
            "output": "1. Redemons"
        },
        {
            "input": "The chest is reported separately.\n\nNo suspicious focal liver lesions are identified.  Caudate appears slightly\nenlarged in rounded appearance.  Left lateral segments are also relatively\nprominent in size.  There is no biliary dilatation.  The gallbladder appears\nnormal.  The pancreas is unremarkable.  The spleen is mild to early enlarged\nmeasuring up to 16.9 cm in length.  A few small infarcts are noted along the\nsuperior margin of the spleen which are age indeterminate.  Adrenals appear\nnormal.  There is no evidence for stones, solid masses or hydro nephrosis\ninvolving either kidney.\n\nStomach and small bowel appear normal.  The large bowel is also unremarkable. \nAppendix is also identified and appears within normal limits.\n\nTrace air in the bladder suggests recent instrumentation.  Prostate is mildly\nenlarged with central hypertrophy.  Seminal vesicles appear normal.  Small\nquantity of ascites in the pelvic cul de sac in addition to anasarca.  No\nenlarged lymph nodes are found.  Major vascular structures appear widely\npatent.\n\nThere are no suspicious bone lesions.  Vertebral body heights and interspaces\nare preserved in height.",
            "output": "Enlarged spleen with infarcts.  Possible early morphological changes of\nchronic liver disease.  Small quantity of ascites and anasarca."
        },
        {
            "input": "LOWER CHEST:\nThere are bilateral small pleural effusions.  Extensive bilateral lower lobe,\nand right middle lobe consolidations compatible with the known septic\npulmonary emboli noted.  There is a trace pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no free intraperitoneal air identified.  Trace perihepatic\nfree fluid noted.  Small volume free fluid is also seen in the pelvis.\nHEPATOBILIARY:  The hepatic parenchyma demonstrates diffuse decreased\nattenuation compatible with steatosis.\nThe gallbladder is under distended and not clearly visualized..\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation..\nSPLEEN:  The spleen is enlarged, measuring 16.4 cm in the craniocaudal axis. \nThere are multiple wedge-shaped hypodensities within the spleen compatible\nwith embolic infarcts.  No abscess or perisplenic fluid collection noted.\nADRENALS:  No adrenal nodules.\nURINARY: Both kidneys demonstrate low-grade enhancement, which is symmetric\nand homogeneous without hydronephrosis or evidence of pyelonephritis.\nGASTROINTESTINAL: No bowel obstruction.  No bowel wall thickening or\npneumatosis noted to suggest bowel wall ischemia.\n\nLYMPH NODES: There are no enlarged abdominal or pelvic lymph nodes..\nVASCULAR: The abdominal aorta is normal in caliber.  No filling defects noted\nwithin the abdominal aortic branches particularly the SMA or the ___.\n\nPELVIS:\nThe bladder is minimally distended and unremarkable there is small volume free\nfluid in the pelvis.  No prostatomegaly.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  No evidence of discitis or\nosteomyelitis involving the visualized lower thoracic or lumbar spine.\nExtensive diffuse subcutaneous edema compatible with anasarca noted.",
            "output": "1. There is no evidence of bowel wall ischemia or edema.  No pneumatosis, free\nintraperitoneal air or portal venous gas identified.\n2. Splenomegaly with multiple splenic infarcts, that are embolic in the given\nclinical context.\n3. Diffuse hepatic steatosis, bilateral small pleural effusions and bilateral\nlower lobe pulmonary consolidations compatible with septic emboli, small\nvolume ascites, diffuse anasarca are additional incidental findings.\n\nNOTIFICATION:  The findings were discussed with ___, MD, by ___\n___, M.D. on the telephone on ___ at 10:30AM , 2 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: There is relative ___ of the liver centrally which\nis likely related to fluid overload.  There is one too small to characterize\nhypodensity in the right lobe segment VII (image 2; 54).  No other focal\nlesions seen.  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.  Extrarenal\npelvis on the right is noted.  There is a 3 cm exophytic renal cyst in the\nupper pole of the right kidney as previously.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops are mildly\ndilated with no or thickening and decreased amount of intraluminal fluid as\nileostomy in the left lower lobe indicated by numerous air-fluid levels. \nIleostomy in the left lower quadrant noted.\n\nABDOMINAL CAVITY: A moderate amount of fluid is seen in the abdominal cavity\nwith relatively uneven distribution.  The large collection seen in the left\nlower quadrant.  Small amount of fluid is in the right paracolic gutter and\n___ pouch.  The small collection in the right lower quadrant,\nanteriorly.  Thickened peritoneum is noted in the left lower quadrant\ncollection (image 2; 82).\n\nPELVIS: The urinary bladder is distended and contains small amount of air,\nlikely post instrumentation..  There is moderate amount of fluid in the cul de\nsub, behind the uterus, with thickened peritoneal lining (image 2; 105).  No\nfree air or abnormal air collection are seen.\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. \nStatus post right hip replacement.\n.\nSOFT TISSUES: Anasarca edema is noted..",
            "output": "1. Mild small bowel ileus.\n2. A symmetric in distribution ascites in the abdomen with some peritoneal\nthickening in the left lower quadrant and cul-de-sac may indicate superimposed\ninfection.\n\nRECOMMENDATION(S):  Consider tapping left lower quadrant and cul-de-sac\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 homogenous attenuation throughout.  A\n1.4 cm hypodensity in segment VIII is likely a 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.  There is a small accessory spleen (02:27).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 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. \nMinimal grade 1 L5 on S1 anterolisthesis is noted with mild degenerative\nchanges at L5-S1.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain.  Normal appendix.\n\n2.  Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.  No\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates fairly homogeneous attenuation\nthroughout.  Slight heterogeneous enhancement of the right lobe is likely\nrelated to delayed image acquisition.  There is no suspicious focal lesion. \nThere is mild-to-moderate circumferential periportal edema, which can be seen\nin the setting of rapid fluid resuscitation.  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.  There is a 1.1 cm accessory splenule in the\nsplenic 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 solid renal lesions.  There is a 0.6 cm simple cyst in\nthe medial upper polar cortex (2:54).  There is no perinephric abnormality. \nThere is no hydronephrosis or hydroureter.  The urinary bladder is\nunremarkable.\n\nGASTROINTESTINAL: The stomach contains multiple high-density tablets but is\notherwise unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement.  There are no abnormally dilated loops of small\nbowel.  Diverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is normal in caliber.\n\nPELVIS:  Trace pelvic free fluid is within physiologic range.\n\nREPRODUCTIVE ORGANS: An intrauterine device is noted within the uterus.  There\nis a small amount of fluid within the endometrial cavity.  There is no adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Periportal edema, which can be seen in the setting of aggressive fluid\nadministration.  Otherwise, no definite acute intra-abdominal process. \nSpecifically, there is no evidence of a small-bowel obstruction.\n2. Sigmoid diverticulosis without evidence of diverticulitis.\n3. Intrauterine device is visualized within the uterus.  Trace pelvic free\nfluid is 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. \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 5.6 mm nonobstructing stone in the interpolar region of the upper\npole of the right kidney.  A punctate nonobstructing calculus is demonstrated\nin the upper pole of the left kidney.  Adjacent vascular calcifications are\nnoted.  A 4.2 cm x 3.3 cm x 6 cm simple cyst is demonstrated in the lower pole\nof the left kidney which is slightly larger than prior exam but simple in\nappearance.  Multiple other low-density probable simple cysts are demonstrated\nin the bilateral kidneys.  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. 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Moderately severe degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic abnormality.  Specifically, no colitis or\nappendicitis.\n2. Nonobstructing stones in the bilateral kidneys, the largest of which is\nlocated in the upper pole of the left kidney and measures approximately 6 mm.\n3. Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Coronary artery and mitral\nannulus calcifications are seen.  Aortic valve calcifications are partially\nimaged.\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: Demonstrated 5 mm calculus in the upper pole of the right kidney. \nMultiple additional bilateral nonobstructing renal calculi.  4.5 x 3.6 cm cyst\narises from the posterolateral left kidney.  Additional cysts measuring 1.3 cm\nis seen arising from the lateral interpolar region of the left kidney. \nScarring at the lateral right kidney is noted.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Stomach is relatively collapsed.  No bowel obstruction or\nbowel wall thickening is seen.  There is colonic diverticulosis without acute\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 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: Severe multilevel degenerative changes are seen L2 through S1,\nincluding disc space narrowing, vacuum phenomenon, and anterior and posterior\nosteophytes.  Moderate to severe narrowing of the central canal is seen L2/L3\nthrough S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Bilateral nonobstructing nephrolithiasis.  No frank hydronephrosis.\n2. Normal caliber appendix.\n3. Extensive atherosclerotic calcifications.\n4. Severe multilevel degenerative changes L2 through S1, including moderate to\nsevere central canal narrowing at L2/L3 through S1."
        },
        {
            "input": "VASCULAR:\n\nNo evidence of active arterial extravasation.  No evidence of peristomal\nhematoma or venous bleeding.  There are a conglomerate of vessels seen around\nthe stoma which appear to be varices draining into the SMV (303; 45).\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions within limitations of the arterial phase\nimaging.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is 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 is enlarged measuring 14.2 cm, with subcentimeter hypodense\nlesions, too small to characterize, but likely represent cysts or hemangioma,\nsimilar to prior CT 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 with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nAgain, the right kidney appears slightly rotated around its axis.  There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post gastric lap band, which appears to be\nin appropriate position.  Patient is status multiple partial small bowel\nresections with ileostomy.  The remaining small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout.  Patient is status post\nproctocolectomy.  There 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.  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. \nSevere levoscoliosis of the lumbar spine with apex at L3-L4 is identified with\nsevere multilevel degenerative changes, most notable at L3-L4.\n\nSOFT TISSUES: Within the lower right anterior abdominal wall is a region\ncontaining locules of air, which may represent a prior catheter insertion site\nor a prior surgical site and is similar to most recent prior CT ___ 30). \nThere is extensive soft tissue edema noted throughout the abdominal wall. \nMultiple soft tissue calcifications within the soft tissues may represent\ninjection granulomas.  3.5 x 6.3 cm soft tissue mass along the left hip is\ncompatible with known fibroma (303; 94).",
            "output": "1. No evidence of active extravasation.  No evidence of peristomal hematoma. \nThere are varices around the stoma draining into the SMV.\n2. Splenomegaly similar to prior."
        },
        {
            "input": "There is extensive artifact related to positioning of the arm and technique\nwhich limits evaluation of the upper abdomen\n\nLOWER CHEST: There is interval development of a trace pneumothorax in the\nmedial anterior right lung.  There is interval development of compressive\natelectasis.  Mild dependent atelectasis.  Moderate atherosclerotic\ncalcifications of the coronary arteries.\n\nHEPATOBILIARY: Patient is status post tips with stent in appropriate position.\nDue to artifacts as described above, further evaluation of the liver is\nmarkedly limited.\n\nPANCREAS: Mild atrophy of the pancreas.\n\nSPLEEN: Splenomegaly the spleen measuring 17 cm.  Re-demonstrated\nsubcentimeter hypodensities in the inferior aspect of the spleen are similar\nto ___.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or nephrolithiasis.  Right renal cysts are similar\ndating back to ___ measuring up to 1 cm.\n\nGASTROINTESTINAL: Small hiatal hernia is re-demonstrated with hyperdensity\nwithin it pre and postcontrast, likely representing embolization clips.  Lap\nband appears in similar position when compared to prior studies. Patient\nstatus post multiple small bowel resections with the right lower quadrant\nileostomy.  Large ventral hernia containing undilated loops of small bowel. \nPatient is status post partial colectomy.  Rectal stump noted.\n\nPELVIS: Foley within bladder with expected air.  Hysterectomy.  The adnexa are\nunremarkable for age.\n\nPERITONEUM/RETROPERITONEUM: Small volume low-density ascites in the right\ngreater left upper quadrant and scattered within the lower quadrant.\n\nLYMPH NODES: No abdominopelvic adenopathy.\n\nVASCULAR: There is no evidence of contrast extravasation.  Patient is status\npost TIPS which appears in appropriate position.  Normal caliber aorta with\nmoderate atherosclerotic calcifications.  The aorta is mildly tortuous.  The\nceliac axis, splenic artery, hepatic artery and SMA are patent.  The ___ is\nagain noted to be occluded.  Limited evaluation of the portal vein due to\ntiming of the contrast, however the main portal vein and portal splenic\nconfluence are patent.  Coils are seen along the superior rectal vasculature.\n\nBONES: Degenerative changes of the spine.  Rotatory scoliosis.  No suspicious\nosseous lesions.\n\nSOFT TISSUES: A right chest port is again seen.  Severe anasarca.  Calcified\ngranulomas in the anterior abdomen and buttock.  The hyperdense soft tissue\nmasses in the lateral aspect of the left hip along the left piriformis and\ngreater left trochanteric region are compatible with the known fibromas,\ndating back to ___.  Large ventral abdominal wall defect again noted.\n\nThe foci of gas seen in the anterior abdominal wall on series 2, image 70 are\nagain noted and unchanged from last year and may be related to air within a\ncrevice related to the large pannus.  No drainable fluid collections are seen.",
            "output": "1. Interval development of small right pneumothorax, partially seen. Small to\nmoderate right and small left pleural effusions.\n2. No site of extravasation demonstrated.Status post TIPS in appropriate\npositioning.\n3. Sequela of portal hypertension including splenomegaly and small volume\nascites.\n4. Esophageal dilatation most likely secondary to the laparoscopic gastric\nband, as on prior.  Additional findings as above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:05 am, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CTA abdomen/pelvis:\n\nThe abdominal aorta is normal in caliber and without evidence of aneurysm or\ndissection. The celiac axis, SMA, bilateral renal arteries, and ___ are\ngrossly patent.  The hepatic arterial anatomy is conventional.\n\nLOWER CHEST/ABDOMEN:\n\nThe lung bases are clear.  The visualized portions of the heart and\npericardium are unremarkable.  There is no pleural effusion.  The liver is\nnormal in appearance and without focal abnormality. The portal venous system\nis patent. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder, pancreas, spleen, and bilateral adrenal glands\nare normal. The kidneys enhance symmetrically and are without suspicious solid\nmass.\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\nnot visualized but there are no secondary signs of appendicitis. There is\nextensive colonic diverticulosis without evidence of acute diverticulitis. \nThere is no active extravasation.  Metallic object seen in the distal\ntransverse colon may reflect a clip. There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum.\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 and adnexa are unremarkable.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  No evidence of active GI bleed.\n\n2.  Extensive colonic diverticulosis."
        },
        {
            "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: 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 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.  A 1.4 cm splenule is seen 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 simple cysts.  Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram. There is no\nevidence of stones, enhancing 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.  There is extensive diverticulosis without\nevidence of diverticulitis.  There is no evidence of active GI bleed. \nAppendix is normal in appearance.  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 trace free fluid\nwithin the pelvis, which is likely physiologic.\n\nREPRODUCTIVE ORGANS: Endometrium is heterogeneous, which is likely due to\nphase of cycle in a premenopausal patient.  No adnexal masses.\n\nBONES: Symmetric sclerosis is seen within the sacroiliac joints and pubic\nsymphysis, which is likely degenerative in nature.  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 evidence of active GI bleed.\n2. Diverticulosis."
        },
        {
            "input": "PELVIS: Patient is status post colonic resection and ___ pouch and end\nileostomy which exits anterior abdominal wall.  Contrast fills the entire\n___ pouch.  There is no evidence of extra luminal contrast or evidence\nof a leak.  The pouch appears unremarkable without wall thickening.  Partially\nvisualized small bowel loops and and ileostomy are unremarkable.  There is no\nevidence of obstruction.  There is contrast noted in distended bladder which\nis otherwise unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is a trace amount of\nfree fluid in the pelvis.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There are moderate degenerative changes of the pubic symphysis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post colonic resection, ___ pouch, and end ileostomy without\nevidence of leak, pouchitis, or obstruction.\n2. Trace amount of simple free fluid in the pelvis is likely physiologic given\nthe patient's age."
        },
        {
            "input": "LOWER 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 ill-defined low attenuating lesions\nscattered throughout the liver highly suspicious for metastatic disease.  The\nlargest is located within segment 8 of the liver measuring 1.6 cm.  There is\nmild intra and extrahepatic biliary ductal dilatation which appears to be\nsecondary to extrinsic compression of an abnormal lymph node at the porta\nhepatis seen on series 3, image 59 and series 601, image 29 measuring 2.4 x\n1.8 x 1.6 cm.  The gallbladder is not confidently identified and may be\ncollapsed 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 size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 1.7 x 1.3 cm right adrenal nodule with Hounsfield units measuring\nless than 10 compatible with a benign adrenal adenoma.  There is mild nodular\nthickening of the left adrenal gland without discrete mass.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a tiny low attenuating lesion within the interpolar region of the\nright kidney (series 3, image 59) which is too small to adequately\ncharacterize but statistically represents a benign cyst.  There is no evidence\nof suspicious cystic or 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. Scattered colonic\ndiverticula.  There is a heterogeneous mass along the anti mesenteric border\nof the cecum measuring 4.5 x 5.0 by 4.0 cm likely representing a serosal\nimplant.  There is a 2.3 x 1.4 x 1.7 cm heterogeneous mass medial to the cecum\nseen on series 3, image 73 and series 601, image 30 most likely representing a\nmetastatic lymph node however additional peritoneal implant is also possible. \nThe colon and rectum are 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: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple enlarged abnormal appearing right and left\nperiaortic retroperitoneal lymph nodes with the largest located adjacent to\nthe left renal vein measuring 3.7 by 2.0 x 1.9 cm.  There is no pelvic or\ninguinal 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.  Soft tissues\notherwise unremarkable.",
            "output": "1. Numerous liver lesions highly suspicious for metastatic disease and\nretroperitoneal lymphadenopathy highly suspicious for metastatic disease. \nThere is abnormal 2.4 cm lymph node at the porta hepatis which has mass effect\nupon the common bile duct resulting in mild intra and extrahepatic biliary\nductal dilatation.  Correlate with biliary enzymes for evidence of\nobstruction.\n2. 5.0 cm mass along the anti mesenteric border of the cecum presumably\nrepresenting a serosal implant.  This is likely the best target for image\nguided biopsy if tissue is desired for diagnosis/staging.\n3. 2.3 cm heterogeneous mass right lower quadrant medial to the cecum\npresumably representing metastatic lymph node or peritoneal implant.\n4. Additional chronic changes as detailed above."
        },
        {
            "input": "ABDOMEN:\n\nSimilar to the previous study, there is high-grade small bowel obstruction\nwith severe dilatation of the mid small bowel which measures up to 7.4 cm in\ndiameter. The degree of small bowel dilatation has increased since the\nprevious study. There are multiple transition points, including the left upper\nquadrant (601b:24) and the right lower quadrant (601b:23). Although contrast\npasses from the stomach into the proximal jejunum, it does not pass distal to\nthis point. Therefore, it is difficult to outrule a closed-loop obstruction.\nHowever, there is no evidence of perforation or bowel ischemia. The distal\nileum appears decompressed within the pelvis.  There is a side-to-side small\nbowel anastomosis within the pelvis (___:24). The colon is completely\ndecompressed and contains residual oral contrast within its lumen. There is a\nG-tube within the body of the stomach.\n\nThe liver is within normal limits. No focal liver lesions. The portal and\nhepatic veins are patent. No intra or extrahepatic duct dilatation.  The\npatient is status post cholecystectomy.\n\nThere are small hypodensities within the upper pole of both kidneys that are\ntoo small to further characterize but are unchanged since previous. The\nkidneys are otherwise unremarkable. No hydronephrosis. The adrenals and spleen\nare within normal limits.  The pancreas is severely atrophic, unchanged since\nprevious.\n\nNo mesenteric or retroperitoneal adenopathy.  The abdominal aorta is of normal\ncaliber. There is a moderate amount of mixed soft and calcified atheromatous\nplaque within the abdominal aorta. Similar to previous, there is calcified\natheromatous plaque at the origin of both the superior mesenteric and celiac\narteries with a moderate stenosis of the proximal SMA.\n\nMinor bibasal atelectasis is noted both lung bases.  There is a trace left\npleural effusion.  The lung bases are otherwise unremarkable. The visualized\nportion of the heart and pericardium is unremarkable.\n\nPELVIS:\n\nThere is a Foley catheter within the bladder which is completely decompressed.\nThe uterus appears retroverted but is otherwise unremarkable. No pelvic\nadenopathy.\n\nOSSEOUS STRUCTURES:\n\nThere are multiple compression fractures throughout the lower thoracic and\nlumbar spine that are unchanged since previous. There is severe osteopenia of\nall of the visualized osseous structures. There is an intramedullary nail\nwithin the left proximal femur and two internal fixation screws within the\nright femoral neck.",
            "output": "1. Progression of high-grade small bowel obstruction since the previous CT.\nMultiple transition points are identified within the left upper quadrant and\nright lower quadrant.  It is difficult to rule out a closed-loop obstruction,\nalthough there are no features suggestive of bowel ischemia or perforation.\n\n2. The degree of dilatation of the stomach and duodenum has decreased since\nprevious.\n\n3. Multiple osteoporotic compression fractures throughout the lower thoracic\nand lumbar spine, unchanged since previous."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 suspicious focal lesion.  There is mild intrahepatic biliary\nductal dilatation, grossly similar to prior MRCP dated ___.  The\ncommon bile duct is dilated measuring up to 14 mm, previously measuring 14 mm.\nThere is no evidence of periductal enhancement.  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 a 9 mm exophytic hyperdense lesion arising from the lower pole of the\nright kidney, incompletely characterized on the current exam.  Otherwise,\nthere is no evidence of solid renal lesions.  Tiny hypodensity at the\ninterpolar region of the left kidney, too small to characterize though\nstatistically a cyst.  There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Fecalization within nondilated small bowel loops in the right\nlower quadrant suggest slow transit.  Otherwise, remaining small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. 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 is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Mild intrahepatic and extrahepatic biliary ductal dilatation, overall\nsimilar to prior study dated ___ and likely sequelae of\ncholecystectomy.  No definite evidence of periductal enhancement.  However, if\nthere is a clinical concern for cholangitis, MRCP should be considered for\nfurther evaluation.\n2. Fecalization of small bowel loops, suggestive of slow transit.\n3. Prostatomegaly.\n4. A 9 mm exophytic hyperdense lesion arising from the lower pole of the right\nkidney, previously seen as enhancing.  This is not entirely characterized on\nthis CT and has never been evaluated by a dedicated study.  MRI of the kidneys\nis suggested to more fully characterize, non urgently.\n\nRECOMMENDATION(S):  MRI of the kidneys with contrast is suggested to more\nfully characterize.\n\nNOTIFICATION:  The updated findings and recommendation was discussed with\n___, M.D. by ___, M.D. on the telephone\non ___ at 2:59 pm, within 1 day 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 suspicious focal lesion. There is mild-to-moderate intrahepatic\nbiliary ductal dilatation, similar in appearance compared to prior.  The CBD\nis dilated and measures up to 9 mm.  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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere redemonstrated 9 mm exophytic hyperdense lesion arising from the lower\npole of the right kidney is unchanged.  Hypodensity in the midpole of the left\nkidney is too small to characterize however likely represents a cyst.  There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe urinary bladder is unremarkable.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Otherwise the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement. The colon and rectum are within normal limits. The appendix\nis normal.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Sclerotic rounded focus within the L3 vertebral body is unchanged from\n___ exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged intrahepatic and extrahepatic biliary ductal dilatation, likely\nsequelae of prior cholecystectomy.  Please correlate clinically.\n2. Redemonstrated 9 mm lesion arising off the lower pole of the right kidney,\nbetter characterized on recent MRI."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Two left lower lobe subpleural\nnodules are noted.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Focal hypoattenuation adjacent to the\nfalciform ligament is likely related to perfusion or focal fat.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. Hyperdensity\nwithin the gallbladder is likely due to vicarious excretion of contrast.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout. A tiny\nhypodensity within the spleen is too small to characterize, most likely a\nsmall cyst or hemangioma.\n\nPANCREAS: The pancreas has normal attenuation throughout. The main pancreatic\nduct is not dilated. An 8 mm pancreatic cystic lesion within the pancreatic\ntail with attenuation ___ ___ is statistically most likely a side branch IPMN\n(02:57).\n\nADRENALS:  The right and left adrenal glands are normal.\n\nURINARY: The right kidney is absent. Per the ___ medical record, patient\nhas a history of renal cell carcinoma.  There is no soft tissue in the\nresection bed to suggest local recurrence.  The left kidney enhances\nhomogeneously and excretes contrast promptly without hydronephrosis. A tiny\nhypodensity in the left renal interpolar region (601b:47) is too small to\ncharacterize, statistically most likely a cyst.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits.\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 of normal caliber throughout. The main\nportal vein, splenic vein and SMV are patent.\n\nPELVIS: The urinary bladder is unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis. Prostate and\nseminal vesicles are unremarkable.\n\nBONES: No bone finding suspicious for infection or malignancy is seen.  Mild\ndegenerative change is noted in the thoracolumbar spine.",
            "output": "1.  No evidence of malignancy in the abdomen or pelvis.\n\n2.  Status post right nephrectomy for renal cell carcinoma. No evidence of\nrecurrent or new disease.\n\n3.  8 mm pancreatic cystic lesion in the tail, most likely representing a side\nbranch IPMN.  Follow up in 6 months with MRCP is recommended.\n\n4. CT chest 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 homogenous attenuation throughout. \nThere is no evidence of focal lesions.  The CBD is again dilated to 1.4 cm,\nunchanged from ___ with prominence of the central intrahepatic\nbiliary ducts.  The gallbladder is surgically absent.\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 show no evidence of hydronephrosis, stones or focal\nlesions.\n\nGASTROINTESTINAL:  Patient is status post Roux-en-Y gastric bypass surgery and\npartial colectomy.  Diverticulosis of the sigmoid colon without evidence of\ndiverticulitis.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  There is no evidence of\nclot within the main portal vein, splenic vein and SMV.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy. Reproductive organs are within\nnormal limits\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Significant increase in size of the peripherally enhancing fluid\ncollection within the superficial soft tissues of the anterior abdominal wall.\nToday the fluid collection measures roughly 8.7 x 3.5 cm and on ___ the fluid collection measured 4.4 x 1.3 cm. There is no intraperitoneal\ncomponent. Mesh is not seen.",
            "output": "Significant increase in size of the fluid collection within the superficial\nsoft tissues of the anterior abdominal wall. Infection cannot be excluded on\nimaging."
        },
        {
            "input": "CTA:  Thoracic aorta is normal in caliber. Infrarenal abdominal aortic\naneurysm is similar in size accounting for differences in measuring technique,\nmeasuring up to 3.8 cm in maximum dimension (previously reported 3.7 cm in ___ but larger since ___ (up to 3.6 cm).  Again seen is heavy\nintramural thrombus burden at this site. There are no signs of intramural\nhematoma, penetrating ulcer, or dissection. The celiac axis, SMA and bilateral\nrenal arteries are grossly patent. Atherosclerotic mural calcifications are\nseen throughout the aorta and its major branches. The hepatic arterial anatomy\nis traditional.  Assessment of the venous vasculature is limited by the timing\nof contrast.\n\nAAA data from 3D lab:\n-Diameter of aneurysm (Cross-sectional): 3.8 cm\n-Inferior renal to top of aneurysm: 3.2 cm\n-Inferior renal to aortic bifurcation:  9.9 cm\n-Inferior renal to right iliac bifurcation:  15.2 cm\n-Inferior renal to left iliac bifurcation:  13.7 cm\n-Volumes:\n--Aneurysm:  43 cm3\n--Inferior Renal to Aortic bifurcation:  57.9 cm3\n--Inferior Renal to Iliac bifurcation:  67 cm3\n\n\nABDOMEN/PELVIS: Liver contour is slightly nodular. Although hypodensities are\nagain seen, largest in segment VIII measuring up to 0.8 cm (image 03:27). At\nleast 2 hypodensities are also seen within the spleen, largest measuring up to\n0.8 mm (image 3:26). Gallbladder and pancreas are normal.  CBD is mildly\nprominent.\n\nRight adrenal limb is slightly thickened and has characteristics of an\nadenoma.  Left adrenal gland is normal.\n\n1 cm hypodensity is again seen in the left lower renal pole, which was not\npreviously evaluated and nonemergent renal ultrasound is recommended. The\nkidneys otherwise enhance symmetrically and are without suspicious solid mass.\nThere are no radiodense stones seen in the kidneys, ureters, or bladder.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening.  The entire\ncolon is filled with stool. There is no free air or free fluid in the abdomen\nor pelvis.\n\nThere is no mesenteric, retroperitoneal, pelvic sidewall, or inguinal\nlymphadenopathy.  Patient is status post hysterectomy.\n\nSignificant multilevel degenerative changes of the spine is again seen.\nAnterolisthesis of L4 on L5 is mild, also likely degenerative in etiology. \nPatient is status post L5-S1 laminectomy. No suspicious bony lesions seen.",
            "output": "1. Infrarenal AAA not significantly changed since prior study from 2 weeks\nago, measuring up to 3.8 cm.  No dissection or active extravasation. \nContinued close followup advised. Continued close followup advised.\n2. 1 cm left renal hypodensity. Nonemergent renal ultrasound is recommended\nfor further characterization.\n3.  Abundant stool throughout the colon may relate to constipation."
        },
        {
            "input": "VASCULAR:\n\nAn infrarenal abdominal aortic aneurysm has increased in size with eccentric\nmural thrombus, overall measuring up to 4.5 cm in the axial plane, previously\n3.8 cm (series 3, image 59).  There is severe atherosclerosis without arterial\nocclusion or severe stenosis.\n\n\nABDOMINAL AORTA DIAMETERS\nAt lowest renal artery bilateral: 1.5 cm\n5 mm below lowest renal artery: 1.6 cm\n10 mm below lowest renal artery: 1.8 cm\n15 mm below lowest renal artery: 1.9 cm\n\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 4.5 x 4.4 cm\nDiameter (Center-line): 4.2 x 4.6 cm\nLength: 5.6 cm\nVolume:\n\n1. Aneurysm: 67 ml\n2. Renal to Aortic bifurcation: 81 ml\n3. Renal to Iliac bifurcation: 90 ml\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 0.7 cm; Left: Normal 0.6 cm.\nExternal Iliacs: Right: normal 0.6 cm; Left: normal 0.6 cm.\nInternal Iliacs: Right: normal 0.4 cm; Left: normal 0.4 cm.\nFemoral: Right: normal 0.5 cm; Left: normal 0.5 cm.\n\nTortuosity Iliacs:  Right: Moderate; Left:  Mild.\nFemoral Calcifications: Right: Mild; Left: Mild.\n\nLOWER CHEST: A small chronic right pleural effusion associated with pleural\nthickening is unchanged since ___.  The partially imaged lung bases are\notherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypoattenuating lesions in the liver too small to completely\ncharacterize, but unchanged and likely reflecting cysts or biliary hamartomas.\nNon masslike enhancement in the posterior aspect of segment III and segment IV\nlikely reflects a transient hepatic attenuation difference.  The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: Mild pancreatic ductal dilation measuring 4 mm is unchanged.  No\nfocal pancreatic lesion identified.  No peripancreatic fat stranding\n\nSPLEEN: Hypoattenuating splenic lesions measuring up to 8 mm are unchanged and\nlikely benign.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is multifocal bilateral cortical scarring, similar to the prior\nexamination.  An intermediate attenuation lesion arising from the posterior\nlower left kidney has increased in size and measures 1.5 cm, but was\npreviously characterized on MRI as a cyst (series 3, image 51).  No concerning\nlesions.  No hydronephrosis.\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.\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. \nThere are severe thoracolumbar spine degenerative changes including grade 1\nanterolisthesis of L4 on L5 and minimal multilevel retrolisthesis of L1 on L2,\nL2 on L3, L3 on L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is unremarkable.",
            "output": "1. An infrarenal abdominal aortic aneurysm has increased in size since ___ years\nprior, measuring up to 4.6 cm, previously 3.8 cm.\n2. Mild chronic pancreatic ductal dilation is unchanged."
        },
        {
            "input": "LOWER CHEST: Right lung base atelectasis is mild.  No pericardial pericardial\nor pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver is homogeneous in attenuation and\nenhancement.  No new focal lesion.  The portal vein anastomosis is\nunremarkable.  The anastomosis with the inferior vena cava is also\nunremarkable.  No portal vein thrombus.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS:  Low density lesion in the pancreatic tail is similar in size to the\nprior MRCP, measuring approximately 2.2 cm, previously 2.4 cm.  No new\npancreatic lesion detected.  No peripancreatic stranding or ductal dilatation.\n\nSPLEEN: As before, the spleen is enlarged, measuring up to 20.2 cm in the\ncraniocaudal dimension.  No new focal splenic lesion detected.\n\nADRENALS: The 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 are simple attenuation, measuring up to 5.4 x 4.7\ncm in the lower pole (6:37).  The largest left renal cysts measures 1.8 cm\n(6:36).  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.  Enlargement of the portal system is unchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is unchanged grade 1 anterolisthesis of L4 and L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to explain the patient's\nsymptoms.\n\n2.  Status post liver transplant, without new focal hepatic lesion or evidence\nof vascular occlusion.\n\n3.  Unchanged splenomegaly and enlargement of the portal system.\n\n4.  Multiple pancreatic lesions are better characterized on prior MRCP, likely\nrepresenting side-branch IPMNs."
        },
        {
            "input": "Bibasilar lung atelectasis is noted.  For detail intrathoracic findings,\nplease refer to concurrent CT chest report.\n\nLIVER:  Patient is status post liver transplant. The transplanted liver\nenhances normally without focal liver lesions. Mild focal narrowing at the\nmain portal vein anastomotic site is again seen (image 16: 27), relatively\nunchanged compared to prior study. Patient is status post cholecystectomy. \nAbdominal varices are unchanged.  There is no ascites.\n\nSPLEEN:  Splenomegaly is stable, measuring 16 cm in maximum AP diameter.\n\nPANCREAS: A cluster of cystic lesions in the junction of pancreas body/tail is\nagain seen, unchanged since MR since ___, likely reflective of small side\nbranch IPMN (images 6:102-104).\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS:  Several within lesions are again seen in the right lower renal pole,\nlikely simple renal cysts, largest of which measures 5.9 cm TV x 5.0 cm AP x\n4.5 cm CC. The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no hydronephrosis.\n\nGI:  The stomach, and visualized portions of the small and large bowels are\nnormal, without signs of obstruction. The appendix is normal.  There is no\nfree air.\n\nRETROPERITONEUM: The visualized portion of the aorta is normal in caliber.\nThere is no retroperitoneal or mesenteric lymph node enlargement.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1.  Post liver transplant.  Hepatic vasculature appears patent. Stable\nabdominal varices.  No ascites.\n2.  Stable mild splenomegaly.\n3.  Unchanged pancreatic cystic lesions, likely side-branch IPMN."
        },
        {
            "input": "LOWER CHEST:  Small nonhemorrhagic bilateral pleural effusions, right greater\nthan left.  Adjacent compressive atelectasis is also noted.  Heart size is\ntop-normal.  Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is diffusely hypoattenuating, suggestive of hepatic\nsteatosis. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  Vicarious excretion of\ncontrast into 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: 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.  Descending and sigmoid diverticulosis, without\nevidence of acute diverticulitis.  Normal appendix.  There is no evidence of\nmesenteric lymphadenopathy.  No pneumoperitoneum.\n\nVASCULAR:  Moderate atherosclerotic calcifications are noted along the\nabdominal aorta.  There has been interval placement of a stent in the distal\nright common iliac artery.\n\nRETROPERITONEUM:  In comparison to the prior study performed on ___,\nthe degree of retroperitoneal hemorrhage has significantly decreased.  There\nis no evidence of active extravasation on the current study.\n\nPELVIS: Bladder is largely collapsed around a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  No adnexal lesions are\nidentified.\n\nBONES: There 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 placement of a distal right common iliac artery stent, with\nsignificantly decreased retroperitoneal hemorrhage compared to ___. \nNo evidence of active extravasation on the current study.\n2. Right greater than left small pleural effusions.\n3. Hepatic steatosis."
        },
        {
            "input": "Evaluation is limited by motion.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is high-grade severe stenosis at\nthe origin of the superior mesenteric artery, with distal contrast\nopacification noted.  The celiac artery is ectatic immediately distal to its\norigin.  The celiac axis, bilateral renal arteries, ___, bilateral common\niliac arteries and their major branches are patent.  There is severe calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: There are large dependent bilateral pleural effusions associated\nwith at least moderate atelectasis in the bilateral lower lobes.  No\npericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation.  No focal mass\nlesions are seen.  The portal and hepatic veins are patent.\n\nThere is severe diffuse intrahepatic biliary ductal dilatation.  A transition\npoint is seen along the course of the CHD where there is a 1.1 cm\nhyperenhancing soft tissue lesion (02:47-50).  Hyperenhancement of the bile\nduct wall is noted proximal and distal to this lesion.  The mass borders the\ngastroduodenal artery.\n\nThe right anterior and left hepatic ducts merge proximal to this lesion.  The\nright posterior hepatic duct has a separate connection to the CHD further\ndistally, but still proximal to the lesion.\n\nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic in appearance, without main pancreatic\nductal dilatation.  A 2.1 cm cystic lesion in the pancreas head (02:50) is new\nfrom ___, and may represent an IPMN.  Additional smaller hypodense\nlesions are seen scattered in the pancreas body and tail, also likely\nrepresenting IPMNs.\n\nSPLEEN: The spleen is normal in size.  Subcentimeter hypodensities are too\nsmall 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. \nNo focal mass lesions are seen.  Left peripelvic cysts are noted.  No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable.  Small and large bowel\nloops are normal in caliber.  There is small volume abdominopelvic ascites. \nNo pneumoperitoneum.\n\nLYMPH NODES: No pathologically enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: Evaluation the pelvis is limited by beam hardening artifact from\nbilateral dynamic hip screws.  The urinary bladder is grossly unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No gross adnexal\nabnormality is seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL4 compression fracture and grade 1 retrolisthesis of L1 on L2 are unchanged. \nRedemonstration of bilateral dynamic hip screws.  There is diffuse osseous\ndemineralization.\n\nSOFT TISSUES: There is diffuse subcutaneous edema.  There is a tiny\nperiumbilical hernia containing fat (05:55).",
            "output": "1. Severe diffuse intrahepatic biliary ductal dilation with focal transition\npoint seen along the CHD, where there is a 1.1 cm hyperenhancing soft tissue\nmass, highly suspicious for cholangiocarcinoma.\n2. Pancreatic cystic lesions measuring up to 2.1 cm in the pancreas head\nlikely represent IPMNs.  Attention on future imaging recommended.\n3. High-grade stenosis of the superior mesenteric artery at its origin with\nlarge GDA to PDA collateral pathway."
        },
        {
            "input": "LOWER CHEST: There is bilateral moderate centrilobular emphysema with thin\nwalled emphysematous bullae in the left lower lobe.  No pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered punctate hypo densities are too small to characterize, however\nlikely represent cysts or biliary hamartomas.  Mild intrahepatic biliary\nductal dilatation appears progressed compared to prior.  The CBD is again\ndilated and measures up to 1.5 cm.  Correlation with liver function tests,\nwhich if abnormal, should prompt MRCP to look for cause of extrahepatic\nprogressive a CBD dilation.\n\nPANCREAS: The pancreas has normal attenuation throughout without evidence of\nfocal lesions.  There is prominence of the 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: The kidneys are of normal and symmetric size with normal nephrogram. \nNo solid renal lesion.  There is a 4.5 cm cyst arising from the lower pole of\nthe left kidney.  Additional hypodensity in the upper pole of the left kidney\nis too small to characterize, however likely represents an additional cyst. \nNo hydronephrosis 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 (series 2, image 93).\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: There 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 process seen in the abdomen or pelvis.\n2. Intra and extrahepatic biliary ductal dilatation as described above appears\nto have progressed compared to ___.  There is focal thickening of\nthe mucosa at the ampulla.  Correlation with liver function tests, is\nrecommended, if the liver function tests are abnormal an MRCP may be obtained.\n\nRECOMMENDATION(S):  Please see impression 2."
        },
        {
            "input": "LOWER CHEST: Redemonstrated 6 mm left lower lobe nodule.  Otherwise, the lung\nbases are clear.  Coronary artery calcifications are partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  The\ncommon bile duct is dilated up to 1.5 cm, previously 2.1 cm.  The gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.  Redemonstrated\n4.0 x 4.4 cm cyst arising from the lower pole of the left kidney.  There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\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.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  No adnexal abnormality.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease.  There is no abdominal\naortic 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 for ischemic colitis, within the limitations of an unenhanced\nscan.\n2. Redemonstrated dilatation of the common bile duct, measuring up to 1.5 cm,\npreviously measuring 2.1 cm.  Previously noted soft tissue prominence of the\nperiampullary area is not clearly seen due to the noncontrast nature of the\nstudy.  If clinically indicated consider MRCP or EUS.\n3. Extensive atherosclerotic calcific disease."
        },
        {
            "input": "LOWER CHEST: There is a 5 mm nodule in the left lobe which is unchanged\ncompared to exams dating back to ___.  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 mild intrahepatic biliary\ndilatation, unchanged.  The common bile duct is enlarged, measuring up to 14\nmm, unchanged compared to exams dating back to ___.  The gallbladder is\nsurgically resected.  There is new mild-to-moderate intra-abdominal ascites\nsurrounding the liver and spleen which tracks 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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is unchanged appearance of a large 4.6 cm simple cyst in the left lower\nrenal pole.  Otherwise, there is no evidence of focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernial.  There is increased wall\nthickening and edematous appearance of multiple small bowel loops in the left\nupper and mid abdomen with mucosal hyperemia, compatible with florid\nenteritis, new since prior exam in ___.  No evidence of obstruction\nor perforation.  No evidence of internal hernia.  The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is moderately distended.  There is no distal\nhydroureter.\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.  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. Multiple small bowel loops in the left upper and mid abdomen appear\ninflamed and edematous, compatible with florid enteritis which is new since\nprior exam in ___.  No evidence of obstruction or perforation.\n2. There is new mild-to-moderate intra-abdominal ascites surrounding the liver\nand spleen which tracks into the pelvis, presumed reactive to new enteritis.\n3. Unchanged prominence of the common bile duct, measuring up to 14 mm, which\ntapers normally compared to multiple exams dating to ___."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  A 4 mm nodule at the left lung\nbase is stable dating back to ___ (series 2:8).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of new focal lesions.  Scattered subcentimeter\nhypodensities are too small to characterize by CT but likely represent cyst\nand are unchanged.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Mild prominence of the central intrahepatic bile ducts is\nunchanged compared to prior studies.  Dilatation of the common bile duct to 13\nmm is also unchanged dating back to ___.  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 solid renal lesions or hydronephrosis.  A simple\nappearing 4.5 cm cyst in the lower pole of the left kidney is unchanged. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal enhancement throughout.  Several loops of small bowel are fluid-filled\nand prominent measuring up to 3.0 cm, however no transition point is\nidentified.  Markedly diffuse bowel wall edema seen on prior has resolved in\nthe interim.  There is fluid in the ascending and transverse colon as well,\nwithout any bowel wall thickening.  The descending and sigmoid colon are\ndecompressed and unremarkable.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  Interval resolution of the previous ascites.\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. \nModerate degenerative change at the right hip including subchondral cyst\nformation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple fluid-filled small bowel loops without evidence of small-bowel\nobstruction.\n2. Liquid contents of the stool compatible with diarrheal illness.\n3. Diffuse small bowel wall edema and ascites seen on prior has resolved.\n4. Unchanged prominence of the common bile duct measuring up to 13 mm dating\nback to ___."
        },
        {
            "input": "LOWER CHEST: Subtle peripheral ___ opacities at the partially imaged\nleft lung base could represent mild inflammatory/infectious process (2:1).\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nPunctate hypodensities, too small to characterize, likely represent hepatic\ncysts or biliary hematomas.  There is no evidence of suspicious focal lesions.\nThere is no evidence of intrahepatic biliary dilatation.  Dilated CBD,\nmeasuring up to 13 mm, is unchanged.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  The proximal main pancreatic duct is conspicuous as before\n(2:23).  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: 4.2 cm simple renal cyst of the left lower pole.  The kidneys are\notherwise of normal and symmetric size with normal nephrogram.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Multiple small bowel loops are\nfluid filled and slightly distended, measuring up to 2.8 cm.  However, there\nis no definitive transition point to suggest a mechanical obstruction.  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: There 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 peripheral ___ opacities at the partially imaged left lung\nbase could represent inflammatory/infectious process.\n2. Multiple fluid-filled small bowel loops without evidence of small-bowel\nobstruction.  Findings may reflect recent diarrheal disease.\n3. No acute intra-abdominal or intrapelvic process otherwise.\n4. Additional chronic findings as above."
        },
        {
            "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 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.  Large appendicoliths are seen in the\nproximal lumen of the appendix.  There is abnormal dilation of the mid and\ndistal segments of the appendix with significant surrounding fat stranding and\nearly phlegmonous changes suggesting contained perforation.  Adjacent reactive\nnodes are seen.  No free air.  No discrete drainable abscess.\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: Enlarged mesenteric lymph nodes are likely reactive.  There is no\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. \nLimbus vertebrae noted at L4, a normal anatomic variant.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Contained perforation of the appendix with no drainable collection though\nsignificant periappendiceal fat stranding.  Large appendicolith in the lumen\nof the proximal 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Along the anterior pancreatic head, there is a 2 mm focus of\nhypodensity (series 2, image 40), likely an invagination of fat.  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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:\nThere is been significant interval progression of patient's perforated\nappendicitis.  Redemonstration of a 2.1 cm appendicolith within the right\nlower abdomen.  Along the lateral aspect of the cecum and proximal ascending\ncolon, there is a circumscribed, rim enhancing collection of heterogeneous\nmaterial containing several foci of extraluminal air and measuring 8.7 x 2.6 x\n8.5 cm (series 2, image 70 and series 601, image 27), concerning for an\nevolving abscess.  This collection appears to communicate with additional\nsmaller and less well-defined collections, for example, a collection located\nsuperolaterally measuring 3.9 x 3.7 x 3.6 cm (series 2, image 63 and series\n601, image 34) and another collection medially measuring 3.3 x 1.7 x 3.4 cm\n(series 2, image 68 and series 601, image 30).  The largest collection may be\namenable to percutaneous drainage.  Multiple foci of extraluminal gas are\nseen.\n\nThere is also been significant worsening of the associated inflammatory\nchanges.  There is interval worsening of pericecal and pericolonic soft tissue\nstranding with free fluid in the right pericolic gutter and increased\nextraluminal air.  Additionally, there is marked wall edema of the cecum,\nproximal to mid ascending colon, and terminal ileum.\n\nNo bowel obstruction.  Diverticulosis of the descending and sigmoid colon is\nnoted.\n\nPELVIS: The urinary bladder is unremarkable.  There is a small amount of\nlow-density pelvic free fluid.\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. \nRedemonstration of limbus vertebrae at L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Significant interval progression of perforated appendicitis. \nRedemonstration of 2.1 cm appendicolith, however, there is now a large\ncircumscribed, rim enhancing collection measuring up 8.7 cm in diameter along\nthe lateral aspect of the cecum and proximal ascending colon, concerning for\ndeveloping abscess.  This large collection communicates with several adjacent\nsmaller collections and may be amenable to percutaneous drainage.  Multiple\nfoci of extraluminal gas.\n2. Interval worsening of associated inflammatory changes, which include\nincreased soft tissue stranding in the right lower abdomen and adjacent free\nfluid, and associated marked wall thickening of the cecum, proximal to mid\nascending colon and terminal ileum."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\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: There has been substantial interval improvement of fat\nstranding in the right lower quadrant.  A dominant right lower quadrant\nabscess is collapsed around a percutaneous drainage catheter with few residual\nlocules of gas.  A smaller fluid collection located more superior and\nlaterally is collapsed around a second smaller the cutaneous drainage catheter\nwith a residual locule of gas.  Remaining loops of large and small bowel are\nunremarkable.  A previously-seen appendicolith is no longer visualized.  There\npersists a small amount of phlegmon, spanning approximately 3.2 x 2.4 cm\n(series 5, image 63).\n\nPELVIS: The urinary bladder is unremarkable.  There is reactive distal right\nureteral thickening adjacent to the patient's perforated appendicitis.\n\nREPRODUCTIVE ORGANS: Prostate is normal in size.\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.\nThere is transitional vertebral anatomy",
            "output": "1. Interval collapse of right lower quadrant fluid collections around the\npercutaneous drainage catheters with trace residual locules of gas and no\nappreciable residual fluid.\n2. Adjacent phlegmon spanning approximately 3.2 x 2.4 cm has improved from\nprior.\n3. A previously-seen appendicolith is no longer visualized.\n4. Interval decrease in stranding along the right lower quadrant.\n5. No new 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 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 dilated to 12 mm with mucosal\nhyperemia and moderate surrounding fat stranding (601:26).  There is mild\nreactive thickening of the cecal base (02:56).  No appendicolith or evidence\nof perforation.  No abscess.\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.  Corpus luteum is present in the right ovary.\n\nLYMPH NODES: Prominent right lower quadrant mesenteric lymph nodes are likely\nreactive.  There is no retroperitoneal, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: Patent visualized abdominopelvic vasculature including the superior\nmesenteric vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are present in visualized spine.  Right greater than\nleft sclerosis adjacent to sacroiliac joints corresponds to finding on prior\npelvic MRI.  Sclerotic focus I in the left iliac wing suggests a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute uncomplicated appendicitis.\n2. Possible mild sacroiliitis as seen on prior MRI."
        },
        {
            "input": "Lung Bases:  Mild atelectasis is noted at the lung bases bilaterally.  The\nheart appears mildly enlarged.\n\nAbdomen: The liver contains several small hypodensities, possibly representing\ncysts, the largest of which is seen on series 2, image 23 within the right\nlobe measuring 1.3 x 1.7 cm likely a simple cyst.  Main portal vein is patent.\nGallbladder is surgically absent.  The pancreas and spleen appear normal. \nAdrenal glands are normal bilaterally.  The kidneys enhance symmetrically and\nexcrete contrast promptly.  Hypodensities in the right kidney appear most\ncompatible with simple cysts the largest of which measures up to 2.4 x 3.0 cm.\nMild nonspecific perinephric stranding is noted.  The abdominal aorta is\nnormal in course and caliber with mild atherosclerotic calcifications noted. \nThere is no retroperitoneal adenopathy.  A small hiatal hernia is noted.  The\nstomach is mostly decompressed.  The duodenum is normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  Lymph nodes in the right lower quadrant\nappear minimally prominent at 9 mm in short axis, likely reactive.  The colon\ncontains a mild fecal load and is without wall thickening or signs of acute\ninflammation.  No signs of diverticulitis.  Urinary bladder is mostly\ndecompressed with a a right ureteral jet seen.  The left ureter opacifies\nnormally.  The prostate gland contains clips.  There is a small fat containing\nright inguinal hernia.  Also noted is fluid within the right scrotum better\nassessed on concurrently performed ultrasound of the scrotum.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.    Patient is\nstatus post laminectomy in the lumbar spine with fusion hardware noted.",
            "output": "1. Right inguinal fat containing hernia.\n2. Right scrotal fluid better assessed on concurrently performed scrotal\nultrasound.\n3. No signs of diverticulitis.\n4. Additional nonemergent findings as detailed above.\n5. Mild cardiomegaly."
        },
        {
            "input": "There remains sigmoid diverticulosis.  There is overlying phlegmonous fat\nstranding centered about a few diverticula in the mid sigmoid, with eccentric\nwall thickening and poor definition of the bowel wall, and adjacent mesenteric\ncongestion and a few prominent left lower quadrant mesenteric lymph nodes,\nlikely reactive and not enlarged by size criteria.  Although a small contained\nmicroperforation is difficult to exclude due to the amount of phlegmonous\nchange, there is no definite extraluminal gas otherwise, fistulous track or\ndrainable fluid collections.\n\nThe IMV and SMV are patent.\n\nThe gallbladder, bile ducts, pancreas, liver, and spleen are unremarkable.\n\nThere may be tiny less than 1 mm punctate nonobstructive calculi in the upper\npole of the left kidney (image 42, series 601), difficult to assess given\npresence of IV contrast.  Right kidney and adrenals unremarkable.\n\nThere remains varices in the inguinal region.",
            "output": "1. Acute diverticulitis of the mid sigmoid confirmed, surrounded by\nphlegmonous changes, raising the possibility of a small contained\nmicroperforation.  No drainable fluid collection.  As there is recurrent\ndisease in the same region as prior CT of ___, a follow up colonoscopy is a\nconsideration, to exclude possibility of a underlying mass once acute\nsymptomatology has quelled.\n2. Possible tiny less than 1 mm nonobstructive left renal calculus.  There are\nno CT Findings of UTI/pyelonephritis, although this remains a clinical\ndiagnosis."
        },
        {
            "input": "LOWER 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 subcentimeter hypodensity at the hepatic dome is too small to\ncharacterize by CT (6:50), unchanged since ___.  The liver otherwise\ndemonstrates homogeneous 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.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  There is a large stool burden throughout the colon.  The appendix\nis not directly 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 5.1 x 5.2 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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 and L5.  Loss of disc height is most\npronounced at L5-S1.  Small bone islands are identified in the sacrum\n(6:96-97).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No evidence of abdominal or intrapelvic malignancy or metastatic disease.\n\n2.  Enlarged prostate.\n\n3.  Large stool burden.\n\n4.  Please refer to the CT chest report of the same date for the intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST:A pacemaker has leads which terminate in the right atrium and\nventricle.  Patient is status post TEVAR with expected postsurgical changes. \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 or\nextrahepatic biliary dilatation.  Multiple small gallstones are demonstrated\nwithin the gallbladder without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is mildly atrophic and fatty replaced, without evidence\nof focal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach 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: Mild prostatomegaly measuring 5.2 x 4.0 cm.  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 within the abdominal aorta and its major branches..  The hepatic\nartery demonstrates conventional anatomy.  The main portal vein and its major\ntributaries are widely patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is demonstrated.  Mild multilevel\ndegenerative changes of the lower thoracic and lumbar spine include\nintervertebral disc space narrowing and osteophytosis.\n\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic pathology.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Please refer to same-day CT chest for detailed report of intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST:  There are small to moderate bilateral pleural effusions with\nadjacent compressive atelectasis. These appear to have increased since prior\nstudy. There is also a small pericardial effusion.\n\nLIVER:  The liver enhances homogeneously, with no focal lesions or\nintrahepatic biliary duct dilatation. The gallbladder is unremarkable and the\nportal vein is patent.\n\nPANCREAS:  The pancreas does not demonstrate focal lesions or peripancreatic\nstranding or fluid collection.\n\nSPLEEN  The spleen is homogeneous and normal in size.\n\nADRENALS: The right adrenal gland is unremarkable. A 2.5 x 2.6 cm left adrenal\nadenoma is unchanged.\n\nKIDNEYS: Hypodense lesions are seen bilaterally, with the largest in the\ninterpolar region of the left kidney measuring 3 cm, likely a simple cyst. The\nkidneys demonstrate symmetric nephrograms and excretion of contrast.  No\npelvicaliceal dilatation or perinephric abnormalities are present.\n\nGI TRACT:  NG tube terminates in the stomach, which is mostly decompressed.\nMultiple dilated loops of small bowel with air-fluid levels appear increased\nin caliber measuring up to 7cm.  There is an abrupt transition point in the\nupper mid abdomen in a similar position to prior study with decompressed\ndistal small bowel (series 2, image 30 and series 601b, image 24).  Most of\nthe transverse, descending, and sigmoid colon is decompressed. There is also\ninterval increase in the amount of free fluid within the abdomen. These\nfindings are consistent with a high-grade small bowel obstruction, which\nappears slightly worse compared to prior study.  There is no evidence of bowel\nischemia at this point. Suture material at the cecum likely reflects prior\nappendectomy.\n\nVASCULAR:  The aorta is heavily calcified with stable ectasia of the\ninfrarenal abdominal aorta measuring up to 2.4 cm. Stents are again seen in\nthe bilateral common iliac arteries.  Calcifications are present at the origin\nof the celiac axis, SMA, and bilateral renal arteries without evidence of\nflow-limiting stenosis. The bilateral external, internal, and femoral arteries\nare also heavily calcified.\n\nRETROPERITONEUM AND ABDOMEN:  There is no retroperitoneal or mesenteric lymph\nnode enlargement.  No free air or abdominal wall hernias are noted.\n\nPELVIC CT:  The urinary bladder and distal ureters are unremarkable.  No\npelvic wall or inguinal lymph node enlargement is seen. There is a small\namount of pelvic free fluid.\n\nOSSEOUS STRUCTURES:  No blastic or lytic lesions suspicious for malignancy is\npresent.",
            "output": "1.  Interval increase in caliber of dilated loops of small bowel with abrupt\ntransition in the mid upper abdomen consistent with high grade obstruction. \nNo current evidence of bowel ischemia.\n\n2.  Increased ascites as well as now small to moderate bilateral pleural\neffusions with adjacent compressive atelectasis.\n\n3.  Small pericardial effusion.\n\n4.  Unchanged renal cysts and left adrenal adenoma.\n\nNOTIFICATION:  Findings were discussed with ___ by ___ telephone at\n4:45pm on ___, 10 minutes following discovery."
        },
        {
            "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\nGENERAL:  Compared to the prior study, there is a similar amount of ascites\nthroughout the abdomen and pelvis. Additionally, small locule is air along the\nnondependent portions of the abdomen are noted, likely postsurgical (2:83).\n\nHEPATOBILIARY:  The liver 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,\nwith no evidence of gallbladder wall edema. Minimal thickening of the wall of\nthe gallbladder fundus may represent adenomyomatosis (2:66), and is unchanged.\nPANCREAS: The pancreas is slightly atrophic, but unchanged in appearance, with\nno surrounding fluid collection.\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS:  Right adrenal gland is unremarkable. A previously described left\nadrenal adenoma is unchanged in appearance..\nURINARY: The kidneys are unchanged, with bilateral renal cysts, but no\nevidence of hydronephrosis or perinephric fluid collection.\nGASTROINTESTINAL:  Since the prior study, there has been interval small bowel\nresection, with anastomotic sutures in the left upper quadrant and right upper\nquadrant. There has been interval improvement in the degree of small bowel\ndilation since the prior study, although bowel loops remain diffusely\ndistended throughout the abdomen. Enteric contrast material traverses the\nproximal small bowel, with no discrete transition point or internal hernia\ndetected. The appendix is not visualized.\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.\n\nPELVIS:\n\nThe urinary bladder is decompressed by a Foley catheter.. There is no evidence\nof pelvic or inguinal lymphadenopathy.  A small amount of free fluid tracks\ninto the pelvis from the abdomen.\n\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Interval small bowel resection since the prior study, with postsurgical\nchanges as described above, and overall improvement in the dilation of small\nbowel loops.\n2. Persistently distended small bowel is likely due to ileus, with no discrete\ntransition point identified.\n3. Volume of ascites is similar compared to the prior study.\n4. Renal cysts and adrenal adenoma are unchanged."
        },
        {
            "input": "LOWER CHEST: The heart is mildly enlarged.  There is no pericardial effusion. \nThere is atherosclerotic calcification involving the thoracic aorta.  There\nare bilateral lung bases atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is mild intrahepatic biliary ductal dilation.  The common bile duct is\nnormal in diameter measuring 7 mm.  There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\n\nPANCREAS: The pancreas is atrophic.  There are multiple low-attenuation\nlesions in the pancreatic body measuring up to 2.5 cm (series 2, image 20). \nFurther evaluation with outpatient nonurgent MRCP is recommended.  There is no\nevidence of pancreatic duct dilation.  There is mild fat stranding surrounding\nthe pancreatic head and uncinate process likely reactive change from duodenum\ninflammatory/infectious change.\n\nSPLEEN: The spleen shows normal size and 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 grossly unremarkable.  There is likely peripelvic\ncyst involving the left kidney.  There is no left hydroureter.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is mild descending\nduodenum wall thickening which may represent duodenitis.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis diffuse wall thickening throughout the colon consistent with pancolitis. \nThere is scattered diverticulosis.\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 with calcified fibroids\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is a left total hip arthroplasty with streak artifact obscuring\nthe pelvic structures.  There is right hip severe osteoarthritis.  There are\nmoderate multilevel degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute pancolitis which may be secondary to infection versus ischemia.\n2. Multiple low-attenuation pancreatic lesions at the pancreatic body. \nFurther evaluation with outpatient nonemergent MRCP is recommended.\n3. Mild fat stranding surrounding the pancreatic head and descending duodenum\nregion with duodenal wall thickening.  This may be secondary to mild\nduodenitis/ulcer disease.\n4. Other chronic/incidental findings described as in above."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable. 1.0 cm\nground-glass nodule in the lingula abutting the major fissure.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nUnchanged 1.6 cm fluid attenuation lesion in segment II, likely a cyst or\nbiliary hamartoma.  No new or concerning hepatic lesions. The portal veins are\npatent. Trace unchanged intrahepatic biliary ductal dilation status-post\ncholecystectomy. 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: Status-post partial left nephrectomy, appearance unchanged since\n___.  No new or enlarging or concerning renal lesion identified. \nNo hydronephrosis.  No perinephric abnormality.\n\nGASTROINTESTINAL: Patient appears status-post Roux-en-Y gastric bypass.  Oral\ncontrast passes through the gastrojejunostomy and jejunostomy without\nopacification of the excluded pancreaticobiliary limb.  Small bowel loops are\nunremarkable. No bowel obstruction.  large bowel containing lateral abdominal\nwall hernia at the anterior/lateral left tenth-eleventh rib space is contained\nby the external oblique musculature.  No obstruction.  The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder is unremarkable.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.\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. \nStatus-post L3-S1 laminectomies and posterior fusion with intervertebral disc\nspacers noted.  There is retrolisthesis of L2 on L3.  Anterior abdominal wall\npostsurgical changes without evidence of a ventral hernia.  Lateral left\nabdominal wall hernia containing a loop of descending colon as described\nabove. Mild sacroiliac joint degenerative changes.",
            "output": "1. Large bowel containing lateral abdominal wall hernia at the\nanterior/lateral left tenth-eleventh rib space contained by the external\noblique musculature. No obstruction.\n2. Incidental 1.0 cm ground-glass nodule in the lingula abutting the major\nfissure. For an incidentally detected single ground-glass nodule bigger than\n6mm, CT follow-up in 6 to 12 months is recommended to confirm persistence. If\npersistent, CT follow-up every ___ years until ___ years after initial detection\nare recommended.\n\nRECOMMENDATION(S):  CT chest in 6 to 12 months is recommended to confirm\npersistence of a 1cm ground glass nodule. If persistent, CT follow-up every ___\nyears until ___ years after initial detection are recommended."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  The small 2 mm\nnodule left lower lobe is stable in size in appearance going back to ___. \nLinear atelectasis is present in the right lower lobe posteriorly.  There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSimple cyst present in segments 2 and 6 of the liver, all unchanged in size or\nappearance.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 particular, no lesions are seen within the left kidney where a solid lesion\nhas previously been resected..  There is no evidence of focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A Roux-en-Y gastric bypass has been performed previously. \nOral contrast passes briskly into the distal small bowel.  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 is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 L3-S1 laminectomy and posterior fusion with\nintervertebral disc space is present.  Again noted is retrolisthesis of L2 on\nL3 mild degenerative changes in the sacroiliac joints.\n\nPersistent unchanged left lateral abdominal wall hernia containing loop of\ndescending colon.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unremarkable appearing left kidney with no evidence for any local or\nregional recurrence of disease.\n2. Stable appearing left lateral abdominal wall hernia containing\nnonobstructed descending colon\n3. Status post gastric bypass, lumbar spine posterior fusions and hernia\nrepair."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. \nMild right hydronephrosis with extrarenal pelvis with the ureter slightly\ndilated in the upper portion without evidence of obstructive stone, a punctate\ncalcification in the region of the ureter (02:52) was present on prior study\nand likely represents a phlebolith.  No left hydronephrosis.\n\nGASTROINTESTINAL: The stomach is filled with enteric contrast.  Enteric\ncontrast is seen through the small bowel which demonstrate normal caliber,\nwall thickness.  Patient is status post cecectomy with anastomosis in the\nright lower quadrant, unremarkable.  There is no bowel obstruction.  Remainder\nof the colon is normal 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: An intrauterine device is seen in appropriate position. \nBilateral adnexa are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nBilateral pelvic and inguinal lymphadenopathy appear mildly enlarged from\nprior study, for instance in the left external iliac chain a 1.3 cm adenopathy\npreviously measure 0.9 cm, and a right inguinal adenopathy measures 1.8 cm,\npreviously 1.3.\n\nVASCULAR: There is no 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 hydroureteronephrosis with mildly dilated upper ureter.  No\nevidence of obstructive stone.\n2. No acute diverticulitis.  No bowel obstruction.\n3. Interval enlargement of bilateral inguinal and external pelvic adenopathy,\nnonspecific.\n4. Interval cecectomy.\n\nRECOMMENDATION(S):  Imaging follow-up is recommended to assess evolution of\nadenopathy.\n\nNOTIFICATION:  An email was sent to the ED QA nurses to ensure notification to\nthe primary care physician about the recommendations for adenopathy follow-up."
        },
        {
            "input": "LOWER CHEST: The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypodense lesion within the right hepatic lobe is seen on\nseries 2, image 16 measuring approximately 17 x 14 x 18 mm, indeterminate,\npossibly a hemangioma.  A second hypodense lesion is seen along the periphery\nof the left lobe on series 2, image 21 measuring 2.8 x 2.9 x 1.4 cm, also\nindeterminate though may represent a hemangioma.  No additional lesions within\nthe liver.  Main portal vein is patent.  No biliary ductal dilation.  The\ngallbladder appears normal.  CBD is nondilated.\n\nPANCREAS: A truncated appearance of the pancreas is noted.  No worrisome\nfindings.\n\nSPLEEN: Spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys enhance symmetrically.  No concerning renal lesion or\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable as is the duodenum.  Small bowel\nloops demonstrate no signs of ileus or obstruction.  The appendix is normal. \nContrast is seen through the level of the sigmoid colon.  A large fecal load\nis noted in the rectum with mild perirectal fat stranding which may reflect\nstercoral colitis in the correct clinical setting.  No free air or free fluid.\n\nPELVIS: Urinary bladder is only partially distended though appears normal.  No\npelvic free fluid.\n\nREPRODUCTIVE ORGANS: Uterus and adnexal regions appear normal.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.\n\nBONES: No worrisome bony lesion.  Bilateral L5 pars defects noted without\nanterolisthesis.  There is degenerative disc disease at L4-5 which is moderate\nin overall extent.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large stool ball within the rectum with mild perirectal fat stranding,\ncould reflect stercoral colitis.  Recommend gentle disimpaction.\n2. Hepatic hypodense lesions as described, possibly representing hemangiomas\nthough not fully characterized.  ___ consider ultrasound to further assess if\nclinically warranted.\n3. Pars defects at L5 without anterolisthesis.  Moderate degenerative disc\ndisease at L4-5."
        },
        {
            "input": "PELVIS:  Diverticulosis of the sigmoid colon noted.  Visualized bowel is\notherwise within normal limits.  The urinary bladder and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight hip prosthesis noted.\n\nSOFT TISSUES: Evaluation of the right groin is limited due to artifact from\nthe patient's right hip prosthesis.  Surgical staples overlie the right groin,\nwith subcutaneous gas compatible with recent operative intervention.  There is\na fluid collection in the subcutaneous tissues of anterior thigh, measuring\n2.4 x 5.1 cm.  More medial to this, there is a second fluid collection,\nmeasuring 1.8 x 3.2 cm.",
            "output": "Fluid collections along the operative site in the groin as above, which may\nrepresent postoperative seroma, hematoma, or abscess.\n\nCase reviewed with Dr. ___.\n\nRECOMMENDATION(S):  Ultrasound is recommended for any further imaging\nfollow-up of these collections, given their subcutaneous location, and\nartifact from the patient's right hip prosthesis."
        },
        {
            "input": "LOWER CHEST: Evaluation of the lower lobe demonstrates patchy bibasilar\nairspace opacities.\n\nABDOMEN:\n\nHEPATOBILIARY: There areas of heterogeneous hyper attenuation involving the\ngreat hepatic lobe presumably representing a trans of attic attenuation\ndifference in the setting of prior IV contrast.  There is no evidence of focal\nlesions within the limitations of an unenhanced scan.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  Percutaneous cholecystostomy\ntube is in place without inflammatory change identified.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 cyst\nnoted lower pole right kidney and upper pole left kidney.  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.  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\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.  IVC filter in place.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse stranding involving the soft tissues of the\nleft groin and compatible with hemorrhage in the setting of recent arterial\naccess.  There is minimal extension into the retroperitoneum along the psoas. \nNo discrete measurable hematoma is identified.",
            "output": "1. Diffuse stranding involving the soft tissues of the left groin and thigh\nwith minimal extension along the psoas consistent with hemorrhage in the\nsetting of recent arterial access.  No significant retroperitoneal hematoma is\nidentified.\n2. Compatible with patchy bibasilar airspace opacities may represent\nsubsegmental atelectasis, aspiration, or developing pneumonia.  Correlate with\nrespiratory symptoms.\n3. Additional chronic changes as above."
        },
        {
            "input": "Lungs: Please see the report of the CT chest performed on the same day for\ndetails on the chest.\n\nLiver: The liver is homogeneous with a smooth contour. Multiple tiny\nhypodensities are seen scattered throughout the liver, too small to\ncharacterize, but likely representing cysts. No suspicious liver lesion.\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: Unchanged right adrenal nodule measuring 1.8 cm. Stable\npreviously described left adrenal nodule measuring 0.8 cm.\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 bowel is within normal limits, except for colonic\ndiverticula. The appendix is unremarkable.  There is no evidence of bowel\ndilatation or obstruction.\n\nVascular: There are moderate to severe atherosclerotic calcifications of the\nabdominal aorta. A left aortoiliac stent is seen.\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 clips are\nseen overlying the left inguinal region.\n\nRedemonstration of stable multiple superficial hypodensities in the\nsubcutaneous tissues of the back on the left, as seen on series 4, images 66,\n59 and 55, measuring up to 2.3 cm in maximal dimension.",
            "output": "1. Unchanged bilateral adrenal nodules.\n2. Redemonstration of stable hypodensities in the subcutaneous tissues of the\nback on the left.\n3. Please see the report of the CT chest performed on the same day for details\non 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. \nRedemonstration of multiple stable subcentimeter hypoattenuating lesions\ndisseminated throughout the liver.  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 stable 15 mm right adrenal nodule and a stable 8 mm left\nadrenal 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.  2 renal arteries are supplying each 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. The appendix 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.  Moderate atherosclerotic\ndisease is noted.  A left aortoiliac stent is seen.\n\nThe portal and hepatic veins are patent.\n\nBONES: There is no acute fracture.  There is an 8 mm sclerotic lesion in the\nleft ischial bone (series 2, image 133) likely reflective of treatment\nresponse given the fact that only retrospectively could we suspect a possible\nfaint ground-glass area in the left ischial bone.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nRedemonstration of multiple superficial hypodensities in the subcutaneous\ntissue of the back on the left, one is smaller on series 2 image 61 measuring\n23 x 6.5 mm (24 x 12 mm previously).  Two other subcutaneous nodules are\nstable measuring 23 mm (series 2, image 67) and 19 mm (series 5, image 6).",
            "output": "1. Demonstration of a sclerotic lesion in the left ischial bone, see detailed\ndescription above this could be reflective of  treatment response.\n2. Mild decrease in 1 of the 3 subcutaneous nodules seen the lower back.\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. \nScattered milli metric hypodensities are seen scattered throughout the liver,\ntoo small to characterize and unchanged from prior study.  These likely\nrepresent cysts or biliary hamartomas.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic 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.  The right adrenal gland\ndemonstrates a adrenal nodule measuring 1.2 x 1.8 cm, unchanged from prior\nconsistent with a adenoma (series 2, image 58).  This has been stable since\n___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRight upper pole density may represent a nonobstructing calculi or vascular\ncalcification.  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. 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: Patient is status post aorto to left common iliac stent.  There is\nno abdominal aortic aneurysm.  Extensive atherosclerotic disease is noted\nespecially at the distal abdominal aorta into the external iliacs..  Scattered\nrenal and splenic artery calcifications.\n\nBONES: No evidence of acute fracture.  Redemonstrated is a 1.1 cm sclerotic\nfocus in the left ischial bone unchanged in size compared to prior (series 2,\nimage 129).  Irregular sclerosis of the right femoral head with central\nlucency is consistent with avascular necrosis (series 2, image 115).\n\nSOFT TISSUES: Redemonstrated are scattered soft tissue nodules along the left\nposterior flank.  Interval increase in size of lesion at the level of the L1\nmeasures 4.1 cm, previously 2.3 cm (series 2, image 63).  Interval decrease in\nsize of lesion at the T12 (series 2, image 56) measuring 1.8 cm and T11\n(series 2, image 51).",
            "output": "1. Increased in size of skin thickening and subcutaneous nodule within the\nleft lower back at the level of L1 measuring 4.1 cm, previously 2.3 cm. \nAdditional 2 skin and subcutaneous nodules are decreased in size.  Correlation\nwith physical exam is recommended.\n2. Sclerotic lesion measuring 1.1 cm within the left ischium is unchanged in\nsize.\n3. Avascular necrosis of the right femoral head without collapse-orthopedic\nconsult recommended\n4. Right adrenal nodule consistent with an adenoma, stable since ___.\n5. No additional evidence of abdominopelvic metastases.  No new\nlymphadenopathy.\nStable appearing right humeral head sclerosis consistent with avascular\nnecrosis.\n6. Please see dedicated CT of the chest for thoracic findings.\n\nRECOMMENDATION(S):  Please see impression 3."
        },
        {
            "input": "LOWER 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 redemonstration of multiple millimetric hypodensities\nscattered throughout the liver, similar in size and distribution. No new\nsuspicious appearing hepatic lesion is identified.  The portal and hepatic\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: A 1.7 cm right adrenal nodule previously characterized as an adenoma\nremains stable.  The left adrenal gland is normal in size and appearance.\n\nURINARY: The kidneys show symmetric nephrogram without evidence of a worrisome\nsolid mass or hydronephrosis.  Vascular calcifications are again noted. \nSubcentimeter low-density lesions in the left kidney are too small to\ncharacterize however most likely represent small cysts.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Few right colonic diverticula\nare noted.  Otherwise the colon is unremarkable.  The appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.  A prominent 7 mm crural lymph\nnode is stable compared to prior examination.\n\nVASCULAR: There is redemonstration of endovascular stenting from the distal\naorta into the left common iliac artery.  The stent appears patent.  Moderate\natherosclerotic calcifications of the abdominal aorta are present with severe\ndense atherosclerotic calcifications of the proximal iliac arteries.  There is\nno abdominal aortic aneurysm.\n\nBONES: A 1 cm sclerotic focus in the left ischial bone is stable.  No new\nsuspicious osseous lesion is identified.  Serpiginous sclerosis in the right\nfemoral head most likely related to avascular necrosis is similar in\nappearance, without evidence of cortical collapse at this time.\n\nSOFT TISSUES: Focal nodular skin thickening at the level of T11-12 in the left\nposterolateral thoracoabdominal wall (2:58) is similar in appearance,\nmeasuring up to 1.2.  An additional nodule at the level of T12 measures up to\n1.6 cm, also similar to prior exam.  The largest focal area of nodular skin\nthickening at the level of L1 is markedly smaller, previously measuring up to\n4.3 cm, and now measuring up to 3.0 cm.  A partially visualized focus of\nsimilar nodular thickening of the skin measuring up to 5 mm along the left\ninferior gluteal fold (2:140) was likely present and partially visualized on\nexam of ___. No new soft tissue findings are identified.  A small\nright fat containing inguinal hernia is present.",
            "output": "1. 1 cm sclerotic lesion in the left ischial remains stable.  No new\nsuspicious osseous lesion identified.\n2. Stable appearance of avascular necrosis of the right femoral head without\nevidence of cortical collapse.\n3. Interval decrease in size of the dominant focus of nodular skin thickening\nalong the left flank, now measuring up to 3.0 cm where it previously measured\n4.3 cm, at the level of L1.  The additional 2 smaller foci of skin nodules are\nstable given differences in technique/slice selection.  Given the interval\nincrease and decrease in size over subsequent examinations, and fluid content\non prior exams these may represent sebaceous cysts.\n4. No new intra-abdominal/pelvic metastasis, lymphadenopathy or ascites.\n5. Patent aorto- left iliac endovascular stent.  Moderate to severe\natherosclerotic calcifications of the iliac arteries."
        },
        {
            "input": "LOWER 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 redemonstration of multiple subcentimeter hypodensities scattered\nthroughout the liver, similar in size and distribution.  There are no\nsuspicious appearing 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 redemonstration of a 1.4 cm right adrenal nodule previously\ncharacterized as an adenoma and unchanged since ___.\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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin 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: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present within the abdominal\naorta. Severe atherosclerotic disease is noted in the bilateral common and\nexternal iliac arteries. There is redemonstration of a patent endovascular\nstent from the distal abdominal aorta to the left common iliac artery. The\nleft SFA is chronically thrombosed.  There is no abdominal aortic aneurysm.\n\nBONES: There is redemonstration of avascular necrosis in the right femoral\nhead.  Previously noted 1 cm sclerotic focus in left ischium is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\nredemonstration of skin thickening and multiple subcutaneous nodules in the\nposterior left back compatible with sebaceous cysts.  These are grossly\nunchanged from the prior exam and have been described since ___.  The\nlargest of these nodules measures 1.5 cm, grossly stable since ___.",
            "output": "1. 1 cm sclerotic focus in the left ischium is unchanged.  No new suspicious\nosseous lesions.\n2. Redemonstration of a right adrenal nodule, previously characterized as an\nadenoma, and unchanged since ___.\n3. Redemonstration of skin thickening and multiple subcutaneous nodules in the\nposterior left back compatible with sebaceous cysts, grossly unchanged since\nthe prior exam.\n4. Redemonstration of moderate to severe atherosclerotic disease of the\naortoiliac vessels, including occlusion the left common and visualized\nsuperficial femoral arteries."
        },
        {
            "input": "LOWER CHEST: There are bibasilar hypoventilatory changes.  Nodular\nconsolidation in the lingula is most compatible with focal atelectasis.  No\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver parenchyma demonstrates decreased attenuation, consistent\nwith hepatic steatosis with areas of fat sparing along the gallbladder fossa. \nThere is no focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is largely collapsed,\nlimiting evaluation.  No definite radiopaque stones 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.  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.  There is\nmild-to-moderate left hydroureteronephrosis with associated 3 mm, obstructing\nUVJ stone (series 2; image 83, series 601; image 37).  There is surrounding\nperinephric stranding and a delayed nephrogram.  There is fullness of the\nright renal collecting system without hydronephrosis.  There are no focal\nrenal lesions.\n\nGASTROINTESTINAL: The stomach is 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 unremarkable.  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.  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. Obstructing, 3 mm stone at the left ureterovesical junction with mild to\nmoderate upstream hydroureteronephrosis, surrounding perinephric stranding,\nand delayed nephrogram.\n2. Hepatic steatosis.  See below for recommendations.\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: Small subendocardial calcification of the left ventricle (601:28)\nmay reflect sequela of prior infarct.  The imaged lung bases are unremarkable.\nNo pleural pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nsubcentimeter hypodensity in the left lobe (02:11) is too small to\ncharacterize, but likely represents a cyst or 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. \nBilateral subcentimeter hypodensities are too small to characterize, but\nlikely represent cysts.  There is no hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small and large bowel loops\nare normal in caliber.  There is no intra-abdominal free fluid.\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": "No acute findings 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 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. \nNo focal renal lesions or hydronephrosis.  Percutaneous nephrostomy tube\nterminates in the right collecting system.  A ureteral stent on the right side\nis also noted.  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: Low-density soft tissue in the right adnexal region\nlikely reflects normal right ovarian tissue.  Fiducial markers are seen more\ninferiorly to this along the distal right ureter.  Soft tissue around the\nfiducial markers is similar to prior and may represent posttreatment fibrosis.\nFocus of hypoenhancement in the anterior uterine fundus on the right side is\nnoted, nonspecific, but new from prior.  Area of hypoenhancement in the\nposterior uterine wall seen on prior exam is no longer appreciated.  No left\nadnexal abnormalities are seen.  There is decreased fluid and fat stranding in\nthe pelvis compared to the prior exam.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nSeveral calcified left periaortic nodes are noted, similar prior.  There is no\npelvic 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. No evidence of metastatic disease in the abdomen or pelvis.\n2. Heterogeneous hypoenhancement in the anterior uterine wall is nonspecific\nand may reflect posttreatment changes.  Previously seen areas of\nhypoenhancement in the posterior uterine wall have resolved.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Focal opacity in the right lung base (2:4) is unchanged, possibly\natelectasis.  There is trace left 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 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: Percutaneous nephrostomy tube is been removed.  Linear scarring is\nseen about its prior tract.  Right-sided ureteral stent appears appropriately\npositioned.  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.  Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.\n\nPELVIS: Prominence of the bladder wall is likely due to underdistention.  The\ndistal ureters are unremarkable.  Presacral soft tissue thickening/edema is\nslightly more prominent than the previous study but could reflect changes\nrelated to prior treatment.\n\nREPRODUCTIVE ORGANS: Low-density soft tissue in the right adnexal region\nappears grossly similar to prior, and likely represents the adnexa.  Fiducial\nmarkers are seen more inferiorly to this along the distal right ureter.  Soft\ntissue around the fiducial markers appears similar prior and may represent\npost treatment changes.  No definite new soft tissue density or area of\nenhancement.  No adnexal abnormality seen on the left.\n\nLYMPH NODES: Multiple calcified left periaortic nodes are unchanged.  There is\nno retroperitoneal or mesenteric lymphadenopathy.  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.",
            "output": "1. No acute findings within the abdomen or pelvis to explain the patient's\nreported symptoms.  Specifically, no evidence of colitis.\n2. Grossly stable appearance of post treatment changes within the\npelvis.Presacral soft tissue thickening/edema is slightly more prominent than\nthe previous study but could reflect changes related to prior 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 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 right ureteral stent remains in place.  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. Colonic\ndiverticulosis is noted, without evidence of wall thickening and fat\nstranding.  Additionally segmental thickening of the descending colon and\nproximal sigmoid is demonstrated raising concern for colitis versus post\nradiation changes.  The appendix is normal.\n\nPELVIS: Again seen are fiducials in the pelvis adjacent to the distal right\nureter.  Fat stranding is additionally seen within the pelvis and sacral\nregion, unchanged from prior.  The bladder is decompressed.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and right adnexa are unchanged in appearance\nfrom prior with heterogeneous appearance in the anterior uterine wall, which\nmay reflect post treatment changes.  The left adnexa 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 findings of metastatic disease identified within the abdomen or pelvis.\n2. Segmental thickening of the distal descending and proximal sigmoid colon\nraising concern for colitis versus post radiation changes.\n3. Please see 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: Subcentimeter hypodensity in the right hepatic lobe is\nunchanged and most likely represents a cyst (series 4: Image 65).  Wise, 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: Right-sided nephroureteral stent appears well positioned.  Otherwise,\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: There is low-density diffuse thickening of the gastric wall.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The sigmoid colon is mildly thickened but non completely\ndistended.\n\nPELVIS: Again seen fiducials in the pelvis adjacent to the distal right\nureter.  Stable soft tissue density adjacent to the distal right ureter.  The\nnephroureteral stent terminates in the urinary bladder.  Presacral thickening\nis unchanged.\n\nREPRODUCTIVE ORGANS: Uterus and right adnexa are unchanged in appearance from\nprior with heterogeneous appearance in the anterior wall, which may reflect\npost treatment changes.  The left adnexae 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. Low-density diffuse thickening of the gastric wall which could represent\ngastritis or neoplasm.  Recommend GI involvement.\n2. Please see same day CT of the chest for description of thoracic findings.\n\nNOTIFICATION:  The findings were discussed by ___ MD with ___\n___ NP on ___ at 4:15 pm, 5 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 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.  A right-sided\ndouble-J stent is again noted.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Interval resolution of the wall edema of the stomach.  No\nbowel obstruction.  Few uncomplicated colonic diverticulosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Again seen\nare fiducial seeds in the pelvis adjacent to the distal right ureter. Stable\nsoft tissue density adjacent to distal right ureter (series 4, image 113). \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and right adnexa are unchanged in appearance\nwith overall unchanged heterogeneous appearance of the anterior and inferior\nwall of the uterus which may represent post treatment changes.  Status post\nleft 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval resolution of the thickening of the gastric wall.\n2. No evidence of new abdominal or pelvic metastases.\n3. Please refer to separate chest CT done the same day 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 has homogeneous attenuation.  No biliary ductal\ndilatation.  The gallbladder is normal.\n\nPANCREAS: The pancreas has no lesions or ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is not enlarged.  No focal lesions.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Double-J stent in the right collecting system appears appropriately\npositioned.  The kidneys are normal size and symmetric. No renal lesions.  No\nstones or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops have normal\ncaliber and enhancement.  Mild scattered pancolonic diverticuli, without signs\nof inflammation.  Otherwise, the colon and rectum are unremarkable.\n\nPELVIS: Fiducial seeds are again seen posterior to the bladder adjacent to the\ndistal right ureter (2:112).  Small irregular soft tissue density along the\ndistal right ureter is largely unchanged (2:110).  The urinary bladder is\nunremarkable.  There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.  The patient is\nstatus post left salpingo-oophorectomy.\n\nLYMPH NODES: There is no lymphadenopathy in the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: There are no worrisome lesions or acute fractures.\n\nSOFT TISSUES: The soft tissues are unremarkable.",
            "output": "1. No findings 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 the dedicated CT chest report from the same day\nfor details of intrathoracic 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a double-J stent present within the right kidney and urinary\ncollecting system.  The proximal aspect of the catheter is well-formed within\nthe upper pole calyx.  The distal aspect of the catheter is well formed within\nthe bladder.  The kidneys are of normal and symmetric size with normal\nnephrogram.  No evidence of solid renal lesions or hydronephrosis. No\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops containing\noral contrast demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Pancolonic diverticulosis without evidence of diverticulitis.\nPELVIS: There is air within the anterior aspect of the urinary bladder likely\nrelated to documented recent cystoscopy and ureteral stent exchange. \nOtherwise, the urinary bladder and left distal ureter are unremarkable.  Again\ndemonstrated are several fiducial markers present adjacent to the right distal\nureter and posterior to the urinary bladder.  Ill-defined hypodense soft\ntissue mass within this region appears unchanged compared to the most recent\nstudy on ___. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The anteverted uterus appears unremarkable.  Patient is\nstatus post left salpingo-oophorectomy.  No gross masses of bilateral adnexa.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.  No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis 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. Stable soft tissue mass at the distal right ureter.  No evidence of\nmetastatic disease within the abdomen or pelvis.\n2. Small foci of air within the urinary bladder are likely related to recent\ndocumented cystoscopy and ureteral stent exchange.\n3. Please refer to the dedicated CT chest report from the same day for details\nof intrathoracic 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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously with no focal\nliver lesions.  No intrahepatic biliary ductal dilation.\nThe hepatic veins, portal vein and its branches are patent.\nThe gallbladder is moderately distended with no radiopaque calculi within it\nor pericholecystic inflammation..\nPANCREAS: There is homogeneous enhancement of the pancreatic parenchyma\nwithout main duct dilation..\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  There are no adrenal nodules.\nURINARY: There is a right-sided nephroureteral stent.  Mild fullness of the\nright renal pelvis without frank hydronephrosis noted.\nNo solid enhancing renal masses noted.\nGASTROINTESTINAL: There is no bowel obstruction.\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: The abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is minimally distended, therefore not completely evaluated.  The\nuterus is anteverted.  The ovaries are not seen separately.\nThere are 2 fiducial markers in the right parametrium with minimal stable soft\ntissue thickening of the right utero-sacral ligament (2:112) as before.  No\ndiscrete soft tissue at the right uterovesical junction noted.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1. Interval decrease in soft tissue thickening at the right ureterovesical\njunction with persistent mild thickening of the right uterosacral ligament.\n2. No abdominal or pelvic lymphadenopathy or metastatic disease seen in the\nabdomen and 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. \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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality. There is a right double-J ureteral stent in place,\nunchanged in position compared to prior.  The previously visualized fullness\nof the right collecting system, has resolved.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon shows\nfew scattered diverticula, without complication.  The rectum is within normal\nlimits.\n\nPELVIS: The urinary bladder is mild to moderately distended and appears\nunremarkable. There is no perceptible soft tissue surrounding the distal right\nureterovesical junction.\nAgain noted 3 fiducial markers posterior to the right UVJ, in the right\nparametrium.\nThe subtle soft tissue thickening of the apparent anterior right uterosacral\nligament (5:113), is unchanged compared to prior.\nThere is no evidence of suspicious pelvic soft tissue abnormality.\nThere is no free fluid in the pelvis.\nThere is edema of the mesorectal fascia, as before.\n\nREPRODUCTIVE ORGANS: Uterus is normal in size. Patient is status post left\nsalpingo-oophorectomy.  There are no right adnexal lesions.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 metastases or lymphadenopathy in the abdomen or pelvis.\n2. No perceptible soft tissue abnormality at the right ureterovesical\njunction.  Stable area of apparent mild thickening of the right ureter sacral\nligament.\n3. Right ureteral stent in place, unchanged in position relative to 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. \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: There is a double-J ureteral stent on the right with the proximal\npigtail at the right renal pelvis and its distal pigtail in the bladder.  The\nkidneys are of normal and symmetric size with normal nephrogram.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is abnormal non dependent and dependent air seen along\nand likely within the gastric wall at the fundus consistent with pneumatosis. \nThis can be a benign finding in patients on chemotherapy however also be seen\nwith gastritis and ischemia.  Recommend correlation with clinical symptoms. \nSmall bowel loops demonstrate normal caliber and enhancement.  There is an\nabnormal position of the duodenal jejunal junction with vertical orientation\nof the third part of the duodenum and duodenal dilation on junction is seen in\nthe lower abdomen (2:162).  No evidence of a volvulus or small-bowel\nobstruction.  Diverticulosis of the sigmoid colon is noted, without evidence\nof wall thickening or fat stranding. The appendix is not visualized.\n\nPELVIS: The urinary bladder is mildly distended.  There is a stent in the\nright distal ureter.  Again seen are 3 fiducial markers at the right UVJ. \nThickening of the anterior right ureteral sacral ligament is unchanged from\nprior imaging (series 2, image 222).  There is no suspicious mass or lesion\nwithin the pelvis.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears within normal limits.  The patient is\nstatus post left salpingo oophorectomy.  The right adnexa appears 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No suspicious mass or lesion within the abdomen/pelvis to suggest\nmetastatic disease within the abdomen/pelvis.\n2. Apparent pneumatosis in the gastric fundus can be a benign finding in\npatients on certain medications including chemotherapy.  Recommend correlation\nwith the patient's symptoms.\n3. The right ureteral stent appears unchanged.\n4. Stable soft tissue thickening at the right ureteral sacral ligament.\n5. Incidental note is made of a small bowel malrotation with abnormal\npositioning of the duodenal jejunal flexure but no evidence of small-bowel"
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.  Numerous phleboliths are visualized.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: The bones are diffusely demineralized, which limits evaluation.  Some\nof the heterogeneity of the bones may also be due to the patient's known\nunderlying multiple myeloma.  Within these limitations, there is a vertical\nlinear lucency within the left sacrum adjacent to the sacroiliac bone (series\n304b, image 84, 86) which is highly suspicious for a sacral insufficiency\nfracture.  There is also nondisplaced fracture through the right iliac wing\n(2:8) no other fractures or dislocations are visualized.  Moderate\ndegenerative changes are seen within the partially visualized lower lumbar\nspine.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.  Otherwise,\nthe abdominal and pelvic wall is within normal limits.",
            "output": "1. The bones are diffusely demineralized, which limits evaluation. \nHeterogeneity may also be due to known multiple myeloma.  Within these\nlimitations, vertical linear lucency within the left sacrum adjacent to the\nsacroiliac bone, highly suspicious for sacral insufficiency fracture.\n2. Additional nondisplaced fracture through the right iliac wing.\n3. No other fractures or dislocations."
        },
        {
            "input": "ORTHO PELVIS: Diffuse heterogeneity of the bone marrow is again noted with\nareas of sclerosis and lucency secondary to the known multiple myeloma.  A\nnew, nondisplaced fracture through the inferior left pubic ramus is noted\n(2:83).  There is a nondisplaced, vertically oriented fracture through the\nleft sacral ala (41b:75), similar in appearance to the prior examination. \nThere is an additional nondisplaced fracture through the superior right iliac\nwing (41b:72), also unchanged from prior examination.  No new or displaced\nfractures identified.\n\nModerate severe, multilevel degenerative changes are noted within the lower\nlumbar spine.  The bilateral hips are grossly unremarkable.\n\nINTRAPELVIC CONTENTS: The partially visualized small and large bowel are\nunremarkable. The urinary bladder and distal ureters are unremarkable. There\nis no free fluid in the pelvis.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted.",
            "output": "1.  New, nondisplaced fracture through the left inferior pubic ramus.\n2.  Unchanged appearance of nondisplaced fractures through the left sacral ala\nand superior right iliac wing.\n3.  Diffuse osseous demineralization with heterogeneity likely due to treated\nmultiple myeloma.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 15:54 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Diffuse background osseous demineralization and heterogeneous lucency is\ndemonstrated, similar to prior limiting assessment for nondisplaced fractures.\nThere is been interval displacement of the left inferior pubic ramus fracture\npresent on prior CT.  There is now 5 mm of medial displacement of the\nposterior fragment.  A fracture at the junction of the left pubic bone and\nsuperior pubic ramus is also now evident, inconspicuous on prior exam, with\nexuberant callus formation on the current study.  Additionally, there is a\nsubtle lucency at the junction of the left acetabulum and superior pubic ramus\n(series 6, image 19 with accompanying mild callus formation (series 4, image\n86) which could reflect a more recent fracture.  Within this area of bone,\nthere is a tiny locule of intraosseous gas possibly reflecting vacuum\nphenomenon in the absence of clinical features for infection.\n\nThere is a vertically orientated fracture of the left sacrum involving the\nleft sacral ala with increased callus formation when compared to prior study.\n\nThere is mild bilateral hip joint degenerative change.  Degenerative changes\nare seen lower lumbar spine.\n\nThere is sigmoid diverticulosis with no evidence of diverticulitis.  Diastasis\nof the rectus muscles is seen and there is a fat containing paraumbilical\nhernia.  No pelvic sidewall lymphadenopathy is identified.\n\nCompression deformity of L4 appears similar to previous lumbar spine MRI of ___.",
            "output": "1. Persistent fractures through the left superior and inferior pubic rami with\nmild increased displacement and callus formation as compared to prior\nexamination.  The fracture lines remain visible.\n2. Subtle nondisplaced fracture at the junction of the left anterior\nacetabulum and left superior pubic ramus with minimal callus formation could\nreflect a more recent fracture.\n3. Tiny locules of gas in the left anterior acetabular bone may reflect vacuum\nphenomenon (in the absence of history concerning for infection).\n4. Left sacral insufficiency fracture was likely subtly present on the prior\nexamination.  There is slightly increased sclerosis about the fracture, but\nthe fracture line remains visible.\n\nNOTIFICATION:  Items 1 and 4 were discussed with ___, NP by ___\n___, M.D. on the telephone on ___ at 12:16 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: There are mild atelectatic changes of the lung bases.  Partially\nvisualized central catheter tip within 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 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.  Stable punctate nonobstructing calculus in the inferior\npole left kidney.  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 and scattered diverticula elsewhere noted, without evidence of wall\nthickening and fat stranding.\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: Innumerable osteolytic lesions throughout the visualized osseous\nstructures, compatible with patient's diagnosis of multiple volume mild.  The\nprevious identified fracture of the left iliac crest has exuberant callus\nformation with an expansile lytic lesion measuring 3.2 x 2.0 cm, series 2,\nimage 114.  Healed/healing left sacral ala fracture and left superior and\ninferior pubic ramus fractures.\nHealed/healing left L1 transverse process fracture.  Additionally there is an\nleft L3 transverse process osteolytic lesion with cortical destruction, series\n2, image 75.  Osteolytic lesion in the proximal left femoral diaphysis appears\nstable to increased in size, measuring 2.4 x 2.4 cm AP by transverse, series\n2, image 192.  The there is the there are multiple bilateral rib fractures in\nvarious stages of healing, including increased fluid for of changes about the\nanterior inferior left rib fractures.  Redemonstrated are multiple compression\nfractures of the visualized lower thoracic and lumbar spine.  There are\nvertebroplasty changes and/or the T11 vertebral body.  There are there is\nincreased height of loss of T12 of up to 25% centrally, with vacuum phenomena.\nMultilevel degenerative changes of the lumbar spine, most pronounced at\nL5-S1..  In the right ilium increased size of an osteolytic lesion with\ncortical breakthrough measuring up to 2.3 cm, previously 1.9 cm, series 7,\nimage 113.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Progression of patient's multiple myeloma with innumerable osteolytic\nlesions, many of which have increased in size, including the left iliac crest\nlesion with known pathologic fracture.  Increased size of a right iliac crest\nlesion with associated cortical disruption.\n2. Healed/healing left L1 transverse process fracture and new osteolytic\nlesion in the left L3 transverse process with cortical disruption. \nNew/increased compression deformity of T11 with vacuum phenomenon.\n3. Bilateral rib fractures in various stages of healing with underlying\nexpansile lytic lesions which appear to have progressed."
        },
        {
            "input": "LOWER CHEST: New nonspecific multifocal ground-glass opacities, most prominent\nin the right middle lobe, are new from ___.  Mild bibasilar airway\nthickening, suggesting bronchitis.  Bilateral atelectasis in the lower lobes,\nright greater than left, more focal within the right lower lobe.  There is no\nevidence of pleural or pericardial effusion.  Coronary artery calcifications\nare seen.  Distal aspect of a Port-A-Cath terminates at the SVC/right atrial\njunction.\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.  Punctate left renal calculus is unchanged.  Trace\nhyperdense material in the collecting system of the bilateral kidneys may\nrepresent inadvertent demonstration of a tiny amount of intravenous contrast. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber and wall thickness throughout.  There is pneumatosis of the ascending\ncolon to the proximal transverse without surrounding fat stranding or mural\nthickening, likely secondary to recent bortezomib therapy.  Diverticulosis of\nthe sigmoid colon is seen without an inflamed diverticulum.  There is mild\nwall thickening of the distal sigmoid colon with surrounding fat stranding,\nraising concern for colitis.  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 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: Redemonstration of diffuse osteolytic lesions in the visualized\nskeleton.Multiple chronic appearing rib fractures and multilevel thoracolumbar\ncompression deformities are largely unchanged.  Patient is status post\nkyphoplasty at the T11 level.\n\nChronic appearing mildly displaced fractures to the left ischium.  Lytic soft\ntissue mass along the anterior left iliac crest is grossly unchanged.  Patient\nis status post right femur fixation.\n\nSOFT TISSUES: Small fat containing periumbilical hernia is unchanged",
            "output": "Within the limits of this non enhanced study:\n\n1. Mild wall thickening of the distal sigmoid colon with surrounding fat\nstranding raises concern for colitis.\n2. Nonspecific pneumatosis of the ascending colon to the proximal transverse\nwithout mural thickening or fat stranding, possibly secondary to recent\nbortezomib demonstration.\n3. New nonspecific multifocal ground-glass opacities, most prominent in the\nright middle ___ suggest inflammation or infection, potentially\nchemotherapy related.\n4. Diffuse osteolytic lesions in the visualized skeleton with multiple\nfracture, grossly unchanged from ___, compatible with history of\nmultiple myeloma."
        },
        {
            "input": "LOWER CHEST: Multifocal ground-glass opacities, most prominent within the\nright middle lobe, increasingly conspicuous compared to the prior study.  Mild\nbibasilar atelectasis, right greater than left.  Trace bilateral pleural\neffusions.\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 diffusely atrophic, 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.\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 nonobstructive stone at the left lower renal\npole, unchanged.  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. \nThere is improved pneumatosis and adjacent extraluminal air of the ascending\ncolon to the proximal transverse colon, without surrounding fat stranding or\nmural thickening, findings which may be related to recent bortezomib therapy. \nDiverticulosis of the sigmoid colon is noted, without evidence of an inflamed\ndiverticula.  Mild wall thickening of the distal sigmoid colon with slightly\nincreased surrounding fat stranding, concerning for slightly worsening\ncolitis.  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: Partially visualized hardware within the proximal right femur.  Diffuse\nlytic lesions throughout the visualized skeleton are grossly similar\nappearance to prior study.  Multiple chronic appearing rib and sternal\nfractures and multilevel compression deformities of the thoracolumbar spine\nare grossly unchanged.  Kyphoplasty changes are again noted at the T11\nvertebral body.  Chronic appearing mildly displaced fractures of the left\nilium and left inferior pubic ramus are unchanged.  Lytic soft tissue mass\nalong the anterior left iliac crest also remains grossly unchanged.\n\nSOFT TISSUES: Small fat containing umbilical hernia is unchanged.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Mild wall thickening of the distal sigmoid colon with slightly increased\nsurrounding fat stranding, concerning for slightly worsening colitis.\n2. Improved pneumatosis of the ascending colon to the proximal transverse\ncolon and adjacent extraluminal air, without evidence of mural thickening or\nfat stranding, which may be related to recent bortezomib therapy.\n3. Increased prominence of multifocal ground-glass opacities, most prominently\nwithin the right middle lobe, suggestive of an inflammatory or infectious\netiology, potentially related to chemotherapy.\n4. Overall similar appearance of diffuse lytic lesions throughout the\nvisualized skeleton and multiple chronic appearing fractures as described\nabove, consistent with history of multiple myeloma."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis without pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is use ___ peau dense, with areas fatty sparing,\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.  A\npunctate nonobstructing 2 mm stone in the left lower pole is unchanged since\nthe study from ___.  Previously described right perinephric stranding\nhas improved.\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: 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: Multiple old, healed anterior bilateral rib fractures\nare again seen.  Patient is post kyphoplasty of the T11 vertebral body,\nunchanged in appearance ___.  Multiple compression deformities of\nthe lower thoracic spine are also unchanged.  Moth-eaten appearance of the\nvisualized vertebral bodies and pelvic bones is consistent with the known\ndiagnosis of multiple myeloma, as seen CT from ___.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain.  Normal appendix.\n\n2.  Punctate nonobstructive left lower kidney stone is unchanged since the CT\nof ___.\n\n3.  Fatty liver."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nLIVER: The liver enhances heterogeneously. No focal hepatic lesions are\nidentified. The portal vein is patent. There is no intra or extrahepatic\nbiliary duct dilatation.\n\nGALLBLADDER: The patient is status post cholecystectomy with clips in the\ngallbladder fossa.\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 in caliber.The large bowel is grossly normal\nappearing however in the right lower quadrant, (series 2, image 40) there is\nsome mild fat stranding in the right pericolic gutter adjacent to a loop of\ncollapsed large bowel.  The bowel loop may have some minimal wall thickening\nthough this could be related to under-distension. The appendix is normal.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: A 3.2 cm cystic structure centered in the left adnexa was\ncharacterized as a hemorrhagic cyst on ultrasound on ___. The\nbladder is unremarkable. The rectum and sigmoid colon are within normal\nlimits. There is a small amount of intermediate density pelvic free fluid.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. Mild fat stranding adjacent to a loop of collapsed large bowel (series 2,\nimage 40), which could represent a mild focal colitis. Normal appendix.\n2. 3.2 cm cystic lesion centered in the left adnexa, with small intermediate\ndensity pelvic free fluid.  In keeping with prior US, findings most likely\nrepresent hemorrhagic cyst with small adjacent hemorrhagic free fluid. By CT\nappearance tubo-ovarian abscess could be considered, however the lack of an\nelevated white blood cell count argues against this as a likely diagnosis.\n3. Heterogeneous perfusion in the liver. This is relatively nonspecific but\ncan be seen in acute hepatitis. Recommend correlation with liver function\ntests.\n\nNOTIFICATION:  These findings were emailed to the ED QA nurses at 9:40 AM on\n___ by Dr. ___."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal 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.  Re-demonstrated is mild pneumobilia in the\nleft hepatic lobe secondary to the common bile duct stent.  The CBD stent\nappears patent.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.  A small amount of gas within the gallbladder\nlumen is also likely due to the patent CBD stent.\n\nPANCREAS: 2 fiducial markers have been placed within the pancreatic head mass,\nwhich measures 1.4 x 1.2 cm, previously 1.5 x 1.2 cm (02:115).  There is\npersistent dilatation of the main pancreatic duct measuring up to 8 mm\n(2:112).  Hazy soft tissue again surrounds the right hepatic artery and GDA. \nVariant anatomy is again noted, although this is better appreciated on the\nprior study.  The right hepatic artery arises directly from the celiac axis. \nThe left hepatic artery supplying the lateral left lobe of liver arises from\nthe left gastric artery.  The left hepatic artery supplying the medial left\nlobe of the liver arises from the GDA.  The mass and surrounding hazy soft\ntissue again contacts the SMV with less than 180 degrees of involvement.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Incidentally noted is a 1.0 cm accessory spleen at\nthe splenic hilum.\n\nADRENALS: Nodular thickening of the right adrenal gland is unchanged.  The\nleft adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities in the right kidney are too small to characterize,\nbut statistically likely represent simple cysts, and are unchanged.  There is\nno 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. Colon and rectum are within normal limits.  The\nappendix is surgically absent.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: Subcentimeter lymph nodes in the left periaortic region are\nunchanged and not pathologically enlarged by CT size criteria.\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 an enlarged fibroid uterus, similar to 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. Aside from interval placement of fiducial markers, there is no significant\nchange in appearance in the poorly defined pancreatic head mass.  There is\nsimilar locoregional involvement.  No evidence of distant metastatic disease\nin the abdomen or pelvis.\n2. Please refer to dedicated CT chest performed on same day for 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.  Pneumobilia is no longer present.  CBD\nstent has been removed.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure.  Fat stranding at the\nsurgical bed could be postoperative.  The remainder of the pancreatic gland is\nunremarkable.  The main pancreatic duct dilation has resolved.\n\nCeliac axis, SMA, proper arteries are intact.  Again seen, the left hepatic\nartery supplying the lateral left lobe arises from the left gastric artery. \nThe left hepatic artery supplying the medial left hepatic lobe of the liver\narises from the gastroduodenal artery.  Portal vein, SMV the and splenic veins\nare 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. \nTiny hypodensities in both cortices are unchanged and too small to\ncharacterize.  No evidence of solid renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Status post Whipple.  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: Enlarged fibroid uterus, 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.  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. Patient is status post Whipple procedure and removal of the CBD stent.\n2. Soft tissue stranding at the surgical bed is likely postoperative. \nAttention on follow-up is recommended.\n3. Resolved pancreatic bile duct dilation."
        },
        {
            "input": "LOWER 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. Residual periportal edema.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis surgically absent.\n\nPANCREAS: Patient status post Whipple procedure, with residual fat stranding\nalong the surgical bed (image 96, series 4), similar to prior.  Unchanged\nappearance of the remaining, atrophic appearing pancreatic gland.\n\nThe celiac, splenic, and superior mesenteric arteries are patent.  The portal,\nsplenic, and superior mesenteric veins are patent.  Left hepatic artery\narising from the left gastric artery.  The right hepatic artery arising from\nthe celiac 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. \nThere is no evidence of solid renal lesions or hydronephrosis.  Unchanged\nright upper and midpole subcentimeter cortical hypodensities, too small to be\ncharacterized.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No abnormally dilated loops of\nbowel.\n\nPELVIS: Well-distended urinary bladder.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Retroverted uterus.  No large adnexal lesions.\n\nLYMPH NODES: Redemonstrated subcentimeter left para-aortic lymph nodes,\nsimilar to prior.  No retroperitoneal or mesenteric lymphadenopathy.  There is\nno 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, without destructive\nlesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Overall unchanged appearance of postsurgical changes of Whipple's\nprocedure, with redemonstrated fat stranding along the surgical bed.  No\nlymphadenopathy.\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 suspicious focal lesion.  There is no evidence of intrahepatic\nbiliary dilatation.  Hepaticojejunostomy is normal in appearance.  Patient has\nundergone cholecystectomy.\n\nPANCREAS: Patient is status post Whipple procedure.  Increasing soft tissue\ndensity and associated mesenteric haziness is identified in the surgical bed\n(2:113).  There is subtle widening of the space between the superior\nmesenteric artery and vein, occupied by this soft tissue density,\ndemonstrating approximately 180 degree contact with the superior mesenteric\nartery and less than 180 degree contact with the superior mesenteric vein. \nHazy fat stranding is seen extending into the root of the mesentery, encasing\nthe first branch of the SMA.  Multiple prominent mesenteric lymph nodes are\nidentified, slightly increased since the prior examination, however no\nindividual lymph node meets criteria for pathologic enlargement. \nRetroperitoneal nonenlarged lymph nodes are similar to the prior examination.\nFat plane between the surgical bed and the adjacent duodenum has been\nobliterated (2: 112 - 115).\nRemnant distal pancreas is unremarkable.  No fluid collection is identified at\nthe site of pancreaticojejunostomy.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 subcentimeter\nlow-density areas in the right kidney are stable, and too small to\ncharacterize.  No evidence of hydronephrosis.  The urinary bladder is\nunremarkable.\n\nGASTROINTESTINAL: Mild mucosal hyperemia and thickening at the gastrojejunal\nanastomosis is similar to slightly increased since prior examination. \nOtherwise small bowel is unremarkable.  The colon and rectum are within normal\nlimits. The appendix is surgically absent.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is retroverted demonstrates fibroids with\ncalcifications.  No adnexal abnormality is identified.\n\nLYMPH NODES: No enlarged pelvic or inguinal lymph nodes are seen.  Innumerable\nprominent nonenlarged mesenteric lymph nodes are seen, some of which are new\nsince previous examination.\n\nVASCULAR: Moderate 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.  There is moderate facet arthropathy in the lower lumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Increasing soft tissue density in the pancreatic surgical bed concerning\nfor recurrent disease, contacting the superior mesenteric artery and superior\nmesenteric vein.  Soft tissue changes encase the first branch off of the\nsuperior mesenteric artery.  There is posterior extension to the adjacent\nduodenum with obliteration of the intervening fat plane.\n2. Otherwise stable postsurgical changes of Whipple procedure.\n3. There is mild increased prominence of mesenteric lymph nodes, nonspecific. \nOtherwise no evidence of metastatic disease in the abdomen or pelvis at this\ntime.\n4.  For chest findings reference is made to CT chest report of the same day"
        },
        {
            "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: 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 is not cirrhotic with no suspicious lesion.  There is\na plastic CBD stent in place with secondary pneumobilia.  The gallbladder is\nnot distended and demonstrates diffuse wall thickening.\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.2 x 1.6 cm\nLocation (head right of SMV, body left of SMV): Head of the pancreas\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent with upstream pancreatic duct dilatation reaching 7 mm.\nBiliary tree abrupt cutoff with or without upstream dilatation: Plastic CBD\nstent in place with secondary pneumobilia.\n\nArterial evaluation\n\nSMA involvement: Present\nSolid soft-tissue contact: Absent\nIncreased hazy attenuation/stranding contact: Abuts with less than 180 degree\ninvolvement (series 3, image 123).\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\nVariant right hepatic artery coursing posteriorly to the portal vein: Encased\ncircumferentially.\n\nVariant anatomy: There is a left hepatic artery originating from a left\ngastric artery.  The right hepatic artery courses posteriorly to the portal\nvein.\nVariant vessel contact:  The right hepatic artery is encased by the tumor but\nremains patent.\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: Trace of free fluid in the pelvis.\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Small 1 cm nodule next to the spleen with\nidentical enhancement suggestive of a splenule.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidney's are unremarkable with the exception of a 5 mm\nhypodensity in the right kidney too small to be characterized.  No\nhydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Surgical changes in the right colon with no signs\nof complications.\n\nRETROPERITONEUM: There is no evidence of abdominal pelvis lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace of\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Retroflexed uterus with a small 18 mm fundic fibroid.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Pancreatic mass with locoregional involvement as described.\n2. Variant right hepatic artery coursing posteriorly to the portal vein that\nis encased by the tumor.  Left hepatic artery originating from the left\ngastric artery.\n3. Trace of free fluid but no signs of peritoneal nodules or distal\nmetastasis."
        },
        {
            "input": "LOWER 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.    3\nmm focal hypodensities noted in hepatic segment 6, more conspicuous on the\ncurrent exam, too small to characterize (5:89).  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nsurgically absent.\n\nPANCREAS: Patient status post Whipple procedure.  The remaining body and tail\ndemonstrate normal attenuation throughout, without evidence of focal lesions\nor pancreatic ductal dilatation.  There is no peripancreatic stranding. \nAbutting the superior mesenteric artery and vein posteriorly, there again\nnoted is an ill-defined soft tissue density.  The fat plane between the lesion\nand adjacent duodenum is not preserved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Focal\nhypodensities are noted within the right renal parenchyma, too small to\ncharacterize though likely simple cysts (5:89).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The remnant stomach is unremarkable.  Interval improvement\nin the previously identified mucosal hyperemia and thickening at the\ngastrojejunal anastomosis.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. 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: There is an enlarged, retroverted fibroid uterus. No\nadnexal abnormality is seen.\n\nLYMPH NODES: Prominent, though nonpathologic retroperitoneal or mesenteric\nlymph nodes.  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. \nUnchanged multilevel moderate facet arthropathy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patient status post ___'s procedure.  In the surgical bed, there is a\nrelatively stable, ill-defined soft tissue density lesion abutting the\nsuperior mesenteric artery and vein.  Posterior to the lesion, the fat plane\nbetween the mass in the duodenum does not appear to be preserved.  No new\nlesions identified.\n2. Prominent mesenteric lymph nodes otherwise, no evidence of new\nlymphadenopathy.\n3. Please refer to same-day CT chest report for further description of\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Please see separate report performed on same day for detailed\nevaluation of the chest.\n\nABDOMEN:\n\n\nHEPATOBILIARY: Unremarkable except for expected pneumobilia post CBD stent\nplacement.\n\n\nPANCREAS: Again seen is a poorly defined head mass measuring approximately 2.1\nx 2.1 cm with upstream pancreatic ductal dilatation (series 4, image 98)\nwithout substantial interval changes.  Nonspecific hazy soft tissue density\nagain surrounds the right hepatic artery and GDA, unchanged compared to CT\nfrom ___.  The right hepatic artery arises directly from celiac\nartery coursing in between the portal vein and IVC.  The hepatic arteries\nsupplying the medial segment of the left hepatic lobe arises directly from the\nGDA.  There is a replaced left hepatic artery arising from the left gastric\nartery supplying the lateral segment of the left hepatic lobe.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable\n\nURINARY: Unremarkable except for stable too small to characterize hypodense\nrenal lesions.  No hydronephrosis.\n\nGASTROINTESTINAL: No evidence of bowel obstruction, ascites, or free air.  The\nappendix is surgically absent.\n\nPELVIS: No pelvic free fluid.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  No adnexal mass.  Stable linear\npelvic calcifications are again seen, perhaps within the vagina.\n\nLYMPH NODES: No enlarged abdominal, pelvic, or inguinal lymph nodes.\n\nVASCULAR: No abdominal aortic aneurysm.  Moderate atherosclerotic disease is\nnoted.  See above for hepatic arterial variant anatomy.\n\nBONES: No acute fractures or suspicious osseous lesions.",
            "output": "1. No change in pancreatic head malignancy with similar locoregional\ninvolvement.  No evidence of distant metastatic disease.\n2. Variant hepatic arterial anatomy is described in the body of the report.\n3. Please see separate report performed on same day for evaluation of the\nchest."
        },
        {
            "input": "PELVIS:  Limited assessment of the small bowel is within normal limits. The\nvisualized large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion.\n\nThe visualized distal abdominal aorta is normal in caliber without aneurysmal\ndilatation. Small amount of atherosclerotic calcification noted. The iliac\narteries are normal in course and caliber.\n\nThe bladder is well distended and normal. No pelvic side-wall or inguinal\nlymph node enlargement by CT size criteria. No free pelvic fluid seen.\n\nChain sutures from prior GI surgery are again seen.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\nChondrocalcinosis is seen in the symphysis pubis.  Enthesophytes along the\nanterior iliac crest. Calcification along the left greater trochanter is again\nseen. Facet joint degenerative changes are again seen in the lumbar spine.",
            "output": "No focal lytic or sclerotic lesion concerning for malignancy. If there is\ncontinuing clinical concern, further evaluation with bone scan or MRI may be\nmore sensitive for the detection of marrow replacing 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 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: Spleen is mildly enlarged with a maximum length of 15.2 cm in length,\nalthough relatively thin.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is mildly enlarged at 8 mm\n(601:22) with some hazy increased attenuation in the adjacent fat and\nhypervascularity (2:63).  There is no fluid collection, intra-abdominal free\nfluid or pneumoperitoneum.\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 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: Very small fat containing umbilical hernia.",
            "output": "Findings suggest early uncomplicated appendicitis in the appropriate setting. \nMildly enlarged spleen."
        },
        {
            "input": "LOWER CHEST: There is a small left and trace right pleural effusion with\nassociated compressive atelectasis.  There is no large pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is diffusely heterogeneous with areas of\nhypoattenuation, with significant hypertrophy of the caudate lobe, compatible\nwith cirrhotic and fibrotic morphology.  The Portal and hepatic veins are\ngrossly patent.  There is no definite focal liver lesion identified.  There is\nextensive perihepatic ascites.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is distended without\nevidence of stones or 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: There is large volume intra-abdominal ascites.  The stomach\nis unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  There is relative bowel wall\nthickening of the distal ascending and proximal transverse colons, which can\nbe seen in the setting of colitis.  The colon and rectum are within normal\nlimits. The appendix is not visualized.  Surgical clips are seen in the right\nlower quadrant.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.  No suspicious adnexal lesions 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\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fluid containing right inguinal hernia.",
            "output": "1. Diffusely heterogeneous appearance of the liver with cirrhotic and fibrotic\nmorphology, raising the concern for Budd-Chiari, diffuse fatty infiltration,\nprimary sclerosing cholangitis, or other autoimmune/inflammatory process. \nFindings are unlikely to be due to infarct given lack of significant vascular\ndisease.  Liver MRI is recommended.\n2. Large volume intra-abdominal ascites.\n3. Small left and trace right pleural effusions.\n4. Relative bowel wall thickening of the distal ascending and proximal\ntransverse colon, which can be seen in the setting of colitis.\n5. No suspicious adnexal lesion identified.\n\nRECOMMENDATION(S):  Liver MRI is recommended for further evaluation\n\nNOTIFICATION:  Updated wet read was discussed with ___ MD by ___\n___ MD on ___ at 9:32AM."
        },
        {
            "input": "Lung Bases: 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 without concerning focal lesion.  The\ngallbladder is surgically absent.  Main portal vein is patent.  Minimal\nprominence of the intrahepatic biliary tree likely reflect prior\ncholecystectomy.  The pancreas enhances normally.  The spleen is normal in\nsize.  Adrenals are normal bilaterally.  The kidneys enhance symmetrically. \nLeft renal parapelvic cyst is noted measuring approximately 2 cm in maximal\ndiameter.  No worrisome renal lesion.  No hydronephrosis.  The abdominal aorta\nis mildly calcified and normal in course and caliber.  No retroperitoneal\nlymphadenopathy.  Suture material is seen at the stomach reflecting prior\nRoux-en-Y gastric bypass.  There is no fat stranding in the region of the\nanastomoses and no evidence of obstruction.  The excluded stomach is\ndecompressed.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  The\njejunojejunostomy suture line appears unremarkable.  Appendix is normal.  The\ncolon is unremarkable containing only a mild fecal load.  No signs of colitis\nor pericolonic inflammation.  The uterus is lobulated and enlarged due to the\npresence of multiple fibroids.  A dominant fibroid is seen measuring\napproximately 4.8 x 5.8 x 5.7 cm near the fundus.  The ovaries appear grossly\nunremarkable.  There is no pelvic free fluid.  No pelvic sidewall or inguinal\nadenopathy.  The urinary bladder appears normal.  A surgical clip is seen\nbetween the urinary bladder and the uterus may represent a dropped clip.\n\nBones: No worrisome lytic or blastic osseous lesion.  There is mild facet\ndisease in the lower lumbar spine.",
            "output": "1. Fibroid uterus with dominant fibroid measuring up to 5.8 cm in maximal\ndimension.\n2. Normal appendix visualized.\n3. Status post Roux-en-Y gastric bypass surgery without evidence of\ncomplication.\n4. Status post cholecystectomy."
        },
        {
            "input": "LOWER CHEST: Mild dependent bibasilar atelectasis.  Multiple calcified\ngranulomas within the bilateral lungs are unchanged compared to prior CT\nabdomen/pelvis from ___.  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 redemonstration of a 1.2 cm hypodensity within the posterior right\nhepatic lobe (02:19), compatible with simple cyst or biliary hamartoma.  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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 hypodensities in the bilateral kidneys are too small to\ncharacterize, likely compatible with simple renal cysts.  There is no evidence\nof hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nFew loops of small bowel within the left hemiabdomen appear fluid-filled and\ndemonstrate mild wall thickening, findings which can be seen in the setting of\nenteritis.  There is a fecalized loop of small bowel noted in the left mid\nabdomen (02:43), without evidence of obstruction.  Remaining small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. The appendix is not visualized,\nhowever no secondary signs of inflammation 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 is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no 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. \nModerate degenerative change of the lumbar spine, most prominent at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Few fluid-filled loops of small bowel within the left hemiabdomen which\ndemonstrate mild wall thickening, findings which can be seen in the setting of\nenteritis.\n2. Fecalized loop of small bowel within the left mid abdomen, without evidence\nof obstruction."
        },
        {
            "input": "LOWER CHEST:.  There are small right and trace left pleural effusions. There\nis bibasilar atelectasis.  Otherwise, no focal consolidation. Extensive\ncoronary artery calcifications are noted. No pericardial effusion. Pacer lead\nis noted terminating in the right ventricle.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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 measures 13.6 cm on AP dimension as before.  No focal\nsplenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient has undergone bilateral percutaneous nephrostomy tubes\nplacement.  The right nephrostomy tube is dislodged outside of the right\nkidney (series 2, image 41).  The left nephrostomy tube is in appropriate\nposition.  There is persistent right hydroureteronephrosis with a obstructing\n0.8 mm right UVJ stone.  When compared to ___, the degree of\nhydronephrosis is unchanged.  There is persistent right perinephric stranding,\nunchanged.  Multiple additional right kidney stones are also noted measuring\nup to 1.7 cm.  The left hydronephrosis has resolved post nephrostomy tube\nplacement.  Again seen are cluster of stones measuring 1.9 cm in aggregate\n(series 302, image 70) in the left UPJ.  Another 0.9 cm stone is noted in the\nlower pole of the left kidney.  The bladder is decompressed with a Foley in\nplace.  In addition to the obstructing right UVJ stone, there are numerous\nbladder stones.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a massive left\ninguinal hernia extending to the scrotum containing multiple small and large\nbowel loops and mesentery without obstruction.  Otherwise the small and large\nbowel loops are within normal limits.\n\nPELVIS: See above for bladder and distal ureters.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There is 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDegenerative changes of the thoracolumbar spine are moderate.\n\nSOFT TISSUES: Left inguinal hernias described above.",
            "output": "1. Dislodged right percutaneous nephrostomy tube with unchanged moderate right\nhydroureteronephrosis secondary to a obstructing 0.8 cm right UVJ stone. \nAdditional nonobstructing right kidney stones and numerous bladder stones are\nunchanged.\n2. Appropriate position of the left percutaneous nephrostomy tube with\nresolution of left hydronephrosis.  Obstructing stones measuring 1.9 cm in\naggregate in the left UPJ are unchanged.\n3. Massive left inguinal hernia extending to the scrotum containing\nnonobstructed small and large bowel loops and mesentery.\n4. Worsening bilateral small right and trace left pleural effusions.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:47 a.m., 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is bilateral gynecomastia.  There is no pericardial\neffusion.  There is a pacer lead with tip terminating in the right ventricle. \nMarked coronary artery calcifications are present.  There are bilateral small\npleural effusion, right greater than left, with associated bilateral lower\nlobe atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 8 mm calcified granuloma in the hepatic segment 7. 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 decompressed with a large calcified stone visualized in the lumen.  Small\namount of perihepatic ascites is present.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  Pancreas is mildly atrophic.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: On the right side, a percutaneous nephrostomy catheter terminates in\nthe posterior interpolar renal collecting system with resolution of previously\nnoted hydronephrosis. There is redemonstration of a 5 mm calculus in the right\nureteropelvic junction (series 2, image 46). On the left side, a percutaneous\nnephrostomy tube terminates in the left renal lower pole with mild\nhydronephrosis demonstrated, increased from ___.  2 renal calculi\nare visualized in the left ureteropelvic junction measuring up to 7 mm, distal\nto the percutaneous nephrostomy catheter tip.  There is persistent and\nrelatively extensive bilateral perinephric soft tissue stranding as well as\nmild stranding about both the ureters, relatively similar to the prior study. \nNo hydroureter, with the distal left ureter partially coursing within a large\nleft inguinal hernia.\n\nGASTROINTESTINAL: There is redemonstration of a massive left inguinal hernia\nextending to the scrotum containing nonobstructive small and large bowel loops\nas well as a portion of the left ureter.  The stomach is elongated and grossly\nunremarkable.\n\nPELVIS: There is a Foley catheter visualized in the urinary bladder.  There\nare multiple stones visualized in the collapsed urinary bladder, as seen\npreviously.  There is small free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate remains enlarged measuring 5.4 cm\ntransverse.  There is extensive scrotal wall thickening and soft tissue edema.\n\nLYMPH NODES: There are prominent inguinal lymph nodes without evidence of\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. \nThere are moderate multilevel degenerative changes of the thoracolumbar spine.",
            "output": "1. Bilateral percutaneous nephrostomy catheters in appropriate positions. \nCompletely resolved right hydronephrosis.  Mild left hydronephrosis is new in\nthe interval.  Persistent perinephric and periureteral fat stranding\nbilaterally is similar to the prior exam, but pyelonephritis can not be\nexcluded on this noncontrast exam.\n2. Bilateral ureteropelvic junction calculi measuring 5 mm on the right and up\nto 7 mm on the left.\n3. Multiple calculi in the urinary bladder, as seen previously.\n4. Massive left inguinal hernia containing nonobstructive small and large\nbowel loops and a portion of the left ureter.\n5. Cholelithiasis.\n6. Small amount of free fluid within the abdomen and pelvis.\n7. Small bilateral pleural effusions."
        },
        {
            "input": "LOWER CHEST: There is a 5 mm pulmonary nodule in the right lower lobe (9:2),\nlikely similar to the prior CT performed in ___.  A smaller 2-3 mm\nnodule is also seen in the right lower lobe (9:6).  4 mm left lower lobe\nnodule (09:11).  Triangular-shaped consolidation in the medial right lower\nlobe dates back several prior studies including a ___ CT abdomen\nand pelvis represents an area of focal scarring (series 9, image 7).  No\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: Stable size of a 2.2 x 1.9 cm right adrenal adenoma.  Left adrenal\ngland is normal in his and shape.\n\nURINARY: The kidneys are of 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.  Patient is\nstatus post partial small bowel anastomosis.  Remaining bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  Other\nthan sigmoid diverticulosis, the colon and rectum are unremarkable in\nappearance.  There is no ascites.\n\nThere is a small rounded structure in the lower anterior mid abdomen measuring\napproximately 1.2 cm (9:70).  It has a dense rim with central hypoattenuation,\nand is surrounded by mild fat stranding.  There is a fat plane separating it\nfrom the bladder wall, and therefore not a urachal remnant.  While a direct\ncommunication is not well visualized, this may represent a torsed epiploic\nappendage.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland 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 throughout the thoracolumbar spine. \nThere is probably at least moderate spinal canal and neural foraminal stenosis\nat L5-S1 due to intervertebral osteophytes and facet joint arthropathy.\n\nSOFT TISSUES: Evaluation of the soft tissues is notable for a right lateral\nventral wall hernia, containing non-obstructed loops of small bowel through a\n3.5 cm wide defect (09:46).  Short segment of colon also protrudes through the\nsuperior margin of the defect (09:43).  More inferiorly, there is a\nsupraumbilical hernia containing non-obstructed small bowel through a 2.7 cm\nwide defect (09:58).",
            "output": "1. Small 1.2 cm rounded structure in the lower mid abdomen with central\nhypoattenuation and surrounding fat stranding, which in the absence of a\nhistory of malignancy raises the possibility of epiploic appendagitis. \nHowever, given that a communication with the adjacent colon is not well\nvisualized, a follow-up CT is recommended in 6 months to ensure\nresolution/stability.\n2. No CT findings to explain patient's hematuria or rectal bleeding.\n3. Right ventral wall and supraumbilical hernias containing non-obstructed\nbowel loops.\n4. Bibasilar pulmonary nodules measuring up to 5 mm.  Chronic right middle\nlobe scarring.\n5. Degenerative changes, with probably at least moderate spinal canal and\nneural foraminal stenosis at L5-S1.\n\nRECOMMENDATION(S):  CT abdomen and pelvis in 6 months.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:48 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 parenchyma is heterogenous and nodular, consistent\nwith cirrhosis.  Patient is status post interval re-TACE now with evidence of\nnew lipiodol uptake in the right hepatic lobe in the distribution of segment 8\nand segment 4.  The lipiodiol is concentrated on tumor surrounding the\nprevious segment 4 TACE.\n\nAt the left edge of the embolization region is a slightly exophytic segment IV\nOPTN-5A lesion detailed on the ___ examination.  This lesion\nappears to demonstrate slight enhancement and washout characteristics (series\n301, image 33, series 303, image 33).\n\nThree ablation cavities within segment VI and VII are again demonstrated,\nwithout definite internal enhancement (series 301, image 40, 49, 73).\n\nThree subcentimeter foci of hyperenhancement within hepatic segment II appear\nminimally enlarged in comparison to the MRI from ___ (series 301,\nimage 28, 36), not definitely demonstrating washout.\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 enlarged measuring 15.7 cm with normal attenuation\nthroughout no evidence of focal lesions.\n\nADRENALS: Left adrenal myelolipoma is unchanged measuring 9 mm.  The right\nadrenal gland is normal.\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 left-sided hydroureteronephrosis due to a 4 mm calculi\nin the left distal ureter (series 303, image 148).  No evidence of renal\ncalculi.  The right kidney is unremarkable.  There is asymmetric stranding\naround the left kidney.  The bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement.  The visualized colon is\nunremarkable..\n\nPELVIS: No evidence of pelvic free-fluid.  The prostate is is enlarged\nmeasuring 5.8 cm.\n\nLYMPH NODES: Aortocaval lymph node measuring 1.3 cm (301, image 72) is\nincreased in size.  Porta hepatis node measuring 1.0 cm (series 301, image\n61).  Additional smaller retroperitoneal and mesenteric lymph nodes are noted.\n8 mm pericardial lymph node (series 301, image 15).  No evidence of pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes with anterior osteophyte formation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New obstructing 4 mm distal left ureteral stone with upstream left-sided\nhydroureteronephrosis and mild perinephric inflammation.  No focal fluid\ncollection.\n2. Status post re-TACE with lipiodol uptake of hepatic segments IV and VIII,\nwith focal uptake through"
        },
        {
            "input": "CT ABDOMEN:  The lung bases are clear. The visualized portions of the heart\npericardium are normal.\n\nThe liver enhances homogeneously and there is no focal liver lesion or\nintrahepatic biliary duct dilatation. The hepatic and portal veins are patent.\nThe gallbladder is within normal limits, without stones.  The spleen is\nmassively enlarged, measuring 22 cm of craniocaudal dimension, significantly\nlarger than on the on ___ when it measured 15 cm. There is significant\nstranding along the lateroconal fascia, abutting the lateral aspect of the\nspleen and extending down into the pelvic inlet which is of unclear clinical\nsignificance. However multiple colonic diverticuli are identified and there\nappears to be a small segment of colon with minimal wall thickening and an\nassociated diverticulum which cannot be clearly evaluated due to collapse but\nthat may represent a small focus of diverticulitis.\n\nThe pancreas and adrenal glands are unremarkable. The kidneys enhance\nsymmetrically and excrete contrast without evidence of hydronephrosis or mass.\nThe small bowel is unremarkable.  Conspicuous retroperitoneal and retrocrural\nlymph nodes are not significantly changed compared with prior exam. There is\nno mesenteric lymphadenopathy. Significant atherosclerotic calcification of\nthe aorta, iliac coma main intra-abdominal vessels is redemonstrated. There is\na significant atherosclerotic plaque at the origin of the right renal artery\nresulting in moderate stenosis (series 601 b image 35).  There is no free air\nor abdominal wall hernia.\n\nCT PELVIS: The appendix is normal.  There is a minimal amount of non\nhemorrhagic pelvic free fluid. There is no pelvic wall or inguinal\nlymphadenopathy.  Sigmoid diverticulosis.\n\nOSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for\nmalignancy.",
            "output": "1.  Significant interval increase of splenomegaly, which now measures 22 cm of\ncranio-caudal dimension.  No evidence of splenic infarcts or focal splenic\nlesions.\n\n2.  Significant stranding along the left lateroconal fascia, abutting the\nlateral aspect of the spleen is compatible with inflammatory process. \nAlthough unclear due to the massive spleen and compression of splenic flexure\nof the colon, there is an apparent focus of colonic thickening with an\ninvolved diverticulum at the splenic flexure which may represent\ndiverticulitis.  No evidence of abscess or perforation.  No other evidence of\nacute abdominal process identified.\n\nOf note, non-hemorrhagic fluid in the pelvis and the absence of focal lesion\nin the spleen makes splenic hemorrhage unlikely."
        },
        {
            "input": "LOWER ABDOMEN: This study is limited secondary to poor bolus timing.\n\nThere is reflux of contrast into the gallbladder, from prior CT scan.  The\ngallbladder is otherwise unremarkable.. The pancreas is unremarkable. There is\na small amount of hemoperitoneum posterior to the lower spleen (3:4).\n\n\nThe kidneys enhance symmetrically. There are no focal renal lesions. There is\nno hydronephrosis. The ureters are normal in caliber and course to the\nbladder.\n\nThe visualized loops of small and large bowel are normal in caliber and\nwithout evidence of wall thickening. Residual oral contrast seen in the\nrectum, sigmoid, and ascending colon. The appendix is well visualized and\nnormal.\n\nHemoperitoneum seen in the left pericolic gutter has mildly increased since\n___ (10:54).\n\nThere are no enlarged mesenteric or retroperitoneal by CT size criteria. There\nis no free air. There are no abdominal wall hernias.\n\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. Pelvic hematoma is stable in\nsize measuring 14.3 cm in greatest dimension (transverse) (7:83).\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.\n\nCTA: There is no evidence of active extravasation. There is no abdominal\naortic aneurysm. The SMA and ___ are patent. Celiac axis is better seen on\nupper abdominal CT from same day.",
            "output": "1. Mild increase of hematoma in the left pericolic gutter. Stable pelvic\nhematoma.\n2. No evidence of active extravasation though scan timing is suboptimal. No\netiology for bleed on this CT of the lower abdomen and pelvis.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 4:15PM, 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. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  Gallstones are noted.  Portal venous\nsystem 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. \nNo hydronephrosis.  There is a simple cyst in the interpolar region of the\nleft kidney measuring up to 2.7 cm.  Additional subcentimeter hypodensity in\nthe anterior interpolar region of the right kidney is too small to\ncharacterize, but statistically likely represents a cyst (02:36).  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.  Multiple diverticula are noted throughout the colon, most extensive\nalong the sigmoid colon.  In this patient with recent prior sigmoid\ndiverticulitis, there is again noted to be acute sigmoid diverticulitis with\nan inflamed diverticulum best seen on series 601 in 29.  Adjacent to this\ninflamed diverticulum are several locule of free air and fascial thickening. \nIn other diverticulum involving the sigmoid colon also appears inflamed best\nseen on series 601, image 32.  There is no evidence of fistula formation\nthough there is reactive thickening along the dome of the urinary bladder. \nThere is reactive thickening involving the sigmoid colon.  No drainable fluid\ncollection.  No evidence of thrombophlebitis of the inferior mesenteric vein. \nNo significant ascites.\n\nPELVIS: Mild bladder wall thickening is likely reactive due to adjacent\ninflammation (2:77).  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 acute fracture.  A 1 cm sclerotic lesion in the left\nacetabulum (601:43), and a smaller subcentimeter sclerotic lesion in the right\nischium (601:45), which are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute sigmoid diverticulitis complicated by micro perforation, given\nlocules of free air.  No drainable fluid collection or evidence of fistula\nthough there is reactive edema of the bladder dome.\n2. Cholelithiasis without evidence of cholecystitis.\n\nRECOMMENDATION(S):  Consider nonemergent colonoscopy once the acute symptoms\nresolve.\n\nNOTIFICATION:  Updated findings were discussed with ___ (ED QA\nnurse) by ___, M.D. on the telephone on ___ at 1:34 pm, 10\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There are areas of linear atelectasis in the 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 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL Status post sleeve gastrectomy (___). \nUnremarkable appearances of gastrectomy.  There remains a moderate sized\nhiatus hernia.  Small bowel loops demonstrate normal caliber and wall\nthickness 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 uterus is not visualized. No adnexal abnormality is\nseen.  The pelvis is obscured by artifact from bilateral hip arthroplasties.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Aneurysmal dilatation of the infrarenal abdominal aorta measuring up\nto 3.1 cm in maximum dimension (2:36), without evidence of complication. \nModerate atherosclerotic disease is noted.\n\nBONES: Total arthroplasty of both hips is noted.  Degenerative changes as\nnoted at multiple levels in the lumbar spine with loss of disc space height\nand osteophyte formation.  There is a compression deformity of the L3\nvertebral body with approximately 50% loss of vertebral body height.  The\nappearances are stable when compared with an MRI from ___.\n\nSOFT TISSUES: Status post repair of left-sided spigelian hernia.  No evidence\nof recurrence.  There is a fat containing supraumbilical hernia.  The hernial\nsac measures 5 x 3 x 5.5 cm.  The neck of the hernia measures 3 x 2.8 cm.\n\nThere is a small fat containing right ventral hernia with a 0.8 cm diameter\nperitoneal defect (series 2, image 28) in the right upper quadrant.  The\nhernial sac measures 3 cm maximally.",
            "output": "1. Status post sleeve gastrectomy (___).\n2. There remains a moderate sized hiatal hernia.\n3. 3 cm fat containing supraumbilical hernia.\n4. Subcentimeter fat containing right upper quadrant ventral hernia.\n5. Aneurysmal dilatation of the infrarenal abdominal aorta with moderate\natherosclerotic disease.  Yearly follow-up is recommended.\n\nRECOMMENDATION(S):  Yearly CTA abdomen follow-up is recommended for infrarenal\nabdominal aortic aneurysm."
        },
        {
            "input": "VASCULAR:\n\nAn infrarenal aorta bi-iliac stent graft is in place.  There is no evidence of\nendoleak.  In greatest dimension the abdominal aorta measures approximately\n3.4 cm.  There is an accessory renal artery on the left and right.  The celiac\naxis, and SMA are widely patent.  Hepatic arterial anatomy is conventional. \nThe ___ is not seen.\n\nLeft:  There is moderate atherosclerotic disease of the left internal and\nexternal iliac arteries however these vessels are widely patent.  The left\ncommon femoral artery contains atherosclerotic calcification but is widely\npatent.  The left popliteal artery is severely narrowed secondary to\natherosclerotic disease.  There is also severe atherosclerosis of the\nthree-vessel runoff to the feet with intermittent areas of attenuation to the\nlevel of the foot.\n\nRight leg:  There is moderate atherosclerotic disease of the right internal\nand external iliac arteries however, these vessels are widely patent.  There\nis complete occlusion of the right common femoral and femoral artery.  The\ndeep femoral artery is occluded at its origin but appears patent distally. \nThere is minimal reconstitution of flow within a severely calcified popliteal\nartery.  There is severe atherosclerosis of the three-vessel runoff with\nintermittent areas of attenuation the level of the foot.  There are no\nsignificant collateral vessels.\n\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 intrahepatic biliary duct\ndilation.  The common bile duct is dilated up to 13 mm.  The gallbladder is\nwithin 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.   Enhancing lesion at the tail of the pancreas which matches\nsplenic enhancement is likely an accessory spleen.\n\nSPLEEN: The spleen shows normal size 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 renal cysts including the largest exophytic cyst\nin the left lower pole which measures 2.7 x 3.5 cm.  Other smaller\nsubcentimeter hypodensities in the kidneys bilaterally are too small to\ncharacterize.  There is no hydronephrosis.\n\nGASTROINTESTINAL:  There is a small hiatal hernia.  Small and large bowel are\nnormal in caliber without focal wall thickening.  There is diverticulosis of\nthe sigmoid colon without evidence of diverticulitis.  The appendix is\nwell-visualized and normal.  There is no intra-abdominal free fluid or free\nair.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\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 mildly enlarged measuring 5.3 x 4.1 cm\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes with anterolisthesis of L4-5 and\nfusion of T12/L1.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias.",
            "output": "1. Complete occlusion of the right common femoral, femoral, and proximal deep\nfemoral arteries.\n2. Severe atherosclerosis of the right popliteal and three-vessel runoff with\nintermittent areas of attenuation to the level of the foot.  No significant\ncollateral vessels.\n3. Severe atherosclerosis of the left popliteal artery and three-vessel runoff\nwith intermittent areas of attenuation to the level of the foot.\n4. Aorta bi-iliac stent graft in place.  No evidence of endoleak."
        },
        {
            "input": "LOWER THORAX: Please refer to separate report of CT chest performed on the\nsame day for description of the thoracic findings.\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 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. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.  There are few scattered hypodense lesions in both\nkidney's, which are too small to characterize but statistically most likely\nrepresent renal cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable with evidence of gastrostomy\ntube in place.  There is a small amount of free intraperitoneal air, which is\nmost likely postprocedural.  There is a small amount of free small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  There\nis fluid within the small bowel loops, colon and rectum, which may represent\ndiarrhea.  The colon and rectum are otherwise within normal limits.  A rectal\ntube is in place.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is partially distended no evidence of filling\ndefect, distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable\naccording to patient's 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 is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Percutaneous gastrostomy tube is unremarkable without any\nevidence of complication.  There is a small amount of free air along the left\nanterior abdominal wall, which is most likely postprocedural.",
            "output": "1. Percutaneous gastrostomy tube is in place with no evidence of complication.\n2. Fluid within the small bowel loops, colon and rectum, which may represent\ndiarrhea.\n3. Otherwise, no acute findings in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There is a new right posterior inferior segmental and\nsubsegmental pulmonary embolism.  Small left pleural effusion with secondary\natelectasis.\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 surgically absent.\n\nPANCREAS: The pancreas head demonstrates normal attenuation.  The majority of\nthe pancreas body is necrotic, as before, with a disconnected distal duct. \nThe body of the pancreas is largely replaced by a rim enhancing collection\nthat demonstrates interval increase in size since prior study measuring today\n12.8 x 6.4 cm previously 9.3 x 5.6 cm.  A pigtail drain is positioned in the\nlateral aspect of this collection.\n\nOthers collections are unchanged in size extending along the course of the SMA\nstarting from the uncinate process.  This collection is hardly measurable and\nis estimated to 4 x 1.6 x 8 cm.\n\ninterval increase in a small amount of fluid next to the left colon.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Unchanged 13 mm left adrenal nodule.  The right adrenal is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nUnchanged 9 mm hypodensity at the inferior pole of left kidney .  No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is compressed anteriorly by the peripancreatic\nfluid collection.  No bowel obstruction.  The colon and rectum are within\nnormal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small amount\nof fluid in the pericolic gutter and in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains a posterior fundic lipoleiomyoma\nmeasuring 2.7 cm.  The endometrial is slightly thickened measuring 11 mm.\n\nLYMPH NODES: Multiple subcentimeter foci mesenteric reactive node\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Again seen is a complete thrombosis of the splenic vein with\nperigastric collaterals.  The origin of the SMV is hardly opacified suggesting\nsevere stenosis/near occlusion.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Necrotizing pancreatitis with increase in size of the acute necrotic\ncollection replacing most of the body of the pancreas measuring up to 12.8 cm.\nThe pigtail catheter is in the posterolateral aspect of the collection. \nRepositioning is recommended or drainage from a transgastric approach.\n\nNew right lower lobe pulmonary embolism.\n\nSevere compression of the SMV and complete thrombosis of the splenic vein.\n\nLeft small pleural effusion with secondary atelectasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:04 pm, 5 minutes after\ndiscovery 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Since ___, there has been substantially decreased size of the\nperipancreatic fluid collection along the ventral pancreatic body/tail which\nnow measures maximally 3.7 x 1.8 x 2.7 cm (5:27, 7:21), previously 6.8 x 3.2 x\n3.9 cm.  Internal cystogastrostomy drains remain within it, well seated within\nthe stomach lumen.  The fluid component adjacent to the percutaneous pigtail\ndrain at the pancreatic tail has completely resolved (05:30).  No new\ndrainable fluid collection.\n\nPersistent peripancreatic stranding remains, although improved.  There is\nsevere attenuation of the main portal vein and splenic vein at the portal\nconfluence with likely focal occlusion of the splenic and superior mesenteric\nveins (05:25).  There is upstream dilatation of the SMV with additional areas\nof severe attenuation of some of its branches within the substantial residual\nmesenteric phlegmon (05:35, 33).  Interval resolution of the previously seen\nascites.\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.  Redemonstrated\nstable appearing left adrenal 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.\n\nGASTROINTESTINAL: Enteric tube terminates in the jejunum.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  Prominent left pelvic and left\ncanal vein may suggest pelvic congestion syndrome in the setting occlusion of\nportal confluence.  Trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus as seen previously\nwith redemonstrated fat containing mass suggestive of a lipoleiomyoma (07:29).\nNo adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Described in detail in the pancreas section.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Post-injection change in the right anterior abdominal wall.  No\ndrainable fluid collection.",
            "output": "1. Smaller peripancreatic fluid collection with resolution of the component\nsurrounding the pigtail drain in the pancreatic tail.  Cystogastrostomy drains\nappear unchanged and well seated within the fluid collection and stomach.\n2. No new drainable fluid collection. Slightly improved peripancreatic\ninflammatory changes with substantial persistent mesenteric phlegmon.\n3. Re-demonstrated severe attenuation and likely focal occlusion of the\nsplenic and superior mesenteric veins at the portal confluence with additional\nareas of attenuation of SMV branches.  No evidence of vascular compromise of\nthe bowel.\n4. Prominence of the left pelvic and gonadal veins may suggest pelvic\ncongestion syndrome in this 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. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\n\nPANCREAS: Multiple intra-abdominal drains have been removed.  There has also\nbeen interval decrease in size in the hypoattenuating, cystic collection in\nthe pancreatic body, now measuring 1.9 x 1.3 x 1.7 cm, previously 3.7 x 1.8 x\n2.3 cm (06:26).  There is also slightly increased prominence of the distal\nmain pancreatic duct measuring up to 4 mm (06:25), possibly secondary to\nscarring.  There has been significant interval decrease in peripancreatic\nstranding.  Additionally, the fluid collection seen anterior to the pancreas\nhas completely resolved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 1.4 cm left adrenal nodule is unchanged (06:15).  The right\nadrenal 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,\nstatistically likely represent simple cysts.  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: A 2.7 cm fat containing lesion in the posterior uterine\nwall is unchanged and again likely represents a lipoleiomyoma.  The bilateral\novaries are within normal limits.\n\nLYMPH NODES: There are multiple prominent, subcentimeter mesenteric and\nretroperitoneal lymph nodes, likely reactive.  There is no retroperitoneal or\nmesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The splenic vein is occluded.  There are multiple large collaterals\nin the upper abdomen.  There is no abdominal aortic aneurysm. Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTransitional anatomy is again noted with lumbarization of S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Near complete resolution of peripancreatic stranding and the large fluid\ncollection anterior to the pancreas.  The smaller fluid collection in the\npancreatic body has also decreased in size.  No new collections are\nidentified.\n2.  As before, the splenic vein appears occluded.\n3.  Slight interval increase in pancreatic ductal dilatation, likely secondary\nto stricture.\n4.  Unchanged 1.4 cm left adrenal nodule."
        },
        {
            "input": "LOWER CHEST: Please refer to CT chest report done separately today.\nSubcentimeter short axis anterior epicardial and paraesophageal lymph nodes\n(06:12 and 13, 14) are unchanged compared to the prior exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The left hepatic lobe remains atrophic.  There are 2 fiducials\nwithin the left lobe and surgical clips, as before.  A single minimally\ndilated left intrahepatic duct is unchanged.  No change in heterogeneous\nenhancement of the left lobe compared to the prior exam.  Persistent mild\nenhancement of the CBD wall.  No new right-sided intrahepatic biliary ductal\ndilation.\nThere is diffuse hepatic steatosis.\nThere is chronic occlusion of the left portal vein and its branches.  The\nright portal vein; SMV and splenic veins remain patent.\n\nPANCREAS: Stable punctate scattered pancreatic parenchymal calcifications\nlikely sequela of prior pancreatitis.  No main duct dilation.  No focal\npancreatic lesions.  A periampullary diverticulum noted (06:55).\n\nSPLEEN: The spleen shows 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 nodules.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis.  2 cm cyst in the lower pole of the left kidney. \nAdditionally, there are multiple subcentimeter hypodensities too small to\ncharacterize by CT, but most likely cysts.  Mild perinephric fat stranding\nbilaterally stable when compared with previous.\n\nGASTROINTESTINAL: The stomach is unremarkable. Periampullary  duodenal\ndiverticulum arising from the second portion of the duodenum.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nScattered colonic diverticuli noted without 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: The prostate is not enlarged.\n\nLYMPH NODES: Unchanged subcentimeter short axis pre aortic lymph node (8:116)\nnoted.  No new enlarged lymph nodes in the upper abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: A geographic area of sclerosis in the subarticular left femoral head\n(8:189) compatible with avascular necrosis without collapse of the adjacent\nfemoral head.  No worrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No new metastatic disease.  Unchanged subcentimeter short axis porta\nhepaticus and retroperitoneal lymph nodes.\n2. Stable appearance of the atrophic left lobe of the liver with chronic\nthrombosis of the left portal vein.\n3. Incidental note is made of avascular necrosis of the left femoral head\nwithout associated collapse."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged atrophy and heterogeneous enhancement of the left\nhepatic lobe.  Left lobe fiducial markers are again noted.  No well-defined\nlesion identified.  The right hepatic lobe is diffusely steatotic.  No\nconcerning right hepatic lobe lesions.  Unchanged chronic occlusion of the\nleft portal vein.  The right portal veins are patent.  The hepatic veins are\npatent.  An accessory left hepatic artery arising from the left gastric artery\nis noted.  No intrahepatic or extrahepatic biliary ductal dilation.  Mild\ncommon hepatic duct wall thickening is similar to the prior examination. \nStatus-post cholecystectomy.\n\nPANCREAS: The pancreas is mildly atrophic.  There are multiple pancreatic tail\ncalcifications.  No focal lesions identified.  No pancreatic ductal dilation\nor peripancreatic fat stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a simple left renal cyst.  Other hypoattenuating lesions\nare too small to completely characterize, but likely reflect additional simple\ncysts.  No hydronephrosis.\n\nURINARY: The kidneys are of normal and symmetric size 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 periampullary\nduodenal diverticulum.  Small bowel loops otherwise demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nunremarkable.  The appendix is normal.\n\nPELVIS: Small urachal remnant.  The urinary bladder otherwise appears\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS:  The prostate is borderline enlarged.\n\nLYMPH NODES: A 1 cm preaortic lymph node is unchanged.  Subcentimeter lower\nparaesophageal lymph nodes are unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Unchanged evidence of avascular necrosis in the left femoral head with\nminimal femoral head flattening superiorly.  No concerning lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged atrophy and heterogeneous enhancement of the left hepatic lobe\nwithout a clearly identifiable lesion.\n2. Unchanged 1 cm pre aortic lymph node.  Otherwise, no evidence of\nabdominopelvic metastasis.\n3. Left femoral head avascular necrosis with evidence of mild femoral head\nflattening."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nPosttreatment changes are again seen throughout the left hepatic lobe, which\nis markedly atrophic (series 4, image 34).  Progressive enhancement of this\nregion is again demonstrated, similar in appearance in comparison to multiple\nprior CTs dating back to ___.  No new discrete lesion is detected. \nFiducial markers are unchanged in configuration.  There is no bile duct\ndilation.  The gallbladder has been resected.  No radiopaque ductal stones are\ndetected.\n\nThe pancreas is mildly atrophic, without duct dilation or focal lesion.\n\nThe spleen size is within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  A 1.9 cm simple-appearing left interpolar renal cyst is\nunchanged (series 5, image 151).  Multiple subcentimeter bilateral renal\nhypodensities are statistically likely cysts, and are unchanged from prior\nexaminations, the remain too small to completely characterize.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.  A small\nduodenal diverticulum is incidentally noted (series 5, image 141).\n\nThe bladder is mildly distended, and appears grossly normal.  The prostate is\nmildly enlarged (series 5, image 236).  There is no mesenteric,\nretroperitoneal, inguinal, or intrapelvic lymphadenopathy, and no ascites. \nProminent upper retroperitoneal nodes are unchanged (series 5, image 134).\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  The portal and hepatic veins are\npatent throughout the right hepatic lobe.  There is a chronically thrombosed\nleft portal vein.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. Post treatment changes throughout an atrophic left hepatic lobe, with a\nchronically thrombosed left portal vein, appearing unchanged in comparison to\nmultiple CT examinations dating back to ___.  No definite recurrent\ntumor detected.\n2. Unchanged prominent upper retroperitoneal lymph nodes.\n3. No new abdominopelvic metastasis or new lymphadenopathy."
        },
        {
            "input": "LOWER CHEST: Please refer to same-day CT chest for description of thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: Post treatment changes are redemonstrated in the left hepatic\nlobe, which is markedly atrophic (02:15), with hyperemia, likely\npost-radiation therapy.  Fiducial markers are unchanged in location.  No new\ndiscrete lesion is noted.  The right lobe is enlarged.  There is minimal\nintrahepatic biliary dilatation, unchanged from prior.\n\nPANCREAS: The pancreas is atrophic and 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 kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.2 cm hyperdense cyst re-demonstrated in the anterior lower pole\nof the left kidney, stable.  There is no other evidence of focal renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a duodenal\ndiverticulum.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder, distal ureters, and reproductive organs are\nunremarkable.\n\nLYMPH NODES: There are stable prominent retroperitoneal lymph nodes, measuring\nup to 1.0 cm in diameter.  There is no mesenteric, pelvic, or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Chronically thrombosed left\nportal vein is re-demonstrated.  The portal and hepatic veins are patent\nthroughout the right hepatic lobe.  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. Post treatment changes throughout an atrophic left hepatic lobe, with a\nchronically thrombosed left portal vein, appearing unchanged in comparison to\nmultiple CT examinations dating back to ___.\n2. No definite recurrent tumor detected.\n3. Please refer to CT chest for description of thoracic findings."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  There is very\nminimal narrowing at the take-off of the celiac artery. There is no dilation\nof the celiac trunk.  The right hepatic artery is replaced, and supplied by\nthe SMA (6, 42).  The take-off of the SMA is widely patent. The SMA and its\nbranches are widely patent. There is no evidence of occlusion or flow limiting\nstenosis.  There is a single renal artery bilaterally, both of which are\nwidely patent. The ___ is widely patent.  The common iliac arteries and their\nbranches are patent with a moderate calcium burden, though there is no\nhigh-grade stenosis.  The abdominal venous vasculature is patent.\nSpecifically, the SMV appears normal.\n\nLOWER CHEST: Stable coarse calcifications are noted along the right pleural\nsurface.  There is a small nonhemorrhagic left pleural effusion a trace\nnonhemorrhagic right pleural effusion.  The septal thickening, fibrosis, and\nscarring at the right base is similar to the prior exam in ___.  There is no\nevidence of scarring or fibrosis in the left base.  The base of the heart is\nnormal in size.  Moderate to severe calcifications are noted along the imaged\ncoronary arteries and aortic valve.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of worrisome focal lesions.  An 8 mm hypodensity in the left\nlobe of the liver is incompletely characterized, though likely represents a\ncyst.  The portal veins are patent.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits,\nwithout CT evidence of 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: On the portal venous phase, the bilateral renal parenchyma is\nslightly heterogeneous, likely due to prior injury, such as prior infections,\nor old infarcts.  No acute infarct is identified. No worrisome renal lesion is\nidentified. There is no renal stone or hydronephrosis. The kidneys enhance\nexcrete contrast symmetrically. There is no perinephric fluid collection.\n\nGASTROINTESTINAL:  The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction or focal inflammatory changes. \nSpecifically, the distal and terminal ileum appears grossly normal.  There is\nno mesenteric lymphadenopathy.  There is colonic wall edema and mucosal\nhyperenhancement involving the cecum, ascending colon, and proximal transverse\ncolon at the hepatic flexure.  There is no pneumatosis. The mid and distal\ntransverse colon, descending colon, sigmoid colon, and rectum are within\nnormal limits.  There is no evidence of a mass, surrounding abscess, or\nperforation.  There is a small amount of simple ascites in the abdomen and\npelvis. The appendix is not definitely visualized.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is no retroperitoneal hemorrhage.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.  The reproductive organs\nare otherwise normal.\n\nBONES AND SOFT TISSUES:  There no concerning lytic or sclerotic osseous\nlesions.  No fracture is identified. There are mild degenerative changes in\nthe spine.  The abdominal and pelvic walls are within normal limits without\nevidence of a hernia.",
            "output": "1. Wall thickening and mucosal hyperenhancement in the cecum, ascending colon,\nand proximal portion of the transverse colon. This is compatible with colitis.\nThe differential includes infectious, ischemic, or inflammatory.  Alternately,\nthis may represent typhlitis if the patient is immunosuppressed, though\ntyphlitis usually does not extend into the transverse colon.\n2. Patent abdominal arterial vasculature with moderate atherosclerotic\ncalcifications. No high-grade stenosis or evidence of occlusion.\n3. Small amount of simple ascites.\n4. Fibrosis and scarring at the right base, similar to ___.\n5. Small left and trace right pleural effusions.\n6. Moderate to severe coronary artery and aortic valvular calcifications."
        },
        {
            "input": "Please refer to separate chest CT report for thoracic details.\n\nThe previously demonstrated hypodense right hepatic lobe lesions are less\ndiscrete than on prior study. No new liver lesions identified. Nondistended\ngallbladder. Patent portal veins.  Normal appearance of the pancreas.  Normal\nspleen and adrenals.\n\nNo suspicious renal mass.  Subcentimeter right renal hypodense foci are noted,\ntoo small to characterize, possible cysts.  No hydronephrosis.\n\nSmall amount of contrast within decompressed stomach.  Stool and contrast\nwithin colon.  Normal appendix and TI.  No small bowel dilation.\n\nModerate atherosclerosis of normal caliber abdominal aorta. No retroperitoneal\nor mesenteric adenopathy.\n\nDecompressed bladder. No free pelvic fluid. Right common femoral venous port\ncatheter terminates in the suprarenal IVC. No pelvic adenopathy.\n\nPreviously demonstrated vertebral body metastases are better demonstrated on\nprior MRI.",
            "output": "-No new liver lesions.  Previously demonstrated hypodense liver lesions are\nless apparent on the current study, possibly representing post treatment\nchanges.  No abdominopelvic lymphadenopathy."
        },
        {
            "input": "CHEST:\nThe visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\n\nABDOMEN:\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\ngallbladder, pancreas, and bilateral adrenal glands, and kidneys are normal.\nNo evidence of nephrolithiasis. Peripheral calcifications are noted in the\nspleen (2:17), which may represent prior trauma or hemorrhage.\n\nThe stomach is not well distended. The small bowel, and large bowel are\nunremarkable in appearance without dilation or wall thickening. The mesenteric\nstranding which was seen on the prior CT dated ___ is not appreciated\non today's study. The appendix is filled with air and contrast, with no signs\nof inflammation. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum. The aorta is\nnormal in course and caliber.\n\nPELVIS:\nThe bladder, prostate and rectum are grossly unremarkable. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nOSSEOUS STRUCTURES:\nNo focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "No acute intra-abdominal process to explain patient's symptoms."
        },
        {
            "input": "LOWER CHEST: Mild subsegmental atelectasis.  There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRight hepatic lobe cyst measures 1.6 cm.  No suspicious hepatic 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.\nChronic left lower pole cortical thinning.  There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable and oral contrast does not pass\nbeyond it.  In the central lower abdomen a loop of small bowel is mildly\ndilated measuring 3.0 cm in diameter with sharp transition to completely\ndecompressed bowel in the central upper pelvis (02:53).  Distal small bowel\nloops are decompressed to the level of the cecum which contains stool and air.\nAir and stool courses throughout the colon and rectum.  Sigmoid diverticulosis\nwithout diverticulitis.  The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace stranding and free fluid in the pelvis.  No abscess.\n\nREPRODUCTIVE ORGANS: Post supracervical hysterectomy an 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes without drainable fluid collection.",
            "output": "1. Mildly dilated loop of small bowel with transition to decompressed bowel in\nthe central lower abdomen could suggest partial/early small-bowel obstruction\ndue to an adhesion.  Upstream small bowel loops are not significantly\ndistended.\n2. Postoperative changes in the pelvis with minimal residual stranding and\nfree fluid.  No abscess."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is mild-to-moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The right hepatic\noriginates off the celiac artery. There is a short segment dissection seen\nalong the left common iliac artery (4:180).  Bilateral common iliac arteries\ndemonstrate aneurysmal dilatation, measuring up to 2.4 cm on the right and 2.0\ncm on the left.  A focal aneurysmal outpouching along the distal abdominal\naorta, at the level of the bifurcation, may represent ulcerated plaque\n(4:165). There are saccular bilateral internal iliac artery aneurysms,\nmeasuring 1.6 cm on the left and 1.3 cm on the right.\n\nLOWER CHEST: Mild atelectasis is noted in the lung bases.  Calcified granuloma\nis seen in the right lung base.  There is no pleural or pericardial effusion. \nPlease refer to separate TAVR protocol for cardiac exam as well as ___\nfor the iliac arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcentimeter hypodensities in the liver are too small to\ncharacterize, but likely hepatic cysts or biliary hamartomas. There is a 2.8\ncm region of enhancement in greatest dimension along the left hepatic lobe,\nwhich is not fully characterized on this exam without definite correlate seen\non the noncontrast CT chest from ___.  Otherwise, the liver\ndemonstrates homogenous attenuation throughout.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\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. \nTiny scattered hypodensities in the renal cortices are too small to\ncharacterize.  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: 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.  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: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the lumbosacral spine with mild\nretrolisthesis of the L4-L5 vertebral level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Bilateral common iliac and internal iliac aneurysms with 3D ___\ndetailed in the same day cardiac CTA.  Note is made of a short-segment\ndissection along the left common iliac artery.\n2. Focal aneurysmal outpouching is seen along the infrarenal aorta at the\nlevel of the iliac bifurcation, likely ulcerated plaque within an aneurysm.\n3. 2.8 cm region of enhancement along the left hepatic lobe is not fully\ncharacterized on this exam.\n\nRECOMMENDATION(S):  Attention on follow up for the region of enhancement along\nthe left hepatic lobe unless the patient is high risk for HCC, in which case a\ndedicated MRI should be obtained for further characterization."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  There are bilateral pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 normal in size and enhances homogeneously.  The\nleft kidney is normal in size.  However, there are heterogeneous areas of\nsubcortical hypoenhancement in the left kidney (series 8, image 28), which may\nreflect a sequela of prior insult.  No parenchymal masses are identified. \nThere is no hydronephrosis.  A 1 cm simple cyst is seen along the posterior\ninterpolar region of the left kidney.  Subcentimeter hypodensities are too\nsmall 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.  Small amount of ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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.  There is moderate\natherosclerotic disease throughout the abdominal aorta, with luminal narrowing\nof the infrarenal abdominal aorta by calcified plaque (5:65).\n\nBONES: Osseous structures are diffusely demineralized.  No suspicious lytic or\nsclerotic lesions are identified.\n\nSOFT TISSUES: Evaluation of the soft tissues is notable for diffuse anasarca.",
            "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Heterogeneous areas of subcortical hypoenhancement in the left kidney is\nnonspecific, may reflect a sequela of prior insult.\n3. Small volume ascites.  Diffuse anasarca.\n4. Bilateral pleural effusions.  Please refer to the separate chest CT\ndictation for details on intrathoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  Celiac axis, SMA, bilateral renal\narteries, and ___ are patent.  Hepatic anatomy is conventional.  Hepatic\nveins, left portal vein, anterior right portal vein, main portal vein, SMV,\nand splenic vein are patent.  Posterior right portal vein is diminutive but\npatent.  There is no calcium burden in the abdominal aorta and great abdominal\narteries.\n\nLOWER CHEST: Limited evaluation of the lung bases notable for small left and\ntrace right non hemorrhagic pleural effusion.  Left lower lobe atelectasis\nnoted.  No pericardial effusion.\n\nHEPATOBILIARY: The liver is enlarged and diffusely hypodense consistent with\nsevere hepatic steatosis.  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\nis contains stones, without evidence of gallbladder wall thickening 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 is mildly enlarged measuring 14.3 cm without focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 0.8 cm renal hypodensity within the interpolar region of the left\nkidney is unchanged since prior and incompletely characterized.  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: An enteric feeding tube courses midline with tip in stomach.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.  Fat deposition is noted within the ascending colonic wall\nsuggestive of chronic inflammatory changes.  Colon and rectum are within\nnormal limits.  Appendix contains air, has normal caliber without evidence of\nfat stranding.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small to moderate\nvolume pelvic free fluid.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is noted.  Bilateral ovaries are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent vasculature.  Specifically, no portal vein thrombus.\n2. Severe hepatic steatosis.\n3. Fat deposition within the colonic wall suggestive of chronic inflammatory\nchanges.\n4. New small left and trace right pleural effusion.\n5. New small to moderate volume ascites."
        },
        {
            "input": "CHEST:  Mild bilateral lower lobe atelectasis is noted on limited assessment\nof the lung bases.  No pleural effusion. The visualized heart is normal in\nsize without pericardial effusion.\n\nABDOMEN:\n\nThe liver is diffusely hypodense. No focal lesion identified.No intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is surgically absent. The\nportal vein, SMV, and splenic vein are patent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion.  The appendix is normal without evidence of\nacute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  The iliac arteries are normal in\ncourse and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen.\n\nOSSEOUS STRUCTURES: A defect along the L2 superior endplate is most consistent\nwith a compression fracture with increased sclerosis.  No retropulsion.  No\nfocal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  Likely old L2 superior endplate compression fracture. Clinical correlation\nis recommended to assess for focal tenderness.\n2.  Normal appendix.\n3.  Hepatic steatosis."
        },
        {
            "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 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 (601:44).\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: Re-demonstrated is a compression deformity of the L2 vertebral body,\nunchanged since ___.  No acute fractures are identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal or intrapelvic process to explain the patient's\npain.\n2. Re-demonstration of hepatic steatosis.\n3. Unchanged compression deformity of the L2 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 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 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.  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: Compression the of the L2 vertebral body is largely unchanged.  There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple air locules in the anterior abdominal primarily in the\nright upper quadrant and a single one in the left lower quadrant (3:40, 71),\nmost likely insulin injection site given patient's diabetes.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "No finding to explain the patient's pain.  Specifically, normal appendix."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  There is no evidence of pleural\nor pericardial effusion.  A central venous catheter tip projects over the\ncavoatrial junction.\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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a very small duodenal\ndiverticulum. There is no small bowel obstruction.  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.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is an unchanged L2 compression deformity.  No new fracture or\nworrisome osseous lesion.\n\nSOFT TISSUES: Scattered radiodensities and foci of air within the subcutaneous\ntissues of the anterior abdominal wall likely reflects sequelae of injections.",
            "output": "No acute process in the abdomen pelvis to explain the patient's symptoms."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis is seen.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is low in attenuation, consistent with fatty\ninfiltration.  No focal intrahepatic lesion is identified.  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 is top-normal in size.  No splenic lesion 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. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is relatively collapsed.  No bowel obstruction\nor bowel wall thickening is seen.  The appendix is normal.\n\nPELVIS: The urinary bladder is not well distended, but is grossly\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.  No atherosclerotic disease\nis seen along the abdominal aorta..\n\nBONES: There is persistent loss of height of the L2 vertebral body.  Chronic\nnonunion of the left L4 transverse process is seen, similar to prior.\n\nSOFT TISSUES: Cluster of foci of gas in the superficial subcutaneous fat of\nthe anterior right mid abdomen, most likely relates to subcutaneous\ninjections.",
            "output": "1. Cluster of foci of gas in the superficial subcutaneous fat of the anterior\nright mid abdomen, most likely relates to subcutaneous injections.  Correlate\nwith history of such.\n2. Otherwise, no acute CT findings seen in the abdomen or pelvis.  Normal\nappendix.\n3. Hepatic steatosis.  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 hypoattenuation, similar to\nprior exam.  There is no suspicious focal lesion.  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.  No hydronephrosis\nobstructive stone, or solid mass.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is not enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nWedge deformity of the L2 vertebral body, similar to prior exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute findings in the abdomen or pelvis to explain patient's symptoms.  The\nappendix 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 homogenous hypoattenuation throughout,\nsimilar to prior, suggestive of hepatic steatosis.  There is no suspicious\nfocal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. The colon and rectum are within\nnormal 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: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Compression deformity of the L2 vertebral body, unchanged compared to\nprior exam.  No worrisome osseous lesions or acute fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute findings in the abdomen or pelvis to explain patient's symptoms."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate centrilobular emphysematous\nchanges, as on prior.  There is no evidence of pleural or pericardial\neffusion.\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 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 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. 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 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 substantial\natherosclerotic disease is noted.\n\nBONES: A well corticated left L4 transverse process ossific fragment is\nunchanged.  Compression deformity of the L2 vertebral body is also unchanged.\n\nSOFT TISSUES: Foci of soft tissue nodularity in the right anterior abdominal\nwall could relate to injections.",
            "output": "1. No acute intra-abdominal or intrapelvic process.\n2. Redemonstrated hepatic steatosis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac artery, SMA, and ___\nare patent.  The portal vein, splenic vein, and SMV are patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is homogenous attenuation throughout the liver.  A 2.5 cm\nhemangioma within the left hepatic lobe is unchanged, previously measuring 2.6\ncm in ___.  A 2.2 cm hemangioma within the right hepatic lobe (3:20) has\nincreased in size, previously measuring 1.6 cm in ___.  Few subcentimeter\nhypodensities throughout the hepatic lobe are too small to characterize but\nstatistically likely represent cysts or biliary hamartomas.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis contains stones, without evidence of gallbladder wall thickening 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 is top-normal in size measuring 12.6 cm.  There is 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. \nFew subcentimeter hypodensities throughout the bilateral kidneys are too small\nto characterize but statistically likely represent cysts.  There is no\nevidence of stones or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is mild wall thickening\nand mural hyperenhancement of a short segment of terminal ileum where there is\nsubtle fat stranding (3:117); these findings may represent ileitis. \nOtherwise, small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening or fat stranding.  Apparent mural thickening and mucosal\nhyperenhancement within the distal descending colon and sigmoid colon may be\ndue to underdistention, though there is suggestion of mild wall thickening\nwithin distended loops of transverse colon (series 3, image 70).\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 and seminal vesicles are grossly\nunremarkable.\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.",
            "output": "1. Findings suggestive of mild ileitis, likely infectious or inflammatory.  No\nevidence of ischemia or bowel obstruction.\n2. Slight wall thickening of the transverse colon, which could represent very\nmild or early colitis.  Assessment of the distal colon is limited due to\nunderdistention.\n3. Diverticulosis without acute diverticulitis."
        },
        {
            "input": "There is mild atelectasis at the lung bases.  There is no pericardial or\npleural effusion.  The heart size is top-normal.\n\nThe liver density is within normal limits.  Again seen are well-circumscribed\nhypodense lesions within left lateral lobe (series 3, image 29, 34) which are\nlikely cysts.  A 2.3 x 1.5 cm hypodense lesion along the central aspect of\nsegment II is unchanged (series 3, image 37), likely a small hemangioma.  A\n2.3 x 1.6 cm right hepatic lobe hemangioma is unchanged (series 3, image 22).\n\nThere is mild hyperemia surrounding the gallbladder (series 3, image 50).  The\ngallbladder is distended, without significant wall thickening or adjacent\nstranding, containing multiple gallstones (series 3, image 53).  No radiopaque\nductal stones are seen.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is top-normal.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nremain normal in caliber.  Again seen is equivocal mild wall thickening along\nthe entire course of the colon, unchanged since the ___\nexamination.  There is no adjacent stranding, pneumatosis, or free air. \nPreviously-seen mild wall thickening along the distal ileum is no longer\npresent.\n\nThe bladder is mildly distended, and appears normal.  The prostate is normal\nin size.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber, without appreciable atherosclerotic\ndisease.  No central venous thrombus is detected.\n\nThere are no osseous lesions concerning for malignancy or infection.  Punctate\nsclerotic foci throughout the sacrum and left iliac bone are statistically\nlikely bone islands (series 3, image 139, 129).",
            "output": "1. Minimal wall thickening throughout the entire colon is similar in\nappearance to the ___ examination, with a distribution atypical\nfor ischemia.  Mild wall thickening of the distal ileum described on\nyesterday's study has resolved, and was likely due to underdistension.  The\nsmall bowel appears normal.  there is no pneumatosis or free air.\n2. There is cholelithiasis with a distended gallbladder.  Although there is no\nwall thickening there is new mild hyperemia of the adjacent liver parenchyma\nsince yesterday, and early cholecystitis should be considered.  Correlate with\nright upper quadrant examination, bilirubin levels, and consider HIDA scan if\nclinical examination remains equivocal."
        },
        {
            "input": "Examination is limited due to artifact from positioning.\n\nLOWER CHEST: There is bibasilar atelectasis.  Aortic annular and valvular\ncalcifications as well as coronary arterial 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 and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: A Foley catheter is seen within the urinary bladder, with small\nassociated air.  The bladder wall is somewhat thick walled, circumferentially,\nand is nonspecific given overall decompressed state.  There is no free fluid\nin 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.  Extensive atherosclerotic\ndisease is noted.  Arterial bypass grafts are noted and patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are seen in the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No definite source of infection identified 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 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 minimally complex cyst 3.4 cm with peripheral calcifications in the\nleft mid kidney.  Subcentimeter hypodensities in the right kidney are too\nsmall to characterize, but statistically likely represent simple cysts.  There\nis no evidence of suspicious focal renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: There is a large hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\nPancolonic diverticulosis is present.  There is a long segment of colonic wall\nthickening, particularly involving the distal transverse colon, descending and\nsigmoid colon, which may represent a mild 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.\n\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 to severe degenerative changes in the lumbar spine as\nevidenced by loss of intervertebral disc space height, endplate sclerosis,\nvacuum phenomena and anterior posterior osteophytes.  This is most pronounced\nat L4-5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Long segment of colonic wall thickening, primarily involving the distal\ntransverse, descending and sigmoid colon may represent a mild colitis, which\ncan be ischemic, inflammatory or infectious in etiology.\n2. Extensive pancolonic diverticulosis.\n3. Large hiatal hernia.\n\nNOTIFICATION:  The updated findings were emailed to the ED QA nurses at 09:35\non ___ by Dr. ___ communication with the primary provider."
        },
        {
            "input": "LOWER CHEST: There are bilateral pleural effusions, with overlying bibasilar\ndependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates decreased attenuation, consistent with\nhepatic steatosis.  There are pericholecystic areas of fatty sparing.  There\nis no evidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains multiple gallstones\nand air, as was seen on the CT from ___, and likely due to prior\nERCP.\n\nPANCREAS: Multiple calcifications are identified in the pancreatic head,\nsimilarly to in ___ (6:52).  There is no peripancreatic stranding or\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. \nSeveral bilateral renal hypodensities demonstrate simple fluid attenuation,\ncompatible with simple cysts (06:47, 7b:  53, 57).  Other smaller\nsubcentimeter hypodensities are too small to characterize, also likely cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is an unremarkable\nappearing small bowel anastomosis in the right mid abdomen (6:62).  The\nremainder of the small bowel demonstrates normal caliber without evidence of\nobstruction.  Diverticulosis of the sigmoid colon is noted, without evidence\nof wall thickening and fat stranding.\n\nPELVIS: Several urinary bladder diverticulum are identified.  The largest of\nthese measures approximately 4.2 cm in the posterior right bladder (6:112,\n7b:55).  In the 1.8 cm left bladder diverticulum, there is a suspicious focus\nof nodular enhancement measuring approximately 1.1 x 1.1 cm (6:96, 7b:42). \nThere is also a smaller 1.5 cm right bladder diverticulum (7b:48).  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.  There is an accessory right renal artery.\n\nBONES: There is no evidence of worrisome osseous lesions.  Multi-level\nextensive degenerative changes are identified in the lumbar spine, pronounced\nat L5-S1, where there is disc space narrowing and vacuum disc phenomenon. \nThere is grade 1 retrolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No suspicious area of increased attenuation in the bowel concerning for\nactive GI bleed.\n\n2.  In the left bladder diverticulum, there is a suspicious focus of nodular\nenhancement measuring approximately 1.1 cm.  This is not identified on the CT\nof ___.\n\n3.  Bilateral pleural effusions and fatty liver.\n\n4.  Cholelithiasis and a small amount of air in the gallbladder, in keeping\nwith history of ERCP.\n\nRECOMMENDATION(S):  Direct visualization by cystoscopy of the left bladder\ndiverticulum suspicious enhancing nodular focus is recommended.\n\nNOTIFICATION:  The above findings and recommendation were communicated via\ntelephone with Dr. ___ to Dr. ___ at 11:25 on ___,\nimmediately after discovery."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nWithin the subcutaneous tissues of the right lower pelvis/ right groin, there\nis an area of active extravasation arising from the right common femoral\nartery, within the subcutaneous tissues, approximately 2.4 cm from the skin\nsurface (series 38, image 150).  This is significant surrounding soft tissue\nswelling and edema. No definite active extravasation is seen within abdomen,\nhowever this is extremely limited by streak artifact. The abdominal aorta is\nnormal in caliber and without evidence of aneurysmal dilation or dissection. \nThere is severe atherosclerotic disease of the intra-abdominal aorta and its\nbranches, with severe soft and calcified plaque seen throughout. The celiac\naxis, SMA, bilateral renal arteries, and ___ are grossly patent. Visualized\nportions of the bilateral common femoral arteries and its ramifications into\nthe superficial femoral artery are patent. The hepatic arterial anatomy is\nconventional.  Assessment of the venous vasculature is limited by the timing\nof contrast.\n\nABDOMEN:\n\nThere is bibasilar atelectasis with mild bronchiectasis at the lung bases.\nVisualized portions of the heart and pericardium are normal.\n\nThe liver enhances homogeneously with no evidence of focal hepatic lesions.\nThe gallbladder is normal. There is a 14 mm hypodensity in the left adrenal\ngland. The right adrenal gland, pancreas and spleen are normal.\nKidneys enhance symmetrically and excrete contrast without evidence of\nhydronephrosis or renal masses.\nThe stomach, small and large bowel are grossly unremarkable. The appendix is\nvisualized and is normal. Evaluation of the lower abdominal structures is\nsomewhat limited by streak artifact generated by the surgical hardware.\nHowever within these limitations, note is made of a region of hypodensity\nspanning approximately 4.1 cm adjacent to the right psoas muscle and measuring\nhigh attenuation, likely a hematoma (series 3a, image 97).\n\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum.\nThere is significant soft tissue and fat stranding in the right groin with an\nadjacent hematoma seen within the subcutaneous tissues measuring approximately\n7.2 cm in transverse dimension. To a lesser degree, note is also made of soft\ntissue stranding along the left inguinal region.\n\nPELVIS:\n\nFoley catheter is seen within a  contrast filled urinary bladder. There is no\npelvic free fluid. Stranding is noted along the left pelvic wall. There is no\npelvic wall or inguinal lymph node enlargement by CT size criteria.\nOSSEOUS STRUCTURES:  Surgical hardware spans the L5 through S1 vertebral\nbodies. No blastic or lytic lesion concerning for malignancy.",
            "output": "1. Active extravasation arising from the right common femoral artery, within\nthe subcutaneous tissues of the right groin, approximately 2.4 cm from the\nskin surface.  No definite active extravasation seen within the abdomen,\nhowever examination is limited by streak artifact from surgical hardware.\n\n2. Hematoma, stranding and soft tissue swelling in the subcutaneous tissues of\nthe right groin.  Soft tissue swelling and stranding in the subcutaneous\ntissues of the left groin, to a lesser extent.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 7:24 ___, 15 minutes after discovery of\nthe findings."
        },
        {
            "input": "Trace bilateral pleural effusions are new since the CT from ___. \nThere is mild adjacent compressive atelectasis.  Tiny left lower lobe\nconsolidations are present (series 3, image 6).  The heart size is top normal.\nThere is no pericardial effusion.\n\nThe liver parenchyma is within normal limits.  Again seen is an ill-defined\n9.7 x 6.9 cm hepatic mass centered at segment 4 demonstrating mixed density,\nwith peripheral areas of high density compatible with blood, also\ncharacterized on the MRI from ___.  The pattern of hyperdensity\nwithin this lesion is unchanged in comparison to the pre biopsy CT from ___.  No new hemorrhagic focus is seen within this noncontrast study.\nNo perihepatic collection is detected.  There is new trace nonhemorrhagic free\nfluid within the pelvis (series 3, image 65).\n\nA 6 mm soft tissue nodule along the liver capsule, abutting the hepatic mass,\nis unchanged from prior (series 3, image 14).\n\nThe gallbladder is normal.  No radiopaque ductal stones are seen.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation.\n\nThe spleen size is within normal limits.\n\nThe kidneys are normal in size, without hydronephrosis.  A 2.9 cm left upper\npole renal cyst is unchanged (series 3, image 24).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  No focal gastrointestinal lesion is detected.\n\nThe bladder is decompressed colon appears normal.  The uterus is anteverted,\nand normal in size.  No concerning adnexal lesions are detected.\n\nThe abdominal aorta and iliac branches are normal in caliber.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. A hemorrhagic 9.7 x 6.9 cm hepatic mass appears unchanged in comparison to\nthe preoperative reference CT from ___.  A 6 mm soft tissue\nperihepatic nodule abutting the hepatic mass is unchanged.\n2. No superimposed acute abdominopelvic hemorrhage.\n3. New small bilateral pleural effusions with adjacent compressive\natelectasis.  Tiny left lower lobe consolidations could reflect aspiration;\nearly pneumonia cannot be excluded.\n4. New trace nonhemorrhagic pelvic free fluid."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 hypodense lesion at the hepatic dome is unchanged, most likely represents a\nhepatic cyst 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.  A splenule is seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No hydronephrosis seen on either side.\nThere is an 8 mm rounded exophytic homogeneously enhancing lesion arising from\nthe lower pole of the right kidney (series 4, image 33) concerning for renal\ncell carcinoma, similar in size to the MRI dated ___.\nA second 4 mm lesion previously characterized as an angiomyolipoma is noted in\nthe superior pole of the right kidney (series 6, image 38).\n\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\njejuno-jejunal anastomosis.  A bilobed duodenal diverticulum is again seen. \nMultiple diverticula are seen in the jejunum.  A large 4 by 2.7 by 3 cm\ndiverticulum arising from the distal jejunum has mild surrounding fat\nstranding (4:36, 6:24).  No fluid collection.  No perforation.  Otherwise, the\nsmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is diffuse colonic diverticulosis without diverticulitis. \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": "1. Mild uncomplicated acute diverticulitis involving a jejunal diverticulum\nlocated in the left upper quadrant.  No perforation or surrounding drainable\nfluid collection/abscess noted.\n2. 8 mm solid enhancing exophytic lesion arising from the lower pole of the\nright kidney remains concerning for renal cell carcinoma with no interval\nchange in size compared to the MRI dated ___.\n3. Colonic diverticulosis without diverticulitis.\n\nRECOMMENDATION(S):  Urology consult recommended for the finding in impression\n2..\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 7:06 pm, 5 minutes\nafter discovery of the findings.\n\n 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 regarding impression 2."
        },
        {
            "input": "LOWER CHEST: Minimal bilateral dependent atelectasis is seen.  There is no\nfocal consolidation.  No pleural or pericardial is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen hypodensity in the hepatic dome, similar to prior and likely a\ncyst.  Slight prominence of the central intrahepatic biliary tree and of the\ncommon bile duct likely relates to 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.  A small accessory spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen 9 mm exophytic posterior right renal lower pole hyperdense\nenhancing lesion, as further characterized on prior MRI.  Small 4-5 mm\nhypodensity at the lateral upper pole of the right kidney on series 2, image\n35 is similar compared to prior, seen 2 previously represent angiomyolipoma. \nNo frank hydronephrosis is seen.  There is no perinephric stranding.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is relatively collapsed.  There is a small\nhiatal hernia.  2 duodenal diverticula are seen.  There is no bowel\nobstruction.  Jejunal anastomosis is seen, with the bowel patulous in this\nregion.  There is colonic diverticulosis without acute diverticulitis.  The\nappendix is normal in caliber, and extends to the left of midline.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Grossly unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic 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 bowel obstruction or bowel wall thickening.  Jejunal anastomosis, with\nbowel patulous in this location, without bowel obstruction.  No free fluid or\nother findings to suggest anastomotic leak..\n2. Again seen 9 mm enhancing lesion exophytic from the posterior right renal\nlower pole, a renal cell carcinoma not excluded.\n3. Status post cholecystectomy.  Mild prominence of the central hepatic\nbiliary tree and of the common bile duct most likely relate to post\ncholecystectomy state."
        },
        {
            "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: Mild atelectasis is noted in the lung bases. There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\n0.7 cm hypodensity in the liver dome is too small to characterize, possibly a\ncyst or biliary hamartoma.  There is mild pneumobilia within the left hepatic\nlobe status post cholecystectomy.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is is 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.  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 0.8 cm cortical solid enhancing mass arising from the inferior pole\nright kidney (303:60).  Few subcentimeter hypodensities are too small to\ncharacterize but likely represent cysts.  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: There is a small hiatal hernia.  The stomach is normal. \nPatient is status post jejunal-jejunal anastomosis.  No bowel wall thickening\nis seen.  There is trace mesenteric edema in the right mid abdomen (303:71,\n___:58) which is nonspecific.  No associated bowel wall thickening or\nobstruction is seen.  No evidence of active bleeding at this site or elsewhere\nwithin the bowel.  There 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.  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. No evidence of active bleeding within the bowel or elsewhere within the\nabdomen or pelvis.\n2. Trace mesenteric edema in the right mid abdomen is nonspecific.\n3. 0.8 cm cortical enhancing mass arising from the inferior pole of the right\nkidney.  Nonurgent renal MRI evaluation is recommended.\n\nRECOMMENDATION(S):  Nonemergent renal MRI."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries but a moderate amount of\nnoncalcified atherosclerotic plaque.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a small 0.7 cm hypodense lesion at the dome of the liver (series 3,\nimage 6), most likely a hepatic cyst.  The gallbladder is again surgically\nabsent.  Again seen is pneumobilia, which may be an expected finding if the\npatient has also undergone sphincterotomy.  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. \nAgain seen is a rounded 0.8 cm exophytic and heterogeneously enhancing\nstructure at the lower pole of the right kidney.  There are several bilateral\ntiny hypoenhancing renal lesions, too small to characterize.  No\nhydronephrosis.  There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Hiatal hernia is small.  As before, there is a bilobed\nperiampullary a duodenal diverticulum (series 3, image 53).  Patient is status\npost jejunal-jejunal anastomosis, with suture material seen within the left\nupper quadrant.  Remnant small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.  There is no evidence of active extravasation or contrast pooling\nwithin the small or large bowel lumen to suggest active hemorrhage.  There is\nno evidence of mesenteric 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: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been interval placement of a left femoral central\nvenous catheter, which terminates in the left common iliac vein.",
            "output": "1. No evidence of active bleed within the visualized bowel or elsewhere within\nthe abdomen and pelvis.\n2. Interval placement of left femoral central venous catheter, which\nterminates in the left common iliac vein.\n3. 0.8 cm enhancing right lower pole renal mass.  A follow-up MRI in 6 months\nis recommended to evaluate change over time and characterize further.\n\nRECOMMENDATION(S):  Renal MRI without and with contrast in 6 months.\n\nNOTIFICATION:  The findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 4:46 Pm, 15\nminutes after discovery of the findings."
        },
        {
            "input": "LUNG BASES:  Streaky opacities in the dependent portions of the lung bases are\ncompatible with subsegmental atelectasis.  Pleural thickening and underline\nsubpleural interstitial thickening are seen in the right middle lobe.  Trace\npericardial fluid is likely within normal physiologic range.  There is no\npleural effusion.  There is no hiatus hernia.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of concerning focal lesion. \nThe portal vein is patent.  The gallbladder is surgically absent.  There is\nnew diffuse intrahepatic biliary ductal dilation.  Additionally, there is\nmarked dilation of the extrahepatic common duct to 15 mm (see series 2, image\n22).  There is also new main pancreatic duct dilation to 4 mm.  The distal\nextrahepatic common duct is filled with hypoattenuating tissue measuring up to\n51 ___, best visualized on the sagittal reformats (series 602b, image 40). \nThere is similar hypoattenuating material within the distal pancreatic duct\nwhich open separately from the CBD, as pancreas divisum.\n\nOtherwise, the pancreas enhances homogeneously without peripancreatic\nstranding.  There is no splenomegaly or focal splenic lesion.  The adrenal\nglands are unremarkable.  There is normal symmetric renal enhancement\nbilaterally.  There is no hydronephrosis.\n\nThe stomach is not markedly dilated.  The pylorus is displaced cranially and\ndemonstrates mild concentric wall thickening with limited ability to follow\nthe duodenum given the presence of a redundant transverse colonic loop filled\nwith fluid and air-filled closely abutting the duodenum obscuring it.\n\nNondilated small bowel loops are normal in course and caliber without evidence\nof wall thickening or obstruction.  Surgical suture is seen in the right lower\nquadrant from prior bowel surgery; the small bowel small bowel anastomosis\nappears patent and intact.  The colon is unremarkable.  The appendix is not\ndirectly visualized, however there are no secondary signs of appendicitis.\n\nModerate atherosclerotic calcification is most severe in the infrarenal\nabdominal aorta.  There is no evidence of abdominal aortic aneurysm or\ndilation.  Major proximal aortic tributaries are patent.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThe previously identified intraperitoneal well-circumscribed cystic lesion is\nagain seen inferior to the right kidney and anterior to the right psoas\nmuscle, currently measuring 4.4 x 3.9 x 4.8 cm (AP X TV X CC) (series 2, image\n38), not appreciably changed in size since prior exam.  The lesion is simple\nappearing, suggestive of an enteric duplication cyst or lymphocele.  There is\nno free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe bladder is prominently distended, but otherwise unremarkable.  There is no\npelvic sidewall, iliac chain, or inguinal lymphadenopathy.  There is no free\npelvic fluid.\n\nMUSCULOSKELETAL:\nAn upper midline anterior abdominal wall laxity is seen measuring 8.6 cm\nacross at the broad-based neck, unchanged since prior exam from ___,\nwith nearby abdominal wall surgical staples.  No frank hernia is present. \nThere is mild dextroscoliosis of the lumbar ___ at L3.  There is\nmoderate multilevel, multifactorial thoracolumbar spine degenerative change. \nThe imaged vertebral bodies demonstrate normal alignment.  No concerning focal\nlytic or sclerotic osseous lesions are seen.",
            "output": "1. New diffuse intrahepatic biliary ductal dilation, along with extrahepatic\ncommon duct dilation to 15 mm and main pancreatic ductal dilation to 4 mm, as\nabove.  Pancreas divisum.  The distal extrahepatic common duct and the distal\npancreatic duct are filled with hypoattenuating tissue, may represent an\nobstructing mass within the duodenum.  The duodenum itself cannot be traced\nbeyond the pylorus given the lack of intra-abdominal fat and large loops of\nredundant transverse colon surrounding it closely.\n2. Intact appearing small bowel anastomosis in the right lower quadrant.  No\nevidence of obstruction.\n3. Stable 4.4 cm intra-abdominal cystic lesion in the right medial abdomen,\npossibly an enteric duplication cyst or lymphocele.\n4. Status post cholecystectomy.\n\nRECOMMENDATION(S):  MRCP or ERCP to rule out a duodenal mass causing this new\nobstruction."
        },
        {
            "input": "CHEST: The imaged lung bases demonstrate mild bibasilar atelectasis, with no\npleural effusion or consolidation. The heart is normal in size with no\npericardial effusion.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal hepatic lesion. The portal\nand hepatic veins are patent. The gallbladder is ___\nhyperdense focus near the fundus (04:39), which may represent gravel. The\npancreas is normal in attenuation with no duct dilatation. The spleen is\nnormal in size and attenuation. The adrenal glands are morphologically normal\nbilaterally. The kidneys enhance and excrete contrast symmetrically. There is\na partially exophytic hyperdense cyst off the midpole of the left kidney\n(04:17), which is new since the prior CT from ___. There is no\nhydronephrosis.\n\nThe distal esophagus and stomach are decompressed. The small bowel is normal\nin caliber with no evidence of obstruction. Again noted are 2 ventral\nabdominal wall hernias containing small bowel and mesentery (4:65) with a\nsmall amount of mesenteric fluid interspersed between the herniated bowel\nloops, but no evidence of wall thickening or ischemia to the herniated loops.\nThe large bowel contains a moderate amount of stool, but with no surrounding\ninflammation. There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes.\n\nPELVIS: The urinary bladder is decompressed. The patient is post hysterectomy.\nNo concerning adnexal masses are detected. There is abnormal low lying\nposition of the bladder and anorectal junction, measuring almost 4 cm below\nthe pubococcygeal line, compatible with pelvic floor dysfunction (series 8,\nimage 38). No pelvic free fluid or pelvic sidewall or inguinal lymphadenopathy\nis appreciated.\n\nVESSELS: The aorta demonstrates moderate atherosclerotic calcification without\naneurysmal dilatation and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Redemonstration of ventral abdominal wall hernias containing fat and small\nbowel/ mesentery respectively. Small amount of interspersed fluid between the\nherniated bowel loops is seen, without evidence of incarceration.\n2. New (since ___ hyperdense cyst off the midpole of the left\nkidney can be further evaluated via ultrasound if indicated, possibly\nrepresenting a hemorrhagic cyst.\n3.  Pelvic floor dysfunction, including a moderate cystocele."
        },
        {
            "input": "THORAX: The chest/ intrathoracic portion of this exam will be dictated under\nanother clip number.\n\nLIVER: The liver is normal in size and attenuation. No focal hepatic lesions\nare identified.  The previously described lesion in segment V of the liver is\nnot seen on the current examination. The portal vein is patent. There is no\nintra or extrahepatic biliary 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 right adrenal gland is normal. A 1.4 x 0.6 cm left adrenal\nlesion is unchanged in size from the prior examination when it measured 1.3 x\n0.6 cm.\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 in caliber and shows no evidence of\nobstruction.  There are few colonic diverticuli noted however there is no\nevidence of diverticulitis.\n\nVESSELS: There is moderate calcified atherosclerosis of the abdominal aorta\nhowever the abdominal aorta is normal in caliber.  There is no aortic\ndissection.\n\nLYMPH NODES:  A 13 mm left common iliac node is present (series 2 image 90).\n\nPELVIS: There is extensive diverticulosis of the sigmoid colon as well as wall\nthickening of the sigmoid with no evidence of acute diverticulitis.  The\nrectum is unremarkable.  The bladder is normal appearing.  There is no free\nfluid in the pelvis.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: A lytic lesion involving the vertebral body\nof L3 as well as focal sclerotic bone lesions involving the vertebral bodies\nof L4 and L5 are unchanged. The patient is post left hip Girdlestone\narthroplasty with a femoral head prosthesis and proximal femoral rod, with the\njoint space filled with mixed soft tissue and fluid density, unchanged from\nprior examination. Sclerotic changes across the cortex of the left proximal\nfemur reflect chronic metastasis. A soft tissue mass involving the right tenth\nrib described previously\n(___) is no longer detectable.",
            "output": "1.  Previously-seen metastases within hepatic segment V and along the right\ntenth rib are no longer perceptible, reflecting treatment response.\n2.  Left adrenal metastasis is stable since ___, markedly decreased in\nsize in comparison to earlier exams.\n3.  Unchanged osseous metastases and enlarged left common iliac lymph node.\nLeft hip Girdlestone arthroplasty is unchanged.\n4.  No new metastasis or enlargement of known lesions.\n5.  Extensive sigmoid diverticulosis."
        },
        {
            "input": "Lung Bases: Please refer to the CT chest obtained on the same day for details\nchest findings. Visualized lung bases are clear.\n\nAbdomen:  The focal thickening of left limb of left adrenal gland is\nunchanged. 3 mm hypodensity in the liver segment 4A/B is stable and too small\nto be characterized.  Gall bladder contains gallstones. The liver, spleen, and\npancreas are unremarkable. Kidneys are unremarkable. The abdominal aorta is\nnormal in caliber. No lymphadenopathy, free air or free fluid is seen. The\nstomach and duodenum are unremarkable. Loops of small and large bowel\ndemonstrate no signs of ileus or obstruction.\n\nPelvis: Bladder and prostate are unremarkable.\n\nBones: 9mm sclerotic lesion in the L5 vertebral body is similar to prior. The\npreviously sclerotic lesion in the L4 vertebral body has become lucent\nperipherally with sclerotic center, overall size unchanged at 10mm.  The 17 mm\nlytic lesion in the L3 vertebral body is unchanged.\nRight tenth rib deformity is stable.\nLeft hip prosthesis is noted. High attenuation in the surrounding soft tissue\nposteriorly is likely heterotopic bone formation and less likely an enhancing\nmass. Sclerotic changes of the left proximal femur is unchanged.",
            "output": "1. Unchanged appearance of sclerotic changes of the left femur and left hip\nprosthesis.\n\n2. Unchanged thickening of left limb of left adrenal gland.\n\n3. The previously sclerotic lesion in the L4 vertebral body has become lucent\nperipherally with sclerotic center, overall size unchanged. Unchanged bony\nlesions involving L3 and L5 spine.  Right 10 rib deformity is stable.\n\n4. No new suspicious lesion is identified.\n\n5. No recurrence of previously seen metastasis to hepatic segment 5 and right\n10 rib (___)."
        },
        {
            "input": "LOWER 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, making\ndifficult to evaluate for previously described 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 is enlarged at 13.4 cm, previously 15.3 cm.  Previously\ndescribed 6 mm hypodense lesion in the spleen is unchanged (5:64).  The other\npreviously described lesion is not seen on the current 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. \nSubcentimeter hypodensity in the right upper renal pole is too small to\ncharacterize but unchanged (8:22).  No new focal renal lesion or\nhydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  The colon and rectum are within normal limits. \nThere is no evidence of mesenteric lymphadenopathy by CT size criteria.\n\nRETROPERITONEUM: Previously described left retrocrural node measuring 6 mm, is\nunchanged on the current study (8:12).  No retroperitoneal lymphadenopathy by\nCT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden\nin the abdominal aorta and great abdominal arteries.  Similarly to the prior\nstudy, the left common femoral artery and superficial femoral artery are\ntortuous and ectatic in course, particularly in the region of the left hip\nprosthesis.  The left femoral vein is difficult to follow along its course,\nand often not identified.  These are unchanged findings since the prior scan.\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:  Compared with the prior study, the previously\ndescribed heterogeneously enhancing irregular mass along the L5 vertebral body\ninvading into the musculature and L5 neural foramen has significantly\ndecreased in size.  On the current study, there is no discrete, measurable\nenhancing mass in this region (5:87, 88).  In addition, there is better\ndelineation of fat planes in this region, including the paraspinal\nmusculature, with persistent cortical irregularities of the vertebral body and\ntransverse process (5:86).\n\nThe lucent lesion at the inferior aspect of the L4 vertebral body has\nincreased in size now measuring 2.7 cm, compared with 1.5 cm previously\n(10:41).  An L3 superior endplate Schmorl's node is unchanged.  Sclerotic foci\nin the L5 and the right iliac bone (5:95) are unchanged.\n\nAgain, the patient is post total left hip arthroplasty, with unchanged\nconfiguration of the unusual appearing of the left femoral intra medullary pin\nand femoral head prosthesis.  Substantial soft tissue thickening in the left\nhip and groin are similar, as are a moderate-sized effusion (5:106) and\nheterogeneous hyperdensities about the left hip, which may be heterotopic\nossification.  The previously seen enhancing 2.3 cm lesion posterior to the\nleft proximal femur enhances less on the current study (5:113).",
            "output": "1.  Compared with the CT from ___, the previously described enhancing\nmass along the L5 vertebral body has decreased in size, resulting in better\nfat plane delineation in this region in in the paraspinal musculature.  There\nis no discrete measurable enhancing mass in this region on the current study. \nIn addition, a previously seen enhancing 2.3 cm lesion posterior to the left\nproximal femur enhances less on the current study.\n\n2.  The previously described 1.5 cm lucent lesion in the L4 vertebral body has\nincreased in size, now measuring 2.7 cm.\n\n3.  Degree of splenomegaly has decreased, with an unchanged 6 mm splenic\nhypodensity.  The other 6 mm splenic hypodensity is not visualize on the\ncurrent study, likely due to contrast bolus timing.\n\n4.  Grossly stable configuration of the left hip arthroplasty with surrounding\nedema, joint effusion, and tortuous vasculature."
        },
        {
            "input": "LOWER CHEST: Evaluation of the lung bases is limited by respiratory motion. \nThere is a dominant left lower lobe lung nodule and left pleural\nirregularity/thickening, which is better assessed on the prior 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. \nPortal venous system 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 an 8 mm hyperdense lesion in the interpolar region of the right\nkidney (02:17), which is too small to characterize, but may represent a\nhemorrhagic or proteinaceous cyst.  It is unchanged from the prior CT.  There\nis a parapelvic cyst on the left.  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.  Normal appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nnonspecific pelvic fat stranding (2:62), stable.\n\nREPRODUCTIVE ORGANS:  Uterus is heterogeneous in attenuation throughout.\n\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 fracture.  Left acetabular fracture is unchanged from ___.  The sacrum is heterogeneous and mottled in appearance, of unclear the\netiology.  This is unchanged in appearance compared to the prior study.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal process.\n2. Mild pelvic fat stranding is nonspecific and may represent a small amount\nof fluid from post-treatment change, unchanged from ___.\n3. Unchanged left acetabular fracture.\n4. The sacrum is heterogeneous and mottled in appearance, unchanged.  This is\nof unclear etiology, and may reflect metastases or post-treatment change. \nCorrelate with treatment history.\n5. Known left lower lobe nodule and pleural thickening is better assessed on\nthe prior outside facility CT.\n6. For staging details, please refer to the recent outside facility PET-CT."
        },
        {
            "input": "VASCULAR:\n\n Pre EVAR Angiogram of the Abdominal Aorta\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal:  3.9 x 3.5 cm\nAt lowest renal artery left: 3.6 x 3.4 cm\n5 mm below lowest renal artery: 4.4 x 3.6 cm\n10 mm below lowest renal artery:  4.8 x 3.6 cm\n15 mm below lowest renal artery:  4.8 x 3.8 cm\n\nANEURYSM Suprarenal\nDiameter (Cross-sectional): 5.4 x 4.6 cm\nDiameter (Center-line): 5.4 x 4.9 cm\nLength: 11.3 cm\nVolume: 153 cc\n\n1. Aneurysm: 153 ml\n2. Renal to Aortic bifurcation: 153 ml\n3. Renal to Iliac bifurcation: 181 ml\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: aneurysm 2.6 cm; Left: aneurysm 2.4 cm.\nExternal Iliacs: Right: aneurysm 1.5 cm; Left: normal 1.1 cm.\nInternal Iliacs: Right: normal 0.8 cm; Left: normal 0.8 cm.\nFemoral: Right: aneurysm 1.8 cm; Left: normal 1.3 cm.\n\nTortuosity Iliacs:  Right: mild; Left:  moderate.\nFemoral Calcifications: Right: moderate; Left: moderate.\n\nIncidental accessory left hepatic artery arising from the left gastric artery.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a small area of heterogeneous arterial hyper\nenhancement in the periphery of segment V/segment VI, probably reflecting a\nhemangioma (series 3, images 55-57).  There is no evidence of biliary\ndilatation.  The gallbladder is unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Indeterminate 1 cm right adrenal nodule (34 Ho___ units)\n(series 601, image 37).  The left adrenal gland is unremarkable.\n\nURINARY: There is a 3 mm nonobstructing stone in the lower pole of the right\nkidney.  No left nephrolithiasis.  No hydronephrosis.  Multiple\nhypoattenuating lesions are too small to completely characterize.\n\nGASTROINTESTINAL: No bowel obstruction or ascites.  No mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is noretroperitoneal lymphadenopathy.\n\nPELVIS: There is no pelvic lymphadenopathy.  There is no free fluid in the\npelvis.\n\nBONES: No worrisome osseous lesions.\n\nSOFT TISSUES: There is a small, fat containing umbilical hernia and a\nmoderate, fat containing left inguinal hernia.",
            "output": "1. An infrarenal abdominal aortic aneurysm extending from the origin of left\nrenal artery to the aortic bifurcation measures up to 5.4 cm in diameter. \nCommon iliac artery aneurysms measure up to 2.6 cm on the right and 2.4 cm on\nthe left.  A right common femoral artery aneurysm measures up to 1.8 cm.\n2. Indeterminate 1 cm right adrenal nodule and nonobstructing nephrolithiasis\nin the lower pole of the right kidney measuring up to 3 mm."
        },
        {
            "input": "Partial visualized left larger than right small pleural effusions with passive\natelectasis.\n\nNo focal liver lesions identified.  Post cholecystectomy.  Patent SMV, splenic\nvein, portal venous system. Homogeneous appearance of the pancreas without\napparent focal lesion or main ductal dilation.  A small amount of ascites is\npresent throughout the abdomen and pelvis. Fat stranding is noted throughout\nthe anterior pararenal space adjacent to the pancreas, with mild generalized\nretroperitoneal fat stranding.\n\nNormal spleen and adrenals.\n\nNo hydronephrosis.  A tiny peripheral subcentimeter midpole left renal\nhypodensity, probable cyst or angiomyolipoma.\n\nContrast within stomach. Mildly thickened distal duodenal folds. Contrast and\nstool within the colon. The retrocecal appendix contains contrast and\ndemonstrates no more adjacent fat stranding in the remainder of the abdomen\nand pelvis. Normal TI. No small bowel dilation.\n\nNormal caliber abdominal aorta. Patent celiac trunk and SMA.\n\nNondistended bladder. Retroverted anteflexed uterus. No pelvic adenopathy.\n\nMild within evident total spine. No suspicious osseous lesions.",
            "output": "-Retroperitoneal and intraperitoneal fat stranding, as detailed above,\npossibly reflecting interstitial edematous pancreatitis with peripancreatic\nedema, for which correlation with pancreatic enzymes is suggested. Homogeneous\nappearance of the pancreas without evidence of necrotizing pancreatitis on\nthis single phase study. Thickening of distal duodenal folds, most likely\nedema secondary to pancreatitis.\n-Normal appearance of the appendix containing contrast.\n-Partially visualized left larger than right pleural effusions.\n- Other findings as detailed above."
        },
        {
            "input": "Lower Thorax: There are small bilateral pleural effusions with adjacent\ncompressive atelectasis, similar to previous.There is no cardiomegaly.\n\nACUTE PANCREATITIS:\n\nExtent of pancreatic non-enhancement on portal venous phase: None\nIs there a collection:Yes - there are acute peripancreatic fluid collections,\nor a single loculated collection, with the largest pockets measuring 1.5 x 3.8\ncm posterior and inferior to the pancreatic body/tail, and another larger\npocket inferior to the pancreatic head and uncinate process that insinuates\nbetween and along the mesenteric vessels, measuring approximately 2.5 x 7.3\ncm, which has increased significantly in size from previous.  Both of these\nare not accessible for percutaneous drainage.\nIf yes, choose one description per question:\n\n1. Relation with pancreas:  See above\n2. Encapsulation: There is rim enhancement around the inferior peripancreatic\ncollection, and less so around the more superior pocket, which may be related\nto peritoneal enhancement rather than true encapsulation given the time course\nof patient's presentation\n3. Content: Simple fluid, no gas\n4. Mass effect: None\n5. Shape: Irregular\n6. Loculated gas bubbles: No\n7. Air-fluid levels: No\nVascular complications: none\nPancreatic duct: Normal\nCalcifications: None\n\n\nPeritoneal Cavity: There is a small amount of free fluid in the pelvis.  There\nis no free air.\n\nLiver: The liver is normal with no focal lesion.\n\nGallbladder and Biliary System: The gallbladder has been surgically\nremoved.There is pneumobilia and likely related to recent sphincterotomy.\nThere is no intra or extrahepatic biliary dilatation.\n\nSpleen: The spleen is nonenlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits with\nno evidence of bowel obstruction.\n\nPelvis:  The urinary bladder is unremarkable.  There is an unchanged\nhyperdense structure at the level of the urethra that is indeterminate.  The\nuterus and ovaries are unremarkable with no adnexal mass.\n\nLymph Nodes: There is no significant mesenteric, pelvic or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "Interval increase in size of acute peripancreatic fluid collections containing\nsimple fluid, which are not accessible for percutaneous drainage.  No\npancreatic necrosis."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Small accessory spleens are identified (601b:36).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions 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 (2:72-73).\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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture. There is grade I retrolisthesis of L5 on S1.  The abdominal\nand pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain. Specifically, normal appendix.\n\nNOTIFICATION:  The above findings were communicated in person by Dr. ___\nto Dr. ___ at 14:45 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 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.\nNo suspicious renal lesions. Previously seen left hydroureteronephrosis has\nresolved. No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No evidence of small-bowel\nobstruction.  The colon and rectum are within normal limits. Relative\nthickening of the sigmoid colon is favored to represent under-distention. \nThere is no pericolonic stranding. Appendix is normal. No free fluid in the\nabdomen.  No intra-abdominal abscess.\n\nPELVIS: Perivesicular stranding and bladder wall thickening are noted, less\nsevere in comparison to the study dated ___ (04:112).  Distal\nureters are normal. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable for\npatient age.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted. The left renal vein is largely recannulized with only a small\neccentric filling defect no appreciated (4:63).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Perivesicular fat stranding and bladder wall thickening. These changes are\nindeterminate and may represent acute cystitis or slowly resolving changes\nfrom the previously seen severe cystitis on the study dated ___.\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. \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\nredemonstration of nonspecific left perirenal stranding without focal fluid\ncollection or hydronephrosis.  No suspicious focal mass lesions.  There is a\npunctate focus of calcification in the superior pole of the right kidney that\nappears cortical rather than within the collecting system.\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 or fat stranding. The\nappendix is not visualized.\n\nPELVIS: The urinary bladder demonstrates mild anterior wall thickening without\nsubstantial stranding..  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple variable-sized rounded subcutaneous densities with\nadjacent foci of air consistent with injection granulomas along the anterior\nabdominal wall.",
            "output": "1. No substantial change in appearance of nonspecific mild left perinephric\nstranding without focal fluid collection or hydronephrosis.  Punctate focus of\ncalcification in the superior pole of the right kidney may represent a tiny\nnonobstructing calculus.  However no hydronephrosis seen on the right side\neither.\n2. On this noncontrast study, no bowel wall thickening or fluid collections\nnoted.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of thoracic findings."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  The celiac artery is\nseverely narrowed at its origin, unclear whether fixed or transient, followed\nby mild poststenotic ectasia.  The SMA, ___, and renal arteries are widely\npatent.  The right internal iliac artery is mildly aneurysmal measuring up to\n1.2 cm.  The left internal iliac artery is ectatic.  Bilateral external iliac\narteries, common femoral arteries, and superficial femoral arteries are widely\npatent.\n\nLOWER CHEST: Small bilateral pleural effusions are present.  A consolidation\nin the right lower lobe may represent aspiration or pneumonia.  Consolidation\nin the left lower lobe is likely atelectasis.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities in the liver measuring upto 1.8 cm are likely cysts or\nbiliary hamartomas.  Subcentimeter hypodensities in the liver too small to\ncharacterize.  A 5 mm arterially enhancing lesion in segment 8 of the liver is\nlikely a perfusional abnormality.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains hyperdense material\nwhich is likely vicarious excretion of contrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A 1.6 cm cystic lesion in the pancreatic head\nis noted.  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.  The left\nadrenal gland is thickened and may represent hyperplasia.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 3.0 cm hypodensity in the lower pole of the right kidney is likely a cyst\ncontaining septations however difficult to assess in the setting of streak\nartifact.  There is no evidence of stones or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  An enteric tube terminates in the distal stomach.  The\nsmall bowel anastomosis is noted in the right lower quadrant.  Colon\ndiverticulosis is also noted.  There is presacral and perirectal edema. \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 bladder is underdistended and contains a Foley catheter.  There is\nno evidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES:  Patient is status post open reduction internal fixation of day left\nintertrochanteric fracture.  The lesser trochanter and attached iliopsoas\nmuscle is completely avulsed and retracted approximately 2.5 cm cranially and\ndisplaced anteriorly.  Again seen is a left inferior pubic ramus fracture,\nleft superior pubic ramus fracture extending to the acetabulum, left sacral\nalar fracture, left L2 transverse process fracture, and multiple acute and\nchronic nondisplaced rib fractures including the left seventh, eighth, ninth\nand right seventh and eighth ribs.  A chronic left wrist fracture with\nhardware is seen on scout images for which dedicated wrist films was obtained.\nOn scout images, hardware seen on the right wrist from prior fracture and the\nbones appear slightly abnormal.\n\nSOFT TISSUES:  Re- demonstrated is a hematoma surrounding the proximal femoral\nfracture proximal and extending down the proximal thigh without evidence of\nactive extravasation.  The inferior portion of the hematoma is not imaged. \nMultiple foci of gas is seen within the soft tissues adjacent to the fracture\nlikely postsurgical.  No hematoma is detected around the sacral and pelvic\nfractures.  The left iliacus muscle appears edematous likely secondary to\ninjury from the surgery without a discrete hematoma.  An umbilical hernia\ncontaining fat is noted.  There is extensive subcutaneous edema.",
            "output": "1. Patient is status post ORIF of a left intertrochanteric fracture. \nPostsurgical changes are noted.  No evidence of active extravasation in the\nhematoma extending down the proximal thigh.\n2. No hematoma is detected around the known sacral and pelvic fractures. The\nleft iliacus muscle is edematous but without a discrete hematoma.\n3. Multiple acute and chronic bilateral nondisplaced rib fractures are noted.\n4. On scout images, hardware is seen on bilateral wrists likely from prior\nchronic fractures.  Dedicated left wrist films have been obtained.  The bones\nof the right wrist appears slightly abnormal.  Recommend dedicated right wrist\nfilms if evidence of trauma.\n5. Visualization of the  right kidney is limited by artifact, however there\nappears to be septa within the right renal cyst.  Recommend non-emergent\nultrasound evaluation.\n6. A 1.6 cm pancreatic head cyst is noted.  Recommend non-emergent ultrasound\nevaluation.\n7. Bilateral pleural effusions are present.  Consolidation in the right lung\nbase may represent aspiration or pneumonia.\n\n\nRECOMMENDATION(S):  Dedicated right wrist films if evidence of trauma.\nUltrasound evaluation of renal and pancreatic cystic lesions.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:18 ___, 25 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST:\n\nThe lung bases are clear. There is no pericardial or pleural effusions\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homoenous attenuation throughout. \nThere is no evidence of focal lesions.  2 tiny hyperdensities, sub 5 mm ,1 in\nthe left and having a right upper lobe are seen, too small to characterize,\nlikely benign There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is slightly dilated, without stones or\ngallbladder 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, focal renal lesions or hydronephrosis.  There\nare 2 small hypodensities, likely cysts 1 in the right, 11 mm and the other in\nthe left, 6.6 mm\n\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR:  The abdominal aorta is not demonstrated. There is moderate calcium\nburden in the distal aorta. The great arteries and veins in the abdomen pelvis\nare patent.\n\nGI:  An NG tube is seen with its tip pre-pyloric there is no small bowel\ndilatation and no obstructing lesion of the common\n\nABDOMEN: There is no ascites, no mesenteric lymphadenopathy and no omental\nthickening\n\nPELVIS:\n\nThe urinary bladder wall is thickened with slight trabeculation. There is the\nsmall diverticulum in the left with a small stone within it.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.  The prostate is not enlarged\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "Thick-walled urinary bladder likely due to rule out of obstruction\n\nBladder diverticulum containing tiny bladder stone"
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion with associated\natelectasis.  An underlying infectious process can not be excluded. Heart size\nis enlarged.  Mitral valve clip and coronary 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 or\nextrahepatic biliary dilatation.  There is mild periportal edema.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is stable\nductal dilatation.  10 mm cystic focus at the pancreatic head is stable. \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 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. There is stool\nseen diffusely within large bowel and rectum.  The appendix appears 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 to severe\natherosclerotic disease is noted.\n\nBONES: There are chronic degenerative changes of the thoracolumbar spine with\nanterolisthesis of L3 and L4 and multilevel disc space narrowing.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild edema and soft tissue swelling of the right groin.\nNo underlying large hematoma.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1. Mild soft tissue swelling of the right groin at the access site.  No large\nfocal hematoma.  No retroperitoneal hematoma.\n2. Findings within the abdomen/pelvis are similar to most recent prior from ___."
        },
        {
            "input": "LOWER CHEST: Again seen is a small left-sided pleural effusion and bibasilar\natelectasis.  Multiple cardiac leads are noted.  There are calcifications\nalong the apical septal wall of the left 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.  There are innumerable calcified\ngallstones without CT evidence of acute cholecystitis.\n\nPANCREAS: The pancreas is atrophic and several calcifications are noted along\nthe pancreatic parenchyma, which may be vascular in nature.  There is no focal\nlesion or 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 adrenal gland is normal.  Again seen is nodular thickening\nof the anterior limb of the left adrenal gland.\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.  And there are numerous colonic diverticula without evidence\nof acute diverticulitis.  The rectum is within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  The prostate is enlarged and contains multiple\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 AND SOFT TISSUES:  Redemonstrated is a large, left psoas muscle hematoma\nmeasuring 5 x 13.3 x4.6 cm (previously 4.9 x 5.4 x 13.4 cm).  There is\nminimal, persistent stranding along the retroperitoneum and mild thickening of\nthe left anterior pararenal and left lateroconal fascia.  Multilevel\ndegenerative changes are seen throughout the spine.",
            "output": "1.  Stable left psoas hematoma.\n2.  Severe atherosclerosis.\n3.  Persistent, small left pleural effusion with bibasilar atelectasis.\n4.  Cholelithiasis without cholecystitis.\n5.  Diverticulosis without diverticulitis."
        },
        {
            "input": "Musculoskeletal: There is no evidence of worrisome osseous lesions or acute\nfracture.  An incompletely evaluated left psoas muscle hematoma appears\nslightly smaller compared to the previous CT abdomen and pelvis dated ___ and measures approximately 52 x 53 mm (previously 62 x 63 cm).  The left\nrectus femoris muscle appears larger, more rounded and hyperintense suggestive\nof a new intramuscular hematoma.  This finding is incompletely evaluated but\nmeasures approximately 36 x 36 mm.  The left adductor muscles are hypodense\nsuggestive of edema.\n\nPELVIS: There are scattered diverticuli in the sigmoid colon.  The urinary\nbladder and distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute osseous abnormalities.  No evidence of a left hip fracture.\n2. New left leg swelling is concordant with the new hyperdense rounded left\nrectus femoris muscle in keeping with an intramuscular hematoma.  This is\nincompletely imaged.\n3. The left rectus psoas hematoma is incompletely evaluated but appears\nslightly smaller compared to the previous 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 attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 in the\ninterpolar region, are unchanged since the prior study.  There are bilateral\nextrarenal pelvises.  No perinephric abnormalities.\n\nGASTROINTESTINAL: A small hiatal hernia is unchanged.  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.\n\nBONES: There 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 abdominopelvic metastasis.\n2.  Small hiatal hernia.\n3.  Please see the dedicated CT chest report of the same date for the\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The hepatic parenchyma enhances homogeneously.  Focal area of\ndecreased attenuation adjacent to the falciform ligament is likely focal fat\ndeposition, unchanged from before.  No suspicious focal liver lesions\nidentified.\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.  There is an accessory\nspleen at the hilum..\nADRENALS:  No right adrenal nodules.  The known 7 mm left adrenal nodule\nappeared more conspicuous on the prior exam and is not well visualized today.\nURINARY: No hydronephrosis or solid enhancing renal masses identified. \nUnchanged 2 cm cyst arising from the lower pole of the left kidney.\nGASTROINTESTINAL: No bowel obstruction.  Moderate stool burden throughout the\ncolon.\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.  Minimal calcified\natherosclerotic plaque is noted within the distal abdominal aorta and left\ncommon iliac artery.\n\nPELVIS:\nThe bladder is minimally distended and unremarkable.  The uterus and adnexae\nare unremarkable.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1. No metastatic disease in the abdomen or pelvis.\n2. Previously visualized 7 mm left adrenal nodule is not conspicuous on\ntoday's exam.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: For thoracic findings, please refer to the chest CT done the same\nday.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  At\nthe periphery of segment 6, there is a 8 mm lesion only seen on the arterial\nphase that would correspond to a hemangioma.  This lesion is unchanged.  there\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ncholedoch measures 7.5 mm the gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Stability of a 7.5 mm left adrenal nodule.  The right adrenal is\nnormal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nUnchanged 2.1 cm cyst at the lower pole of the left kidney.  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 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 signs of metastatic disease in the abdomen or pelvis.\n2. Unchanged 7 mm left adrenal nodule.\n3. 8 mm hyperenhancing lesion in the periphery of segment 6 corresponding most\nprobably to a flash filling hemangioma.\n4. Please refer to the chest CT for the thoracic finding."
        },
        {
            "input": "LOWER 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 a 0.9 cm hyperenhancing lesion in the periphery of the segment 6\nacromion hemangioma, unchanged from prior exam.  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 normal in size with no focal splenic lesion. There is a\nsmall splenule adjacent to spleen..\n\nADRENALS: There is a 0.7 cm left adrenal nodule, unchanged from prior exam\nlikely representing a small adenoma. The right adrenal gland is normal.\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\nare bilateral extrarenal pelvises. 2.1 cm left upper pole cyst is unchanged. \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 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 disease in the abdomen or pelvis.\n2. Stable 7 mm right adrenal nodule, likely representing adenoma.\n3. Stable 8 mm lesion in the right hepatic lobe likely representing\nhemangioma."
        },
        {
            "input": "LOWER 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.  Hyperenhancing lesion in segment 6\nseen on the prior exam is not well appreciated on the current study.  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: Unchanged 7 mm nodule in the left adrenal gland, better appreciated\non the prior exam (6:265).  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.  Bilateral\nextrarenal pelvises are noted.  Simple cyst in the interpolar region of the\nleft kidney measures 1.9 cm additional subcentimeter hypodensity in the lower\npole of the left kidney is too small to characterize, but also likely\nrepresents a simple 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 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.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. Unchanged 7 mm left adrenal nodule.\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. 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. \nA 2.3 cm cyst is seen in the lower pole of the left kidney.  Bilateral\nextrarenal pelvis noted.  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.\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 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 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 2.3 cm simple cyst is seen arising from the lower 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. 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 grossly 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.  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 evidence of metastatic disease in the abdomen or pelvis.  Please see the\nseparate report for same day CT chest 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.  Mild central intrahepatic biliary\ndilatation is unchanged.  Mild dilatation of the CBD measuring 1.0 cm is\nunchanged since at least ___.  The CBD tapers normally to the ampulla. \nNo obstructing lesion identified.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 2.1 cm simple cyst in the lower pole of the left kidney is unchanged.  There\nis no evidence of suspicious renal lesion.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  A moderate amount\nof stool seen throughout the colon.  Otherwise, the colon and rectum are\nunremarkable.  The appendix is not visualized although 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: The uterus and bilateral adnexae are grossly 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 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. 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 a 7 mm are new hypervascular lesion in the posterior segment of the\nright lobe of the liver.  There is minimal central intrahepatic biliary\ndilatation, nearly resolved compared to most recent study.  There is no\nevidence of extrahepatic biliary dilatation.  There is prominent common\nbiliary duct without mechanical obstruction.  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. \nThere is redemonstration of a simple cyst in the lower pole of the left in the\nkidney, again measuring 2.1 cm.  There is no evidence of solid 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 and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There are nonpathologic, slightly enlarged aortocaval and\npara-aortic lymph nodes that are indeterminate, but in the setting of thoracic\ndisease progression, metastatic disease cannot be excluded.  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. New 7 mm hypervascular liver lesion which could be further characterized\nwith MRI.\n2. Interval slightly increased size of aortocaval and para-aortic lymph nodes,\nnot meeting criteria for pathologic enlargement; however in the setting of\nthoracic disease progression, metastatic disease cannot be excluded.  Close\nattention on follow-up is advised.\n3. Please refer to separate report of CT chest for description of the thoracic\nfindings.\n\nRECOMMENDATION(S):  MRI of the abdomen\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:54 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.  A\npreviously evidenced 7 mm hypervascular lesion in the posterior segment of the\nright lobe of the liver, is not seen in this study, likely from differences in\nthe phase in which the images were acquired.  There is minimal, central\nintrahepatic biliary dilatation, without evidence of extrahepatic biliary\ndilatation.  There is a prominent biliary duct, without mechanical\nobstruction.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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. \nAgain seen is a simple cyst in the lower pole of the left kidney, measuring\n2.5 x 2.3 cm.  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. 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 grossly 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 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. Please refer to separate report of CT chest for description of the thoracic\nfindings."
        },
        {
            "input": "Lung bases clear.\n\nNormal liver. Patent portal veins. Normal appearance of pancreas without main\nductal dilatation.  Normal spleen or adrenals.\n\nNo hydronephrosis.  1.5 cm midpole left renal cyst.  Bilateral extrarenal\npelvis is noted.\n\nContrast within stomach. Stool throughout colon.  Normal appendix.  No small\nbowel dilatation.\n\nNormal abdominal aorta.  No retroperitoneal or mesenteric adenopathy.\n\nSmall foci of gas within the nondependent bladder, most likely secondary to\nrecent catheterization.  Anteverted uterus.  No free pelvic fluid. No pelvic\nadenopathy.\n\nNo suspicious osseous lesions.",
            "output": "-No evidence of abdominopelvic metastatic disease.\n-Small foci of gas within nondependent bladder. Recommend correlation with\nrecent catheterization."
        },
        {
            "input": "Please refer to separate chest CT report for thoracic details.\n\n Normal liver, gallbladder and pancreas. Patent portal veins. Normal spleen\nand adrenals.\n\nNo hydronephrosis or suspicious renal lesion. A 1.8 cm midpole left renal cyst\nis noted.\n\nContrast and ingested material within the stomach.  Stool and contrast within\ncolon. Normal appendix. Normal appearance of small bowel loops.\n\nNormal caliber abdominal aorta with minimal atherosclerosis. Subcentimeter\nretroperitoneal and mesenteric nodes.\n\nNo focal bladder wall thickening. No free pelvic fluid. Anteflexed uterus. No\npelvic adenopathy.\n\nNo suspicious osseous lesions.",
            "output": "-No evidence of abdominopelvic metastatic disease.\n-Please refer to separate chest CT report for thoracic details."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 appendix is\nenlarged measuring 1 cm with surrounding fat stranding (601; 35).  There is\nassociated cecal wall thickening and surrounding fat stranding (602; 26). \nThere are prominent right lower quadrant mesenteric lymph nodes which measure\nup to 9 mm (2; 50).  There is no drainable fluid collection.  There is no\nvisualized appendicolith.  There is sigmoid diverticulosis without evidence of\nacute diverticulitis.\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 lymphadenopathy.  There is no pelvic\nor 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.  There is diastasis\nrecti.",
            "output": "1. Enlarged appendix and inferior cecal wall thickening with surrounding fat\nstranding and regional lymphadenopathy concerning for appendicitis.  No\ndrainable fluid collection or radiopaque appendicolith."
        },
        {
            "input": "The imaged lung bases are clear.\n\nAbdomen: Noncontrast enhanced liver, spleen, pancreas, gallbladder, adrenal\nglands, and kidneys are unremarkable. There is no hydronephrosis or renal\nstone. The abdominal aorta appears normal in course and caliber and contains\nscattered calcification. . There is no lymphadenopathy. The stomach is\nrelatively collapsed. There is no evidence of bowel obstruction.\n\nPelvis: No bowel obstruction or bowel wall thickening is seen. There is\ncolonic diverticulosis without evidence of acute diverticulitis. The appendix\nis normal. The urinary bladder appears unremarkable. The uterus is retroverted\nand may contain small fibroid. . Trace dependent free fluid is within\nphysiologic range. No evidence of a retroperitoneal hematoma is seen.\n\nBones: No concerning osteoblastic or lytic lesion is seen.",
            "output": "No evidence of retroperitoneal hematoma. No CT findings to explain epigastric\nand back pain and hematocrit drop."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 distended and demonstrates\nsignificant diffuse wall edema.  There is a punctate focus of gas within the\ngallbladder lumen, which may represent a small gas containing gallstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions 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 is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nThere is a tiny focus of air adjacent to the right SI joint, likely\ndegenerative. There are also mild degenerative changes at L4-5 with vacuum\nphenomena, intervertebral disc space loss and endplate sclerosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "The gallbladder is distended with diffuse wall edema.  A punctate focus of gas\nwithin the gallbladder lumen may represent a small gas containing gallstone. \nThese findings are suspicious for acute cholecystitis.  A right upper quadrant\nultrasound may be considered for further evaluation if clinically indicated.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:24 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is severe calcium burden in the abdominal aorta and great abdominal\narteries.  No abdominal aortic aneurysm is seen.  Mildly tortuous common iliac\narteries are seen bilaterally.\nBoth common iliac arteries are minimally narrowed by calcium burden, right\nslightly worse than left.  On the right, there is 60% stenosis with\nsignificant calcium burden.  Overall diameter of the right distal common\nfemoral artery measures 8 mm and the true lumen measures 4 mm (7: 274).  On\nthe left, there is 50% stenosis with significant calcium burden.  Overall\ndiameter of the left distal comon femoral artery measures 7 mm and true lumen\nmeasures 4 mm.  However, it maybe overestimated due to blooming effect.\n\nRight and left axillary arteries are patent and measure 7 mm in diameter\nbilaterally.\nNECK:  The thyroid is not visualized.  The neck vessels are patent.  There is\nno cervical adenopathy.\n\nCHEST: There are multi segmental right upper and lower lobe pulmonary emboli.\nExtensive aortic arch calcification is seen.  Moderate calcification of aortic\nvalve is noted. The heart is mildly enlarged with evidence of mild pulmonary\nhypertension. For detailed report of the findings in the chest, please refer\nto the CT chest from the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout, but\nnodular. There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, and contains hyperdense sludge without gallbladder wall\nthickening.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy with a 5.6 x 1.7 cm residual\nsplenic tissue.\n\nADRENALS:  There is a 1.2 x 1.5 cm hypodense nodule in the left adrenal gland,\nlikely an adenoma.  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 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. \nDiverticulosis of the cecum, ascending colon and sigmoid colon are seen\nwithout evidence of diverticulitis.  There is an umbilical hernia containing\nsmall loops of bowel.  There is no evidence of obstruction.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The anterior bladder wall is slightly thickened in a small foci of air\nis seen in non dependent portion.  Foley is in place.  Distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Atrophic uterus with multiple calcified fibroids is seen.\nRight adnexal cyst measures 1.6 x 1.8 x 2.2 cm in contains simple fluid.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMinimal left convex scoliosis seen with severe degenerative changes of L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multi lobar and segmental pulmonary emboli on the right.\n2. Severe calcium burden throughout the abdominal aorta and its major\ntributaries.\n3. Bilateral common femoral artery stenosis, right worse than left, with\nsignificant calcium burden.\n4. Bilateral patent axillary arteries, measuring up to 7 mm in diameter.\n5. Umbilical hernia containing loops of bowel without umbilical obstruction.\n6. Please refer to separate report for detailed findings in the chest.\n\nNOTIFICATION:  Critical findings regarding the pulmonary emboli were\ncommunicated by Dr. ___.\n The impression and recommendation above was entered by Dr. ___ on\n___ at 15:20 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 low homogenous attenuation throughout,\nsuggestive of steatosis.  Scattered hypodensities throughout the liver are\nnonspecific but most likely represents biliary hamartomas.  There is no\nevidence of concerning 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 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. \nMild degenerative changes in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic abnormality.  Specifically, no\nhydroureteronephrosis, urolithiasis, or inguinal hernia.\n2. 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 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 difficult to visualize\nsecondary to paucity of intra-abdominal fat and lack of enteric contrast. \nGiven these limitations, no definite secondary signs of appendicitis.\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 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. The appendix is not visualized.  However, there are no convincing secondary\nsigns of appendicitis.\n2. Otherwise, new acute findings in the abdomen or pelvis to account for\npatient's symptoms."
        },
        {
            "input": "No hepatic lesion is demonstrated.  There is no intra or extrahepatic biliary\ndilatation. The gallbladder is unremarkable.  The spleen is normal size.\n\nThere is no pancreatic mass or ductal dilatation.  The adrenal glands and\nkidneys are unremarkable.\n\nThere is minor atheromatous calcification involving the abdominal aorta which\nis normal caliber. There is focal narrowing of the celiac artery at its origin\nin keeping with median arcuate ligament syndrome.  No abdominal or pelvic\nlymphadenopathy is demonstrated.\n\nThere is moderate fecal loading present. No small or large bowel dilatation is\npresent.  The stomach is poorly distended, and not optimally assessed.\n\n2.8 x 2.3 cm hypodense structure is seen in the right adnexa (series 4 image\n64).  This may represent an enlarged ovary (for post menopausal state and in\ncomparison with the left side) or adnexal mass.\n\nNo osseous lesion is demonstrated. Advanced degenerative disc changes are\nnoted at L3-L4 on L5-S1 with endplate sclerosis.",
            "output": "1. 2.8 x 2.3 cm right adnexal structure may represent an asymmetrically\nenlarged right ovary or adnexal mass.  CT is limited in assessment of this\nfinding and further characterization with pelvic ultrasound is recommended. A\ncommunication of this finding was issued via the radiology non urgent critical\ncommunication system at 11:45.\n2. Moderate fecal loading."
        },
        {
            "input": "LOWER CHEST: There is mild scattered subsegmental atelectasis in the bilateral\nlung bases.  There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is a heterogeneously enhancing mass in the left\nhepatic lobe measuring 7.1 x 4.5 cm (series 5, image 21), decreased in size\nand overall enhancement status post Y-90 radioembolization on ___,\npreviously 8.3 x 5.4 cm on outside CT of the abdomen from ___,\nconsistent with known cholangiocarcinoma.  There is mild intrahepatic biliary\nductal dilatation in segment II peripheral to the mass.  Two 7-8 mm satellite\nlesions in segment II are unchanged (series 5, image 15).  5 mm hypodensities\nat the border of segments VII and VIII (series 7, image 16) and more\ninferiorly in segment VII (series 7, image 29) are too small to characterize\nin demonstrated restricted diffusion on outside MRI of the abdomen from ___.  A tiny cyst is also noted in segment VI (series 7, image 66). \nThe common bile duct is top normal in caliber, measuring up to 7 mm.  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 unremarkable.  Nodular thickening of the\nleft adrenal apex measuring 1 cm is unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are a few tiny cysts in both kidneys.  There is no evidence of solid\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber.  The colon 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.  Bilateral adnexal regions\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.  There are mild\natherosclerotic calcifications of the abdominal aorta.  Hepatic arterial\nanatomy is conventional.  Portal veins are patent, noting that the left portal\nvein is diminutive.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe multilevel degenerative changes of the lumbar spine, with\nendplate sclerosis and irregularity, and vacuum disc phenomenon.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Known cholangiocarcinoma the left hepatic lobe measuring approximately 7.1\nx 4.5 cm has decreased in size and overall enhancement status post Y-90\nradioembolization compared to outside CT of the abdomen from ___.  Two\nsubcentimeter satellite lesions segment II are unchanged from prior.\n2. Two 5 mm hypodensities in the right hepatic lobe are too small to\ncharacterize.  Attention on follow-up is recommended."
        },
        {
            "input": "LOWER CHEST: There is a trace right pleural effusion and right basilar\natelectasis.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic segment VII/VIII there are 2 adjacent hypodense\ncollections.  No rim enhancement is visualized.  The most superior collection\nmeasures 3.1 x 2.2 x 3.0 cm (series 2: Image 11).  The more inferior\ncollection measures 2.5 x 2.4 x 2.9 cm (series 2: Image 17), and appears to\nconnect to a prior percutaneous transhepatic biliary drain tract (series 601:\nImage 24).  A right posterior percutaneous transhepatic biliary drain is\nvisualized extending into the duodenum.  Patient is status post left\nhepatectomy.  There is apparent thrombosis of a branch of the right middle\nhepatic vein with associated parenchymal hypoenhancement (series 2: Image 25).\nThere is mild intrahepatic biliary ductal 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: Spleen is mildly enlarged measuring 12.0 cm.  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 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. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume ascites..\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  No adnexal\nabnormalities 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. \nPatient is status post right hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Thrombosed branch of the middle hepatic vein.\n2. Two hypodense collections in the right hepatic lobe, likely representing\nbilomas.\n3. Mild intrahepatic biliary ductal dilatation that may be postsurgical in\nnature.\n4. Small volume ascites.\n5. Trace right pleural effusion or right basilar atelectasis.\n6. Mild splenomegaly, 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. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 hypodensity in the lower pole of the left kidney (60___:84)\nthat is too small to characterize, but may represent a cyst.  No enhancing\nrenal masses 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.  Normal appendix.  No free air free fluid\nwithin the abdomen or 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 unremarkable.\n\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\ncalcifications are seen in the distal abdominal aorta and proximal common\niliac branches.\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": "No acute findings on ct of 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 diminished 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 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 enlarged and has a lobular shape.  It\ncontains multiple circumscribed hypodense lesions, 1 with peripheral\ncalcification on the right.  There is no abnormal adnexal mass or fluid\ncollection.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 not identified but there is no secondary evidence an acute\ninflammatory process in the right lower quadrant.\n2. Enlarged leiomyomatous uterus as demonstrated previously.\n3. Fatty infiltration of the liver."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with bibasalar\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 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 2.3 x 1.9 cm\nhyperdense exophytic cyst is seen arising from the interpolar region of the\nleft kidney, unchanged from prior.  A 4 mm cortically based hyperdense focus\nwithin the interpolar region of the left kidney appears new, and may represent\na small focus of papillary necrosis.  Additional small cysts are seen in the\nbilateral kidneys.  There is no hydronephrosis.  Mild nonspecific perinephric\nstranding appears unchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable.  A gastrostomy tube is present,\nin unchanged position.  Small bowel loops demonstrate normal caliber and wall\nthickness throughout.  A small focus of extraluminal gas adjacent to the cecum\nhas decreased in volume over the interval, corresponding to interval decrease\nin free fluid surrounding the cecum.  No collection seen surrounding the\ncecum.  This finding may related to prior infectious or inflammatory process,\nwhich appears to be resolving. Residual high-density contrast is seen within\nthe colon and rectum, related to administration from recent prior examination.\nThe appendix is not seen, however there are no secondary signs of\nappendicitis.  There is no intra-abdominal or retroperitoneal hematoma.\n\nPELVIS: A Foley catheter is within the bladder, which contains a large amount\nof air and urine.  There is a small amount of simple free fluid within the\npelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized.  A 2.7 x 1.6 cm cystic\nstructure within the right adnexa appears unchanged from 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse anasarca is mild.",
            "output": "1. Status post percutaneous gastrostomy tube placement.  No intraperitoneal a\nretroperitoneal hemorrhage.\n2. 2.7 cm cystic structure within in a right adnexa may represent a\nparaovarian cyst.  Pelvic ultrasound could be performed for further\nevaluation, if clinically indicated.\n3. Stable bibasilar nonhemorrhagic pleural effusions."
        },
        {
            "input": "LOWER CHEST: Patchy airspace abnormality at bilateral lung bases is likely the\nsequela of aspiration.  There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense lesions are seen in the left hepatic lobe measuring up to\n1.5 cm, likely hepatic cysts.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is mildly atrophic.  There is no main ductal\ndilatation.  A punctate calcification is seen in the pancreatic tail (2; 38). \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.  A cyst is seen\nin the interpolar region of the right kidney.  Additional bilateral\nsubcentimeter cortical hypodensities are too small to characterize but are\nstatistically likely to be simple cysts.  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 wall\nthickening along the ascending colon without significant 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 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 aorta is ectatic measuring 2.7 x 2.7 cm.  A focal outpouching\nalong the right lateral wall of the infrarenal abdominal aorta is noted (601;\n62).  Extensive 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": "1. Equivocal wall thickening and mucosal hyperemia in the ascending colon is\nequivocal for mild colitis versus underdistention, recommend clinical\ncorrelation.\n2. Patchy airspace abnormalities along the bilateral lung bases, likely the\nsequelae of aspiration and concerning for infection.\n3. Normal appendix.\n4. Extensive atherosclerotic disease with ectatic abdominal aorta and a small\nfocal outpouching along the lateral abdominal aorta."
        },
        {
            "input": "LOWER CHEST: Please refer to same day chest CT report for subdiaphragmatic\nfindings.\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 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. \n1.6 cm calculus in the left renal pelvis (4:74) without associated\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 is partially filled with normal thin walls.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus has an intrauterine device but is otherwise\nunremarkable.  3.2 cm hypodense round lesion in the left pelvis, in the\ntopography of 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": "1. Cholelithiasis with no evidence of associated cholecystitis.\n2. Large left nonobstructive renal stone.\n3. Possible left-sided ovarian cyst measuring more than 3.0 cm.  Pelvic\nultrasound evaluation is recommended.\n4. No evidence of metastatic disease within the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\nAppreciated only on the arterial phase sequence, there is an ill-defined\napproximately 7 mm high-density focus in the region of the groove between the\n___ to ___ portion of the duodenum and the pancreatic head (series 4:60)\nwithout definite correlate but possible suggestion of possible hyper dense\nareas on the delayed portal venous phase sequence (series 5:62).  There is no\nabdominal aortic aneurysm.  There is mild calcium burden in the abdominal\naorta and great abdominal arteries.\n\nLOWER CHEST: There is trace dependent atelectasis in the right lower lobe. \nThere 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 pancreas has normal attenuation throughout.  As mentioned above\nthis hyperattenuating focus does seem to abut the head of the pancreas and\nduodenum and it is uncertain whether is primary pancreatic or duodenal in\norigin.  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: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Colonic diverticulosis is noted without\ndiverticulitis.  Dense focus in the splenic flexure (series 2:24) is noted on\nall sequences.  Appendix not visualized but no secondary sign of acute\nappendicitis.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Heterogeneous lobulated fibroid uterus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is subcutaneous fluid along the bilateral flank regions.",
            "output": "On the arterial phase images, there is an 7 mm high-density focus (series 4:\nimage 60) in the groove between the ___ to ___ portion of the duodenum and in\nthe region of the pancreatic head without definite correlate on delayed phase\nimages.  Exact location is difficult to establish with confidence but it may\nbe within the pancreas in which case may represent a hyperenhancing lesion\nsuch as a neuroendocrine tumor.  Alternatively this may represent a\npseudoaneurysm.  The possibility of this representing active extravasation as\ncause of underlying GI bleed is less likely but cannot be excluded.  No\nadditional suspicious regions or other evidence of active extravasation."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Subcentimeter hypodensity in the periphery of hepatic segment\nVII (3:20) is unchanged since the prior study, and too small to characterize,\nbut likely a hepatic cyst or biliary hamartoma.  The liver otherwise\ndemonstrates homogeneous 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 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\nnon-obstructing 3 mm right renal collecting system stone is present (3:32). \nNo evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is unchanged.  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: Patient is 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.  Mild atherosclerotic disease\nis noted.\n\nRETROPERITONEUM:  Previously described retroperitoneal soft tissue fat\nstranding and fascial thickening has resolved.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL4-5 disc protrusion noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Previously described abdominal retroperitoneal soft tissue stranding and\nfascial thickening has completely resolved, most likely related to\npancreatitis or third spacing.  No evidence of retroperitoneal fibrosis.\n\n2.  3 mm non-obstructing right renal stone.  No evidence of ureteral or\nbladder stones."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 0.9 cm hypodensity in hepatic segment 6 (02:33), which may\nrepresent a cyst or hematoma.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There is trace fluid surrounding the\ngallbladder (02:42), which is a nonspecific finding.  No abnormal luminal\ndistension 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 focal renal lesions 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 in the descending colon is noted (02:32), without evidence of\nacute diverticulitis.  Ingested oral contrast has passed distally into the\nrectum, without evidence of bowel obstruction.  Minimal fecal loading in the\nrectum.  Note is made of prominent soft tissue along the posterior perineum\ninferior to the rectum, which may represent rectal prolapse.  No ascites.  No\npneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is grossly 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild lateral subluxation of the left femoral head, without frank\ndislocation.  This appears of progressed compared to the prior CT dated ___.\n\nSOFT TISSUES: A fluid-filled tubular structure extending across the right\nanterior pelvic wall (2:65) and connecting to the anterior bladder (602b:42),\nmost likely represents a cutaneous appendicovesicostomy.",
            "output": "1. No acute intra-abdominal process identified.  Specifically, no evidence of\nbowel obstruction.\n2. Small amount of fluid adjacent to the gallbladder, a nonspecific finding\nthat could reflect recent fluid resuscitation or liver disease.  Clinical\ncorrelation is recommended.\n3. Prominent posterior perineal soft tissue inferior to the rectum is\nincompletely assessed.  Recommend clinical correlation for rectal prolapse.\n4. Diverticulosis.\n5. Lateral subluxation of the left femoral head without frank dislocation,\noverall progressed from ___."
        },
        {
            "input": "LOWER CHEST: A 7 mm pulmonary nodule in the right lower lobe is unchanged from\nprior (2:4).  A 3 mm left lower lobe pulmonary nodule is also unchanged (2:1).\nMild bibasilar atelectasis is noted.  No pleural pericardial effusion.\n\nABDOMEN: There is a somewhat mottled enhancement pattern of the liver, a\nnonspecific finding.  No focal hepatic lesions are identified. There is\nextensive intrahepatic and extrahepatic biliary dilatation consistent with the\nprior ultrasound.  There is mild periportal edema. The common bile duct\nmeasures up to 18 mm in axial diameter (02:23). Two large stones are noted\nwithin the common bile duct measuring up to 17 mm (02:21, 23). The gallbladder\nis distended with intraluminal sludge. The previously identified gallstones\nare not well seen on the current study. There is a small amount of\npericholecystic fluid and perihepatic ascites (02:31, 36).\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout without\nevidence of focal lesion.  The main pancreatic duct is somewhat prominent but\nnot enlarged by size criteria.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 hiatal hernia with intraluminal debris (2:1). \nThe patient is status post partial gastrectomy and gastrojejunostomy.  No\nevidence of bowel obstruction.  The colon and rectum appear normal within the\nlimitation of sites of underdistention.  Mesenteric haziness may related to\nthird spacing.\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.\n\nLYMPH NODES: There is no 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 linear opacity at the confluence of the splenic vein and SMV is\nfavored to represent mixing artifact (02:19).\n\nBONES: Healed fracture involving the inferior left pubic ramus, new from\n___. Unchanged bone island right ilium.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Findings consistent with choledocholithiasis with extensive upstream intra\nand extrahepatic biliary ductal dilatation.\n2. Distended gallbladder with intraluminal sludge.  Previously described\ngallstones are not well seen on the current modality.  The findings again\nraise the possibility of acute cholecystitis secondary to choledocholithiasis.\n3. Hiatal hernia with intraluminal debris.\n\nRECOMMENDATION(S):  ERCP for further evaluation."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent atelectatic\nchanges and a 7 mm similar right lower lobe pulmonary nodule (2:1).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is mild intrahepatic biliary\ndilatation, particularly in the left hepatic lobe.  There is a 1.3 x 1.1 cm\nstone in the mid common bile duct resulting in upstream dilatation of the\nextrahepatic biliary tree, with the CBD measuring up to 1.8 cm (601:39, 40). \nDiffuse mural enhancement of the common bile duct and hepatic ducts are noted.\nGallbladder contains stones.  The gallbladder is distended with gallbladder\nwall thickening and edema with mild surrounding 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis.  Mild prominence of the left ureter\nis likely secondary to a distended urinary bladder.  The urinary bladder is\notherwise unremarkable.\n\nGASTROINTESTINAL: Redemonstration of postoperative changes of partial\ngastrectomy and gastrojejunostomy with a patulous distal esophagus.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement. The\ncolon and rectum are within normal limits. The appendix is normal.\n\nPELVIS:  There is trace free fluid tracking along the right paracolic gutter,\nlikely reactive.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged measuring 4.7 cm in the\ntransverse dimension with coarse calcifications.\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.  Redemonstration of a linear hypodensity at the splenic vein\nconfluence (2:48), improved from the prior exam.\n\nBONES: Chronic fracture deformity of the left inferior ramus noted.  No\nsuspicious osseous lesions or acute fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Choledocholithiasis noting a 1.3 x 1.1 cm stone in the mid common bile duct\nresulting in upstream mild intrahepatic and moderate to severe dilatation of\nthe extrahepatic biliary tree, with the CBD measuring up to 1.8 cm.  Diffuse\nmural enhancement of the common hepatic and bile ducts indicative of\ncholangitis.\n2. Cholelithiasis with CT findings compatible with acute cholecystitis\nsecondary to the choledocholithiasis in the common bile duct.\n3. Redemonstration of a linear hypodensity in the splenic vein near the portal\nconfluence, improved from the prior exam.  Findings may represent mixing\nartifact or chronic splenic vein thrombus, decreased in the interval."
        },
        {
            "input": "LOWER CHEST: Bilateral small pleural effusions.  Bibasilar atelectasis. \nUnchanged 7 mm right lower lobe pulmonary nodule (2:3)\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is mild left greater than right\npneumobilia with mild left intrahepatic biliary ductal dilatation.  Patient is\nstatus post cholecystectomy and choledochoduodenostomy.  The anastomosis\nappears intact with presence of refluxing contrast in the residual CBD.  There\nis no evidence of contrast extravasation to suggest dehiscence or leak.  There\nis no evidence of abnormal contrast pooling.\nThere is combination of trace fluid and fat stranding in the hepatic hilum,\nexpected postsurgical findings.  No evidence of organized fluid collection in\nthe abdomen or 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: 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.\n\nGASTROINTESTINAL: Patient is status post hemigastrectomy with Roux-en-Y\ngastrojejunostomy.  The proximal gastric pouch is herniated into the thorax. \nThere is a patulous esophagus with intraluminal contrast.  The\ngastrojejunostomy is intact.  Small bowel loops in the left upper quadrant and\nleft hemiabdomen are moderately distended with air and contrast, with a smooth\ntransition point in the left upper quadrant (601:26, 2:64), near the\nenteroenteric anastomosis.  With oral contrast present into more distal\ndecompressed loops of bowel.  The small bowel overall demonstrates normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly with prostate measuring 5 by 4.4 x 5 cm. \nSymmetric seminal vesicles.\n\nLYMPH NODES: Prominent porta hepatis and portacaval lymph nodes, are likely\nreactive largest measuring 1.2 cm (601:47).  There is no retroperitoneal\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Mild hypoattenuation of the splenic vein at the confluence, is\nimproved compared to prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLimbus vertebra at L2.  Chronic deformity of the left inferior pelvic ramus.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPostsurgical changes in the midline of the anterior abdominal wall.",
            "output": ""
        },
        {
            "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  Mild intrahepatic biliary dilation is noted. Common bile duct\nis not dilated. The liver is unremarkable.\nThe gallbladder is not visualized.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY: The kidneys are unremarkable. No renal stone is identified. \nBilateral ureters appear mildly distended but there is no hydronephrosis.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.\nAppendix is unremarkable.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is unremarkable.  There is a round homogeneous structure in the\nright adnexa measuring 4.8 x 4.9 cm.  The lesion is mildly hyperdense but not\nshow enhancement.  Adjacent to this is a more hyperdense round structure\nmeasuring 2.8 x 2.6 cm located anterior to the uterus, which could be a normal\nright ovary or ovarian mass mass, part of a mixed solid and cystic adnexal\nmass, but potentially a pedunculated or broad ligament fibroid.  This part is\nof soft tissue density but only increases by 10 ___ in density with contrast\nadministration so low level enhancement is equivocal.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  A benign hemangioma is noted in\nthe L2 vertebral body.",
            "output": "1.  Unremarkable bilateral kidneys.  No renal stone is identified.  No\nhydronephrosis.\n\n2.  There is a 4.9 cm round structure in the right adnexa.  Adjacent to this\nis a 2.8 cm more hyperdense round structure which could be right ovary or\npedunculated fibroid.  Nonemergent pelvic ultrasound is recommended for\nfurther evaluation given the possibility of cystic ovarian neoplasm.\n\n3.  There is mild intrahepatic biliary duct dilation, which could be\nassociated with post cholecystectomy changes, but obstruction is not excluded.\nPlease correlate clinically with laboratory findings if necessary.\n\nRECOMMENDATION(S):   Nonemergent pelvic ultrasound 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 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 few subcentimeter hypodensities are seen in the right renal cortex.  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. 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 and contains some\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.  Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen along the visualized spine.  These\ninclude prominent anterior osteophytes at L 3 and L4.  There is narrowing of\nthe central canal L2 through L5, in part due to short pedicles.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted.  Otherwise,\nthe abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute CT abdominopelvic findings.  Specifically, no evidence of\ndiverticulitis or abscess formation.\n2. Narrowing of the central canal from L2 through L5 at least in part due to\nshort pedicles."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  There is moderate to severe\natherosclerotic disease.  The celiac trunk is patent.  There is severe\nnarrowing at the origin of the SMA with greater than 50% noncalcified plaque\nat the ostia.  Distally the SMA is patent.  There is a replaced left hepatic\nartery from the left gastric artery.  There is a single renal artery\nbilaterally.  The portal vein is patent.  The SMV and splenic veins are\npatent.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is heterogeneous in enhancement with relative\n___ along the posterior right lobe, possibly due to phase of\ntiming.  No focal hepatic lesions are seen.  The gallbladder is surgically\nabsent.  There is no intra or extrahepatic biliary duct dilation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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 spleen is displaced anteriorly by a large left\nretroperitoneal hematoma.\n\nADRENALS: The right adrenal gland is unremarkable.  The left adrenal gland is\ndisplaced anteriorly by the large hematoma.  No focal adrenal lesion is seen.\n\nURINARY: The left kidney is displaced anteriorly.  Kidneys enhance\nsymmetrically.  No focal renal lesions are seen.  There is no hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small and large bowel loops\nare normal in thickness and not dilated.  Bowel loops enhance normally.  There\nis no intra-abdominal free air.  Note is made of a large lower quadrant\nventral abdominal wall hernia with the defect measuring approximately 5.2 cm\ncontaining loops of small bowel and some hyperdense fluid.  No evidence of\nobstruction.  Appendix is normal.\n\nRETROPERITONEUM: There is a large left retroperitoneal hematoma with multiple\nlayering hematocrit levels.  Hematoma extends from the upper abdomen to the\nlevel iliopsoas inferiorly.  There are at least three focal areas of active\narterial bleeding, located at the superior and posterior, the mid anterior,\nand mid inferior aspect of the hematoma (series 303, image 99, 145, 162).  Two\nadditional foci of high density seen on delayed phase along the\ninferior/anterior and mid lateral aspect of the hematoma, which may represent\nadditional arterial foci of hemorrhage (series 303, image 186, 168).  Overall\nextent of the hematoma expands 8.3 x 11.6 x 26.4 cm (AP by transverse by CC). \nThere is small perihepatic hemorrhagic ascites.\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is moderate\nhemorrhagic pelvic free fluid.  There is no pelvic sidewall or inguinal lymph\nnodes.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  Ovaries are not well\nseen.\n\nBONES: There are no suspicious bony lesions.  There is no superficial soft\ntissue abnormality.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large left retroperitoneal hematoma spanning 26 cm (CC) with at least three\nfocal regions of active arterial extravasation as detailed above.\n2.  Small volume perihepatic and pelvic hemorrhagic ascites.\n3. Severe atherosclerosis with greater than 50% narrowing at the SMA ostia\nsecondary to noncalcified plaque.\n4. Unremarkable appearance of the bowel.  Specifically, no evidence of\nischemia.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:14 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 has been\ninterval increase of a now 3.5 cm exophytic, isoattenuating lesion in upper\npole of the right kidney, incompletely characterized on this exam. There is a\n1.7 cm simple cyst in lower pole of the right kidney.  There is a 2 mm\nnonobstructing stone in the lower pole of the left kidney.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass without\nanastomotic complications.  Small bowel loops demonstrate normal caliber and\nwall thickness throughout.  The colon and rectum are within normal limits.\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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been substantial interval decrease in size of the\npreviously seen large fluid collection in the anterior abdominal wall with\nonly a small residual collection in the left lateral flank measuring 6.9 x 3.4\nx 4.0 cm.  The patient has bilateral breast implants.  Clips are seen within\nthe ventral abdominal wall.",
            "output": "1. No acute process within the abdomen or pelvis to account for the patient's\nsymptoms.  No intraperitoneal or retroperitoneal hematoma.\n2. Interval growth of a 3.5 cm exophytic, isoattenuating lesion in the upper\npole of the right kidney.  This lesion remains indeterminate.  Recommend\nnonemergent follow-up MRI as was suggested on prior renal ultrasound.\n3. 2 mm non-obstructing left renal stone.\n4. Marked decrease in size of previously noted large anterior abdominal wall\nfluid collection with only a residual left lateral flank collection measuring\n6.9 x 3.4 x 4.0 cm."
        },
        {
            "input": "VASCULAR:\n\nThere has been interval placement of an aorto bi iliac Endograft in a\npreviously ruptured infrarenal abdominal aorta aneurysm.   There is moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.\nThere is mild  stenosis at the origin of the celiac trunk.   A stent in the\nright renal artery is noted, which is patent.  There is moderate stenosis at\nthe origin the left renal artery.  No flow is noted within the proximal right\ninternal iliac artery, however it reconstitutes distally.\n\n POST EVAR EVALUATION\nANEURYSM infrarenal\nDiameter (Cross-sectional): 7.8 x 5.7 cm\nDiameter (Center-line): 8.3 x 5.7 cm\nVolume:\n\n-Aneurysm: 231 ml\n-Renal to Aortic bifurcation: 237 ml\n-Renal to Iliac bifurcation: 309 ml\nENDOLEAK: no\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 0.3 +/-0.07 cm;\nLength distal graft to iliac bifurcation:  Right: 0.2 +/-0.07 cm\n\nANEURYSM COMMON LEFT ILIAC ARTERY:  3.8 x 3.7 cm, unchanged from prior.  Mural\nthrombus redemonstrated.\n\nANEURYSM RIGHT COMMON ILIAC ARTERY:  3.6 x 3.3 cm, unchanged from prior. Mural\nthrombus redemonstrated.\n\nLOWER CHEST:  There is a consolidative opacity within the right middle lobe\n(05:19) Minimal atelectasis is noted in the lung bases. There is no pleural or\npericardial effusion.  Coronary artery calcifications are redemonstrated.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.   \nThere is colonic diverticulosis involving the sigmoid colon.\n\nRETROPERITONEUM:  There has been significant interval decrease in size in a\nleft retroperitoneal hematoma, tracking along the anterior and lateral aspect\nof the left psoas muscle  measuring approximately 4.0 x 2.6 cm (5:125),\ndecreased from 7.7 x 5.5 cm.  There is no evidence of retroperitoneal\nlymphadenopathy.\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\npelvic free fluid.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are noted within the prostate gland.\n\nBONES: There 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 placement of an aorto bi iliac Endograft in a previously ruptured\ninfrarenal abdominal aorta aneurysm with no evidence of endoleak.  Significant\ninterval decrease size in a left retroperitoneal hematoma.\n2.  Stable aneurysms in the left and right iliac common iliac arteries, with\nmural thrombus.\n3.  Mild stenosis at the origin of the celiac trunk and moderate stenosis at\nthe origin of the left renal artery.\n4.  Consolidative opacity in the right middle lobe could represent early\ninfection or could be due to aspiration.  Please correlate clinically.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:14 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "GASTROINTESTINAL:  The rectum, sigmoid colon and intrapelvic loops of small\nbowel are normal in caliber without abnormal bowel wall thickening or\nenhancement. A normal appendix is visualized in the right lower quadrant.\n\nVASCULAR:  There is no calcium burden in the imaged portion of the iliac or\nfemoral 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 of normal size and enhancement. No evidence of\nadnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  Bilateral L5 pars defects are\nnoted. The pelvic wall is within normal limits without hernia.",
            "output": "1. No hernia or fluid collection.  No acute intrapelvic process.\n2. Bilateral L5 pars defects."
        },
        {
            "input": "LOWER 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.  A small\ncalcification is seen within the spleen, likely a granuloma.  Incidentally\nnoted is an accessory spleen measuring approximately 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.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nmild pelvic fullness and ureteral prominence on the left.  No definite stone\nis seen within the left ureter.  A miniscule hyperdensity is seen at the left\nUVJ, which may represent a very small stone.  These findings may also be seen\nin a recently passed stone.  There is minimal prominence of the right ureter\nas well. There is no perinephric fat 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.  There is no significant diverticular disease.  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.  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. Mild left-sided hydroureteronephrosis which may be related to a small stone\nat the left UVJ or a recently passed on.  No definite large calculus is\nidentified.\n2. No significant diverticular disease or evidence of acute diverticulitis."
        },
        {
            "input": "PELVIS: Patient is status post bilateral femoral fixation rods. Streak\nartifact from these rods obscures detail from adjacent structures. The\npartially visualized small and large bowel are unremarkable.  Diverticulosis\nwithout evidence of diverticulitis throughout the descending and sigmoid\ncolon.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: No evidence of acute fracture of the pelvis or hips.  Unchanged\ncompression deformity of the L4 vertebral body.  Chronic right inferior pubic\nrami fracture.\n\nSOFT TISSUES: Fat containing umbilical hernia is noted.",
            "output": "1. No evidence of acute fracture or traumatic injury to the pelvis."
        },
        {
            "input": "CTA:  Extensive collateral network of veins in the body wall again seen in\nthis patient with chronic occlusion of the SVC.  The abdominal aorta appears\nnormal in caliber and contains mild calcification.\n\nCTA RIGHT: The right internal and external iliac arteries are patent though\nextensive calcification is seen involving the right internal iliac artery and\nbranches.  The right external iliac artery remains patent through the right\ngroin with right superficial and deep femoral arteries opacifying normally. \nWhile there is scattered calcification involving the arterial system of the\nright lower extremity, there is blood flow into the right anterior tibial and\nperoneal arteries.  The right posterior tibial artery is difficult to assess\nand may be thrombosed.\n\nCTA LEFT:  The left common iliac artery is patent.  The left internal iliac\nartery and branches appear calcified though patent.  At the level of the left\ngroin, there is an an AV dialysis graft which appears patent and communicates\nwith the left common femoral vein and artery.  The left superficial and deep\nfemoral arteries appear patent though contain calcification.  The left\npopliteal artery is patent trifurcation.  Posterior tibial, anterior tibial\nand peroneal veins of the left calf appear patent through the level of the\nleft ankle.\n\nPELVIS:  Small volume ascites is noted.  Imaged bowel loops appear\nunremarkable.  Prominent left pelvic sidewall and left inguinal lymph nodes\nare present measuring up to 12 mm at the left groin and up to 10 mm along the\nleft pelvic sidewall.  Urinary bladder is mostly decompressed.\n\nBONES AND SOFT TISSUES:  Extensive soft tissue gas tracks along the deep fat\nshoulder planes extending from the left foot superiorly through the level of\nthe left knee.  Findings are compatible with necrotizing fasciitis.  No\ndrainable abscess.  Bony destructive changes at the level of left forefoot,\nconcerning for osteomyelitis.  There is a chronic deformity at the left knee\nwith malalignment and degenerative changes.  Bony sclerosis likely reflects\nrenal osteodystrophy.",
            "output": "1. Findings concerning for necrotizing fasciitis with extensive soft tissue\ngas tracking along the left lower extremity from the left foot through the\nleft knee.\n2. Probable osteomyelitis involving the left forefoot.\n3. Extensive atherosclerotic calcification without evidence of acute embolic\nvascular occlusion.\n4. Patent dialysis fistula in the left groin likely compromises blood flow to\nthe left lower extremity.\n5. Chronic deformity at the left knee with malalignment.\n6. Extensive collateral network of veins in the body wall due to central\nvenous occlusion at the level of the SVC.\n\nNOTIFICATION:  Findings were discussed with vascular surgery consult service."
        },
        {
            "input": "LOWER CHEST: Linear atelectasis at the lung bases.  No pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 7 mm hypodensity in hepatic segment VII (2:14), too small to\ncharacterize.  No other focal lesions are identified.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  Portal venous system 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 markedly enlarged, measuring up to 19.9 cm (601b:26). \nIrregular peripheral hypodensities along the superior (2:8) and inferior\nmargins of the spleen are consistent with prior infarctions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  No ascites.  No pneumoperitoneum.\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 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 a small amount of fluid about the right hip joint (2:70).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of abscess within the abdomen or pelvis.\n2. Marked splenomegaly with sequela of prior infarctions in the superior and\ninferior spleen.\n3. Small amount of fluid about the right hip."
        },
        {
            "input": "VASCULAR:\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.  An enteric tube is seen in the esophagus.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nPreviously demonstrated right hepatic lobe abscess is not seen on today's\nexam.  No new abscess is seen.  There is mild residual rim of hyper\nenhancement and slightly central hypodense area in segment VII (03:29) with\ncapsular retraction, thought to represent scarring and perfusional changes\nfrom the treated hepatic abscess.  Patient is status post metallic CBD stent\nplacement with left to lobe worse than right pneumobilia.  There is stable\nmild intrahepatic ductal dilatation.  The extrahepatic duct at the hepatic\nhilum measures up to up to 2.1 x 2.2 cm and contains air-fluid levels, similar\nin size compared to prior MRI on ___.  As previously, the distal\nCBD is compressed between the smaller pseudocyst and the larger pseudocyst. \nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.  The hepatic vascular remains patent.\n\nPANCREAS: CBD stent appears to terminate above the ampulla, unchanged since\n___.  Again seen is atrophy of the pancreatic parenchyma with\nenumerable calcifications and main pancreatic ductal dilatation, compatible\nwith history of chronic pancreatitis.  There are several stones within the\nmain pancreatic duct with upstream a ductal dilatation.  The main pancreatic\nductal dilatation is stable since ___, measuring up to 10.0 cm,\nallowing for differences in methodology.  Again seen is transition point in\nthe pancreatic duct due to mass effect from the mass.  A hypodensity measuring\nup to 1.1 x 0.8 cm is slightly anterior to the dominant pseudocyst and appears\nto be in communication with the dominant pseudocyst (3:68), likely\nrepresenting a dilated portion of the pancreatic duct.  The pancreatic tail\nparenchyma enhances within normal limits.  However, the pancreatic body\ncontinues to demonstrate decreased enhancement (03:48).\n\nAs previously, there are 2 dominant pseudocysts.  There is similar extension\ninto the duodenum wall with mass effect on the duodenum.  The direct\ncomparison with the immediate prior exam is difficult due to differences in\nmethodology.  However, the larger medial, unilocular cyst measures up to 6.5 x\n6.8 cm, previously 6.2 x 6.0 cm on the MRI from ___.\nA small hypodensity lateral to the large pseudocyst measuring up to 1.7 x 2.6\ncm, previously measuring to 3.7 x 2.3 cm and is in communication with the\ndominant pseudocyst (601b:37).\n\nThe dominant pseudocyst exerts mass effect on the IVC, and the main portal\nvein as it joins the portal confluence, slightly attenuates the caliber of the\nSMV and displaces the SMV to the left, not significantly changed since ___.  There is no evidence of aneurysm or venous thrombosis.\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 diffusely thickened, not significantly changed compared to\nprior exams.  No focal lesion is seen.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensity in the midpole of the left kidney is slightly\nhyperdense on the noncontrast exam, possibly representing a hemorrhagic cyst\n(2:32, 3:67).  There is no evidence of stones or hydronephrosis.  Other\nsubcentimeter hypodensities are too small to characterize by CT, the likely\nrepresent simple cysts.  There is no 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. Colon and rectum are within normal limits.  The\nenteric tube is folded upon itself at the ligament of Treitz with tip\nterminating in the third portion of the duodenum.  Appendix contains air, has\nnormal caliber without evidence of fat stranding.  There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nMultiple mildly enlarged lymph nodes at the gastroc hepatic ligament, near the\nceliac axis, portacaval station are not pathologic by CT size criteria, though\nmeasures up to 9 mm.  Multiple aortocaval lymph nodes are also not pathologic\nby CT size criteria.\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. Sequela of chronic pancreatitis with pancreatic head pseudocysts, which now\nappears to be in communication with each other.  The dominant unilocular cyst\nmeasures up to 6.8 cm, previously 6.2 cm.  The smaller pseudocysts located\nlaterally is in communication with the largest cyst and has slightly decreased\nin size, measuring up to 2.6 cm, previously 3.7 cm.\n2. Persistent intra and extrahepatic biliary ductal dilation, likely a due to\ncompression of the distal common bile duct between the pseudocysts.  Unchanged\npositioning of the common bile duct stent.\n3. Minimal residual hyper enhancement in the hepatic segment VII and capsular\nretraction, corresponding to the treated hepatic abscess.\n4. Multiple pancreatic duct stones, with upstream dilation, partially due to\nthe stones and mass effect from the pseudocyst.\n5. Enteric tube folded on itself near the ligament of Treitz with tip\nterminating in the third portion of the duodenum.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:32 ___, 50 minutes after discovery\nof the findings."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great arteries.  Celiac anatomy is standard.  There is no\nevidence of active arterial extravasation.  Gastroduodenal artery terminates\nshortly after its takeoff, may be secondary to edema or postsurgical.\n\nLOWER CHEST: Mild basilar atelectasis.  There is small right pleural effusion.\n\nABDOMEN:\nStatus post ___ modification of a duodenum-preserving pancreatic head\nresection.  This involves coring out the head of the pancreas, a Roux-en-Y\npancreaticojejunostomy, a Roux-en-Y  hepaticojejunostomy, and a\njejunojejunostomy.\n\nSurgical drain entering at the right lower quadrant lays along the anterior\naspect of the pancreas.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is evidence of mild intrahepatic\nbiliary dilatation.  The gallbladder is absent.  Status post set aside\nRoux-en-Y hepaticojejunostomy. The hepatic duct wall appears slightly\nedematous and the hepatic duct is markedly dilated at its proximal aspect,\nmeasuring 2.0 cm, similar to prior stable mild prominence of intrahepatic bile\nducts..\n\nPANCREAS: Moderate volume of acute blood products is seen in intraluminally\nwithin bowel at pancreaticojejunostomy, without evidence of active contrast\nextravasation, or adjacent pseudoaneurysm.  Pancreatic parenchyma is atrophic\nand contains numerous punctate calcification consistent  with chronic\npancreatitis.  The head of the pancreas has been cored out per duodenum\npreserving pancreatic head resection.  Status post pancreatico jejunostomy. \nExtensive pancreatic calcifications consistent with chronic pancreatitis. \nPreviously seen pancreatic duct dilatation has significantly improved.  There\nis mild peripancreatic stranding in fluid, may be postsurgical, consider acute\npancreatitis.  There is small area the non organized, enhancing fluid in the\nperiportal area, likely postoperative.  Few mildly enlarged right upper\nquadrant, upper abdominal lymph nodes, stable, likely reactive largest\nmeasures 1.2 cm short axis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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, worrisome focal renal lesions, or\nhydronephrosis.  There is small benign simple left renal cyst.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Gastrostomy is noted with a jejunostomy tube in place. \nSmall bowel loops demonstrate normal caliber. Colon and rectum are within\nnormal limits.  Sutures associated with bowel anastomoses are noted.\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: Mass arising from the uterus may be a fibroid.  Bilateral\novaries are normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic AVN left femoral head, stable.\n\nSOFT TISSUES: Anasarca.  ___ incision is noted.",
            "output": "1. There is moderate volume of blood products within the bowel lumen at\npancreaticojejunostomy, without evidence of contrast extravasation or adjacent\npseudoaneurysm.\n2. Mild peripancreatic stranding may be postsurgical, consider mild\npancreatitis.  Pancreatic ductal dilatation has improved since prior.. \nPostsurgical changes in the right upper quadrant, without drainable fluid\ncollection.\n3. Stable marked dilatation of the proximal common hepatic duct.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:51 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.  There is a small amount of\npericholecystic fluid, a nonspecific finding, and may relate to aggressive\nfluid rehydration.  No abnormal luminal distension to suggest acute\ncholecystitis.  Portal venous system 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.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  Normal appendix.  No abdominal free fluid. \nNo pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace free\nfluid in the pelvis (2:70).\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 process identified.  Specifically, no evidence of\nrenal abnormality.\n2. Trace pericholecystic free fluid and small amount of pelvic free fluid,\nfindings which may be due to aggressive fluid rehydration.  No abnormal\nluminal gallbladder distension to suggest acute cholecystitis."
        },
        {
            "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 background liver parenchyma is diffusely fatty.  There is a 2.2 x 1.8 cm\nhypodense lesion within segment VII/VIII of the liver (2:16), demonstrating\nnodular peripheral enhancement and stable from the prior examination. Findings\nlikely represents a hemangioma. The portal venous system is patent. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder, pancreas, and right adrenal gland are normal. The left adrenal\ngland demonstrates a 1.7 x 1.3 cm intermediate density nodule (2:28, 601 be:\n43), more conspicuous on the prior examination. The spleen is mildly enlarged,\nmeasuring up to 15.7 cm (previously measuring up to 19.3 cm in ___. The\nkidneys enhance symmetrically and are without suspicious solid mass.\n\nThe patient is status post gastric lap band placement, with the band seen in\nunchanged position as compared to the prior examination.  The small and large\nbowel are normal in caliber and without evidence of wall thickening. Mildly\nprominent lymph nodes are noted within the porta hepatis and bilateral\ninguinal regions, none of which are pathologically enlarged by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum. The aorta and\niliac branches are normal in course and caliber. The celiac trunk and SMA are\ngrossly patent.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. Incidentally\nnoted is a 2.8 cm right adnexal lesion demonstrating intermediate density,\npossibly reflecting a hemorrhagic cyst. There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Stable appearance of a diffusely fatty liver and segment VII/VIII\nhemangioma.\n2. Interval decrease of now mild splenomegaly and minimal portal hepatis\nlymphadenopathy.\n3. 1.7 x 1.3 cm left adrenal nodule demonstrating intermediate density.\nFindings could be further evaluated by MRI.\n4. Stable appearance status post gastric lap band placement. No evidence of\nobstruction or oral contrast holdup.\n\nNOTIFICATION:  Findings were entered into the radiology dashboard by Dr.\n___ at 10:55 on ___."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The status post\ncholecystectomy with surgical clips in the gallbladder fossa.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.The duodenum and jejunum are within normal limits, without evidence\nof obstruction.  There is continued mucosal hyperenhancement and wall\nthickening of the terminal ileum and ascending colon with prominent, but not\npathologically enlarged, adjacent mesenteric lymph nodes, consistent with\ncolitis and the given history of a Crohn's disease flare (2:48-51). There is\nno evidence of abscess or fistula formation. There is no stenosis at prior\nsmall bowel anastomotic site (2:38). There are several surgical clips in the\nright upper anterior abdominal wall (2:33).  There is a fat-containing ventral\nwall hernia, without bowel involvement (2:29 and 602b:41).\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith no atherosclerotic calcifications. There are multiple prominent\nretroperitoneal and mesenteric lymph nodes, however none of these meet CT size\ncriteria for pathologic enlargement.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.The uterus is unremarkable.\n\nBONES: No focal lesion suspicious for malignancy.",
            "output": "1.  Continued mucosal hyperenhancement and wall thickening of the terminal\nileum and ascending colon consistent with ileitis   a Crohn's disease flare.\nNo evidence of abscess or fistula formation.\n\nNOTIFICATION:  Dr. ___ the above findings to the primary team\non ___."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear.  No pleural or pericardial effusion. \nThere is cardiomegaly and a metallic mitral valve.\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 1.4 cm right upper pole renal cyst.  There is no evidence of\nsuspicious renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis mild diverticulosis of the sigmoid evidence of diverticulitis.  The\nappendix is normal.\n\nPELVIS: There is trabecular thickening of the urinary bladder with some\nadjacent stranding and mucosal hyperenhancement, which could be seen with\ncystitis.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  A 3.4 cm right cyst is 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.L5\nspondylolysis is present with grade 1 anterolisthesis on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Trabecular thickening of the bladder with adjacent stranding could be seen\nin cystitis.  Please correlate with urinalysis.  Normal appendix.\n2. 3.4 cm right adnexal cyst.  Non urgent pelvic ultrasound is recommended.\n\nRECOMMENDATION(S):  Non-urgent pelvic ultrasound."
        },
        {
            "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.  The\nanterior pancreatic head shows fatty replacement which is a common normal\nvariant.  Adrenals appear normal.  A few small hypodense foci in the right\nkidney are too small to characterize but doubtful in significance.  The left\nshows a relatively severe but chronic appearing multifocal scarring including\nsome cortical calcification along left lower pole in addition to a few small\nsimple cysts.  No hydronephrosis is found on either side or solid mass.\n\nThe stomach and small bowel appear normal.  Sigmoid diverticulosis is\nmoderately severe.  Uterus and adnexa appear normal.\n\nThere is a flat hyperenhancing mass along the right lateral bladder wall.  The\ncore part of this measures at least 20 mm in length, but beyond that there is\nmore extensive mild wall thickening and hyperenhancement involving the\nextending from the posterior midline of the the bladder to the right anterior\nlateral wall.  There is nonspecific stranding along the right lateral bladder\nwall which is particularly nonspecific in the setting of recent resection\nalthough minimal transmural spread is not excluded.  Abnormal enhancement\nincludes the right posterolateral bladder wall where the ureterovesical\njunction is located.\n\nIncidental note is made of a retroaortic left renal vein which is a common\nnormal variant.  Major vascular structures appear widely patent.  Mixed type\natherosclerotic changes in the aorta are mild-to-moderate.  Aorta is not\ndilated.  Nonocclusive thrombus is found in the mid right gonadal vein (for\nexample 3:78).\n\nTrace air in the bladder suggests sequela of instrumentation.  Small right\ncommon iliac lymph nodes, as well as other lymph nodes, are not enlarged by\nsize criteria.  There is no free air or fluid.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Mild\ndegenerative changes affect lower lumbar facet joints.",
            "output": "1. Hyperenhancing tumor along the mid right lateral bladder wall. Hazy\nnonspecific stranding about the outer right lateral bladder wall.  Minimal\ntransmural spread cannot be excluded but findings may be postsurgical. No\nevidence for regional or distant metastatic disease.\n\n2.  Nonocclusive right gonadal vein thrombosis.\n\n\nRECOMMENDATION(S):  Findings discussed with Dr. ___ at 12:01 pm on ___ by telephone."
        },
        {
            "input": "LOWER 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 small 4 mm hypodense lesion in hepatic segment VI, without\nsuspicious features but not definitively seen on prior study (2:101).  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 right kidney is normal in size with a normal nephrogram.  The\nleft kidney is atrophic with extensive scarring, unchanged.  There are\nmultiple subcentimeter hypodense lesions in the right kidney, too small to\ncharacterize, but overall unchanged from prior study.  There is no evidence of\nsolid renal lesions.   There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The patient is status post cystectomy and\nright lower quadrant ileal conduit formation.  No definite evidence of soft\ntissue density within the surgical bed to suggest local recurrence.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a right lower\nquadrant ileal conduit with unremarkable appearance of the right lower\nquadrant anastomosis.  Otherwise, remaining small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding.\n\nPELVIS:  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 are scattered subcentimeter mesenteric and retroperitoneal\nlymph nodes, none pathologically enlarged by size criteria and overall\nunchanged from prior study.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  A retroaortic left renal vein is incidentally noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a right lower quadrant ileal conduit.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Status post cystectomy and right ileal conduit formation.  No definite\nevidence of local recurrence or metastatic disease in the abdomen or pelvis.\n2. Small subcentimeter hypodense hepatic lesion, likely benign but not\ndefinitively seen on prior study.  Continued attention on follow-up imaging is\nrecommended.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "There is extensive soft tissue stranding in the subcutaneous fat adjacent to\nthe left buttocks as well as a 3.8 x 4.1 cm intramuscular hematoma in the left\ngluteus maximus muscle. Additionally, there is a 9.4 x 2.0 cm hematoma within\nthe soft tissues overlying the sacrum on the left.  The bladder is distended\nbut normal appearing.  There is significant calcified atherosclerosis of the\nbilateral internal iliac arteries.  Three fixation screws seen the within the\nleft femoral neck. Mild to moderate degenerative changes are seen at the\nfemoroacetabular joints bilaterally with no evidence of fracture.",
            "output": "1. Extensive soft tissue stranding in the subcutaneous fat adjacent to the\nleft buttocks as well as a 3.8 x 4.1 cm intramuscular hematoma in the left\ngluteus maximus muscle.\n2.  9.4 x 2.0 cm hematoma within the subcutaneous tissues overlying the sacrum\non the left.\n3. No evidence of fracture."
        },
        {
            "input": "LOWER CHEST:  A 6 mm nodule is seen in the right lower lobe (2:5).  The imaged\nportion of the heart and pericardium are normal.  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 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 thickening of the left adrenal gland, without focal nodule.\nThe right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  A 1.4 cm partially\nexophytic simple cyst is seen arising from the upper pole of the right kidney.\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 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 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.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Sclerosis and bridging osteophytes are noted at the bilateral\nsacroiliac joints.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute process in the abdomen or pelvis.\n2. 6 mm pulmonary nodule in the right lower lobe.  Recommend nonemergent CT of\nthe chest for further evaluation of pulmonary nodules.\n3. Sclerosis and bridging osteophytes are noted at the bilateral sacroiliac\njoints.  Recommend correlation with symptoms and history.\n\nRECOMMENDATION(S):\nSclerosis and bridging osteophytes are noted at the bilateral sacroiliac\njoints.  Recommend correlation with symptoms and history."
        },
        {
            "input": "LOWER CHEST: Linear hypodensity along the posterior aspect of the left main\npulmonary artery (2:1) was previously seen on the CTA chest of ___\nand is likely artifactual due to partial volume averaging of adjacent\nstructures, but given its slightly increased conspicuity.  There is a small\namount of right middle lobe scarring.  Patchy bibasilar opacities likely\nreflect atelectasis or scarring.  A small left Bochdalek hernia is seen. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nEvaluation of the mid abdomen is slightly limited due to patient motion.\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. Severe\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: The uterus is not visualized.  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: There is no evidence of worrisome osseous lesions or acute fracture. \nMild anterolisthesis of L4 on L5 and minimal retrolisthesis of T11 on T12 are\nunchanged, likely degenerative in etiology.\n\nSOFT TISSUES: Bones are diffusely demineralized.  There is a tiny fat\ncontaining umbilical hernia.  Calcified soft tissue densities within the\nsubcutaneous tissues overlying the gluteal regions likely represent injection\ngranulomas.",
            "output": "1. No acute findings within the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Linear hypodensity along the posterior aspect of the partially visualized\nleft main pulmonary artery was previously seen on the CTA chest of ___ and is likely artifactual due to partial volume averaging of adjacent\nstructures, but given its slightly increased conspicuity, pulmonary embolism\ncannot be excluded.\n3. Diverticulosis without acute diverticulitis.\n\nNOTIFICATION:  Inability to exclude pulmonary embolism was discussed with\n___, MD by ___, MD via telephone at 10:41 on ___,\nimmediately following discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nliver is dysmorphic with shrunken portions of the right lobe.  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 is somewhat atrophic but exhibits 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Note is made of a left sided fat containing Bochdalek's\nhernia.  The stomach is unremarkable.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Severe diverticulosis of\nthe descending and sigmoid colon is noted, with diffuse diverticular disease\nalso throughout the remainder of the colon, without evidence of wall\nthickening or fat stranding. The appendix 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 uterus is not visualized.  There is no large 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 retrolisthesis of T11 on T12 and anterolisthesis of L4 on L5 are chronic.\n\nSOFT TISSUES: Calcified soft tissue density within the subcutaneous tissue\noverlying the gluteal regions likely represent injection granulomas.",
            "output": "1. No acute intra-abdominal or intrapelvic process.\n2. No CT evidence of pyelonephritis.  No kidney or ureteral stone identified\nwithin limits of the examination.\n3. Diverticulosis without evidence for diverticulitis."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. \nAppendix is normal.  The urinary bladder and distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Central defect in the prostate is suggestive of prior\nTURP.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 3.7 cm lower abdominal aortic aneurysm is noted with moderate\natherosclerotic calcifications.  The left common iliac artery measures 1.8 cm.\nThe right common iliac artery measures cm.\n\nBONES: Multilevel degenerative disease the lower lumbar spine and bilateral\nhips is seen 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 fracture identified within the sacrum or bilateral hips.\n2. Chronic findings including DJD of the hips and lower lumbar spine and\nextensive atherosclerotic disease.\n3. A 3.6 cm lower abdominal aortic aneurysm without prior to evaluate for\ninterval 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.  Trace perihepatic free\nfluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There are\nbilateral rounded, hypodense lesions measuring up to 35 mm in the right kidney\nand 12 mm in the left kidney, incompletely characterized on noncontrast CT but\nlikely representing simple cortical cysts.  There is no hydronephrosis.  There\nis no nephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.\n\nThere is an abnormal edematous loop of small bowel in the right lower quadrant\nwhich is hypodense with mesenteric stranding.  Though not clearly evaluated in\nfull detail, the mesenteric vessels appear to converge at a point, next to\nwhat appears to be a tethered portion of small bowel with possible transition\npoint (602:22).  The associated loops do not look overtly distended, however\nthe edematous appearance of the bowel and mesentery is concerning for\nischemia, potentially in the setting of an internal hernia or closed loop\nobstruction.\n\nThere is severe diverticulosis.  As seen on the previous CT from ___,\nthere is a long segment of sigmoid colonic thickening.  There is no associated\nsurrounding stranding.  The appendix is not visualized.\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 severe atherosclerotic disease of the abdominal aorta and\nits major branches.  There is no abdominal aortic aneurysm, however the\nabdominal aorta is noted to be ectatic, measuring up to 2.8 cm, similar in\ncomparison to the prior CT exam from ___.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multi level degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Abnormal edematous loops of small bowel in the right lower quadrant which\nare hypodense with mesenteric stranding.  The mesenteric vessels associated\nwith this loop of bowel appears to converge at a region adjacent to what\nappears to be a tethered portion of bowel with possible transition point.  The\noverall appearance of the bowel is concerning for ischemia, potentially in the\nsetting of an underlying internal hernia or closed loop obstruction.\n2. Severe diverticulosis, without evidence of acute diverticulitis.  There is\na long segment of sigmoid colonic thickening with no surrounding stranding, an\nappearance similar to prior.  If no colonoscopy is been completed in the\ninterval since the prior CT scan in ___, colonoscopy should be obtained to\nexclude a mass.\n3. Severe atherosclerotic disease of the abdominal aorta, with ectatic\ninfrarenal aorta measuring up to 2.8 cm.\n\nRECOMMENDATION(S):  Colonoscopy is recommended to exclude a mass in the\nsigmoid colon if no colonoscopy has been obtained since the prior CT scan in\n___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___ , M.D. on the telephone on ___ at 1:45 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 focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a small splenule 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.  There is a 0.6\ncm hypoattenuating cystic lesion in the lower pole of the right kidney.  There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe urinary bladder is minimally distended but appears unremarkable.\n\nGASTROINTESTINAL: The stomach is markedly distended with enteric contents. \nThere are multiple dilated loops of small bowel in the mid abdomen with\ncollapsed bowel distally consistent with an intermediate to high-grade small\nbowel obstruction.  There is infiltration of the jejunal mesentery with a\nsmall amount of mesenteric fluid.  There is a potential transition point in\nthe mid abdomen (3:74).  The evaluation for bowel ischemia is suboptimal in\nthe absence of intravenous contrast.  There is a curvilinear focus of gas\nadjacent to the wall of the small bowel, which could reflect pneumatosis\nalthough this is considered less likely given the small focal area of\ninvolvement.  There is no portal venous or mesenteric venous gas.  Unchanged\nappearance of the small bowel anastomosis in the right lower quadrant of the\nabdomen.  There is extensive colonic diverticulosis without evidence of acute\ndiverticulitis.  There is mural thickening of a segment of sigmoid colon.  The\nappendix is not visualized.\n\nPELVIS: Trace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged containing several\npunctate calcifications.\n\nLYMPH NODES: There are several prominent mesenteric and retroperitoneal lymph\nnodes, not pathologically enlarged by size criteria.  There is no inguinal or\npelvic lymphadenopathy.\n\nVASCULAR: Severe atherosclerotic disease is present.  Aneurysmal dilation of\nthe descending thoracic aorta to 3.2 cm.  The infrarenal abdominal is ectatic\nmeasuring up to 2.9 cm, similar compared to the prior study.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Small fat containing left inguinal hernia.",
            "output": "1. Multiple dilated loops of fluid-filled small bowel in the mid abdomen with\ndecompressed small bowel distally is consistent with an intermediate to\nhigh-grade small bowel obstruction.  There is infiltration of the small bowel\nmesentery with a small amount of mesenteric free fluid.  Evaluation for bowel\nischemia is suboptimal in the absence of intravenous cont"
        },
        {
            "input": "LOWER CHEST: Dependent bibasilar atelectasis.  Otherwise, 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. 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.\n\nPELVIS: The urinary bladder is markedly distended.  The distal ureters appear\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild asymmetric stranding overlying the left hip soft tissues\n(601:38).  No evidence of underlying drainable fluid collections or discrete\nabscess.  No evidence of deep skin ulcerations.  A spinal stimulator is seen\nin the left posterior pelvic soft tissues with catheter extension into the\nthecal space at the level of T12 extending superiorly.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1.  Marked urinary bladder distention.  Foley catheterization may be\nconsidered if clinically indicated.\n2. Asymmetric left hip soft tissue swelling in stranding without evidence of\nunderlying drainable fluid collections or discrete abscess.  No subcutaneous\ngas.\n3. No acute abdominopelvic process otherwise."
        },
        {
            "input": "LOWER CHEST: Please refer to the separately reported same-day chest CT for\ncomplete description of the intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen is a subcentimeter hypodense lesion adjacent to the gall bladder,\nwhich is too small to characterize (02:82), but doubtful in significance and\nunchanged compared to prior.  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. Staple lines are\nvisualized within the sigmoid 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 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. Status post sigmoid colonic resection with no evidence of local recurrence\nor abdominopelvic metastatic disease.\n2. Please refer to the separately reported same-day chest CT for complete\ndescription of the intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: There is a stable appearance of a 1.3 cm solid pulmonary nodule\nin the right lower lobe, consistent with metastatic disease. A 3 mm pulmonary\nnodule in the left lower lobe is also stable. Two punctate calcified\ngranulomas are seen at the left base as well. The visualized portion the heart\nand pericardium are normal. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout.  Two\nstable hypodensities are seen in the liver, in segment III and segment\nVII/VIII. The previously described ill-defined hypodensity lateral to the\nfalciform ligament in segment ___ is again seen (2:25).  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is\nunremarkable.\n\nPANCREAS: Again seen is a hypoenhancing mass centered in the body and tail of\nthe pancreas, which has increased in size from the prior study, now measuring\n6.4 x 4 cm, previously 5.7 x 2.9 cm.  In the interval, there has been\ndevelopment of fat stranding and fluid surrounding the pancreatic mass which\ncould reflect superimposed pancreatitis though in the setting of normal serum\nlipase, tumor extension is a concern. Free fluid is also noted to track along\nthe left lateral conal fascia and anterior left pararenal space. Again, the\nSMV is somewhat compressed though patent as it courses posterior to the\npancreas, unchanged from the prior study. The splenic artery is encased in\ntumor, but remains patent. The splenic vein is occluded with multiple\ncollateral vessels present.  Omental nodularity indicative of peritoneal\ncarcinomatosis is stable to minimally increased.\n\nSPLEEN:  The spleen is normal in size and homogeneous enhancement. Note is\nmade of 2 small 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. \nBilateral renal cysts are unchanged. No evidence of stones or hydronephrosis.\nThe ureters are normal in caliber along their visualized course to the\nbladder. There is no perinephric abnormality.\n\nGASTROINTESTINAL:  The stomach is underdistended, but grossly normal. The\nsmall large bowel are normal in course and caliber. There is pancolonic\ndiverticulosis without evidence of diverticulitis. The appendix is well seen\nand normal appearing.\n\nRETROPERITONEUM:  Numerous prominent mesenteric and retroperitoneal lymph\nnodes are again seen, similar to the prior study.\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 normal. The prostate is not enlarged.\nThere are no pathologically enlarged pelvic sidewall or inguinal lymph nodes\nby CT size criteria. There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: Increased sclerosis involving the left iliac bone is\nunchanged. Multiple right-sided lipomas in the body wall are unchanged from\nthe prior study.",
            "output": "1. Pancreatic mass in the distal body and tail appears intervally increased in\nsize.  Increased surrounding fat stranding and free fluid raises concern for\ntumor extension, less likely superimposed pancreatitis given normal serum\nlipase values.\n2. Minimal progression of omental nodularity consistent with peritoneal\ncarcinomatosis.\n3. Stable appearance of bilateral lung base pulmonary nodules.\n4. Stable sclerosis in the left iliac bone, likely benign given long-term\nstability though attention on followup imaging advised.\n5. Normal spleen."
        },
        {
            "input": "The base of the right lung demonstrates a 1.5 cm nodule, which appears stable\ncompared to the prior exam from ___.  A tiny 3 mm nodule seen at the\nbase of the left lung, series 2, image 3 also unchanged compared to the prior\nexam.\n\nThe liver demonstrates multiple subcentimeter hypodensities, too small to\ncharacterize by CT but unchanged compared to the prior exam.  There is no\nintrahepatic or extrahepatic biliary ductal dilatation.  The gallbladder is\nnormal.  The right adrenal gland is normal.  Nodularity of the left adrenal\ngland is unchanged compared to the prior exam.  The interpolar region of the\nright kidney demonstrates a hypodense lesion which measures 2.5 cm x 1.6 cm,\nlikely secondary to a simple renal cyst, unchanged compared to the prior exam.\nAdditional cystic lesions within the right kidney are also stable.  There is\nno evidence of hydronephrosis.  The left kidney demonstrates a cyst at the\ninferior pole measuring 8 mm also stable compared to the prior exam.  The\nspleen is top normal in size, measuring 12 cm.  A new peripheral, wedge shaped\nhypodense lesion is seen in the lower pole of the spleen, measuring 1.3 x 1\ncm, series 2, image 25.  Medially, a 6-mm peripheral hypodense lesion may\nreflect a second infarct.\n\nA 5.2 cm x 3.3 cm hypoattenuating mass in the distal pancreatic body and tail\nis grossly unchanged in size compared to the prior exam with adjacent\nheterogeneous soft tissue and fat stranding. The previously noted collection\nbetween the spleen and the stomach is not seen on this exam, and has resolved.\n\nThe main portal vein remains patent.  The splenic vein remains chronically\noccluded.  Large gastric varices are unchanged compared to the prior exam. \nThe stomach, duodenum, and small bowel are normal without evidence of wall\nthickening, or obstruction.  Thickening of the wall of the splenic flexure\nappear slightly improved compared to the prior exam.\n\nOmental nodularity is re-demonstrated compatible with peritoneal\ncarcinomatosis, overall worse compared to the prior exam, particularly along\nthe anterior abdomen (2;32), and thickening of the peritoneal reflection\nposteriorly within the left pelvis (2;69).  There is no retroperitoneal or\nmesenteric lymphadenopathy.  There has been an interval increase in the extent\nof ascites.  There is no pneumoperitoneum.  Lipomas are redemonstrated in the\nsoft tissues of the right back and right upper thigh.  Moderate\natherosclerotic calcifications are seen throughout the aorta and iliac\narteries.\n\nCT pelvis:  There is thickening along the anterior wall of the bladder.  There\nis no pelvic wall or inguinal lymphadenopathy.\n\nOsseous structures:  Sclerosis of the left iliac wing is unchanged compared to\nthe prior exam.  No other lytic or blastic lesions concerning for malignancy\nidentified.",
            "output": "1.  No significant interval change in size of the hypoattenuating mass within\nthe distal pancreatic body and tail, measuring up to 5.2-cm, compatible with\nknown pancreatic cancer.\n\n2.  Interval resolution of the fluid collection between the stomach and the\nspleen with improved inflammatory changes in the left upper quadrant and about\nthe splenic flexure, findings which on the previous CT were likely due to\npancreatitis.\n\n3.  Interval progression of patient's extensive peritoneal carcinomatosis,\nwith increased ascites.\n\n4.  New hypodense lesions in the lower pole of the spleen concerning for\ninfarcts.\n\n5.  Bladder wall thickening.  Correlation with urinalysis is recommended to\nexclude infection.\n\nNOTIFICATION:  Updated findings were d/w Dr. ___ by Dr. ___ by phone\nat 10pm on the day of the exam."
        },
        {
            "input": "LOWER CHEST: Please see separately submitted report of Chest CT for full\ndescription of the lungs.\n\nLIVER: The liver enhances homogeneously without intrahepatic biliary duct\ndilation. Two small hepatic hypodensities in segment III and segment VII/VIII\nare unchanged from the prior study (04:51, 04:46). An ill-defined hypodensity\nimmediately lateral to the falciform ligament in segment ___ is slightly more\nprominent compared to the prior exam, measuring 2.0 cm compared with 1.9 cm\n(04:59 compared with 06:66). This is most likely transient hepatic attenuation\ndifference or focal fatty infiltration given the classic location, however,\nattention on followup is recommended to exclude a developing metastatic\nlesion. The portal and hepatic veins are patent. The nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: The spleen and 2 small accessory spleen are homogeneous and normal in\nsize, unchanged from the prior study.\n\nPANCREAS: The previously seen hypoenhancing partially necrotic pancreatic body\nand tail lesion has apparently decreased in size compared with the prior study\nnow measuring 4.6 x 3.8 cm (4:60), compared with 5.6 x 4.3 (6:67 on the prior\nstudy). However, the SMV is compressed as it courses behind the body of the\npancreas, which is new from the prior study, suggesting medial extension of\nthe tumor (07:27 compared with 6:69 on the study of ___. The\nsplenic artery is encased but remains patent, and the splenic vein is\noccluded. Associated left peritoneal carcinomatosis is unchanged.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no hydronephrosis.  Bilateral renal cysts are unchanged,\nand unchanged subcentimeter renal hypodensities that are too small to fully\ncharacterize likely represent additional simple cysts.\n\nGI: The stomach is decompressed without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction. A normal appendix is visualized. There\nis extensive colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with scattered\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS:   The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nSOFT TISSUES: Multiple small right-sided lipomas are unchanged from the prior\nstudy (4:63, 94, 114). The soft tissues are otherwise unremarkable.\n\nOSSEOUS STRUCTURES: A sclerotic lesion within the left ileum is unchanged from\nprior studies.",
            "output": "1. Partially necrotic pancreatic body/tail lesion appears to decreased in\nsize, however the SMV demonstrates new compression concerning for interval\nmedial extension.\n2. Parafalcine hepatic hypodensity is slightly more prominent, likely\ntransient hepatic attenuation difference or focal fat, attention on followup\nis recommended.\n3. Unchanged peritoneal carcinomatosis and multiple stable hepatic\nhypodensities.\n4. For findings above the diaphragm, please refer to separately submitted\nreport of CT chest."
        },
        {
            "input": "Please see the dedicated CT chest report from the same date for the thoracic\nfindings.\n\nLIVER: Multiple hepatic cysts are again noted in the left lobe of the liver,\nthe largest measuring 3.1 x 2.6 cm, unchanged from the CT in ___\n(2:55). There is no evidence of intra or extrahepatic biliary dilatation.\nSimilarly to the prior study, there is perihepatic and pericholecystic fluid,\nwithout evidence of gallbladder wall thickening or distention.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: There is a 1.1 cm cyst in the lower pole of the left kidney (601b:38\nand 2:76), unchanged since the prior study.  There is a 4 mm stone in the left\nlower kidney and a 3 mm stone in the right lower kidney.  No evidence of\nhydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild atherosclerotic calcifications. A lymph node in the periaortic\nregion measures 9 mm in the short axis (2:83). However, there is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.A left inguinal region lymph node measures\n0.2 cm in the short axis (2:117).\n\nBONES: Multiple lytic lesions are seen in the L1 the L4 vertebral bodies, as\nwell as the right proximal femur, correlating with the radiographic findings.",
            "output": "1. Evaluation is limited in the absence of IV contrast. Lytic bone lesions of\nthe lumbar spine are present. Nothing points to a specific primary malignant\nlesion.\n\n2. Unchanged hepatic and renal cysts.\n\n3. Bilateral kidney stones, measuring up to 4 mm on the left.\n\n4. Perihepatic and pericholecystic fluid, likely due to third spacing."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits.  No pleural effusion..\n\nABDOMEN:\nThe superior portion of the abdomen was not included on the study, limiting\nevaluation.  Also no intravenous contrast was administered, which greatly\nlimits evaluation.\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 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. The colon and\nrectum are within normal limits. The appendix appears normal (601:32).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: There is a large predominantly cystic appearing mass\nwithin the central pelvis measuring 19.0 x 16.5 x 8.8 cm.  Along its left side\nthere are a few internal cystic components though 1 has slightly thickened\nsepta and another appears to have slight nodularity.  These are suboptimally\nassessed because of the lack of intravenous contrast.  This appears to arise\nfrom the left ovary, though this is not completely certain.  There is an\nadjacent roughly 4 cm cystic lesion within the left adnexa.  Within the right\nadnexa there is an oval lesion of increased density (roughly 70 Hounsfield\nunits) measuring 3.0 x 1.6 x 2.3 cm.  The there also may be a cystic lesion or\ndilated to it appears posterior and medial to this that is not well delineated\non this noncontrast 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.  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": "Large predominantly cystic mass within the pelvis, possibly arising from the\nleft ovary, though this is uncertain.  There appear to be other\novarian/adnexal lesions bilaterally.  All these findings are suboptimally\nevaluated without intravenous contrast.  MRI pelvis without and with contrast\nis recommended to characterize further."
        },
        {
            "input": "LOWER CHEST: The base of the lungs are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.  An adjustable\nlaparoscopic gastric band is in place, an appropriate position.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  There is mild edema adjacent to the left kidney.\nGASTROINTESTINAL:  There is wall thickening and inflammatory fat stranding\nabout the sigmoid colon in the left lower quadrant (2:62, 601b:36), with\nadjacent thickening of the lateral conal fascia.. 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 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: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions. A small fat\ncontaining umbilical hernia is noted.  Grade 1 anterolisthesis of L4 on L5 is\nnoted, along with mild degenerative changes of the lumbar spine and bilateral\nhips.",
            "output": "1. Acute uncomplicated sigmoid diverticulitis.  No intraperitoneal free air or\nfree fluid.\n2. Adjustable gastric band in appropriate position.\n\nRECOMMENDATIONS:    1.  Colonoscopy is recommended after treatment for\nfindings described in IMPRESSION #1 to exclude underlying mass lesion."
        },
        {
            "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 liver is consistent with\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.  Subcentimeter\nhypodensity in the lower pole of the left kidney and in the interpolar region\nof the left kidney are too small to characterize, but likely represent simple\ncysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Lap band device appears\nappropriately positioned.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\npresent.  There is mild fat stranding around a diverticulum in the proximal\nsigmoid colon (02:55).  The 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.  Mild to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is unchanged anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  The port\nof the gastric band device is noted in the subcutaneous fat in the mid\nanterior abdominal wall.",
            "output": "1. Acute uncomplicated sigmoid diverticulitis.\n2. 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\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:49 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 incompletely distended with no radiopaque calculi\nwithin it.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 peripelvic cysts, better characterized on the MRI\ndated ___.  No hydronephrosis or hydroureter noted.  Limited\nevaluation for solid enhancing renal masses in the absence of intravenous\ncontrast.\n\nGASTROINTESTINAL: There is no bowel obstruction.  No evidence for colitis\nnoted on this 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 uterus and adnexae are age-appropriate.  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.  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": "Optimal evaluation of organ pathology and vasculature is limited without the\nbenefit of intravenous contrast.\n\n1. There is no evidence of acute colitis on this exam.  No bowel obstruction.\n2. Bilateral peripelvic renal cysts noted."
        },
        {
            "input": "VASCULAR:  The abdominal aorta is normal in course and caliber with no signs\nof atherosclerosis, dissection or injury.  There is no evidence of arterial\nbleeding in the pelvis at the site of small volume hemo peritoneum.\n\nLOWER CHEST: Mild basal dependent atelectasis.  The imaged portion the heart\nis unremarkable.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is a small amount of\nintermediate density free fluid in the pelvis, better assessed on ultrasound\nand consistent with hemoperitoneum.  No active bleeding.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  There are 2 cystic\nlesions in the left adnexa measuring 2.3 x 1.9 cm and 3.7 x 3.2 cm, better\nassessed on pelvic ultrasound and most consistent with hemorrhagic\ncysts(3:126, 134).  There is an additional cystic lesion in the right adnexa\nmeasuring 2.2 x 2.4 cm (3:128).\n\nBONES:  Degenerative changes L4-L5 are not significantly changed.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Bilateral adnexal cystic lesions, consistent with hemorrhagic cysts better\nassessed on pelvic ultrasound.  Small volume hemoperitoneum which may reflect\nrecent cyst rupture.  No active bleeding."
        },
        {
            "input": "There is a small 3.2 mm pulmonary nodule in the right lower lobe. There is no\npleural 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 within\nnormal limits, without wall thickening or pericholecystic fluid.\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: The adrenal glands are unremarkable.\n\nKIDNEYS: There is mild hydronephrosis of the left kidney and minimal\nhydronephrosis of the right kidney. No renal calculi are seen. There are no\nfocal lesions identified.\n\nGI:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.\n\nRETROPERITONEUM: The aorta is normal in caliber, without atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.  There are no calculi seen\nwithin the bladder. There is no ureteral dilatation.  There are no ureteral\nstones identified. No pelvic wall or inguinal lymph node enlargement by CT\nsize criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. Mild hydronephrosis of the left kidney with minimal hydronephrosis of the\nright kidney.\n2. No renal, ureteral, or bladder calculi identified."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. The aorta, celiac axis, SMA, ___, renal\narteries, and all major branches are patent. There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: The lung bases appear normal.  There is no pleural or pericardial\neffusion.\n\nABDOMEN:\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 is 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass.  No\nabnormality of the large or small bowel is seen.  Appendix contains air, has\nnormal caliber without evidence of fat stranding.  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: Reproductive organs are within normal limits.  Follicle\nin the right ovary is noted.  There is an IUD in the uterus.\n\nBONES: 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 vasculature of the abdomen and pelvis.  No atherosclerotic disease. \nPost Roux-en-Y gastric bypass with expected appearance."
        },
        {
            "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 diffusely hypoattenuating relative to the spleen,\nconsistent with hepatic steatosis.  Focal hypodensity adjacent to the\nfalciform ligament may be perfusional or could reflect focal fatty deposition.\nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreatic tail is atrophic, unchanged in appearance.  No\npancreatic 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 with normal nephrogram. \nThere is a 1.7 x 1.6 cm intermediate density lesion in the lower pole of the\nleft kidney, stable in size from ___.  It had features of a simple cyst\non the MRCP dated ___.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Mild fecalization\nof terminal ileum is incidentally noted, a non-specific finding.  The colon\nand rectum are within normal limits.  Normal appendix.  No ascites.  No\npneumoperitoneum.\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.  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 identified.  No evidence of acute\npancreatitis.\n2. Re- demonstration of atrophy of a portion of the pancreatic tail which\nlikely represent sequelae of prior inflammatory changes as previously assessed\nwith MRI.\n3. Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: Nonenhancing consolidation within the dependent aspect of the\nright lower lobe is consistent with a right lower lobe pneumonia.  No\npericardial or pleural 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 within normal limits.\n\nPANCREAS: Patient is status post distal pancreatectomy.  The remainder of the\npancreatic head and proximal body are unremarkable.  No pancreatic ductal\ndilatation.  No peripancreatic stranding.\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. \nStable 1.5 cm left lower pole renal cyst (02:30) better characterized on\npreceding MRI from ___.  No hydronephrosis is seen.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Gastrojejunostomy tube is in\nsitu.  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 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. Right lower lobe pneumonia.\n2. Hepatic steatosis.\n3. Status post distal pancreatectomy, proximal pancreas is unremarkable\nwithout CT evidence of acute pancreatitis or peripancreatic collections."
        },
        {
            "input": "LOWER CHEST: Right-sided pleural effusion is demonstrated.  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 within normal limits.\n\nPANCREAS: Previously described millimetric cystic lesions throughout the\npancreas on MRCP from ___ are not definitively visualized within\nthe limits of 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. \nThere is a 1.2 cm x 1.8 cm exophytic hypodensity in the interpolar region of\nthe left kidney, that most likely represents a cyst.  There is no evidence of\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality. \nThere is mild cortical thinning.\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 wall appears thickened, most likely secondary to\nunder distention.  The distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and contains 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: Innumerable sclerotic osseous lesions throughout the imaged osseous\nstructures, increased from prior exam.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.",
            "output": "1. Innumerable sclerotic lesions throughout the imaged osseous structures that\nwere fewer and smaller on previous exam.  This most likely represents a\ncombination of disease progression may have a contribution of treatment\nresponse.\n2. No evidence of visceral metastatic disease in the abdomen or pelvis or\nnodal disease.\n3. Please see separate report of CT chest performed on 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: 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: Millimetric pancreatic cysts seen on the MRCP of ___\nare not visualized on the current study.  The pancreas has normal attenuation\nthroughout.  Focal ductal dilatation within the pancreatic tail, better seen\non the MRCP of ___, appears overall similar.  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 1.3 cm exophytic simple cyst is not significantly changed, previously\nmeasuring 1.2 cm.  Few other subcentimeter hypodensities throughout the\nbilateral kidneys are too small to characterize but statistically likely cysts\nas well.  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.\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 contains multiple\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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Extensive widespread sclerotic osseous metastatic disease appears\noverall similar in size and distribution with respect to individual lesions. \nSome lesions demonstrate increased density, possibly post treatment effect. \nThere is no acute fracture.\n\nSOFT TISSUES: A small fat containing left inguinal hernia is again seen.",
            "output": "1. Similar size and distribution of sclerotic osseous metastatic disease with\nincreased density of some lesions which may reflect treatment response.  No\ndefinite new lesions, although the multiplicity of existing lesions makes\nassessment difficult.\n2. No evidence of intra-abdominal or pelvic metastatic disease.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "Lung Bases:  At the imaged lung bases, there is mild dependent atelectasis. \nThe imaged portion of the heart is unremarkable.  No pleural or pericardial\neffusion is seen.\n\nAbdomen: The liver appears nodular in contour with relative prominence of the\nleft hepatic lobe likely reflective of cirrhosis.  Clips are seen in the\ngallbladder fossa.  No discrete focal liver lesion is identified.  There is\nsmall volume perihepatic ascites.  No biliary ductal dilation is seen.  The\npancreas, adrenal glands appear normal.  The spleen is mildly enlarged\nmeasuring 14.1 cm in length.  The kidneys enhance symmetrically with prompt\nexcretion of contrast noted.  There is no focal renal lesion, hydronephrosis\nor signs of pyelonephritis.  The stomach and duodenum appear normal.  The\nabdominal aorta is mildly calcified and normal in caliber.  No abdominal\nlymphadenopathy.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction.  A\nclip in the right lower quadrant abuts the cecum.  The appendix appears\nnormal.  The colon is thin walled without significant fecal loading.  Urinary\nbladder is only mildly distended with distal ureters opacifying normally.  No\npelvic sidewall or inguinal lymphadenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Degenerative\ndisc disease is most pronounced at L3-L4 level.  Pars defects at L5 noted\nbilaterally without significant anterolisthesis.\n\nSoft tissues:  A rim enhancing fluid collection is seen within the anterior\nabdominal wall extending inferiorly from the umbilicus measuring approximately\n12.8 x 5.6 x 11.6 cm concerning for abscess.  Please note, there is no\nintra-abdominal extension.",
            "output": "1. Superficial fluid collection the anterior body wall extending inferiorly\nfrom the umbilicus concerning for abscess.\n2. Nodular liver concerning for cirrhosis with small volume ascites and mild\nsplenomegaly.\n3. Pars defects at L5."
        },
        {
            "input": "LOWER CHEST: Stable 6 mm pulmonary nodule in the right middle lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Scattered sub-centimeter hypo-densities\nare unchanged in comparison to ___, likely simple cysts or biliary\nhamartomas. A punctate hypodensity in hepatic segment VII with peripheral\nenhancement is incompletely characterized on the current exam (04:23). There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains gallstones without gallbladder 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. \nBilateral simple renal cysts are again noted.  Scattered subcentimeter\nhypodensities are too small to characterize but statistically likely represent\nsimple renal cysts.  No obstructing renal stones.  No hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable in appearance however\nunder-distention of the fundus under the left hemidiaphragm limits evaluation.\nNo small bowel obstruction. There is a highly redundant colon with a moderate\nstool burden. The rectum is unremarkable. No free fluid in the abdomen.\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 chronic dissection, incompletely visualized on the\ncurrent exam but extending from immediately proximal to the aortic hiatus into\nthe left common iliac artery, similar in size and morphology to the exam dated\n___ but incompletely assessed on this non-dedicated protocol. The\ndissection flap again extends into the proximal left renal artery. The celiac\ntrunk and SMA are both patent and originate from the true lumen. The proximal\nceliac artery is narrowed with post-stenotic dilatation measuring up to 17 mm,\nunchanged. The SMA contains a small thrombosed and calcified aneurysm in its\nproximal aspect, unchanged (04:23). The ___ arises from the false lumen and is\nthrombosed at the origin with distal reconstitution. There is a 15 mm\ncalcified and partially thrombosed aneurysm of left renal artery, unchanged\n(04:28). A 1.7 cm thrombosed saccular aneurysm involving the left common iliac\nvein is unchanged from. 2\n\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\ninguinal surgical clips are noted. There is evidence of prior anterior wall\nhernia repair.",
            "output": "1. No acute process in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Chronic dissection involving the abdominal aorta as described above. The\nceliac trunk and SMA are patent. The origin of the ___ remains thrombosed with\ndistal reconstitution, unchanged from ___.\n3. Cholelithiasis.\n4. Redundant colon with a moderate stool burden.\n5. Stable 6 mm pulmonary nodule in the right middle lobe.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:07 pm."
        },
        {
            "input": "VASCULAR:\nNo abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  There is a replaced left\nhepatic artery (series 3, image 36).  The main portal vein and SMV are patent.\nThe celiac trunk and SMA are patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  No pleural or\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, without stones or\ngallbladder wall thickening.\n\nPANCREAS:  The patient has had a distal pancreatectomy since the prior MR to\nresect an endocrine tumor with persistent fat stranding and fat necrosis\nadjacent the anastomotic site in the left upper quadrant, similar to at least\n___ CT chest (series 3, image 41).  No evidence to suggest local\ndisease recurrence.\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. \nA sub-centimeter hypodensity in the right upper renal pole is too small\naccurately characterize on CT (series 3, image 61). 5-mm right upper and right\nlower stones are nonobstructive (series 2, image 29, 41).  No hydronephrosis\nor perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.  The\nappendix contains air, has normal caliber without evidence of fat stranding.\nNo evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM:  Multiple retroperitoneal lymph nodes are measurable up to 7\nmm (aortocaval; series 3, image 102).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No pelvic or\ninguinal lymphadenopathy. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland has coarse calcifications.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.  Small\nsclerotic lesion in the right proximal femur is likely a bone island (series\n601b, image 66).\n\nSOFT TISSUES: A fat-containing periumbilical hernia is small (series 602b,\nimage 80).",
            "output": "1. Stable-appearing fat necrosis after a distal pancreatectomy and\nsplenectomy.  No definite evidence of local recurrence or metastasis in the\nabdomen or pelvis.\n2. Nonspecific retroperitoneal lymph nodes measuring up to 7 mm. '\n3. Replaced left hepatic artery."
        },
        {
            "input": "VASCULAR:\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.  Uncomplicated cholelithiasis.  Replaced\nright and left hepatic arteries.\n\nPANCREAS: The patient has had a previous distal pancreatectomy.  Knee\npancreatic parenchyma appears unchanged.  There are no new pancreatic lesions.\nThe previously seen and region of fat necrosis at the pancreatic tail has\nresolved.\n\nSPLEEN: The patient has had a previous 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. \nNonobstructive caliceal stones at the upper and lower poles of the right\nkidney, unchanged.  There is no 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. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding. \nStable mild mesenteric panniculitis.\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: Tiny fat containing umbilical hernia.",
            "output": "1. No evidence of disease recurrence.  The previously seen region of fat\nnecrosis at the pancreatic tail has resolved.\n2. Stable mesenteric panniculitis.\n3. Replaced right and left hepatic arteries."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles are\nunremarkable.\n\nLYMPH NODES:  There is no lymphadenopathy.  Scattered not pathologically\nenlarged inguinal lymph nodes are identified bilaterally.  There is no pelvic\nsidewall adenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES:  Numerous sclerotic lesions, some with central relative lucency are\nseen scattered throughout the pelvis most confluent involving the left iliac\nbone.  Sacrum is also affected.  There is no fracture.  Degenerative changes\nnoted at the SI joints.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Numerous sclerotic foci, some with central lucency, throughout the pelvic\nbones compatible with metastatic disease.  No fracture."
        },
        {
            "input": "LOWER CHEST: The imaged lung bases demonstrate minimal atelectasis. No pleural\npericardial effusion is seen.  The blood pole of the cardiac chambers appears\nlower in density than the myocardium, suggesting 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 relatively collapsed without evidence of wall\nthickening or CT evidence of gallstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 seen.  No hydronephrosis is seen\nbilaterally.  No renal or ureteral calculus is seen.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is relatively\ncollapsed.  No bowel obstruction or bowel wall thickening is seen.  No\nevidence of acute appendicitis.\n\nPELVIS: The urinary bladder distended, but overall, thin-walled. Equivocal\nthin region of hyperdensity along the dependent portion of the urinary bladder\non series 2, image 74, may relate to volume averaging with the adjacent\nprostate gland. Correlate with urinalysis to assess for blood in the urine. No\nfree fluid is seen.\n\nREPRODUCTIVE ORGANS: There appears to be subtle enlargement of the median lobe\nof the prostate gland, possibly related to BPH.  Prostate calcifications are\nseen.  Vas deferens calcifications are seen, correlate with history of\ndiabetes.\n\nLYMPH NODES: Scattered small retroperitoneal lymph nodes are not\npathologically enlarged.  There is 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 spine.\n\nSOFT TISSUES: Small fat containing left inguinal hernia is noted, partially\nimaged.",
            "output": "1. No bowel obstruction or bowel wall thickening.  No fluid collection or\nextraluminal gas seen.\n2. Equivocal thin region of hyperdensity along the dependent portion of the\nurinary bladder may relate to volume averaging with the adjacent prostate\ngland.  Correlate with urinalysis to assess for blood in the urine.\n3. No renal, ureteral, or bladder calculus seen.\n4. Bilateral renal cysts.  No frank hydronephrosis.\n5. Hypodensity of the blood pool in the cardiac chambers in relation to the\nmyocardium suggests anemia."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post resection of the left lateral\nsegment.  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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  An extrarenal\npelvis is noted bilaterally.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Suture lines are\nidentified in the splenic flexure on series 5 ___ 66 and identified in the\nsigmoid colon on series 5, ___ 109.  The appendix 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\nsalpingo oophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  There is a 6.6 x 4.8 cm cystic\nstructure in the retroperitoneum adjacent to surgical clips and the aorta on\nseries 5, ___ 80.  This is decreased in size on the prior examination where it\nmeasured 12.3 x 8.0 cm\nVASCULAR: There is no 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 umbilical hernia containing small bowel.  There\nis no evidence of obstruction.",
            "output": "1. No evidence for tumor recurrence or metastatic disease in the abdomen and\npelvis\n2. Decrease in retroperitoneal fluid collection which is most consistent with\na lymphocele\n3. New small umbilical hernia containing small bowel.  No evidence for\nobstruction\n4. For full description of the lung bases please see chest CT report from the\nsame day"
        },
        {
            "input": "LOWER CHEST:\nThere is minimal bibasilar dependent atelectasis.  No pleural effusions.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The hepatic parenchyma enhances homogeneously.  No focal liver\nlesions.\nThe gallbladder is partially distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement without focal lesions or main duct\ndilation..\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: No solid enhancing renal masses or hydronephrosis seen on either\nside.\nGASTROINTESTINAL: There is no bowel obstruction.  Surgical sutures are noted\nat the rectosigmoid and distal transverse colon.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is only minimally distended and unremarkable.  The uterus and\novaries are not visualized, surgically absent.  There is no free fluid in the\npelvis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\n\nThere is a ventral abdominal wall hernia at the umbilicus and supraumbilical\nregion containing nonobstructed small bowel loops.  The hernial defect\nmeasures 7.8 cm in the craniocaudal axis and 6.4 cm in the transverse axis\nrespectively.",
            "output": "1. Ventral abdominal wall hernia at the umbilicus and supraumbilical region\ncontaining nonobstructed small bowel loops.  The neck of the hernial sac\nmeasures 7.8 cm in the craniocaudal axis and 6.4 cm in the transverse axis.\n2. No ascites, abdominal or pelvic lymphadenopathy or focal liver lesions\nidentified."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There has been prior left lateral resection of the liver.  No\nconcerning liver lesions.  The liver 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: Colorectal anastomosis noted which is intact without\ncomplication.  ___ anastomosis in the left upper quadrant involving\nthe distal transverse colon is intact.  The remainder of the colon is\nunremarkable.  Normal appendix is seen.  Incidental lipoma involving the\nsecond/third segment of the duodenum.\n\nRedemonstration of a large ventral hernia just superior to the umbilicus.  The\nhernia neck is wide measuring up to 8.1 cm.  The hernia sac measures 5.8 by\n9.2 by 9.1 cm (AP by TR by cc).  Previously it measured only 6.4 cm in width. \nIt contains multiple loops of small bowel.  No free fluid within the hernia\nsac or evidence of obstruction of the bowel loops within the hernia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Incidental\nurachal remnant of the bladder noted.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Previous hysterectomy with bilateral salpingectomy.  No\nconcerning nodularity or enhancement in the pelvis to suggest local\nrecurrence.\n\nPERITONEUM/RETROPERITONEUM: No concerning nodularity or enhancement to suggest\nperitoneal disease.  No ascites.\n\nLYMPH NODES: Multiple surgical clips noted in the retroperitoneum related to\nprior lymph node dissection.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is marked narrowing of\nthe IVC just proximal to its entry into the liver (series 4, image 47).  The\nabdominal IVC is normal in 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 wide neck supraumbilical hernia, containing multiple loops of small\nbowel, measuring up to 9.2 cm in size"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.\nA subcentimeter hypodensity in the interpolar region of the left kidney is too\nsmall to characterize, but likely a cyst (601b:31, 2:23).  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 ascites\nidentified.\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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is grade 1 retrolisthesis of L5 on S1.  Subcutaneous\nfat stranding identified in the soft tissues overlying the left greater\ntrochanter.",
            "output": "Mild subcutaneous fat stranding identified in the soft tissues overlying the\nleft greater trochanter.  Otherwise, no acute intra-abdominal or intrapelvic\nprocess."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.  Limited views of the heart demonstrated\nnormal size, and there is no pericardial effusion. Coronary artery\ncalcifications are partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver is shrunken with nodular contours, in keeping with\nknown history of cirrhosis.  The liver demonstrates homogeneous attenuation\nthroughout.  No arterially enhancing hepatic masses are identified that are\nconcerning for hepatocellular carcinoma.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  There are stones within the gallbladder,\nbut no 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 is enlarged measuring 14.3 cm, but demonstrates homogeneous\nattenuation 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 nephrogram. \nThere is a 5 mm stone in the interpolar region of the right kidney.  No\nevidence of stones in the left kidney.  A 8 mm hypodensity is seen in the\nlower pole of the left kidney that is too small to characterize.  No\nabnormally enhancing renal masses or hydronephrosis bilaterally.  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. Colon and rectum are within normal limits.\nAppendix contains air, has normal caliber without evidence of fat stranding.\n\nPERITONEAL CAVITY:  There is a small amount of non-hemorrhagic ascites,\npredominantly perihepatic.  No pneumoperitoneum.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR:\nThere are esophageal varices.  There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries, without evidence of aneurysmal\ndilation.  The celiac axis and its major branches are patent.  The right\nhepatic artery is replaced to the SMA. The left hepatic artery is replaced to\nthe left gastric artery.  The superior mesenteric artery, bilateral renal\narteries and inferior mesenteric artery are patent.\n\nThere is a non-occlusive thrombus in the proximal splenic vein, immediately\nadjacent to the porto-splenic confluence (6:40); this was not seen on the\nprior MRI in ___.  The superior mesenteric and portal veins are patent. \nThere are ___ varices, with evidence of a splenorenal shunt (11:53).\nThe umbilical vein is also patent. These findings are in keeping with portal\nhypertension.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is a small amount of\nnon-hemorrhagic free fluid in pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable..\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes are seen throughout the thoracolumbar spine. \nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1.  Shrunken liver with nodular contours, compatible with known history of\ncirrhosis.  No arterially enhancing lesions that are suspicious for\nhepatocellular carcinoma.\n2.  Non-occlusive proximal splenic vein thrombosis, new from the prior MRI in\n___.\n3.  Sequela of portal hypertension including mild splenomegaly, small volume\nascites, esophageal varices, patent umbilical vein, perisplenic varices and\nsplenorenal shunting.\n4.  Cholelithiasis, without evidence of cholecystitis.\n5.  5 mm non-obstructing stone in the interpolar region of the right kidney.\n6. Replaced right and left hepatic arteries, normal anatomic variants.\n\nNOTIFICATION:  The above findings were entered into the critical results\ndashboard by ___ on ___ at 5:37pm for communication to the ordering\nclinician."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver contour is nodular and irregular consistent with\ncirrhosis.  The liver parenchyma 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:  There is progressive pancreatic ductal dilation since ___ with\na sharp transition point at the body-tail junction where there is also focal\nside branch dilation (06:44 6:47).  The pancreas has normal attenuation\nthroughout, without evidence of focal lesions or chronic pancreatitis.  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 hydronephrosis.  In the mid right kidney is a 7 mm\nnon-obstructive radiopaque stone.  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\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:  The splenic vein is widely patent without evidence of partial\nthrombosis seen on prior examination.  Extensive prominent esophageal varices,\nsplenorenal shunt, and inferior epigastric collaterals are present. \nIncidentally noted is a replaced right hepatic artery off the SMA.  An\naccessory left hepatic artery off the left gastric artery is noted.  There is\nno abdominal aortic aneurysm.  Moderate atherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Bilateral hip\nosteoarthritis is present.  Sacroiliac joints are fused anteriorly likely due\nto degenerative changes.  The bones appear diffusely osteopenic.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Cirrhotic liver without evidence of focal lesions. Splenomegaly, extensive\nesophageal varices, splenorenal shunt, and inferior epigastric collaterals\nfrom portal hypertension.\n2. Widely patent splenic vein without evidence of thrombosis.\n3. Progressive pancreatic ductal dilation with sharp transition point at the\nbody-tail junction and further side branch dilation which is concerning for\nunderlying pancreatic tumor although no mass is seen on this examination. \nFurther evaluation with endoscopic ultrasound is recommended.\n4. Cholelithiasis.\n5. Non-obstructive 7 mm right nephrolithiasis.\n\nRECOMMENDATION(S):  Endoscopic ultrasound of the pancreas is recommended.\n\nNOTIFICATION:  The recommendation above was entered by Dr. ___ on\n___ at 18:21 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: Minimal bilateral dependent atelectasis is seen.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Minimal prominence of the central\nintrahepatic biliary tree may relate to post cholecystectomy state.  The\ncommon bile duct is not dilated.  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 1.5 cm hypodensity in the right upper pole is a cyst.  No solid renal masses\nare 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.  The 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 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 atherosclerotic\ndisease is noted.  There is narrowing of the distal infrarenal abdominal aorta\ndue to eccentric thrombus although the aorta remains patent throughout.  There\nis also moderate narrowing of the proximal left common iliac artery limb and\ndue to atherosclerotic changes.\n\nBONES: Well defined lesion with sclerotic borders in the medial right iliac\nbone appears nonaggressive and is likely benign, possibly representing the\nfocal bone infarct, enchondroma, less likely a subchondral cyst.  Just lateral\nto this is a 7 mm sclerotic focus which most likely represents a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Distal infrarenal abdominal aortic lumen is narrowed by mural thrombus\nalthough appears patent.  Also moderate narrowing of the proximal left common\niliac artery due to mural thrombus.\n2. Enlarged prostate gland.\n3. Minimal prominence of the central intrahepatic biliary tree may relate to\npostcholecystectomy state.\n4. Otherwise, no acute CT findings seen in the abdomen or pelvis.  No bowel\nobstruction or bowel wall thickening.  Normal appendix.\n\nNOTIFICATION:  Findings discussed with Dr. ___ at 16:00 on ___ via telephone by Dr. ___."
        },
        {
            "input": "VASCULAR:\n\nNew hyperdense material compatible with hemorrhage within the excluded portion\nof the stomach status post Roux-en-Y gastric bypass without evidence of active\nbleed into the remnant or duodenum.\n\nThere is mild residual ill-defined stranding surrounding the second portion of\nthe duodenum with discontinuity of the duodenal wall (3b:238) which is more\nprominent compared to prior studies.  Previously seen adjacent foci of free\nair have almost entirely resolved.  There is a tiny focus of possible free air\nremaining along the medial aspect of the second portion of the duodenum on\n02:27.\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nThere is an accessory left hepatic artery arising from the left gastric\nartery.  The common hepatic artery arises from the SMA.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Mild reflux of contrast into the\nintrahepatic IVC may represent elevated right heart pressures.\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 not visualized.  Punctate\ncalcifications in the liver most likely represent the sequela of prior\ngranulomatous disease.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic 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 2.5 cm left adrenal myelolipoma.  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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Status post Roux-en-Y gastric bypass.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.  Appendix contains air, has normal\ncaliber without evidence 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: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are 3 metallic pins traversing the right femoral neck.\n\nSOFT TISSUES: Postsurgical changes are seen in the anterior abdominal wall.",
            "output": "1. New hyperdense material compatible with hemorrhage within the excluded\nportion of the stomach status post Roux-en-Y gastric bypass without evidence\nof active bleed into the remnant or duodenum on this study.\n2. There is mild residual ill-defined stranding surrounding the second portion\nof the duodenum with discontinuity of the duodenal wall which is more\nprominent compared to prior studies compatible with perforation. Previously\nseen adjacent foci of free air have almost entirely resolved.\n3. There is an accessory left hepatic artery arising from the left gastric\nartery. The common hepatic artery arises from the SMA."
        },
        {
            "input": "No active extravasation is demonstrated to suggest active GI hemorrhage at the\nmoment of the exam.  A replaced left hepatic artery to the left gastric is\nnoted.  The abdominal aorta, SMA, celiac axis and ___ remain patent.\n\nThe upper abdominal organs are unchanged.  Left adrenal myelolipoma is\nredemonstrated.  There is no intestinal obstruction, ascites or free air. \nChanges of Roux-en-Y and cholecystectomy are again noted.  No change in\ndiscontinuity of the medial duodenal wall with similar pocket of fluid and\nimproved soft tissue stranding.  Right hip screws are redemonstrated.",
            "output": "No evidence of active contrast extravasation."
        },
        {
            "input": "VASCULAR:\n\nNo active extravasation or pseudoaneurysm is identified.  No intraluminal\nbowel contrast is identified. There is no abdominal aortic aneurysm.  There is\nminimal calcium burden in the abdominal aorta and great abdominal arteries.\nReplaced left hepatic artery from the left gastric artery.  Two right renal\narteries and a single left renal artery.\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.  Mild central intrahepatic biliary duct\ndilatation is demonstrated, likely related to cholecystectomy status.  There\nis mild enhancement of the common bile duct wall and some regional stranding\nwhich is likely reactive.  The gallbladder is is 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: Small collection in the splenic hilum containing foci of gas measures\n1.2 x 5.2 cm.\n\nADRENALS: The left adrenal gland contains macroscopic fat and is consistent\nwith an adrenal myelolipoma measuring 2.1 x 2.2 cm.  Right adrenal gland is\nnormal.\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 patient is status post gastric bypass surgery and near\ntotal gastrectomy.  A surgical drain is noted through a right frontal approach\nwith tip in the epigastric region.  Mild mucosal enhancement is demonstrated\nof the biliary limb adjacent to the anastomotic suture which is likely\nreactive.  No evidence of bowel obstruction.  No focal fluid collection. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder contains air with Foley catheter in situ.  There\nis no evidence of pelvic or inguinal lymphadenopathy.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nSmall focal hyperdense lesion in the right prostate is stable.\n\nBONES: Three pins are noted through the femoral neck.  No acute fracture or\nworrisome osseous lesion.\n\nSOFT TISSUES: Laparotomy wound with surgical skin staples.",
            "output": "1. No evidence of active extravasation or pseudoaneurysm.\n2. The patient is status post gastric bypass surgery and near total\ngastrectomy.\n3. Small fluid and gas collection in the splenic hilum is likely postsurgical.\n4. Stable left adrenal myelolipoma."
        },
        {
            "input": "LOWER: 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal\nlimits.Trace ascites is demonstrated in the bilateral pericolic gutters.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: Small hiatal hernia, otherwise the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The colon is suboptimally evaluated secondary to lack of enteric\ncontrast and marked colonic fecal.  The rectum is dilated with mesorectal fat\nstranding which is non specific in  the setting of the recent hemorroidectomy.\nHowever proctitis cannot be excluded.  The appendix is normal.\n\nPELVIS: The urinary bladder is markedly distended.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The rectum is dilated with mesorectal fat stranding which is non specific\nin the setting of the recent hemorroidectomy.  Please note proctitis cannot be\nexcluded.\n2. Trace ascites in the pericolic gutters.\n3. No free intra-abdominal air.\n4. Markedly distended urinary bladder."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 right kidney is atrophic.   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 retrocecal appendix is dilated with\nsurrounding fat stranding consistent with acute uncomplicated appendicitis. \nAn appendicolith is seen at the base of 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": "Uncomplicated retrocecal appendicitis."
        },
        {
            "input": "CHEST:   The bases of the lungs are clear. The visualized heart and\npericardium are unremarkable.\nABDOMEN:  The liver demonstrates a hypodense lesion in segment VIII of the\nliver measuring 1.7-cm x 1.7-cm (2;15) and a hypodense lesion in segment II of\nthe liver measuring 1.3-cm x 1.2-cm (2;17), overall unchanged compared to the\nprior exam.  No focal hepatic lesions concerning for malignancy are\nidentified. There is mild intrahepatic biliary ductal dilatation. The CBD is\nenlarged measuring up to 1.2 cm. Small dependent density (series 2, image 27)\nin the CBD is concerning for choledocholithiasis. The spleen is homogeneous\nand normal in size. The adrenal glands bilaterally are normal. The kidneys\nbilaterally and normal without evidence of focal solid or cystic lesions\nconcerning for malignancy.\n\nThe gallbladder appears mildly distended with cholelithiasis. No surrounding\nfat stranding. The pancreas is normal without evidence of focal lesions or\npancreatic duct dilatation. The stomach, duodenum, and small bowel are normal\nwithout evidence of wall thickening or obstruction. There is no\nretroperitoneal or mesenteric lymphadenopathy. There is no intra-abdominal\nfree air or free fluid.  There is impression of mild thickening of the\nsigmoid, descending, and mid transverse colon, although these segments of\nbowel are collapsed.  There is evidence of diverticulosis without evidence of\ndiverticulitis.\nPELVIS:  The urinary bladder is normal. There is no pelvic wall or inguinal\nlymphadenopathy. There is no pelvic free fluid.\nBONES AND SOFT TISSUES:  No lytic or blastic lesions concerning for malignancy\nare identified.",
            "output": "1.  No evidence of diverticulitis.  Mild diverticulosis.\n\n2. Intrahepatic biliary dilation, common bile duct dilation and gallbladder\ndilation with possible filling defect in the common bile duct raising\npossibility of choledocholithiasis. Recommend correlation with LFTs and MRCP.\n\n3.  Possible mild thickening of the transverse, descending and sigmoid colon\nraising possibility of mild colitis.\n\nNOTIFICATION:  ___ findings d/w Dr. ___ by Dr. ___ by phone at\n10:15A on the day of the exam."
        },
        {
            "input": "VASCULAR:\n\nNo significant change in positioning of aorto bi-iliac stent graft,\noriginating at the level of the renal arteries.  The celiac axis, SMA, and\nboth renal arteries are patent.  The ___ again demonstrates calcification its\norigin but is patent distally.\n\nJust distal to the stent bifurcation there is again seen linear contrast\nextravasation in the excluded aneurysm sac, which appears decreased compared\nto prior, representing type 3A or 2 endoleak. The aneurysm sac at this level\nmeasures 3.5 cm (05:58).\n\nThere is been interval placement of a new stent graft extension into the right\ncommon iliac artery, with resolution of previously identified type 1B\nendoleak.  There is no significant residual endoleak in the area of previous\nidentified endoleak type 1 B in the left common iliac artery.\n\nThe right internal iliac artery is occluded with minimal to no reconstitution\ndistally. The left internal iliac artery is heavily calcified but patent. \nThere is overall severe calcium burden in the abdominal aorta and major\nbranches.\n\n POST EVAR EVALUATION\nANEURYSM Suprarenal\nDiameter (Cross-sectional): 3.5 x 3.7 cm\n\nVolume:\n\n-Renal to iliac arteries: 135 ml\n\nLOWER CHEST: Moderate emphysematous changes.  Partially visualized coronary\nartery calcifications.\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 contains stones, without\nevidence of gallbladder 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: No significant change in size of splenic mass measuring 5.4 x 5.0 cm\n(05:23).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  Scattered subcentimeter hypodensities too small to accurately\ncharacterize but likely cysts and unchanged.  The kidneys are otherwise of\nnormal and symmetric size with normal nephrogram. 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. Colon and rectum are within normal limits.  There\nis no evidence of mesenteric 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: Reproductive organs are within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine with short-term vertebral body height\nfrom L3-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Aorto bi-iliac stent with unchanged size of aneurysm sac.\n2. The previously identified type 3a or 2 endoleak at the origin of the\nbi-iliac stent has decreased.  The type 1b endoleak at the distal end of the\nleft common iliac stent is also decreased.\n3. Interval placement of a new stent graft extension into the right common\niliac artery, with resolution of previously identified type 1b endoleak.\n4.  Unchanged splenic mass since ___, previously characterized as a splenic\npseudo tumor or hamartoma."
        },
        {
            "input": "VASCULAR:\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Center-line): 3.6 x 3.7 cm\nVolume:\n\n-Aneurysm: 106.1 ml\n-Renal to Aortic bifurcation: 130.6 ml\n-Renal to Iliac bifurcation: 174.2 ml\nANEURYSM Common Iliac\nThe bilateral common iliac aneurysms appear unchanged in diameter, measuring\nup to 2.9 cm on the right and 2.7 cm on the left.\n\nENDOLEAK:\n\n-Aorta: Type IIB: aneurysm sac filling via branch vessel (multiple vessels) OR\ntype IIIA: leak through defect in graft (junctional separation of the modular\ncomponents)\n-Left common iliac: Type IB: leak at distal graft attachment site\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.3 cm; compared to 0.4 cm.\nLength distal graft to iliac bifurcation:  Right: 5.0 cm, compared to 4.8 cm;\nLeft: 2.7 cm, compared to 1.1 cm.\n\nLOWER CHEST: At least moderate centrilobular emphysema is unchanged.  Mild\natelectasis.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  Tiny hyperenhancing foci within the medial aspect of segment\nVII and anterior aspect of segment V are too small to completely characterize,\nlikely a perfusional anomalies rather than flash filling hemangiomas as they\nwere not seen on prior examinations (series 5, image 15, image 40, and image\n57).  The liver otherwise demonstrates homogeneous attenuation throughout\nwithout suspicious hepatic lesions.  No intrahepatic or extrahepatic biliary\nductal dilatation.  The gallbladder is contains stones, without evidence of\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: There is a round, masslike region of the superior spleen spanning 5.4\nx 4.8 cm, unchanged and previously characterized is probably a splenic pseudo\ntumor.  No new or suspicious splenic lesion 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.  Decreased enhancement\nof the left lower pole is unchanged compared to prior examinations, likely the\nsequela of an accessory renal artery occlusion caused by the stent.  A\nhypoattenuating lesion within the lateral aspect of the interpolar left kidney\nis unchanged and statistically likely reflects a simple cyst.  Additional,\npunctate, hypoattenuating lesions are too small to completely characterize,\nbut likely also reflects simple cysts.  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.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.  The\nappendix is not clearly visualized.  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: The prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSignificant osseous demineralization is again noted.  Multiple levels of\nvertebral body height loss in the lower lumbar spine are unchanged.  Moderate\nmultilevel degenerative changes are worst at L5-S1.  Bilateral sacroiliac\njoint arthrosis is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval increase in contrast about the distal aortic stent and bilateral\ncommon iliac stents reflecting a type IIB or III endoleak of the aortic stent\ncomponents and a type IB endoleak of the left common iliac component.\n2. Tiny hyperenhancing foci within the medial aspect of segment VII and\nanterior aspect of segment V are too small to completely characterize, likely\na perfusional anomalies rather than flash filling hemangiomas as they were not\nseen on prior examinations.\n3. Unchanged appearance of the spleen consistent with splenic pseudo tumor.\n4. Cholelithiasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:31 ___, less than 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: Liver demonstrates diffusely decreased attenuation, which may\nrepresent fatty liver on this contrast enhanced exam.  There are punctate\nhypodensities throughout the liver, which are too small to characterize, but\nlikely represent cysts versus biliary hamartomas.  There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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, there\nare multiple adjacent loops of fluid containing small bowel, which are mildly\nprominent, which can be seen with enteritis.  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 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": "Multiple fluid-filled loops of small bowel, with normal wall thickness and no\nsurrounding stranding, can be seen in the setting of enteritis.  No bowel\nobstruction.\nNormal appendix."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Limited assessment of the lung bases demonstrate lower lobe\natelectasis. The right hemidiaphragm is significantly elevated.  No pleural\neffusion or large pneumothorax. The visualized heart is normal in size without\npericardial effusion.  Coronary artery and ascending aortic calcifications\nnoted.  Midline sternotomy wires are noted.\n\nABDOMEN:\n\nThe liver is homogeneous and grossly unremarkable. The gallbladder is normal\nwithout calcified gallstones.\n\nThe spleen is normal. The pancreas is homogeneous without peripancreatic fat\nstranding or focal fluid collection. The adrenal glands are unremarkable.\n\nThe kidneys are symmetric in size. No focal renal lesions.  The left\nextrarenal pelvis is noted, unchanged from previous examination. No\nhydronephrosis or hydroureter identified. No renal or proximal ureter calculi.\n\nA small hiatal hernia is present. The stomach is grossly unremarkable in\nappearance. The small bowel is slightly prominent in caliber measuring 1.9 cm\nin maximal without width without wall thickening. A new large stool ball\nmeasuring approximately 8.9 x 9.1 cm is seen within the rectum.  The remaining\nlarge bowel is normal in caliber without wall thickening, fat stranding, or\nfocal mass lesion. The appendix is not visualized however no evidence for\nacute appendicitis.\n\nThe abdominal aorta is ectatic without aneurysmal dilatation.  Dense\ncalcification is seen throughout the abdominal aorta. The iliac arteries are\nnormal in course and caliber.\n\nMultiple subcentimeter retroperitoneal lymph nodes do not meet CT size\ncriteria for enlargement. No free abdominal fluid, abdominal wall hernia, or\npneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria. No free pelvic fluid\nseen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  Dextroscoliosis of the lumbar\nspine is again noted. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Chronic elevation of the right hemidiaphragm.\n2.  Massive fecal impaction may be the cause of patient's symptoms with\nslightly prominent small bowel loops. No definite obstruction.\n3.  No colitis or diverticulitis."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  There is severe calcium\nburden in the abdominal aorta which causes multilevel luminal narrowing in the\ninfrarenal region most severe at the bifurcation where it measures\napproximately 0.5 cm (4:152).  The bilateral common, internal, and external\niliac arteries are widely patent with mild narrowing at the bifurcation but\notherwise no significant narrowing.  Bilateral common femoral arteries\ndemonstrate moderate calcified atherosclerotic plaque causing approximately\n50% narrowing bilaterally.  Hepatic arterial anatomy is conventional.  Single\nbilateral renal arteries demonstrate moderate atherosclerotic calcified plaque\nand narrowing at their origins. Accessory lower pole right renal artery noted\nincidentally (4:123). Mild ___ narrowing at its origin. There is moderate to\nsevere stenosis at the celiac axis origin with poststenotic dilatation\n(602:87).\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 is subcentimeter hypodensity hepatic segment IV which is too small to\ncharacterize but statistically most likely represents a cyst or biliary\nhamartoma, probable stable (4:97).  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is not visualize.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of symmetrically mildly atrophic.  There is no\nevidence of stones or hydronephrosis.  There are numerous hypodensities in\nboth kidneys some of which are clearly simple cysts and many of which are\nsubcentimeter and too small to characterize but most likely represent small\ncysts. A 2.0 cm cystic lesion in the upper pole the left kidney was seen as\nhyperdense on noncontrast examination in ___ when it appeared similar,\ncompatible with a proteinaceous or hemorrhagic cyst (601:46).  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Sigmoid diverticulosis.  Unremarkable rectum. \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.  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. \nDegenerative changes are present spine with grade 1 anterolisthesis of L5 on\nS1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Severe calcium burden in the infrarenal abdominal aorta which causes\nmultilevel narrowing most severe at the bifurcation where there is\ncircumferential calcium and the lumen measures approximately 0.5 cm in\ndiameter.\n2. Approximately 50% narrowing of the bilateral common femoral arteries by\ncalcified plaque. Mild narrowing of the common iliac arteries at the\nbifurcation. No significant narrowing in the external iliac arteries.\n3. Moderate to severe stenosis at the celiac axis origin with poststenotic\ndilatation."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  133 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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 adrenal is normal in size and shape\nThere is marked enlargement of the left adrenal which measures 82.9 x 99.8 mm\nin cross-sectional diameters and 127.6 mm in length a (12;17 and 9;49). The\nadrenal mass displaces the body and tail of the pancreas anteriorly and the\nkidney inferiorly\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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare no diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is not visualized.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nUterus and adnexae are normal\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. Large left adrenal mass, likely metastatic melanoma  (82.9 x 99.8 mm).\n2. No other evidence of metastatic disease in the abdomen 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 a 3 mm hypodensity along the periphery of segment VI (5:65) that is\ntoo small to characterize but most likely represents a cyst or hamartoma.  No\nother focal liver lesions identified. 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:  Right adrenal gland is normal in size and shape.  There has been\ninterval decrease in size of the dominant left adrenal mass, which currently\nmeasures 7.4 x 8.7 x 10.7 cm (TV x AP x CC), previously 8.3 x 10 x 12.7 cm in\n___.  It abuts the posterior aspect of the splenic artery (5:61), which\nremains widely patent. Distal left renal artery is attenuated prior to\nentering the left renal sinus (5:70).  Left renal vein appears obliterated\nshortly after its origin from the IVC (5:66). However, the left kidney\ncontinues to demonstrate homogeneous enhancement, apparently due to collateral\nflow from the left common iliac vein (5:72, 8:25).\n\nNotably, there is now a retroperitoneal soft tissue nodule/lymph node\nmeasuring 3.6 x 1.8 cm that appears to coalesce with the inferior medial\naspect of the dominant mass described above (5:68-70).  This is new from ___, and likely represents a new metastatic focus.\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:  Retroperitoneal soft tissue mass/node as described above.\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: Uterus is unremarkable.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1.  New 3.6 x 1.8 cm retroperitoneal soft tissue mass/node at the root of the\nmesentery, along the inferior medial aspect of the previously noted left\nadrenal mass, likely another metastatic focus.\n2.  Dominant left adrenal mass itself has decreased in size.\n3.  Main left renal vein appears obliterated by the mass, with continued\ndrainage of the left kidney by collateral flow from the left common iliac\nvein. Left renal artery is attenuated, but remains opacified.\n4.  CT Chest dictated separately."
        },
        {
            "input": "LOWER CHEST: There is bibasilar dependent atelectasis, but no pleural\neffusions.  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 portal and hepatic veins are patent. \nThere are multiple hyperdense gallstones, but the gallbladder is not distended\nand there 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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 free air or free\nfluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is post prostatectomy with surgical clips in the\nsurgical bed.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nAn infrarenal IVC filter is identified (400b:57).  Hypodense occlusive\nexpansile thrombus is identified within the visualized portions of the\ninfrarenal inferior vena cava, extending distally into the common iliac veins,\nand into the common, superficial and deep femoral veins bilaterally, as seen\non the recent ultrasound (400b:68, 73).  A small amount of hypodense thrombus\nis also identified extending superiorly above the filter and extending to just\nbelow the insertion of the bilateral renal veins (400b:59).\n\nBONES AND SOFT TISSUES: Severe degenerative changes of the lumbar spine are\nidentified, most pronounced at L2-L3 and L5-S1.  Anterior osteophytes are\nnoted at L3-L4 and L4-L5.  Enthesophytes present at the bilateral iliac\ncrests.  Bilateral soft tissue edema is identified, greater at the right flank\nand right lateral upper thigh.",
            "output": "1. Infrarenal IVC filter is present.  Extensive expansile hypodense thrombus\nfills the infrarenal IVC, extending distally to the common iliac veins and\ninto the common, superficial, and deep femoral veins bilaterally, as seen on\nthe recent ultrasound.  A small amount of thrombus is also identified just\nsuperior to the IVC filter, extending to just below the insertion of the\nbilateral renal veins.  Suprarenal IVC and hepatic veins are patent.\n2. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusion with consolidations/atelectasis\npartially covered on this exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nAgain seen are multiple cystic lesions some of them with gross calcifications\nin the left lobe of them unchanged consistent with the polycystic disorder. \nThe CBD is difficult to accurately assess in this noncontrast CT. The\ngallbladder is collapsed on gallstones.\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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are markedly increased in size with the renal\nparenchyma predominantly replaced by multiple cystic lesions in keeping with\nthe autosomal dominant polycystic kidney disease.  There is a renal transplant\nin the right the lower quadrant.  Again seen is a cortical cyst in the\ninferior pole of the transplant kidney slightly enlarged since ___.  There is\na percutaneous nephroureterostomy stent.  The bladder is collapsed.\n\nGASTROINTESTINAL: There is a feeding tube in the stomach.  No bowel\nobstruction.  No pneumoperitoneum.  No ascites.\n\nPELVIS: The urinary bladder is collapsed.\n\nREPRODUCTIVE ORGANS: Calcified fibroid in the uterus. No adnexal masses.\n\nLYMPH NODES: No abdominal or pelvic adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted.\n\nBONES: Prior sternotomy.  Unchanged compression fracture of the T12 vertebral\nbody.\n\nSOFT TISSUES: Again seen are multiple subcutaneous varices in the lower\nabdomen/pelvis.  Subcutaneous edema in keeping with the third-spacing of\nfluid.",
            "output": "1. No intra-abdominal abscess or infectious process.\n2. Bilateral enlarged polycystic kidneys in keeping with the known autosomal\ndominant polycystic kidney disease.  Right lower quadrant renal transplant\nwith no hydronephrosis.  Simple cyst measuring up to 5.2 cm in the lower pole\nof the transplant kidney.\n3. Bilateral pleural effusions with lower lobe consolidation partially imaged."
        },
        {
            "input": "LOWER CHEST: Please refer to the chest CT obtained on the same day for more\ndetails of thoracic findings. The imaged lung bases are clear.\n\nABDOMEN:\n\nLiver:  The 1 cm hypodensity in the right lobe of the liver is stable from\nprior. The 1.3cm hypodensity in the segment 2 was previously characterized as\na hemangioma and is stable from prior.\n\nKidney: Postsurgical changes from prior left kidney lower pole AML resection\nare again noted. There is right hydronephrosis and hydroureter. There is no\nperinephric stranding.\n\nThe spleen, gallbladder, adrenal glands, and pancreas are unremarkable.\nThe stomach and duodenum are unremarkable. Loops of small and large bowel\ndemonstrate no signs of ileus or obstruction. The appendix is unremarkable.\nThe abdominal aorta is normal in caliber.  No free air or free fluid is seen.\n\nLymph nodes:  Extensive retroperitoneal lymphadenopathy is overall larger\ncompared to prior.  For example, a para-aortic lymph node measures 1.3 x 1.2\ncm (2:68) (previously 0.9 x 0.7 cm). A right common iliac node measures 4.3 x\n2.8 cm (2:19) (previously 2.0 x 1.3 cm). A left common iliac node measures 2.5\nx 1.5 cm (2: 85) (previously 1.2 x 0.8 cm).  Other enlarged lymph nodes are\nalso larger overall.\n\nPELVIS:\n\n Prostate: Prostate measures in 6.4 x 6.1 x 6.2 cm, slightly larger than prior\n(6.0 x 5.1x 5.8 cm)\n\nBladder is unremarkable.\n\nBONES:\nAn interosseous pneumatocyst is again noted in the left ilium. No worrisome\nlytic or blastic osseous lesion is seen.",
            "output": "1.  Retroperitoneal and pelvic lymphadenopathy, larger compared to prior.\n\n2.  Enlarged prostate, larger compared to prior.\n\n3.  Right sided hydronephrosis and hydroureter, new since prior."
        },
        {
            "input": "LOWER CHEST: Mild, bibasilar atelectasis.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nMultiple foci of enhancement are demonstrated at the peripheral right and left\nhepatic lobes, likely perfusional (2:39, 52, 55).  Mild intrahepatic biliary\ndilatation appears unchanged.  Tiny focal hyperdensities are within the\ngallbladder (2:56), which may reflect small stones.  No gallbladder wall\nthickening or pericholecystic inflammation.\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: Left adrenal lesions measure 3.0 x 2.5 cm and 1.3 x 1.1 cm, similar\nin size to prior, previously characterized on MRI as adenomas.  The right\nadrenal gland is nodular, likely smaller adenomas, unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA fat containing lesion arising from the mid left kidney measures\napproximately 4.3 x 2.1 cm, with coursing vessels, compatible with an\nangiomyolipoma, as characterized on prior MRI.  Cysts of the left kidney\nmeasure up to 4.0 cm, and have not substantially changed.  A mildly hyperdense\nlesion within the mid left kidney measures 1.0 cm (2:50), likely a hemorrhagic\ncyst.  Multiple subcentimeter right renal hypodensities are too small to\ncharacterize.  There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Scattered colonic\ndiverticulosis, without evidence of acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS:  Trace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: Fibroid uterus.  Trace fluid within the endometrial\ncavity.  No adnexal masses.\n\nLYMPH NODES: Multiple small upper abdominal and retroperitoneal nodes are not\npathologically enlarged.  There is no mesenteric, pelvic, or inguinal\nlymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.",
            "output": "1. No evidence of malignancy within the abdomen or pelvis.  No acute\nabdominopelvic abnormality.\n2. Multifibroid uterus.  Trace fluid within the endometrial cavity.  Reference\nis made to pelvic ultrasound done ___\n3. Cholelithiasis, without evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST:\nMild bibasilar dependent atelectasis is noted. There is no pleural or\npericardial effusion.\n\nABDOMEN:\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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:  The stomach and proximal small bowel is filled with enteric\ncontrast material. Prominent left upper quadrant small bowel loops measure up\nto 2.8 cm in greatest dimension (02:41), however there is no discrete\ntransition point or other findings to suggest small bowel obstruction..\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\nburden in the abdominal aorta and great abdominal arteries, with no\nflow-limiting stenoses.\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 are within normal limits, other than incidentally noted\nvaginal cysts.\n\nBONES AND SOFT TISSUES:\nA Schmorl's node is present in the inferior endplate of the T8 vertebral body,\nwith minimal anterior height loss (602b:41).  No osseous lesion worrisome for\nmalignancy is identified.  Multiple calcified injection granulomas are noted\nin in the bilateral buttocks (2:64, 62).",
            "output": "No acute pathology in the abdomen or pelvis. Normal appendix.\n\nMajority of enteric contrast remains in the stomach and proximal small bowel,\npossibly due to slow transit. No evidence of mechanical obstruction. \nOutpatient gastric emptying could be obtained if indicated."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear apart from dependent changes. There is a\n4 mm left lower lobe pleural based nodule (series 2:21). No pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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 right kidney is unremarkable, without evidence of stones or\nmasses within limitations of an unenhanced scan.  There is mild left\nhydroureteronephrosis, without visualization of a radiodense obstructing\nstone.  There is asymmetric perinephric stranding, which extends inferiorly\nalong the pararenal fascia and left colic gutter.  Left periureteral stranding\nsuggest ureteral inflammation.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness. The colon and rectum are within normal\nlimits.\n\nPELVIS: There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.  There is grade 1\nanterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild left hydroureteronephrosis with left perinephric stranding, without\nvisualization of an obstructing stone.  Differential includes recently passed\nstone or radiolucent stone.  Otherwise, no acute process within the abdomen or\npelvis.\n2. 4 mm left lower lobe pleural based nodule.  Please see recommendation below\nfor follow-up.\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 recommend 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: Visualized lung fields are within normal limits.  There is\nscarring at the left lingula.  There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A 6\nmm hypodensity in the right lobe of the liver previously described as a\nhemangioma.  There is no evidence of new focal 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.  Previously seen pancreatic\nhead cyst is not visualized in this study.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. There is a new 1.0 cm hypodensity in 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. \nSeen again is the right renal artery aneurysm which measures 1.9 cm,\npreviously 1.4 cm.  Extrarenal pelves seen bilaterally.  No evidence of renal\ncalculi.  Mild hydroureteronephrosis on the left.  There is no evidence of\nfocal renal lesions.  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: Punctate hyperdensity is seen in the bladder dependently consistent\nwith calculus, potentially recently passed given findings on the left. There\nis no 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Moderate degenerative changes are seen along the lumbar spine. \nSchmorl's nodes are seen at T11 and L3.  There is right unilateral\nspondylolysis at L5.  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. Mild left hydroureteronephrosis with punctate stone in the bladder.  These\nfindings are likely due to recently passed stone, especially in light of\npatient's improved symptoms.  No current obstructing renal or ureteral\ncalculi.\n2. Enlarging right renal artery aneurysm measuring up to 1.9 cm.\n\nNOTIFICATION:  An update to the interpretation of this study was given to\nemergency room physician ___ by Dr. ___ at 1500 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. The\nknown hepatic cysts demonstrates interval decrease in size over serial\nimaging.  It contains proteinaceous or hemorrhagic content (on prior MRI), and\nhas likely involuted subsequent to hemorrhage.  There is otherwise no evidence\nof focal 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.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right 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, some of which are exophytic. The\nlargest cyst is in the anterior pole of the right kidney and measures 3.1 x\n1.5 cm, unchanged since ___.  There is a 0.7 cm stone in the distal left\nureter (5:109). There is mild hydroureter (ureter measuring 7 mm diameter)\nwith mild urothelial enhancement and periureteric stranding proximal to the\nstone, most likely reactive.  No left hydronephrosis.\nThere is a 0.5 x 0.3 cm nonobstructing stone in the inferior pole of the left\nkidney.  There is otherwise no evidence of focal renal lesions or\nhydronephrosis.  There is mild perinephric stranding on the lateral border of\nthe right kidney (9:35). There is no perinephric stranding around the left\nkidney.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Status post\nsigmoidectomy.  Extensive diverticulosis without diverticulitis. The appendix\nis normal.\n\nPELVIS: There is a 0.8 x 0.9 cm hyperdensity on the posterior wall of the\nbladder (5:109).  Imaging modality does not allow for distinguishing between\nwhether it is precontrast hyperdense, or hyperenhancing.\nThere is no free 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 no 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. The soft\ntissue thickening posterior to the liver (5:58-61) is fairly similar to\nimaging done in ___.  Stability over time is reassuring.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. 0.8 x 0.9 cm hyperdensity on the posterior wall of the bladder as described\nabove is concerning for a bladder mass.  Evaluation with bladder ultrasound or\ncystoscopy would further characterize the lesion.\n3. 0.7 cm nonobstructing stone in the distal left ureter, with mild\nhydroureter.  No hydronephrosis.  There is a second 0.5 cm nonobstructing\nstone in the inferior left kidney.\n4. Renal cysts appears stable over time.\n5. Stable soft tissue thickening posterior to the liver.\n\nRECOMMENDATION(S):  Bladder ultrasound or cystoscopy for bladder lesion.\n\nNOTIFICATION:   The findings and impression above were discussed with ordering\nprovider ___, MD, by telephone by ___ van ___, MD, at 9:30 AM\non ___."
        },
        {
            "input": "LOWER CHEST: Please refer to dedicated CT chest report from the same day for\ndetails of intrathoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstrated is a 2 cm exophytic hypodensity within segment 2 previously\ncharacterized as a proteinaceous or hemorrhagic hepatic cyst on the MRI of ___ continue to decreased in size since ___ likely due to\ninvolution.  Mildly dilated peripheral ducts within the lateral left lobe may\nbe due to mass effect, unchanged since ___.  No suspicious focal\nlesions. No evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is normal\n\nPANCREAS: There is mild-to-moderate atrophy of the pancreas.  The remaining\nparenchyma, the pancreas has normal attenuation throughout, without evidence\nof 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 nephrogram. \nThere are multiple renal cysts some partially exophytic bilaterally measuring\nup to 1.9 cm in the right interpolar region and 1.5 cm in the left upper pole.\nAll are stable in size.  No evidence of solid renal lesions or hydronephrosis.\nRedemonstrated is a 4 mm, nonobstructive left lower pole renal calculus\nunchanged in size or position.  No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Pandiverticulosis,\nmost pronounced from the sigmoid to distal transverse colon.  There is an\nintact sigmoid colonic anastomosis.  No evidence of diverticulitis.  The\nrectum appears normal.  The appendix is normal.\n\nPELVIS: The posterior bladder wall hyperdensity seen on the ___ study\nand to a lesser degree on the ___ study is not well visualized on\ntoday's examination. Prior 7 mm distal left ureteral stone is no longer\nvisualized. No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains punctate calcifications, otherwise\nis normal\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Mild atherosclerotic disease is\nnoted.  The celiac axis, SMA, bilateral renal arteries and ___ are patent. \nThere is conventional anatomy of the celiac axis.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.  Is\nmoderate L5-S1 disc space and bilateral hip joint narrowing.\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. Pandiverticulosis without evidence of diverticulitis.\n3. Posterior wall hyperdensity seen on the ___ study is not\nvisualized on today's examination.\n4. Nonobstructive 4 mm left lower pole renal calculus unchanged in size or\nposition.\n5. Prior 7 mm distal left ureteral stone no longer visualized."
        },
        {
            "input": "LOWER CHEST: Mild atelectasis at the lung bases.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is new portal venous gas predominately in segment 2.  A 1.0 cm\nhypodensity in the peripheral right hepatic lobe is unchanged.  There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.  A\nmildly prominent common bile duct is unchanged, likely related to post\ncholecystectomy appearance.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left 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 1.4 cm hypoattenuating (62 Hounsfield units)\ncyst in the lower pole of the left kidney is unchanged, consistent with a\nhemorrhagic cyst.  Additional hypodensities in the left kidney is too small to\ncharacterize by CT but likely represent cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is interval development\nof pneumatosis intestinalis and bowel wall thickening involving multiple loops\nof small bowel in the mid abdomen as well as cecum (series 2, image 65).  The\naffected small bowel does appear to enhance.  There is extensive\ndiverticulosis of the sigmoid: Without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unchanged.  There is a\nsmall amount of free fluid in the pelvis and within the mesentery.\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.  There is severe stenosis of the SMA, which\nis diminutive and appearance.  This configuration is unchanged from prior\nstudy on ___.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAgain noted is a compression deformity of T12, unchanged.\n\nSOFT TISSUES: Hematoma in the right inferior abdominal wall measures 8.1 x 4.7\ncm, previously 7.1 x 5.0 in a similar measurement.  There are slight\ndifferences in patient positioning, and there is likely no significant change\nin the size of the hematoma compared to prior.",
            "output": "1. Interval development of new bowel wall thickening and pneumatosis\nintestinalis involving multiple small bowel loops in the mid abdomen as well\nas the cecum, with portal venous gas.  All the bowel walls appear to enhance,\nischemia remains a consideration, and correlation with lactate levels is\nrecommended.\n2. Severe stenosis of the origin of the SMA, which is unchanged from the ___ study.\n3. No significant change in size of right lower anterior abdominal wall\nhematoma.  No evidence of active extravasation.\n4. Sigmoid diverticulosis.\n\nNOTIFICATION:  The findings were discussed with ___, N.P. By\n___, M.D. on the telephone on ___ at 1:26 pm, 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: There are new ill-defined areas of ill-defined hypodensity\nthroughout the liver, more prominent in the right hepatic lobe (02:43).  A\nsubcentimeter hypodensity in the posterior right hepatic lobe is not\nsignificantly changed (02:41).  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: Spleen is normal in size and enhances slightly heterogeneously.\n\nADRENALS: The 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 likely hemorrhagic cyst arising from the left lower pole is not\nsignificantly changed.  There is no hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a hiatal hernia.  Patient is status post right\nhemicolectomy and small-bowel resection followed by interval transverse\ncolonic anastomosis in the right hemiabdomen.  Compared with ___,\nthere is worsening pneumatosis in small bowel loops extending from the distal\nduodenum/proximal jejunum in the left upper quadrant and extending throughout\nthe majority of the remaining small bowel, with only a portion of the small\nbowel just proximal to the enterocolonic anastomosis possibly spared.  Some of\nthe small bowel loops appear slightly wall thickened.  There is colonic\ndiverticulosis.  There are trace foci of free air.  No evidence of\nextraluminal contrast to suggest a leak at the anastomosis.\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.  Extensive atherosclerotic\ndisease is noted.  There is near complete occlusion of the origin of the SMA\nfor a short segment spanning approximately 9 mm which appears stable to\nslightly worsened compared with prior (301:417).  There is no significant\nchange in severe narrowing of the remainder of the SMA.  Distal branches of\nthe SMA in the right lower quadrant display less enhancement in the remainder\nof the SMA, however this due to timing of contrast bolus on this non\nangiographic study (2:83).  There is worsening portal venous gas in the liver\nas well as in branches of the SMV (2:65; 83).\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: There are postsurgical changes along the anterior abdominal\nwall.  A hematoma along the right anterior lower abdominal wall measures 6.5 x\n4.3 cm, previously measuring 7.1 x 5.0 cm.  There is a fat containing left\ninguinal hernia.",
            "output": "1. Status post right hemicolectomy and small bowel resection with\nenterocolonic anastomosis, with worsening pneumatosis intestinalis involving\nthe majority of the remaining small bowel loops, some of which are mildly wall\nthickened, and worsening portal venous gas in the liver and in branches of the\nSMV in the right lower quadrant, concerning for worsening small bowel\nischemia.\n2. New ill-defined areas of hypodensity throughout the liver, concerning for\ninfarction/infection.\n3. Near complete occlusion of the origin of the SMA appear stable to slightly\nincreased from prior, with no significant change in severe narrowing\nthroughout the remainder of the SMA.\n4. Trace free fluid and free air may be due to recent surgery.\n5. No evidence of extraluminal contrast to suggest leak.\n6. 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 by Dr. ___ with Dr. ___\non the telephone on ___ at 7:20 pm, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions and bibasilar atelectasis. \nOtherwise, the visualized 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 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.  There\nredemonstration of multiple subcentimeter hypodensities, too small to further\ncharacterize.\n\nADRENALS: The right and 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 3.9 cm simple cyst at the interpolar region of the right kidney. \nThere other subcentimeter hypodensities, which are too small to further\ncharacterize but statistically cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is fluid in the esophagus, suggestive of dysmotility\nversus reflux.  The stomach is unremarkable.  There are multiple dilated\nfluid-filled loops of small bowel, measuring up to 3.8 cm.  There is a\npossible transition point in the large ventral hernia with collapsed bowel\nseen distally (series 2, image 79).  Diverticulosis without evidence of wall\nthickening or fat stranding.\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: There is a large ventral hernia containing fat and loops of\nsmall and large bowel, as detailed above.",
            "output": "1. Small-bowel obstruction with a possible transition point in the large\nventral wall hernia.\n2. No free air, portal venous gas, or pneumatosis intestinalis.\n3. Diverticulosis without evidence of diverticulitis.\n4. There is fluid within the esophagus, suggestive of dysmotility versus\nreflux."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Cardiac leads are partially\nevaluated.\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 3 cm hypodense\nlesion in the lower pole of the left kidney, compatible with a cyst.  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 diverticulosis without\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\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: Severe degenerate disease is visualized in the lower lumbar spine\nincluding anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Unremarkable CT of the abdomen and pelvis."
        },
        {
            "input": "LOWER CHEST: Heart is mildly enlarged.  There is a left-sided pacer with 2\nleads terminating in the right atrium and right ventricle.  Bilateral lung\nbases are clear.  There is no focal consolidation.\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.  Mild\nthickening of the left adrenal gland is unchanged without discrete nodule.\n\nURINARY: There is redemonstration of a left renal midpole 3.4 x 2.9 x 2.5 cm\nlow-attenuation lesion likely representing a cyst..  There is no suspicious\nrenal 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.  There is mild relatively\ndiffuse dilation of the small bowel measuring up to 3.1 cm with no definite\ntransition point.  There is fluid visualized throughout the colonic lumen\nindicative of ongoing diarrhea.  There is no wall thickening or caliber change\nof the colon.  The appendix is not visualized.  There are small diverticula\ninvolving the cecum without diverticulitis.  There is mild mesenteric\ncongestion.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is lobulated with calcified fibroids\nvisualized.\n\nLYMPH NODES: There are multiple prominent mesenteric lymph nodes without\nevidence of lymphadenopathy.  There is no retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild to moderate\natherosclerotic disease is noted.\n\nBONES: There is grade 1 anterolisthesis of L4 on L5, unchanged from previous\nstudy.  There are moderate multilevel degenerative changes of the\nthoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild fluid-filled dilation of the small bowel measuring up to 3.1 cm with\nno definite transition point as well as fluid visualized throughout the colon\nand mild mesenteric congestion.  Findings are compatible with an ongoing\ndiarrheal illness and suggestive of a gastroenteritis, without evidence for\nbowel obstruction.\n2. Cecal diverticula 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.  Status post cholecystectomy.  Portal\nvenous system 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.  Incidental note is made of a 1.4 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. \nNumerous bilateral subcentimeter hypodensities measuring up to 7 mm in the\ninterpolar region on the right are noted.  These are too small to\ncharacterize, but statistically likely represent cysts.  There is no evidence\nof enhancing renal masses 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 is\nextensive sigmoid colon diverticulosis.  Again noted is sigmoid colonic wall\nthickening and pericolonic fat stranding around sigmoid diverticula that is\nsimilar in location compared to the prior CT performed in ___.  There is\nan air-filled enhancing intramural sinus tract in the anterior wall, new in\nthe interval (2:77).  Small amount of free fluid is seen within the pelvis\nadjacent to the sigmoid colon (601b:23).  No evidence of surrounding abscess\nor perforation.  Normal appendix.  No pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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.  Minimal atherosclerotic\ndisease 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.",
            "output": "Acute sigmoid diverticulitis with evidence of an intramural sinus tract.  No\nevidence of abscess or perforation.  A colonoscopy is recommended after\ntreatment has resolved to exclude an 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 is unremarkable.  Cholecystectomy changes are again\nseen.  There is no biliary ductal dilatation.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable.  No hydronephrosis.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.\n\nPELVIS: The necrosis in the left inguinal region with an open wound is again\nnoted and appears similar to ___.  This necrotic collection tracks\nalong the left external iliac vasculature which is worse at this level\nmeasuring 6.4 cm, previously 3 cm.  The left external iliac and visualized\ncommon and femoral vasculature are occluded.\n\nThe urinary bladder is decompressed via Foley catheter.  An enlarged uterus is\nagain noted.\n\nLYMPH NODES: There is worsening of necrotic adenopathy, for example new 2.0 cm\ndeep right inguinal; new 2.2 cm deep right internal iliac and new necrotic\nobturator adenopathy on the right measuring up to 1.9 cm.  A 1.3 cm deep left\ninternal iliac lymph node is now more necrotic.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Thrombosis of the left\nexternal iliac vein is more conspicuous on current exam due to timing of the\ncontrast.  There is also likely new thrombosis of the left common and femoral\nveins.\n\nBONES: No worrisome osseous lesions seen.\n\nSOFT TISSUES: Diffuse subcutaneous edema is again noted worse in the left\nthigh and gluteal regions.",
            "output": "1. Interval worsening of pelvic adenopathy.\n2. Thrombosis of the left common femoral common femoral and left external\niliac vein, worse than on prior, possibly secondary to worsening of necrosis\ntracking from the left inguinal to the left external iliac region. \nConsequently, there is worsening of diffuse soft tissue edema in the left\nthigh.\n3. Please refer to CT chest for findings in the thorax dictated separately by\nthe thoracic radiology service."
        },
        {
            "input": "A trace left pleural effusion is unchanged from the ___\nexamination, however, there is slight worsening of bibasilar atelectasis\n(series 2, image 14).  The heart size is normal.  There is a trace pericardial\neffusion which is unchanged (series 2, image 19).  A central venous catheter\nterminates at the caval atrial junction (series 2, image 18).\n\nThe liver density is within normal limits.  There is a new perihepatic\nhyperdense collection measuring approximately 15.9 x 5.5 x 22.0 cm (series\n601, image 46, series 2, image 42), with moderate abdominopelvic intermediate\ndensity fluid (series 2, image 82), compatible with a large hematoma.  Focal\nhyperdense material is also seen within the pelvis, reflecting additional clot\n(series 2, image 99).\n\nAgain seen is a 3.0 x 1.6 cm hypodense lesion at the pancreatic head, better\nvisualized on the contrast-enhanced study from ___, reflecting a\npreviously-described pseudocyst which has gradually decreased in size since\n___ (series 2, image 51).  There is no pancreatic duct dilation.  The\npancreatic body and tail are atrophied.\n\nThe spleen size is top-normal.  There is no focal splenic lesions.\n\nThe adrenal glands are normal in size.\n\nThe kidneys are normal in size, without hydronephrosis.\n\nA nasogastric tube terminates within the proximal stomach.  The stomach and\nintra-abdominal and intrapelvic loops of small and large bowel remain normal\nin caliber.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy.\n\nThe bladder is decompressed by a Foley catheter.\n\nThe prostate is normal in size.\n\nThe abdominal aorta and iliac branches are normal in caliber.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. New large abdominopelvic intraperitoneal hematoma originating from the\nright abdomen.  The exact bleeding source cannot be identified on this\nnoncontrast study.\n2. Slight worsening of mild bibasilar atelectasis.  Unchanged trace left\npleural effusion and trace pericardial effusion.\n3. Known 3.0 x 1.6 cm hypodense lesion at the pancreatic head likely reflects\na resolving pseudocyst, gradually decreasing in size since ___."
        },
        {
            "input": "LOWER 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 hypodense lesions, the largest measuring 23 x\n20 mm within segment VII (series 2, image 62), consistent with known\nmetastases, are unchanged from the previous examination on ___. There\nis no intrahepatic or extrahepatic biliary dilatation. There are multiple\npathologically enlarged porta hepatis lymph nodes measuring up to 20 x 18 mm\n(series 2, image 67; series 2, image 72) with one demonstrating central\nhypodensity, consistent with necrosis, unchanged from the previous\nexamination. The gallbladder is within normal limits, without stones or\ngallbladder 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 left kidney is normal in appearance. The right kidney\ndemonstrates multiple cortical nodules, and there are numerous pararenal\nnodular densities extending from ___ pouch to the right pericolic\ngutter, abutting the right psoas muscle, are minimally changed.  For example a\nlarge conglomerate along the lateral posterior aspect, previously measuring 73\nx 53 mm on ___ now measures 72 x 55 mm.  Within the posterior aspect\nof the conglomeration are increased linear calcifications, possibly reflecting\ntreatment effect. The cortically based renal lesions are also stable. There is\nno collecting system obstruction.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix is\nnot visualized.\n\nMESENTERY AND RETROPERITONEUM:   There are multiple pathologically enlarged\nperirenal, retroperitoneal lymph nodes which are unchanged from the previous\nexamination. There is no free fluid and no free air.\n\nVASCULAR:  The aorta is mildly tortuous, however there is no abdominal aortic\naneurysm.  There is minimal calcium burden in the abdominal aorta and great\nabdominal arteries. The main portal vein, splenic vein and SMV are patent.\n\nPELVIS: There is  ill-defined increased density within the right lower\nanterior intraperitoneal fat extending to the abdominal wall (series 2, image\n109), spanning 3.9 x 3.0 cm, which appears gradually more conspicuous in\ncomparison to several prior examinations dating back to ___, with increased\nnodular components (series 2, image 107). 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. The prostate has\nminimal calcifications, otherwise the prostate and seminal vesicles are\nnormal.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  There is a small fat-containing left inguinal hernia.",
            "output": "1.  Extensive right renal and pararenal soft tissue masses remain unchanged.\n2.  Unchanged numerous hepatic metastases.\n3.  Ill-defined 3.9 x 3.0 cm opacities within the right lower anterior\nmesenteric fat has gradually become more conspicuous since ___, suspicious\nfor metastases, not appreciably changed since the last CT examination.\n4.  No new metastasis."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Please refer to separate CT chest dictated on the same day for\nfindings regarding the thorax.\n\nABDOMEN:\n\nMultiple hepatic hypodensities, largest measuring 2.0 x 1.9 cm (02:51)\n(previously 2.1 x 1.9 cm) within segment 7, consistent with known metastases\nare unchanged from previous examination on ___. Additional 1.8 x\n1.3 cm (02:56) hypodensity within segment ___ (previously 1.6 x 1.3 cm) is\nstable from previous examination with differences in size likely related to\nslice selection. No intra or extrahepatic biliary duct dilatation. The\ngallbladder is normal without calcified gallstones. Multiple enlarged porta\nhepatis lymph nodes, largest measuring 2.7 x 1.8 cm (02:55) (previously 2.8 x\n1.8 cm) demonstrate central hypodensity, consistent with necrosis is stable\nfrom previous examination. An additional 2.3 x 1.6 cm (02:59) (previously 2.1\nx 1.4 cm) enlarged lymph node is adjacent to the posterior wall of the distal\nstomach with mild mass effect, unchanged from previous examination.\n\nThe spleen is normal. The pancreas is homogeneous without peripancreatic fat\nstranding or focal fluid collection. The adrenal glands are unremarkable.\n\nThe left kidney is unremarkable. Mild perinephric fat stranding around the\nleft kidney is unchanged from previous examination. The right kidney again\ndemonstrates multiple cortical nodules as well as numerous pararenal nodular\ndensities extending from ___'s pouch to the right pericolic gutter\nabutting the psoas muscle, essentially unchanged from previous examination. A\nlarge conglomerate is stable measuring 6.9 x 5.3 cm (2:73) (previously 7.1 x\n5.3 cm) with differences in size likely related to slice selection within the\nright posterior para renal space. Again seen within the posterior aspect\ncooperation are increased linear calcifications, likely reflecting treatment\neffect. Cortically based renal lesions are stable. No hydronephrosis or\nhydroureter identified. The proximal right ureter courses through the\nconglomerate, similar to previous examination without associated dilatation.\nNo renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without focal mass lesion.\nThe appendix is not visualized however no evidence of acute appendicitis.\nSmall amount of mesenteric fluid is seen adjacent to the large bowel without\nassociated bowel wall thickening, mucosal hyper enhancement, or fat stranding\nto suggest acute inflammation. A stable 3.0 x 1.7 cm (2:94) (previously 3.0 x\n1.7 cm) the soft tissue deposit is seen adjacent to the cecum posteriorly.\nFluid is seen within the right pericolic gutter, new from previous\nexamination.\n\nThe abdominal aorta is mildly tortuous however normal in caliber without\naneurysmal dilatation.  Moderate amount of atherosclerotic calcification\nnoted. The iliac arteries are normal in course and caliber.  A 1.5 x 1.2 cm\n(2:72) enlarged caval lymph node posterior to the IVC is again seen causing\nminimal indentation on the IVC. The IVC is otherwise normal in caliber.\n\nAgain seen are a few subcentimeter mesenteric lymph nodes, unchanged from\nprevious examination. No pneumoperitoneum. Subcutaneous tissues is\nunremarkable. Ill-defined area of fat stranding along the anterior mesentery\nmost notable within the right lower quadrant is similar to previous\nexamination and most consistent with omental deposition.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria. Small amount of free\npelvic fluid seen. A small fat containing left inguinal hernia noted. The\nprostate and seminal vesicles are unremarkable.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. Stable disease within the abdomen and pelvis with extensive right renal and\npararenal soft tissue masses, hepatic metastases, right lower quadrant fat\nstranding concerning for omental deposition, and porta hepatis lymph nodes.\n2.  Stable 1.5 cm stable lymph node posterior to the IVC causing minimal\nindentation on the IVC.\n3.  No new sites of metastases within the abdomen/ pelvis.\n4.  Please refer to separate CT chest dictated on the same day for findings\nregarding the thorax."
        },
        {
            "input": "LOWER CHEST: Please see separately submitted report of Chest CT for full\ndescription of the lungs.\n\nLIVER:  Again seen are numerous hypodense lesions within the liver, the\nlargest of which is in segment VII, measuring 2.1 x 2.0 cm, minimally changed\nfrom the prior study allowing for differences in slice selection.  No new\nlesions are identified, and liver lesions are minimally changed overall. A\nmoderate amount of perihepatic fluid is also unchanged. Given the stability of\nthese lesions over several years, MRI could be considered for the possibility\nof nonneoplastic etiology.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: Numerous right renal, right perinephric, and retroperitoneal masses\nand nodes in a similar distribution to the prior study appear to have\nincreased slightly in size. The dominant conglomeration in the right posterior\nperinephric space measures 7.2 x 5.8 cm compared to 7.2 x 5.5 cm on the\nprevious study. Numerous additional lesions adjacent to the cecum and psoas\nmuscle demonstrate slight interval growth as well. The left kidney remains\nwithin normal limits.\n\nGI: The stomach is moderately distended without obvious intraluminal mass or\nwall thickening. The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction. Diffuse nodularity of the omentum\nis minimally changed from the prior study (3:76).  Moderate amount of free\nfluid is unchanged from the prior study.\n\nRETROPERITONEUM: The aorta is normal in caliber, with diffuse atherosclerotic\ncalcifications.\n\nCT PELVIS:  A fat containing left inguinal hernia is unchanged from the prior\nstudy. The urinary bladder appears normal. No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. Slight interval growth of numerous right renal, right perinephric, and\nright retroperitoneal masses.\n2. Numerous hepatic hypodensities demonstrate stability over several years,\nconsider MRI to evaluate for nonneoplastic etiology."
        },
        {
            "input": "LOWER CHEST: Consolidation in the right lower lobe is concerning for\npneumonia.  No pericardial effusion.  Trace right-sided pleural effusion.  A 4\nmm right perifissural nodule is unchanged (series 2:1).\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 solid renal lesions or hydronephrosis.  A\nsubcentimeter hypodensity in the lower pole of the left kidney is too small to\ncharacterize by CT but likely represents a simple cyst, is unchanged from the\nprior study in ___.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\nExtensive colonic diverticulosis, most significant in the sigmoid colon,\nwithout evidence of pericolonic fat stranding or wall thickening.  The\nappendix is not definitely seen but there are no secondary signs of acute\nappendicitis.\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.d there is peripherally calcified 1.1 cm right thyroid artery\naneurysm (2:22)\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nModerate degenerative change in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPartially visualized postop changes suggestive of left mastectomy are noted.",
            "output": "1. Right lower lobe pneumonia.\n2. No acute process within the abdomen or pelvis.\n3. Colonic diverticulosis, without evidence of acute diverticulitis.\n4. Moderate hiatal hernia."
        },
        {
            "input": "CHEST:\n\nThe lower chest is unremarkable.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal. The kidneys enhance normally and excrete\ncontrast briskly. There are no solid renal lesions or hydronephrosis.  There\nare several simple cysts in the left kidney, the largest measuring up to 7.0 x\n8.5 cm in size, and several sub cm hypodensities which are too small to\ncharacterize in the right kidney. The stomach and duodenum are normal. The\nsmall bowel and large bowel are normal in caliber, without wall thickening or\nmass.  The appendix is normal.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The uterus is notable for a 2 cm posterior\nuterine body fibroid.  No adnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "No acute abdominal or pelvic 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 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 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. 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: Filling defect and expansion of the left common iliac to the IVC\nbifurcation,, extending to the external iliac, common femoral vein at the\ninferior margin of the image.  There is also non opacification of the internal\niliac vein suspicious for thrombus.  There is no abdominal aortic aneurysm. \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. Partially visualized thrombus extending cephalad within the left common\niliac to the IVC verification, and distally to the left common femoral vein\nand beyond the field of view.  Possible additional involvement of the left\ninternal iliac.  No evidence of IVC compression.\n2. No evidence of lymphadenopathy or masses in the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\nThere is an expansile, occlusive thrombus seen in the left common iliac vein\nextending through the common femoral vein below the level included in the\nstudy.  The left superficial femoral and greater saphenous veins are also\ninvolve (series 4, image 136).  The thrombus extends into the left internal\niliac vein (series 4, image 97), were it extends distally into the left\nsciatic vein. Thrombus extension is also seen into the inferior aspect of the\nleft ileal lumbar veins, but more cephalad these veins are patent. (Series 4,\nimage 85; series 6, image 50). There is surrounding soft tissue stranding\nconsistent with acute thrombotic process.\nThe right common iliac artery passes over the left common iliac vein at its\norigin (series 4, image 77) at the site of the most cephalad thrombus.\nThe IVC is patent without intraluminal extension of thrombus.  The\ninfrahepatic IVC is distended, consistent with volume resuscitation.  The\nright iliac veins are patent throughout.\n\nThere is no abdominal aortic aneurysm.  There is no substantial calcium burden\nin the abdominal aorta and great abdominal arteries.  The abdominal aorta and\nits principal large vascular branches are patent without evidence of filling\ndefect or acute injury.\n\nThe portal venous vasculature is patent and within normal limits throughout\nits course.  The splenic vein is patent.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The bilateral ureters opacify appropriately and are demonstrated\ndraining into the bladder.\n\nGASTROINTESTINAL: The stomach is 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\nRETROPERITONEUM: No substantial retroperitoneal lymphadenopathy.  There are\nnumerous prominent enhancing lymph nodes within the left inguinal station\nmeasuring up to 1.1 cm in the short axis (series 4, image 129), which are\nlikely reactive.  An external iliac node measures 1.1 cm in short axis (series\n4, image 116).\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 and seminal vesicles are grossly\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Asymmetric edema of the left proximal thigh muscles as well as\nthe left iliopsoas muscle.",
            "output": "1. Extensive thrombus within the left common iliac vein extending from the\nbifurcation of the IVC inferiorly along the left internal and external common\niliac veins and their branches, with associated wall thickening and stranding\nas described above.  The right common iliac artery passes over the left common\niliac vein at the beginning of the thrombus, with moderate focal narrowing\nwhich raises concern for iliac vein compression syndrome such as ___\nsyndrome.\n2. No soft tissue lesions are demonstrated within the abdomen or pelvis.  No\nevidence of IVC compression or thrombus.\n3. Lymphadenopathy in the left external iliac and inguinal stations are most\nlikely reactive."
        },
        {
            "input": "LOWER CHEST: Please refer dedicated CT chest for further characterization.  Of\nnote, there is a mass at the left lung apex.\n\nABDOMEN:\n\nHEPATOBILIARY: There are innumerable lesions scattered throughout the liver\nthe largest seen in the left lobe measures up to the 5.7 cm in diameter. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\n\nThere is irregular enhancement of the gallbladder neck where it abuts a lesion\nin hepatic segment V. This could represent malignancy. There are multiple\nnonobstructing calcifications within the gall bladder which most likely\nrepresent stones.  The common bile duct is at the upper limits of normal,\nmeasuring 0.7 cm in 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.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia.  The stomach is\notherwise unremarkable the duodenum is slightly distended.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nEvaluation is slightly limited due to stool burden. The colon and rectum a\nappear re 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 enlarged and hypoattenuating nodes in the\nportal confluence measuring up to 1.7 cm in the short axis (series 4, image\n63).  There is adjacent lymph node measuring 1.0 cm (series 4, image 64). \nThere are multiple prominent periaortic lymph nodes.  No adenopathy by size\ncriteria.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The SMV, splenic vein and portal vein appears patent.  There appears\nto be mild mass effect of the portacaval nodes on the IVC.  There is expansile\nhypodensity within the right femoral vein consistent with thrombosis.\n\nThere is no abdominal aortic aneurysm.  Branches of the abdominal aorta are\npatent.  Mild atherosclerotic disease is noted.\n\nBONES: The bone appears slightly mottled.  There is a lytic lesion within the\nright ilium measuring 1.8 cm in diameter (series 4, image 89).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Innumerable lesions within the liver as well as portacaval nodes are\nconcerning for metastatic disease.  A primary malignancy was not identified.\n2. Multiple calcified lesions within the gall bladder could represent\nadenomyomatosis versus cholelithiasis.  There is no cholecystitis.\n3. There is a lytic lesion in the right ilium.  The axial lesion appears\nmottled and concerning for additional, less conspicuous metastasis.\n4. There is thrombosis of the right femoral vein.\n5. Please refer dedicated CT chest for further characterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are notable for trace atelectasis at the\nright lung base.  Additionally multiple scattered pulmonary nodules are\ndemonstrated bilaterally, measuring up to 3 mm and not substantially changed\nin size or character from prior study.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are innumerable metastatic lesions throughout the\nliver larger since the prior study, measuring up to 10 cm in the left hepatic\nlobe on axial imaging (2:29), previously measuring up to 7 cm.  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A moderate hiatal hernia is redemonstrated.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nModerate is too large stool burden is demonstrated throughout the colon and\nrectum which is otherwise 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 grossly within\nnormal limits.\n\nLYMPH NODES: Several enlarged lymph nodes are demonstrated the porta hepatis\nmeasuring up to 1.3 cm (2:31), previously measuring up to 1.7 cm.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: An IVC filter is redemonstrated.  There is no abdominal aortic\naneurysm.  Mild atherosclerotic disease is noted.  Decreased but persistent\nthrombus is redemonstrated in the right femoral vein.\n\nBONES: There is redemonstrated lytic lesion within the right ilium measuring 2\ncm in addition to new lytic lesions in the left ilium and sacrum measuring up\nto 2.6 cm (2:54).  There is no evidence of acute fracture.\n\nSOFT TISSUES: Partially imaged breast implants are redemonstrated and intact.",
            "output": "1. Interval increase in size of innumerable hepatic metastases in addition to\nincrease in number and size of osseous metastases in the pelvis and sacrum.\n2. No findings of bowel obstruction, diverticulitis, or perforation.\n3. Moderate to large volume stool burden throughout the colon.\n4. Interval decreased but persistent venous thrombosis in the right femoral\nvein.\n5. Cholelithiasis without findings of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: There is moderate left pleural effusion with associated\ncompressive atelectasis.  There is right basilar atelectasis.  Otherwise no\nfocal consolidation.  No right pleural effusion.  Central venous catheter tip\nterminates in the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple hypoattenuating lesions in the right hepatic lobe measuring\nup to 1.2 cm (series 2, image 12), likely represent cysts.  No suspicious\nfocal hepatic lesion.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The patient is status post recent cholecystectomy and\nRoux-en-Y hepaticojejunostomy.\n\nPANCREAS: There is a multilobulated 4.0 x 3.0 x 2.9 cm (AP by TV by CC) fluid\ncollection centered in the distal pancreatic body and pancreatic tail with\nmild surrounding fat stranding, new since ___ (series 2, image\n26).  There is filling defect within the splenic vein (series 2, image 24 and\nseries 601, image 37), consistent with a nonocclusive thrombus.  The remaining\npancreas is somewhat atrophic but without pancreatic ductal dilatation.  There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a 1.7 cm accessory spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is markedly atrophic containing heterogeneous\nmaterial, similar to ___, potentially reflective of chronic\nhematoma.  The right kidney is also mildly atrophic.  No hydronephrosis on the\nright.  Multiple hypoattenuating lesions are seen throughout the right kidney\nmeasuring up to 1.5 cm (series 2, image 29), likely cysts, without suspicious\nfeatures.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\nhepaticojejunostomy.  Thin catheter is noted in the jejunum of the\nhepaticojejunostomy (series 2, image 24).  The jejunojejunostomy in the left\ncentral abdomen is intact.  Otherwise, the small bowel loops are within normal\nlimits.   There is extensive sigmoid diverticulosis without evidence of\ndiverticulitis.  Large stool ball is noted in the rectum without definite wall\nthickening or fat stranding.  Mild presacral edema is nonspecific.\n\nThere is a 5.8 x 3.9 x 8.2 cm (AP by TV by CC) rim enhancing fluid collection\nin the left upper quadrant adjacent to a loop of jejunum, proximal to the\njejunojejunostomy and inferior to the pancreatic tail (series 2, image 37). \nThis is new from ___.\n\nThere is a 5.2 x 3.7 x 4.0 cm (TV by AP by CC) hyperdense lobulated collection\nin the anterior left abdomen, inferior to the ventral hernia mesh with\nsurrounding stranding, consistent with a hematoma (series 2, image 45), new\nfrom ___.\n\nThere is a JP drain entering the right lateral abdomen coursing across the\nmidline and terminating adjacent to the stomach (series 2, image 22).\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 a 2.5 cm\nhomogeneous left adnexal cyst, unchanged from ___.  No right\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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the thoracolumbar spine are mild.\n\nSOFT TISSUES: Status post ventral hernia repair.  Subcutaneous edema is noted\nin the bilateral flanks.  Ruptured bilateral breast implants are\nredemonstrated.",
            "output": "1. Multilobulated 4.0 x 3.0 x 2.9 cm fluid collection centered in the distal\npancreatic body and pancreatic tail with mild adjacent fat stranding.  This is\nnew from ___ and may reflect an acute necrotic collection/early\nwalled-off necrosis as the sequela of necrotizing pancreatitis.\n2. 5.8 x 3.9 x 0.2 cm rim enhancing fluid collection in the left upper\nquadrant, inferior to the pancreatic tail, new from ___, could\nreflect an acute necrotic collection/early walled-off necrosis, with abscess\nnot excluded.\n3. Nonocclusive splenic vein thrombosis, new since ___.\n4. 5.2 x 3.7 x 4.0 cm hematoma in the left anterior abdomen inferior to the\nmesh.  No active extravasation.\n5. Moderate left pleural effusion with compressive atelectasis.\n\nNOTIFICATION:  The updated findings were discussed with surgery consult\nresident by ___, M.D. on the telephone on ___ at 8:28 pm, 2\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is redemonstration of a moderate left pleural effusion with\ncompressive atelectasis.  Also seen is right basilar atelectasis.  Coronary\ncalcifications noted.\n\nABDOMEN:c\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen are multiple subcentimeter hypodense lesions within the liver, too\nsmall to characterize but likely represent simple cysts.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The patient is status\npost cholecystectomy and Roux-en-Y hepaticojejunostomy.\n\nPANCREAS: There is redemonstration of a 3.6 x 3.2 x 3.4 cm multilobulated\nfluid collection in the pancreatic with mild surrounding fat stranding,\npreviously measuring 4.0 x 3.0 x 2.9 cm.\n\nThere is a 2.3 x 2.0 x 3.4 cm rim enhancing fluid collection in the left upper\nquadrant anteroinferior to the pancreatic tail, decreased in size from the\nprior exam when it measured 5.8 x 3.9 x 8.2 cm.\n\nThe remaining pancreas is atrophic without pancreatic ductal dilatation.\n\nThere is complete thrombosis of the splenic vein.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Accessory spleen noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Again seen is an atrophic left kidney with heterogeneous material\npossibly reflecting a chronic hematoma.  The right kidney is mildly atrophic\nwith multiple hypodense lesions, likely representing cysts.  The urinary\nbladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Status post\nhepaticojejunostomy.  Again seen is a thin catheter entering into jejunal\nloops in the right lower quadrant.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. Diverticulosis of the colon is\nnoted, without evidence of wall thickening or fat stranding.  There is a large\nfecal burden within the rectum with surrounding presacral edema, similar to\nprior exam.  The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  There is\nredemonstration of a 2.5 cm left adnexal cyst, unchanged since ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nhas been interval enlarged gastrohepatic lymph node now measuring 1.1 cm in\nshort axis (2:24), with preserved fatty hilum, likely reactive..  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease. There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes in the thoracolumbar spine.\n\nSOFT TISSUES: Postop changes of ventral hernia repair.  Again seen is a\nhyperdense lobulated collection in the anterior left abdomen adjacent to the\nhernia repair likely representing a hematoma.  Bilateral ruptured breast\nimplants are again seen.",
            "output": "1. Redemonstration of a multilobulated 3.6 x 3.2 x 3.4 cm fluid collection in\nthe pancreatic tail/distal pancreatic body with mild adjacent fat stranding,\nconsistent with walled-off necrosis.  This collection has decreased in size,\npreviously measuring 4.0 x 3.0 x 2.9 cm.\n2. Redemonstration of a 2.3 x 2.0 x 3.4 cm rim enhancing fluid collection in\nthe left upper quadrant anteroinferior to the pancreatic tail previously\ncharacterized as a hematoma.  This has decreased in size, previously measuring\n5.8 x 3.9 x 8.2 cm.\n3. Interval worsening thrombosis of the splenic vein, now occlusive, extending\nto the level of the portal confluence.\n4. Large fecal burden within the rectum with new perirectal stranding and\nsurrounding edema, likely representing proctitis increases the risk for\nstercoral colitis.\n5. Moderate left pleural effusion, grossly unchanged.\n6. Other chronic findings as described above.\n\nNOTIFICATION:  Updated findings were communicated with ___, MD by\n___, MD via telephone on ___ at 11:17 a.m."
        },
        {
            "input": "LOWER CHEST: Please refer to dedicated chest CT report, performed concurrently\non the same day for intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a new area of decreased attenuation within the right\nhepatic lobe extending from the dome, involving segments VIII and V, with\nextension to the caudate lobe (series 2, image 37-58) without causing\ncompression over the traversing vasculature.  There is no rim enhancement to\nsuggest presence of an abscess at this point.  This may be a perfusion L\nchange.\nThe hepatic artery and its branches appear patent.  Persistent narrowing of\nthe porto-splenic confluence by the known thrombus with decrease in caliber of\nthe main portal vein and its intrahepatic branches compared to the prior exam.\nThe splenic vein remains occluded.  The hepatic veins are faintly visualized,\nbut remain patent.\n\n\nPANCREAS: Again seen are changes of pancreatitis with an intrapancreatic fluid\ncollection in the tail measuring 6.3 x 4.3 cm in maximum transaxial ___\n(2:58).  Stranding of peripancreatic fat and subcentimeter short axis lymph\nnodes are unchanged compared to ___.  There is a minimal interval\ndecrease in size of the left infra pancreatic fluid collection (series 2,\nimage ___).  The main pancreatic duct does not appear dilated.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Splenic vein remains thrombosed.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Right kidney demonstrates thinning of the cortical parenchyma with\npreserved enhancement.  Multiple rounded cortical hypodensities in the right\nkidney are likely cysts.  No solid enhancing renal masses.  Again visualized\nis a hyperdense fluid collection in the left renal bed measuring 3.9 x 3.0 cm,\n(2:61) compatible with a hematoma, slightly smaller compared to the prior\nexam.\n\nGASTROINTESTINAL: No bowel obstruction.  Orally ingested contrast is seen\nwithin nondilated loops of colon.  Compared to the prior exam, the rectum\nappears more normalized on today's exam.  A percutaneous tube terminating\nwithin small-bowel loops in the right upper quadrant noted.\n\nPELVIS: The urinary bladder is empty, therefore unremarkable.  There is small\nvolume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are not visualized separately.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric 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 diffuse anasarca.",
            "output": "1. New area of decreased attenuation within hepatic segments VIII, V and I may\nbe perfusional without discrete evidence of an abscess on this scan.  The\nsplenic vein is occluded and there is persistent narrowing of the\nporto-splenic confluence by the known thrombus with decrease in caliber of the\nmain and intrahepatic portal venous branches without visualization of an acute\nthrombus within them.\n2. Small volume free fluid in the pelvis, no new fluid collections in the\nabdomen or pelvis, minimal decrease in size of the pancreatic tail fluid\ncollection, as well as the mesenteric fluid collection extending inferior to\nthe pancreatic tail\n3. Chronic atrophy of the left kidney, with hyperdense fluid collection in the\nleft renal bed, appears to be a hematoma-with slight interval decrease in\nsize.  Interval increase in small volume free fluid in the pelvis and\nanasarca.\n4. Please refer to dedicated chest CT report, performed concurrently on the\nsame day for intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Mild increase in size of bilateral pleural effusions, left\ngreater than right, with compressive atelectasis of both lower lobes.  No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged appearance of an area of decreased attenuation in the\nright hepatic lobe (2:23), likely reflecting perfusion changes versus ischemic\ninsult.  Unchanged appearance of multiple hypoattenuating lesions, for example\nin segment 7 (2:13), likely cysts/biliary hamartomas.  No new suspicious\nlesions.  Patient is status post Roux-en-Y hepaticojejunostomy.\nStable mild intrahepatic biliary dilation.  There is no evidence of\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Redemonstration of a fluid collection centered in the tail of the\npancreas measuring 4.5 x 2.5 cm, previously 6.3 x 4.3 cm (2:32).  The\ncollection adjacent and inferior to the pancreatic tail measuring 2.3 x 1.8 cm\n(2:42) is not significantly changed in size.  Pancreatic duct is not dilated. \nThere is no current peripancreatic stranding.\nHypoenhancement of the head of the pancreas, in keeping with prior history of\npancreatitis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  The splenic vein continues to be occluded.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Unchanged appearance of a right kidney which is mildly atrophic with\nnumerous cystic structures in the cortex representing simple cysts.  In the\nleft retroperitoneal space, a hematoma is again noted measuring 4.4 x 3.4 cm\n(2:35), not significantly changed in size.  The left kidney is not present. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nright perinephric abnormality.\n\nGASTROINTESTINAL: A new collection is identified in the superior aspect of the\nhepatic hilum, in the gastrohepatic space, measuring approximately 6.9 x 3.2\ncm (2:24), with a mild rim enhancement.\nA second new fluid collection is noted to be tracking along the right lateral\nwall of the stomach measures 3.4 x 1.9 cm (2:24). The stomach is otherwise\nunremarkable.\nA percutaneous jejunostomy is noted within the loop of bowel anastomotic to\nthe liver.  Remaining small bowel loops are unremarkable.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.\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.  Moderate atherosclerotic\ndisease is noted.  Notable stenosis of the origin of the celiac artery with\nnormal enhancement of the artery distally.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDiffuse degenerative disease.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Mild\ndiffuse anasarca.",
            "output": "1. New fluid collections in the gastrohepatic space and a second tracking\nalong the gastric wall in the lesser curvature which may represent biloma\nversus walled-off necrosis related to necrotizing pancreatitis more likely the\nlatter.\n2. Walled-off necrosis in the pancreatic tail is smaller compared to prior\nstudy.  The small fluid collection inferior to the pancreatic tail is\nrelatively unchanged in size since prior.\n3. Stable appearance of a hematoma in the left retroperitoneal space.\n4. Unchanged occlusion of the splenic vein.\n5. Stable postoperative appearance of Roux-en-Y hepatic all jejunostomy with\nunchanged position of a percutaneous jejunostomy tube.\n6. Bilateral pleural effusions, increased compared to the prior exam with\nbibasilar 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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of focal lesions.  Tiny scattered hypodensities within the liver, too\nsmall to characterize are likely cysts.  No evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nRight posterior fat containing Bochdalek hernia is small.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 x 1.9 cm enhancing partly exophytic right upper pole renal mass is unchanged\nand better characterized on renal MRI from ___. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Hiatal hernia is small.  Contrast filled, nondistended\nstomach is without definite abnormality.  Nondistended loops of small bowel\nare unremarkable.  Moderate amount of colonic stool is noted in ascending and\ntransverse colon.  Very redundant, air-filled sigmoid colon. Moderate stool is\nnoted in the lower rectum.  The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No free\nfluid 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: Small fat containing umbilical hernia is without complication\nevident.",
            "output": "1. Moderate colonic stool burden within the ascending, transverse and proximal\ndescending colon.  Very redundant air-filled loops of sigmoid colon.\n2. Stable right posterior upper pole partly exophytic 2 cm enhancing renal\nmass, appears similar to renal MRI from ___.  Overall imaging\nfeatures are suggestive of fat poor angiomyolipoma.  Other less likely\ndifferential considerations include oncocytoma.  Recommend MRI in 12 months\nfor follow-up.\n3. Please refer to dedicated CT thoracic report, dictated separately for\nintrathoracic findings.\n\n\nRECOMMENDATION(S):  Renal MRI without and with contrast in 12 months"
        },
        {
            "input": "VASCULAR:\n\nThe distal thoracic aorta is normal in caliber. The abdominal aorta is normal\nin caliber without aneurysmal dilatation. The celiac axis, SMA, bilateral\nrenal arteries, and ___ are widely patent. The bilateral common, external, and\ninternal iliac arteries are also patent.  Hepatic arterial anatomy is\nconventional. A right femoral venous catheter is identified.\n\nLOWER CHEST: There is bibasilar atelectasis with small bilateral pleural\neffusions.  There is no pericardial effusion. Heart size is top-normal.\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. There\nis periportal edema. 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. \nA 2 cm peripherally calcified lesion is seen in the interpolar region of the\nright kidney, previously evaluated on dedicated renal MRI, and remains\nconcerning for renal cellular carcinoma.  Other scattered renal hypodensities\nare again identified, some which are too small to fully characterize but\nlikely represent cysts.  There is no hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post partial gastrectomy and Roux-en-Y\nreconstruction with multiple prior revisions.  A gastrostomy tube is noted\nwith the balloon likely within the lumen of the stomach.  Again seen is a\ncollection at the hepatic flexure with rim enhancement which appears to be\ncommunicating with the ascending colon, as before.  There are mildly dilated\nloops of small bowel particular in the left lower abdomen measuring up to 6 cm\nin diameter, previously 4.5 cm.  No definite transition point is identified to\nsuggest obstruction.  There is dense contrast within the rectum and the\nsigmoid colon, probably from prior fluoroscopy study.  There is no evidence of\nactive extravasation to suggest active bleeding at this time.  There is\ninterval increase in the amount of fluid at the right paracolic gutter.  There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder contains air and is mostly decompressed due to the\npresence of a Foley catheter. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is a small amount of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not identified. No large adnexal mass is\nseen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen throughout the thoracic as well as the lumbar\nspine.\n\nSOFT TISSUES: Again seen is an anterior midline abdominal wound intimately\nassociated with some loops of bowel, compatible with known enterocutaneous\nfistula although site of communication cannot assessed without the\nadministration of oral contrast. There is a drainage catheter traversing\nthrough this midline wound.  There is no active extravasation at the\nenterocutaneous fistula or abnormal vessels to suggest active bleeding at this\ntime.  There is diffuse body wall anasarca, more pronounced since the prior\nstudy.",
            "output": "1. No evidence of active extravasation at the midline enterocutaneous fistula\nor within the bowel to suggest active bleeding at this time.\n2. No significant interval change to the prior study with extensive\npostoperative changes as described above.  No evidence of acute\nintra-abdominal findings.\n3. 2 cm partially calcified lesion in the interpolar region of the right\nkidney, better assessed on prior MRI, and remains concerning for RCC.\n4. Diffuse body wall anasarca, increased since the prior study."
        },
        {
            "input": "LOWER CHEST: An enteric tube courses through the distal esophagus and\nterminates in the anterior gastric lumen.  There are stable left greater than\nright small layering pleural effusions with adjacent relaxation basilar\natelectasis.  There is no pericardial effusion.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: Again seen is a heterogeneous enhancement pattern of the liver,\nwith an ill-defined area of irregular enhancement affecting the left hepatic\nlobe (for example see series 2, image 26).  Additional irregular hypodensities\nin segments IV A/B (series 2, image 27) are also similar in appearance, and\nabut the gallbladder fossa.  Previously demonstrated right hepatic\nhypodensities are less well-defined; for example, see series 2, image 12 for\nlesion near the liver dome which is decreased in conspicuity since prior.  An\nadditional similar hypodensity is seen in segment VIII (series 2, image 25),\nless conspicuous.  There is a persistent, heterogeneous 2.5 x 2.4 cm\nphlegmonous appearing collection in the gallbladder fossa (series 2, image\n29), unchanged since prior.  The gallbladder is surgically absent.  Mild\ncentral and left predominant intrahepatic biliary ductal dilation is\npersistent.  The portal vein is patent.\n\nPANCREAS: There is stable prominence of the proximal main pancreatic duct\nmeasuring 4 mm.  Otherwise, the pancreas enhances homogeneously. There is no\nperipancreatic stranding.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: Again seen is a stable 1.7 x 0.9 cm intermediate density left lower\npole lesion (series 2, image 39).  An additional 2.1 x 1.7 cm (series 2, image\n33) peripherally calcified right complex cyst is again noted.  There are left\nparapelvic cysts.  Smaller bilateral renal cortical hypodensities are too\nsmall characterize accurately by CT.  Otherwise, the kidneys enhance normally\nand symmetrically.  There is no hydronephrosis.\n\nGASTROINTESTINAL:  Two (2) JP drains are seen in unchanged location entering\nvia the right hemiabdomen terminating around the proximal afferent limb.  The\npatient is status post distal gastrectomy with Roux-en-Y reconstruction.  A\npercutaneous gastrojejunostomy tube is seen in unchanged, appropriate location\nwith the balloon inflated in the distal remaining stomach.  The distal tip\nterminates near the JJ anastomosis.  Again seen is hypoenhancement of the\nproximal a pharynx limb (series 2, image 43), with adjacent surgical suture,\nconcerning for ischemic bowel.  An additional segment of small bowel are no\nthe anterior midline is hypoenhancing, also again concerning for ischemia\n(series 2, image 57).  The JJ anastomosis itself appears intact and\nunremarkable.  The remaining small bowel loops are distended and filled with\nfluid but not frankly dilated.  The colon is decompressed.  Again noted is\nwhat appears to be marked hypoenhancement of the distal ascending and\ntransverse colon (for example see series 2 image 47 and image 40), concerning\nfor ischemia.  A transition to normal enhancement of the distal transverse\ncolon is noted (series 2, image 44).  This is concerning for ischemia.  The\ndistal colon is decompressed, but unremarkable.\n\nUniform enhancement of the peritoneal lining is concerning for peritonitis,\nmost apparent in the dependent portion of the peritoneal cavity.\n\nVASCULAR AND LYMPH NODES: Mild atherosclerotic disease is most prominent in\nthe infrarenal abdominal aorta.  The abdominal aorta is normal in caliber\nwithout evidence of aneurysm or dilation.  Major proximal tributaries,\nincluding the imaged course of the SMA, are patent.\n\nAgain seen is diffuse ascites, small volume.  There is no free intraperitoneal\nair.\n\nCT PELVIS:\nA Foley catheter is inflated in the bladder lumen, which otherwise\ndecompressed.  Otherwise, the imaged pelvic organs are unremarkable.  There is\nno pelvic sidewall, iliac chain, or inguinal lymphadenopathy.\n\nMUSCULOSKELETAL: Diffuse anasarca is again noted.  There is severe\nthoracolumbar spine degenerative change.  Alignment is normal.  No concerning\nfocal lytic or sclerotic osseous lesions are seen",
            "output": "1. Persistent hypoenhancement of multiple loops of small and large bowel,\nincluding the proximal afferent limb as well as the distal ascending and\nproximal transverse colon, as above.  Findings concerning for small bowel and\ncolonic ischemia.\n2. Uniform enhancement of the peritoneum most apparent in the pelvis is\nconcerning for peritonitis.\n3. Stable JP drain location surrounding the proximal efferent limb.  Stable\nlocation of enteric and gastrojejunostomy tubes.\n4. Stable heterogeneity of the liver, primarily affecting the left hepatic\nlobe.  While some of these areas, particularly near segments II and ___\nreflect retraction injury in the setting of recent surgery, more medial\nhypodensities abutting the region of the gallbladder fossa collection may\nrepresent developing abscess.\n5. Persistent small volume ascites.  Diffuse anasarca.\n6. Unchanged 2.5 x 2.4 cm heterogeneous, phlegmonous appearing collection in\ngallbladder fossa.\n7. Unchanged mild central and left intrahepatic biliary ductal dilation.\n8. Stable small to moderate left and small right layering pleural effusions\nwith adjacent bilateral lower lobe relaxation atelectasis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 10:31 AM, 10 minutes after\ndiscovery of the findings.\n\nModification to preliminary read (regarding impression point #2 above) was\ndiscussed by Dr. ___ with Dr. ___ on the ___\n___ at 2:16 ___, 10 minutes after discovery of the findings."
        },
        {
            "input": "Visualized lung fields appear clear.\n\nThere is no biliary dilatation.  No focal liver lesions are identified. \nGallbladder appears normal and only partly full.  The spleen is normal in size\nand appearance.  The pancreas is unremarkable.  Adrenals also appear normal. \nThere is no evidence for stones, solid masses, hydronephrosis or perfusion\ndefect involving either kidney.\n\nThe stomach appears normal.  Small bowel appears normal.  Large bowel is also\nunremarkable.\n\nAppendix is mildly dilated measuring up to 9 mm in diameter with surrounding\nfat stranding and suspicion for mild wall thickening and trace luminal fluid. \nFindings are consistent with acute uncomplicated appendicitis.  No evidence\nfor free air or abscess.\n\nBladder, uterus and adnexa appear normal.  Major vascular structures appear\nwidely patent.  There is no lymph adenopathy, or free fluid.\n\nThere are no suspicious bone lesions.  Vertebral bodies are preserved in\nheight.",
            "output": "Findings consistent with acute uncomplicated appendicitis."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Otherwise, 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. \nMultiple subcentimeter hypodense lesions are too small to further characterize\nbut likely cysts or hamartoma and unchanged compared to CT dated ___.  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. \nNo hydronephrosis.  Bilateral subcentimeter hypodense lesions are too small to\nfurther characterize but statistically 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 is not significantly enlarged though there\nis median lobe hyperplasia resulting in bladder base indentation.\n\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: Sclerotic foci seen in the right acetabulum and left iliac wing are\nunchanged compared to prior dated ___ and 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": "No acute findings in the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\n POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 5.2 x 4.6 cm\nDiameter (Center-line): 5.8 cm, previously 6.4 cm\nVolume:\n\n1. Aneurysm: 162 ml\n2. Renal to Aortic bifurcation: 187 ml\n3. Renal to Iliac bifurcation: 205 ml\nENDOLEAK: no\n\nLength proximal graft to lowest renal artery: The proximal graft overlies the\nright renal artery, as on prior.\nInferior margin of stent to femoral bifurcation: 15.7 cm on the left, 15.1 cm\non the right.\n\nThere is an infrarenal abdominal aortic aneurysm which is status post stent as\ndescribed above.  There is substantial atherosclerotic plaque burden.\n\nThe proximal portion of the graft overlies the right renal artery origin. \nThere is intra stent thrombus noted along the superior aspect of the graft\nwhich approaches the right renal artery (series 6, image 37).  This is\nunchanged in extent from the prior study, and extends into the right iliac\ngraft which is occluded as on prior.  Compared to the prior study, there has\nbeen interval placement of a left to right femoral bypass, which is patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  There is mild intraluminal plaque at the\norigin of the left femoral to femoral bypass graft (series 6, image 117).\n\n The celiac trunk and SMA are normal in caliber and patent.  There is\nmild-to-moderate atherosclerotic calcification of the proximal SMA.  There is\na replaced right hepatic artery off of the SMA.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  A 6 mm\nhypointense focus at the posterior spleen appears unchanged from ___ (series\n6, image 35).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic, which appears advanced from the prior\nstudy.  The main renal artery is patent however overlies the proximal portion\nof the stent and has atherosclerotic calcification along its course.  There\nare several low-density renal cysts on the right kidney measuring up to 1.7\ncm.\nThe left kidney demonstrates normal size, morphology and nephrogram.  There\nmultiple hypodensities within the renal cortex which are too small to\ncharacterize but likely represent simple cysts not appreciably changed from\nthe prior study.  There is a 1.3 cm interpolar left renal simple cyst.\nNo hydronephrosis bilaterally.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits. 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: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAn area of cortical thickening along the lateral right eighth rib (series 8,\nimage 3) may represent a prior healed fracture.  There is anterior height loss\nat the T12 vertebral body (series 8, image 32), which appears similar extent\nto the prior study from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval decrease in size of a infrarenal abdominal aortic aneurysm\nmeasuring up to 5.8 cm, previously 6.4 cm.  Status post aortobifemoral stent\ngraft without endoleak.\n2. Status post left to right femoral to femoral artery bypass which is patent.\nUnchanged occlusion of the right common iliac stent graft which extends to the\nbifurcation of the internal and external iliac arteries on the right.\n3. Advanced atrophy of the right kidney which has progressed from the prior\nstudy from ___.  The right renal artery is patent with atherosclerotic\ncalcification and originates from the proximal portion of the stent graft\nwhere there is some intraluminal noncalcified plaque.\n4. Small hiatal hernia.\n5. Chronic anterior height loss at the T12 vertebral body which is unchanged\nfrom prior.\n6. Possible old rib fracture at the lateral right eighth rib."
        },
        {
            "input": "PELVIS:  The imaged loops of bowel appear normal with a normal appendix\nvisualized in the right lower quadrant.  There is no free air or free fluid\nseen.  The uterus and both ovaries appear grossly unremarkable.  Urinary\nbladder is decompressed.  No adenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: No buttock abnormality.  No fluid collection in the body wall.",
            "output": "Essentially normal exam."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  Enhancing venous varices are\nnoted involving the descending colon for approximately 8-10 cm of its\nretroperitoneal course (09:52-77; 11:34-42).  There is no evidence of active\nextravasation of contrast.  No other focal vascular anomaly is identified.\n\nLOWER CHEST: Lung bases are clear.  There is no pleural or pericardial\neffusion.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits.  A hyperdense foreign body in the right upper\nquadrant corresponds to capsule endoscopy, which is located either within the\nof the transverse colon or an adjacent loop of small bowel (08:37, 07:29). \nStreak artifact slightly limits assessment of the surrounding area.   There is\nno evidence of mesenteric 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: The uterus and bilateral adnexa are within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTranscervical screws noted bilaterally.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Colonic wall and submucosal venous varices involving approximately 8-10 cm of\nthe retroperitoneal descending colon.  No other focal vascular anomaly is\ndetected."
        },
        {
            "input": "Patient is status post right hip relocation now with the right femoral head\nwell aligned with the right acetabulum.  There is an acute minimally displaced\nfracture involving the posterior superior to inferior acetabulum with bone\nfragments mild displaced posteriorly.  There is also an acute mildly displaced\nfracture involving the femoral head fovea capitis which is concerning for\nligamentum teres attachment site fracture.  There is a focus of free air\nvisualized in the right hip joint.\n\nThere is severe sacroiliitis of the left sacroiliac joint with subchondral\nsclerosis, and erosion.\n\nThere is no significant degenerative change or osteoarthritis of bilateral\nhips.\n\nThere is small right hip joint small effusion.\n\nThere is contrast material visualized in the urinary bladder likely from\nprevious IV contrast administration.",
            "output": "1. Acute minimally displaced fracture of the right posterior acetabulum.\n2. Right femoral head fovea capitis ligament teres attachment site mildly\ndisplaced fracture.\n3. Severe left sacroiliitis.  The differential diagnoses include infection,\npsoriatic arthritis, reactive arthritis, etc.  Please correlate clinically."
        },
        {
            "input": "VASCULAR:\nThere is extensive atherosclerotic calcification.  Dense plaque with eccentric\ncalcification is seen in the left common iliac artery.  There is no evidence\nof vascular injury or active extravasation.  A stent is seen in the right\ncommon iliac artery.  A right femoral line is noted.  The left external iliac\nand common femoral veins are not opacified due to phase of contrast.\n\nPELVIS: Urinary bladder is decompressed with a Foley catheter.  Note is made\nof sigmoid of diverticulosis without evidence of diverticulitis.  There is no\nevidence of pelvic or inguinal lymphadenopathy.   There is minimal presacral\nfree fluid which is hyperdense, likely minimal hemorrhagic fluid, tracking\ninto the extraperitoneal compartment of the pelvis from the left hip joint.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable\n\nBONES: The comminuted fracture of the left acetabulum extending into the left\niliac wing appears unchanged from the prior CT.  There is a small left hip\njoint effusion.  There is mild thickening of the left obturator internus\nmuscle adjacent to the fracture with a  likely intramuscular hematoma\nmeasuring up to 3 cm in greatest dimension.\n\nSOFT TISSUES:  There is subcutaneous edema surrounding the left hip joint.",
            "output": "1. No evidence of vascular injury or active extravasation.\n2. Unchanged appearance of comminuted left acetabular fracture extending into\nthe left iliac wing\n3. Mild thickening of the left obturator internus muscle overlying the\nfracture likely reflects presence of an associated intramuscular hematoma.\n4. Minimal hypderdense free fluid in the pelvis likely represents trace\nhemorrhage, tracking into the extraperitoneal pelvis from the left hip joint.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 2:00 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Diffuse hazy opacity at the lung bases may be due to poor\ninspiration.  A focal area of pleural thickening at the right lung base is\nunchanged from ___. 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 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 demonstrate symmetric and normal size.  There is left-sided\nperinephric stranding which is new from the prior study.  Otherwise the\nbilateral kidneys demonstrate normal nephrogram.  No hydronephrosis is\ndemonstrated.  No stones or suspicious lesions.\n\nGASTROINTESTINAL: The stomach 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 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine, unchanged from\nprior.\n\nSOFT TISSUES: There is a right fat containing inguinal hernia.  Within the\nhernia sac, there is a oval density measuring approximately 1.5 cm (series 2,\nimage 93), which is unchanged from prior study.  There is a rectus diastasis\nof the anterior abdominal wall.",
            "output": "1. No acute findings in the abdomen or pelvis to correlate with the patients\nsymptoms.\n2. Nonspecific stranding along the left perirenal fascia without focal fluid\ncollection.  No focal renal parenchymal abnormality is demonstrated.  No\nhydronephrosis.  No stones or mass lesions.\n3. 1.5 cm density within a right inguinal hernia, stable from the prior study.\nFindings could represent a remote torsed inguinal lipoma or a diminutive and\natrophied retracted testicle.  Recommend clinical correlation."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. A normal appendix\nis not identified.  There are no indirect signs of an appendicitis.  The cecum\nis medially displaced in the lower pelvis.  There is a few fecalized loops of\nsmall bowel in this region, likely secondary to slow transit.  Otherwise, the\nvisualized colon 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 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 process seen on this scan.  The appendix is not definitively\nvisualized but there are no secondary signs of appendicitis.  If there is\ncontinued ongoing worsening right lower quadrant pain short-term interval\nfollow-up CT pelvis may be obtained.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:39 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.  1.8\nhypodensity in the segment 7 of the right hepatic lobe could represent a\nhepatic cyst or hamartoma.  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 is distended with fluid and air.  Fecalized loop of\nsmall bowel with transition point in the right upper quadrant where there is\nmild mural thickening, resulting in upstream dilation of the loops of bowel to\nthe left upper quadrant without high-grade obstruction (02:30).  There is\nnormal wall enhancement throughout.  Small amount of fat stranding and fluid\nis seen surrounding the dilated loops small bowel as well as small amount of\nascites.\n\nIntramural fat of the terminal ileum is likely secondary to prior enteritis. \nThe colon is decompressed with diffuse diverticulosis without diverticulitis\nnoted.  Rectum is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small amount\nof ascites.\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. Partial small-bowel obstruction with transition point in the right upper\nquadrant where there is mural thickening without high-grade obstruction.\n2. Small amount of ascites.\n3. Colonic diverticulosis without diverticulitis.\n4. Intramural fat in the terminal ileum likely secondary to prior enteritis."
        },
        {
            "input": "Evaluation for abdominal was organs is limited due to lack of intravenous\ncontrast.  Within this limitation, the liver demonstrates homogeneous\nattenuation.  There is no evidence of intrahepatic or extrahepatic biliary\nductal dilatation.  There is a 12mm right supradiaphragmatic lymph node of\nuncertain clinical significance (02:50).  The gallbladder is surgically\nabsent.  The spleen is of normal size.  The pancreas demonstrates homogeneous\nattenuation without ductal dilatation.  The adrenal glands are unremarkable. \nKidneys demonstrate no evidence of hydronephrosis.  There is a 3.5 x 0.7 cm\nhypodense lesion arising from the upper pole of the left kidney with 11 ___ in\nattenuation, compatible with a cyst.\n\nPatient's is status post intra-abdominal aortic repair.  The patency and\nintegrity of the vessels cannot be assessed due to lack of intravenous\ncontrast.  At the level of the SMA origin, the aorta demonstrates irregular\ncontour  with approximately adjacent 7 x 3.4 cm hypodensity, which may relate\nto postsurgical changes, hemorrhage or leak.  There is a left renal artery\ntubular graft (2:84).  Infrarenal aorta measures approximately 7.4 x 5.5 cm\npreviously measuring 7.1 x 7.4 cm with abnormal contour, which again may\nrepresent postsurgical changes, leak or hemorrhage.  Moderate amount of\nhypodense fluid is seen in the anterior and predominately posterior para renal\nspaces extending inferiorly to the level of the aortic bifurcation where it\nmeasures approximately 8 x 1.2 cm (02:10 6).  There is extensive left\nperirenal fat stranding which is likely secondary to hemorrhage.\n\nThere is no free air within the abdomen.  No mesenteric or retroperitoneal\nlymphadenopathy is identified.  Small and large bowel loops are normal in\ncaliber without evidence of bowel wall thickening or obstruction.\n\nCT of the pelvis:  The bladder, rectum, sigmoid colon, are unremarkable. \nThere is no free referral fluid within the pelvis.  No pelvic wall\nlymphadenopathy  is identified.\n\nOsseous structures:  No suspicious lytic or sclerotic bony lesion is seen.",
            "output": "1.  Postsurgical changes related to recent abdominal aortic aneurysm repair,\nwhich was complicated by hemorrhage.  The lack of intravenous contrast limits\nevaluation.  Aneurysmal wrap arouind the aortic graft noted.  Left renal\nartery tubulat graft noted as well.\n2.  There is a moderate amount of hypodense fluid in the left perirenal spaces\nextending inferiorly to the level of the aortic bifurcation, suggestive of\nhemorrhage. Active leak cannot be assessed on non IV contrast study,\n\nNOTIFICATION:  Findings discussed with Dr. ___ at 16:00 ___ by\nphone immediately 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 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 solid 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 extensive diverticulosis.  There is a\nshort collapsed segment of sigmoid colon with mild surrounding stranding and\ntrace amount of free fluid.  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: There is an IUD visualized within the uterus with the\ncrossbars appearing to penetrate the myometrium.  The ovaries appear 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. Malpositioned IUD with cross bars penetrating through the myometrium.\n2. Sigmoid diverticulitis.  No drainable fluid collection.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:30 pm, 50 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:  Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\nABDOMEN:  There is a hypodense lesion in segment 4A of the liver measuring\napproximately 1.1 cm series 5, image 44. An additional hypodense lesion is\nseen in segment 4B/ 5 of the liver measuring approximately 1.4 cm, series 5,\nimage 49. These are too small to characterize by CT. No focal hepatic lesions\nconcerning for malignancy are identified. The spleen is enlarged measuring up\nto 17.5 cm overall unchanged compared to the prior exam from ___. The spleen\nis otherwise homogeneous. The adrenal glands bilaterally are normal. The\nkidneys bilaterally are normal without evidence of focal solid or cystic\nlesions concerning for malignancy. There is no evidence of hydronephrosis. The\npancreas is normal without evidence of focal lesions or pancreatic duct\ndilatation.\n\nThe stomach, duodenum, small bowel and large bowel are normal without evidence\nof wall thickening or obstruction. There is no retroperitoneal or mesenteric\nlymphadenopathy. The colon demonstrates evidence of diverticulosis, without\nevidence of diverticulitis.\nPELVIS:  The urinary bladder is normal. There is no pelvic wall or inguinal\nlymphadenopathy. There is no pelvic free fluid. The prostate and seminal\nvesicles are normal. Note is made of bilateral fat containing inguinal\nhernias.\nBONES AND SOFT TISSUES:  No lytic or blastic lesions concerning for malignancy\nare identified.",
            "output": "No evidence of recurrence of lymphoma, 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:\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, and bilateral adrenal glands\nare normal.  The spleen is surgically absent. The kidneys enhance\nsymmetrically and are without suspicious solid mass.\n\nInterval placement of a gastric stent seen transversing a known, large\nhypodense mass at the level of the gastric antrum/pylorus. Oral contrast is\nseen extending into the stomach, through the stent, and into the small bowel.\nSuture material is noted within the mid pelvic region and right mid abdomen. A\nfocal dilation is seen within a loop of small bowel adjacent to suture\nmaterial (2:54), measuring 5.0 cm in diameter (previously measuring 4.4 cm on\n___.\n\nThe appendix is not definitively visualized, but there are no secondary signs\nof appendicitis..  Mild fecal loading is noted. There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum. The aorta and iliac branches are normal in course and\ncaliber. The celiac trunk and SMA are grossly patent.\n\nPELVIS:\n\nThe bladder and rectum are grossly unremarkable. There is no pelvic side-wall\nor inguinal lymphadenopathy by CT size criteria.  Within the deep pelvis, a\ncluster of surgical clips is adjacent to a 3.3 cm hypodense rounded mass\n(2:63), indeterminate in etiology but stable from the prior examination. No\nfree pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Interval placement of a gastric stent transversing a large hypodense known\nmalignant gastric mass. The stent itself remains patent and without evidence\nof obstruction.\n2. Slight interval increase in the degree of dilation of a focal segment of\nsmall bowel within the mid pelvis, adjacent to suture material. Findings are\nlikely secondary to postsurgical bowel anatomy, and given the lack of proximal\nbowel dilation, obstruction is unlikely.\n3. Stable, 3.3 cm hypodense round left pelvic mass.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 02:29 on ___."
        },
        {
            "input": "An angulated fracture through the left iliac crest is seen extending\ninferiorly through the anterior ilium. The distal fracture fragment is now\nincreasingly displaced, approximately 1.7 cm laterally, 0.7 cm posteriorly\n(2:39), and 1.0 cm inferiorly (6:63). The fracture spares the left acetabulum.\nSeveral tiny, irregular, calcific density fragments are seen in the vicinity\nof the fracture, and may represent interval mineralized callus formation.\nThere is probable soft tissue callus at the fracture site, but no acute\nhematoma is detected. No definite underlying lytic or sclerotic lesion\nidentified, though this can be hard to conclusively assess following fracture.\nElsewhere, no suspicious lytic or sclerotic lesion is detected.\n\nIncompletely imaged posterior spinal fusion hardware is noted, involving at\nleast the levels of L4 and L5, without evidence of hardware loosening or other\nhardware related complications. Moderate, multilevel degenerative changes of\nthe lower lumbar spine, bilateral hips, and pubic symphysis are noted. The\nsacroiliac joints are unremarkable in appearance.  There is no pubic symphysis\ndiastasis.\n\nThe imaged portions of the intraperitoneal lower pelvis are grossly\nunremarkable. Atherosclerotic calcifications are seen within the aorta and its\nmajor branches.",
            "output": "Interval increased in the degree of displacement of an angulated fracture of\nthe left iliac crest and ilium.  Callus formation noted.  No definitive\nevidence of underlying pathologic lesion, though this can be difficult to\nconclusively assess following a fracture."
        },
        {
            "input": "LOWER CHEST: There is a 4 mm pulmonary nodule adherent to the right horizontal\nfissure (series 201, image 3).  Minimal bibasilar dependent atelectasis also\nnoted.  No pleural effusions.  Dense coronary artery calcification noted.\n\nABDOMEN:\n\nHEPATOBILIARY: There is homogeneous enhancement of the hepatic parenchyma on\nthis single phase study.  No intrahepatic biliary ductal dilation noted.  The\nhepatic veins, portal vein and its branches are patent.\nThere are multiple subcentimeter short axis porta hepaticus lymph nodes\nmeasuring up to 9 mm in maximum dimension.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Surgically absent.\n\nADRENALS: There are no adrenal nodules.\n\nURINARY: The kidneys are of 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 hiatus hernia.  A periampullary duodenal\ndiverticulum is also noted.\nExtensive sigmoid diverticulosis noted.  There is concentric wall thickening\nof an approximately 15 cm length of the sigmoid colon located in the midline\npelvis with prominence of pericolonic vessels and adjacent prominent lymph\nnodes concerning for mild acute diverticulitis in the appropriate clinical\nsetting.  There is no evidence of perforation or drainable fluid collection. \nOnce this acute episode settles down, correlation with colonoscopy is\nrecommended to exclude an underlying mass lesion at this site.\n\nPELVIS: The urinary bladder is moderately distended and appears normal.  The\nuterus and adnexae are unremarkable.\n\n\nLYMPH NODES: Subcentimeter short axis porta hepaticus lymph nodes noted. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted.  The abdominal aorta is ectatic without aneurysmal dilation.\n\nBONES: There is mild wedge compression of the L1 vertebral body.  No worrisome\nosseous lesions identified.\n\nSOFT TISSUES: Midline supraumbilical fat containing abdominal wall hernia\nnoted.  Soft tissues otherwise appear unremarkable.",
            "output": "1. There is mild acute sigmoid diverticulitis affecting an approximately 15 cm\nlength of the sigmoid colon located in the midline pelvis with no perforation\nor complications.  Please correlate with colonoscopy to exclude an underlying\nmass, once the acute episode settles down.\n2. A periampullary duodenal diverticulum is seen causing mild prominence of\nthe extrahepatic common duct.  No intrahepatic biliary ductal dilation seen.\n3. Small hiatus hernia; multilevel midline supraumbilical ventral abdominal\nwall hernia containing fat are additional incidental findings.\n\nRECOMMENDATION(S):  Correlation with sigmoidoscopy/colonoscopy is recommended\nonce the acute episode settles down to exclude an underlying mass."
        },
        {
            "input": "LOWER 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.  2\nsmall stones in the cystic duct remnant are visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Main pancreatic duct dilated up to 5 mm, stable compared to\nthe prior MRI from ___.  There is no evidence of obstructing lesion\ntherefore pancreatic ductal dilatation is likely related to sphincter of Oddi\ndysfunction.  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 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.  Right inguinal\nhernia containing small bowel loops without evidence of obstruction.  Diffuse\nfatty deposition within ascending colon, the rectum and sigmoid consistent\nwith known 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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Stable prominent right external\niliac lymph nodes are again noted measuring up to 1.2 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Aneurysmal dilatation of left common iliac artery up to 1.8 cm. \nModerate celiac stenosis with poststenotic dilatation.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nStatus post L3-L4 laminectomy with postsurgical changes in the soft tissues of\nthe back.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 2 small stones in the cystic duct remnant are visualized.\n2. Main pancreatic duct dilated up to 5 mm, stable compared to the prior MRI\nfrom ___.  There is no evidence of obstructing lesion therefore\npancreatic ductal dilatation is likely related to sphincter of Oddi\ndysfunction.\n3. Right inguinal hernia containing small bowel loops without evidence of\nobstruction.\n4. No evidence of lymphadenopathy in the abdomen and pelvis."
        },
        {
            "input": "PELVIS:  The partially visualized small bowel is unremarkable.  There is\nsigmoid diverticulosis without evidence of diverticulitis.  The urinary\nbladder and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormalities are\ndetected.\n\nLYMPH NODES: Multiple enlarged pelvic lymph nodes are noted, measuring up to\n1.6 cm on the left (2:62) and 1.2 cm on the right.  Multiple other nonenlarged\npelvic and retroperitoneal lymph nodes are also noted.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: Patient is status post right total hip arthroplasty.  There is no\nperiprosthetic lucency or evidence of perihardware fracture.  As seen on prior\nradiographs, a posterior acetabular screw extends through the cortex into the\nright gluteus musculature (3:61).  An adjacent screw also extends through the\ncortex into the musculature (03:57).  There is no hematoma or soft tissue\nedema adjacent to the screws.\n\nSevere degenerative changes of the left femoroacetabular joint are also noted\nwith extensive subchondral cystic change and sclerosis as well as loss of\njoint space and spurring.  There is a disc bulge at L5-S1 that causes likely\nmild-to-moderate neural foraminal stenosis.  No evidence of acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post right total hip arthroplasty with no evidence of fracture or\nhardware loosening. The acetabular screws extend through the bony cortex\nslightly into adjacent musculature without evidence of hematoma or soft tissue\nstranding.\n2. Severe degenerative changes of the left femoroacetabular joint.\n3. Pelvic lymphadenopathy predominantly on the left needs correlation with\nhistory of malignancy and clinical lymph node examination.  Follow-up in 3\nmonths with pelvic CT if no cause is found.\n4. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S):  If no cause is found for pelvic lymphadenopathy, a\nfollow-up CT in 3 months should be performed.\n\nNOTIFICATION:  Follow-up recommendations.  Discussed with ___,\nM.D. by ___ M.D. on the telephone on ___ at 10:02 am."
        },
        {
            "input": "CT pelvis with contrast:  Soft tissue stranding of the right popliteal soft\ntissues adjacent to the gluteal fold with overlying skin thickening is noted\nroughly 2 cm caudal to the anus extending inferiorly spanning an area of\nroughly 7.3 x 3.8 cm (601b: 59). Phlegmonous changes noted without frank\nabscess formation. No definite perianal or perirectal involvement.\n\nThe visualized intra-abdominal pelvic structures are unremarkable with the\nexception of postsurgical changes from prior small bowel anastomosis and a\nmoderate fat containing bilateral inguinal hernias.\n\nBones: No suspicious focal bone lesion. Probable bone islands in the left\niliac bone.",
            "output": "Right inferior gluteal fold phlegmon compatible with cellulitis without\ndiscrete abscess formation. Phlegmonous change begins roughly 2 cm caudal to\nthe anus and the there is no evidence for perianal or perirectal involvement. \nBecause of the low soft tissue contrast, separate perianal or perirectal\nfistula cannot be excluded.  If there remains concern, MR of the pelvis should\nbe obtained."
        },
        {
            "input": "LOWER CHEST: There is mild right basilar atelectasis.  The imaged portion of\nthe heart and pericardium are normal.  There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely nodular and heterogeneous.  There is no\nevidence of focal lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.  The portal vein is patent,\nhowever the superior mesenteric vein appears distended with low-density\nmaterial, concerning for thrombus (2:38).  Note is made of a small-to-moderate\namount of simple 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 top-normal in size, measuring 13.1 cm.  No splenic\nmasses 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. \nA subcentimeter hypodensity is seen in the interpolar region of the right\nkidney, which is too small to fully characterize, but likely represents a\ncyst.  There is no evidence of hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The distal esophagus is normal appearing with no hiatal\nhernia.  The stomach is under distended, but grossly normal.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \n.  The large bowel is grossly unremarkable, without evidence of obstructive\nmass lesions or wall thickening.  There is diverticulosis without\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 reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or 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 well-circumscribed fluid collection within the subcutaneous\nfat of the anterior abdominal wall measures 1.3 x 2.9 x 3.1 cm, and is most\nconsistent with a small umbilical hernia containing ascitic fluid.  This has\ndecreased in size from ___.",
            "output": "1. Interval development of superior mesenteric vein thrombosis.  Patent portal\nvein.\n2. Cirrhosis and small to moderate simple ascites.\n3. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  There is re- demonstration of right hepatic lobe hemangioma\n(02:23), unchanged. Otherwise, the liver demonstrates homogeneous attenuation\nthroughout.  There is no evidence of worrisome focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within 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 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: A small cortical thinning, possibly from prior inflammatory event, in\nthe interpolar right kidney is unchanged. Otherwise, the kidneys are of normal\nand symmetric size with normal nephrogram.  There is no evidence of stones,\nfocal renal lesions or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL: A duodenal diverticulum is again seen. The patient is status\npost total colectomy, within ileoanal anastomosis, which appears intact.\nEnteric contrast material travels through the stomach, duodenum, and small\nbowel to the level of the anus, with no evidence of wall thickening or\nobstruction. The anastomosis in the low pelvis is unremarkable.\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.\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. No evidence of bowel obstruction or other acute abdominal or pelvic\npathology.\n2. Stable postsurgical changes related to prior colectomy and ileoanal\nanastomosis.\n3. Stable right hepatic lobe 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 suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Patient is status post sleeve gastrectomy.  There is no\nevidence of leak.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement. The colon and rectum are within normal limits. The\nappendix is normal (2:52).  There is no evidence of organized intra-abdominal\nfluid collections.\n\nPELVIS:  There is trace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus.  There is a 5.1 x\n3.0 x 5.4 cm cyst within the right adnexa (2:68, 601:36).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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 findings in the abdomen or pelvis.  Specifically, no bowel\nobstruction.  Status post sleeve gastrectomy, without evidence of\ncomplication.\n2. 5.4 cm right adnexal cyst.\n3. Enlarged fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Lung bases are included and show multiple pulmonary nodules\nbilaterally highly suggestive for metastatic disease.  A separate chest CT is\nperformed and will be reported individually.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple ring enhancing hypodense liver lesions are identified\nhighly suggestive for metastatic disease.  The these are accessible for\nultrasound guided biopsy.  The largest 1 is located in segment 4A of the liver\nand measures 2.6 x 3 cm.  The gallbladder is within normal limits, with a\nsingle calcified stone but no gallbladder wall thickening.  There is no\nevidence for intrahepatic or extrahepatic bile duct dilation.\n\nPANCREAS: Within the pancreatic tail is 7.2 x 4 2 cm hypodense masses\nidentified which is obliterating the splenic vein and splenic artery.  The\nmass abuts the spleen without any clear invasion as also the stomach wall. \nThe whole mass could represent a neoplastic process or some of it could\nrepresent a underlying cystic pancreatic lesion such as an IPMN.\n\nSPLEEN: There is splenomegaly with the spleen measuring 15 cm craniocaudally.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Both kidneys are normal in size.  There is no evidence for\nhydronephrosis.  Multiple hypodense renal lesions are identified which most\nlikely represent renal cysts.  A slightly complex renal lesion is seen arising\nfrom the upper pole the right kidney which measures up to 1.8 cm.  This most\nlikely represents a slightly hemorrhagic or proteinaceous renal cyst.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.  There\nis extensive colonic diverticulosis without evidence of diverticulitis.  The\nappendix is normal.  .\n\nRETROPERITONEUM: There is extensive retroperitoneal lymphadenopathy is also\nmultiple necrotic enlarged lymph nodes in the portacaval space and\nperipancreatic.  The largest 1 measures up to 2.6 cm.  Smaller but also\nsuspicious lymph nodes are identified in the gastrohepatic ligament.\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: Soft tissue stranding is identified in the right lateral\nabdominal wall and subcutaneous tissues which could be due to prior trauma,\ninjection, or infection.",
            "output": "1. The constellation of findings are suggestive for metastatic adenocarcinoma\nof the pancreatic tail.  Suspicious metastatic lesions are identified in the\nlung bases, the liver, and the upper abdominal lymph nodes.  2.  Extensive\ndiverticulosis without evidence of evidence of diverticulitis.  3.  Multiple\nhypodense renal lesions most likely presenting renal cysts.  4.  Subcutaneous\nfat stranding in the right lateral abdominal wall which could be due to\ninjections, trauma or infection."
        },
        {
            "input": "LOWER 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 multiple hypodense lesions throughout the\nliver. Most show decrease in size, for example a 1.2 cm lesion in segment 3\n(05:56), previously 1.7 cm. However, a 4.3 x 3.9 cm lesion in segment ___\n(05:50) has increased from 2 smaller lesions measuring 1.8 and 1.5 cm on the\nprevious study, which have coalesced and increased in size. There is a new\nill-defined 1.5 cm hypodense lesion in segment 8 (05:40). There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder contains a\ngallstone without wall thickening or surrounding inflammation.\n\nPANCREAS: The hypodense pancreatic tail mass measures 5.1 x 3.5 cm, previously\n5.9 x 4.3 cm. The remainder of the pancreas is unremarkable. There is no\nsignificant peripancreatic stranding.\n\nSPLEEN: The spleen measures 17.9 cm, previously 18.2 cm and demonstrates\nhomogeneous 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 are multiple bilateral cortical hypodensities, most too small to\ncharacterize but likely cysts. This includes a 1.7 cm\nhemorrhagic/proteinaceous cyst arising exophytically at the right upper pole,\ndemonstrated on multiple prior studies. There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is extensive\ncolonic diverticulosis.\n\nPELVIS: The bladder is underdistended and not well evaluated. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable aside\nfrom mild prostatic enlargement.\n\nLYMPH NODES: Necrotic peripancreatic lymph nodes have decreased. A 1.9 x 1.5\ncm node anterior to the main portal vein was previously 2.4 x 2.4 cm and a 2.6\nx 1.7 node just superior to the pancreatic head was previously 2.7 x 2.3 cm.\nThere is no pelvic or inguinal lymphadenopathy. Notably, there is a 2.0 x 1.9\ncm diaphragmatic node, increased from 1.3 x 1.3 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There multiple sclerotic osseous metastases in the lumbosacral spine\nand pelvis, increased in size and number. No pathologic fractures are noted.\n\nSOFT TISSUES: A 1.5 x 0.9 cm soft tissue nodule in the right posterior\nretroperitoneal fat is unchanged from recent prior studies (5:73). This\nmeasured 0.9 x 0.5 cm on CT from ___ and is nonspecific but unlikely\nrelated to pancreatic cancer.",
            "output": "1.    Mixed changes in the liver with most lesions decreased, but there are\nincreased and new lesions.\n2.    Slight decrease in primary pancreatic mass and peripancreatic\nadenopathy.\n3.    Progressive osseous metastatic disease.\n4.    Please refer to the separate report for the CT chest."
        },
        {
            "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: Multiple hypodense metastatic lesions are demonstrated\nthroughout the liver, some which are increased in size and others unchanged\ncompared to CT from ___.  For example a segment VI/VII lesion now\nmeasures 4.5 x 4.2 x 5.2 cm (4:85 and 7:70), previously 4.3 x 3.9 x 3.8 cm.  A\n1.7 cm segment VIII lesion previously measured 1.5 cm (4:69), and a 4.3 x 4.0\ncm segment IV lesion (4:77) previously measured 2.9 x 2.6 cm.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.\n\nThe gallbladder is contracted and contains stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The hypodense pancreatic tail mass measures 5.3 x 3.5 cm (4:109),\nsimilar to prior, previously 5.1 x 3.5 cm.  There is no main ductal\ndilatation.  Again seen is occlusion of the splenic vein with left upper\nquadrant collaterals.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring up to 17.8 cm though demonstrates\nnormal attenuation throughout, without evidence of focal lesions.\n\nADRENALS: A left adrenal nodule measures 1.2 x 1.0 cm (4:102), more\nconspicuous compared to prior, likely a metastasis.  The right adrenal gland\nis normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal cysts and subcentimeter cortical hypodensities too\nsmall to characterize, are re-demonstrated and unchanged from prior. \nAdditionally a hyperdense right upper pole 1.7 cm lesion ___ 65) is also\nunchanged and likely represents a hemorrhagic or proteinaceous cyst.  There is\nno hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Extensive pancolonic diverticulosis is\ndemonstrated without focal bowel wall thickening or adjacent fatty stranding\nto suggest active inflammation.  There is no evidence of mesenteric\nlymphadenopathy.\n\nVASCULAR:  There are mild atherosclerotic calcifications of the abdominal\naorta, without aneurysmal dilatation.\n\nLYMPH NODES: A 1.5 x 1.1 cm node anterior to the main portal vein has\nminimally decreased in size, previously 1.9 x 1.5 cm (4:99).  A 2.7 x 1.6 cm\nportacaval node (4:102) is unchanged.\n\nA pericardiophrenic node measures 1.9 x 1.9 cm (4:71), unchanged.  A 1.1 cm\ngastrohepatic lymph node (4:94) has increased in size, previously 0.7 cm.\n\nA 1.7 cm right posterior pararenal soft tissue nodule has increased in size\n(4:129), previously 1.5 cm, and there is an adjacent new tiny soft tissue\nnodule (4:125).\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 mildly enlarged and the seminal vesicles\nare unremarkable.\n\nBONES: Multiple sclerotic osseous metastases throughout the thoracolumbar\nspine and pelvis are re-demonstrated, similar in number and distribution, but\nsome of which have increased in size.  For example, a sclerotic lesion in the\nL1 vertebral body measures 1.3 cm (4:118), previously 0.8 cm, and a sclerotic\nlesion in the right iliac wing measures 0.8 cm (4:171), previously 0.5 cm.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval progression of metastatic disease with interval increase in size\nof multiple hepatic metastases, osseous metastases, lymph nodes, left adrenal\nnodule, and right retroperitoneal soft tissue nodules, compared to CT from ___, as detailed above.\n2. Unchanged size of primary pancreatic tail mass, with associated occlusion\nof the splenic vein and left upper quadrant collaterals.\n3. Please refer to same-day CT chest for characterization of thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Moderate emphysematous changes and minimal atelectasis are seen\nat the lung bases.  There is no focal consolidation.  There is no significant\npleural effusion.  The imaged heart is unremarkable without evidence of\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 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: Mild thickening of the left adrenal gland is noted without discrete\nnodule.  Otherwise the glands are unremarkable.\n\nURINARY: Bilateral cortical renal cysts measuring up to 4 cm in the upper pole\nof the right kidney and 5 cm in the lower pole of the left kidney are\ndemonstrated.  Otherwise, the kidneys are of normal and symmetric size with\nnormal nephrogram.  There is no evidence of concerning 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 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. No acute findings in the abdomen or pelvis.  No diverticulosis or\ndiverticulitis.\n2. Prostatomegaly.\n3. Moderate emphysematous changes in the lung bases."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 appendiceal wall is thickened and the\nappendix is fluid-filled and measures up to 1 cm in greatest diameter. \nSubtle, minimal periappendiceal fat stranding is noted.  There is no extra\nappendiceal fluid or free air.  These findings are suggestive of early/mild\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall free fluid in the pelvis, likely reactive.\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 is noted.  Incidentally noted is a retroaortic left\nrenal 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. Mildly dilated fluid filled appendix with subtle periappendiceal fat\nstranding.  These findings are consistent with early/mild appendicitis.  No\ndrainable fluid collection or extraluminal gas."
        },
        {
            "input": "GASTROINTESTINAL: Visualized loops of small bowel are normal in caliber, wall\nthickness, and enhancement.  Surgical suture in the right lower quadrant is\nconsistent with prior appendectomy.  There is diffuse colonic wall thickening\nand submucosal enhancement in the visualized colon suggestive of mild colitis.\nNo discrete fluid collection is identified.  There is no pneumatosis or free\nair seen.\n\nURINARY: 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: Few scattered mesenteric nodes are seen, likely reactive, not\npathologically enlarged.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFew sclerotic foci pelvis are consistent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Mild colitis without discrete fluid collection or evidence of perforation. \nEtiology favored to be infectious, much less likely inflammatory or ischemic.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___, M.D. by\n___, M.D. on the telephone on ___ at 4:07 ___, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Notable subsegmental pulmonary emboli in the bilateral lower lobe\npulmonary arterial branches.  There is a minimally increased in size\nmetastatic anterior chest wall nodule measuring 1.3 cm (09:28) compared to 0.9\ncm previously.\n\nHEPATOBILIARY: There has been marked worsening of diffuse metastatic disease\nwithin the liver, mainly the right hepatic lobe and involving segment 4. \nRepresentative lesions are as follow:\n\nDominant mass in segment ___ (09:22), measures 7.7 x 5.8 cm compared to 6.3 x\n4.4 cm.\nOther smaller masses in segment 8 measuring 3.1 and 2.9 cm (9: 17) compared to\n2.5 and 2.2 cm.\nOn the current examination, there is diffuse tumoral infiltration of segment 5\nand 6, markedly worsened compared to previously.\n\nThe main portal vein remains patent as well as the left portal vein.  The\nposterior branch of the right portal vein is effaced however, not completely\noccluded.\n\nThere is no biliary ductal dilatation.  Gallbladder demonstrates unchanged\nmild gallbladder wall thickening.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSPLEEN: Spleen measures 9.5 cm.\n\nADRENALS:   Left adrenal gland is mildly thickened and unchanged since\n___.  There is in stable enhancing nodule measuring 0.7 cm, consistent\nwith a metastatic nodule.  Right adrenal gland is unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis.  There are scattered\nrenal cortical hypodensities likely cysts.\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 or free fluid.  There is no peritoneal\nstranding.\n\nLYMPH NODES: There are overall unchanged subcentimeter left periaortic lymph\nnodes.  Although these do not meet size criteria for adenopathy.\n\nVASCULAR: There is no evidence of contrast extravasation within the bowel. \nThere is no retroperitoneal hemorrhage.  Abdominal aorta is normal in caliber\nwith patent intra-abdominal branches.\n\nPELVIS: Uterus is normal in size.  There is a right adnexal cyst, stable\nmeasuring 3 cm.  Urinary bladder is unremarkable.\n\nBONES:Osseous structures are intact with no acute osseous abnormalities. \nThere are no aggressive osseous lesions.\n\nSOFT TISSUES: Soft tissues are unremarkable.",
            "output": "1. No evidence of active GI bleeding or abdominopelvic hemorrhage.\n2. Subsegmental pulmonary emboli within the bilateral lower lobe arterial\nbranches.\n3. Worsening hepatic metastatic disease.\n4. Stable left adrenal metastatic nodule and left anterior chest wall nodule.\n5. Stable prominent retroperitoneal lymph nodes.\n6. Unchanged gallbladder-wall thickening with differential considerations of\nlow albumin state, hepatic dysfunction with cholecystitis being less likely."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.2 x 1.6 cm (series 4, image 48, series\n5, image 146).\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, as\nthere is a plastic stent within the CBD.\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):\npresent, series 5, image 143)\nExtension to first draining vein:  absent\nThrombus within vein: absent; type of thrombus:  None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: 9 x 6 mm hypo attenuating lesion within the left lobe of the\nliver, segment 2, indeterminate in etiology.  Further assessment with hepatic\nMRI is recommended.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: Multiple small gastrohepatic and periportal lymph\nnodes are identified, the largest seen in the periportal space measuring 2.2 x\n1.1 cm (series 5, image 139).\nOther extrapancreatic disease (invasion of adjacent structures): absent\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Lower lung bases and pleural spaces are clear.  Lower mediastinal\nstructures are grossly normal.  Please see concurrently performed, however\nseparately reported CT scan of the chest.  .\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously.  Within segment 2 there is a\n7 mm hypo attenuating foci (series 4 image 14), which is indeterminate in\netiology and requires further assessed with hepatic MRI.  Pneumobilia is\nidentified secondary to recently inserted CBD stent.  The degree of biliary\nductal dilatation has decreased since the comparison study.  The common bile\nduct demonstrates mild wall enhancement which may be secondary to recent stent\ninsertion and/or underlying cholangitis.  Hepatic vasculature is patent. \nGallbladder wall is hyper enhancing which may be secondary to global\nadenomyomatosis.  .\n\nPANCREAS: The pancreatic parenchyma itself is atrophic with marked duct\ndilatation, measuring up to 10 mm in diameter, with abrupt cut off at the\nlocation of the pancreatic mass.\n\nSPLEEN: Spleen is normal in size.  No focal splenic lesion.\n\nADRENALS: Adrenal glands are normal in size and appearance.\n\nURINARY: The kidneys enhance symmetrically with no dilatation of the\nintrarenal collecting system.  Both ureters are opacified with contrast and\ncan be traced to the UVJ.  13 mm hypo attenuating lesion within the lower pole\nof the left kidney represents a simple cyst.  The bladder is moderately\ndistended and grossly normal.  The base of the prostate indents the base of\nthe bladder, in keeping with underlying BPH.  The prostate gland itself is\nenlarged measuring 5.0 x 3.9 cm.\n\nGASTROINTESTINAL: There are no dilated loops of bowel or areas of bowel wall\nthickening or differential bowel wall enhancement.  Appendix is identified in\nthe right lower quadrant and is normal in appearance.  No free fluid is\nidentified within the abdomen or pelvis.  Uncomplicated sigmoid colon\ndiverticulosis.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nMultiple small lymph nodes are seen in the right obturator space, (series 5,\nimage 211 through 219), measuring up to 5 mm in diameter.\n\nBilateral varicoceles are identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 2.2 x 1.6 cm pancreatic head/ uncinate process mass, as described above. \nThe mass abuts superior mesenteric vein.  The main pancreatic duct is dilated\ndistal to this lesion and the pancreatic parenchyma demonstrates atrophy. \nMultiple gastrohepatic and periportal lymph nodes are identified, largest\nmeasuring up to 2.2 cm in size.\n\n2. Recently inserted CBD stent with pneumobilia.  The caliber of the\nintrahepatic biliary tree has decreased since the comparison study.  The\ncommon bile duct demonstrates wall enhancement may be secondary to recent\nstent insertion and/or underlying cholangitis.\n3. 7 mm hypo attenuating lesion within the left lobe of the liver is\nindeterminate in etiology.  Given the underlying pancreatic adenocarcinoma,\nfurther assessment hepatic MRI is recommended.\n4. Prostate gland is enlarged.  Correlation with PSA can be considered.\n\nRECOMMENDATION(S):  Hepatic MRI.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:05 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): Poorly evaluated secondary to artifact\nfrom fiducial markers though appears decreased in size from prior examination.\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: CBD stent is\nin place.\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:  Less than 180\u00b0\nDegree of increased hazy attenuation/stranding contact:  Less than 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: likely benign\nPeritoneal or omental nodules: absent\nAscites: present, about likely related to bowel obstruction.\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nSmall amount of stranding is seen surrounding the celiac trunk extending to\nthe common hepatic artery, image 60___, images 55-60, though of uncertain\nsignificance as somewhat remote from the mass itself.\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 liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  Pneumobilia predominantly in the left lobe\nis again noted.  .  The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: See above.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  There is a 1.4 cm simple appearing cyst in the midpole region of\nthe left kidney.\n\nGASTROINTESTINAL: There are moderately dilated small bowel loops seen\nthroughout the abdomen and pelvis extending to the ileum.  There is a gradual\ntransition to oral collapsed terminal ileal loops.  No dilated colonic loops\nare seen  Appendix has normal caliber without evidence of fat stranding. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There are numerous small retroperitoneal lymph nodes not\nsignificantly changed from priors.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small amount of free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is severe multilevel degenerative changes of the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The hypoattenuating mass in the pancreatic head seen on prior examination\nis not well seen secondary to artifact arising from the adjacent fiducial\nmarkers though appears slightly decreased in size.  Gastrohepatic, periportal,\nand retroperitoneal lymph nodes not significantly changed from priors.\n2. Stranding surrounding the celiac axis and common hepatic artery is remote\nfrom the tumor however attention to this area is recommended on follow-up\nexaminations.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 4:55 ___, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST: There is minimal right greater than left basilar atelectasis. \nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypoattenuating lesion in the medial aspect of segment II is\nunchanged and better characterized on prior MRI, demonstrating T2\nhyperintensity and lack of enhancement with contrast consistent with a cyst. \nThere is no intrahepatic biliary ductal dilatation.  There is pneumobilia\nsimilar in comparison to prior.  The gallbladder appears unremarkable, noting\na small amount of intraluminal air, similar in appearance to prior.  There is\nno extrahepatic biliary of ductal dilatation, noting the common bile duct\nstent which is unchanged position, oval with some shelving along the superior\naspect which may cause intermittent partial obstruction (05:39).  The\ngallbladder is\n\nPANCREAS: The known pancreatic head lesion measures approximately 2.2 x 2.7 cm\nin maximum axial ___ (03:42), minimally smaller in comparison to\n___ and much smaller in comparison to ___, at which time it\nmeasured approximately 2.8 x 3.7 cm.  There is an abrupt cut off of the\npancreatic duct with increased pancreatic ductal dilatation measuring up to\n1.4 cm in maximum diameter (05:36).  The pancreatic body and tail are\natrophic.  There is at least hazy contact with the SMV and hepatic portal\nvein.  There is no compression or obstruction of the SMV or hepatic portal\nvein.  There is stable haziness of the fat surrounding the celiac axis. \nProminent and enlarged retroperitoneal and porta hepatic lymph nodes are\nunchanged, measuring up to 1.2 cm the short axis (03:30).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: An approximately 1.2 x 1.4 cm hypoattenuating lesion near the lower\npole of the left kidney is essentially unchanged, but intermediate in density,\npossibly a simple or proteinaceous cyst.  There are no additional renal\nlesions.  The kidneys are relatively symmetric in size, shape, and nephrogram.\nThere is no hydronephrosis or nephrolithiasis.  There is no pre rib nephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Anastomotic suture material is noted within the\ncentral lower abdomen.  There is a focus of fat stranding and nodularity\nwithin the lower left anterior abdomen, likely postsurgical in nature (3:78). \nThere is diverticulosis without evidence of diverticulitis.  Appendix contains\nair, has normal caliber without evidence of fat stranding.\n\nLymph nodes: As above, there is stable lymphadenopathy in the porta hepaticus\nand retroperitoneum measuring up to 1.2 cm in short axis (03:30).  Additional\nprominent nodes are located in the aortocaval septation (03:51) and right\npelvis (3:97).\n\nPELVIS: There is substantial enlargement of the prostate superiorly displacing\nthe urinary bladder.  The urinary bladder and distal ureters are otherwise\nunremarkable.  There is no free fluid in the pelvis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is lumbar scoliosis and severe degenerative changes throughout the\nvisualized spine\n\nSOFT TISSUES: Midline anterior wall subcutaneous fat stranding is likely\npostsurgical fibrosis.  Scattered subcutaneous emphysema in the anterior\nabdominal wall is likely related to medication injection.",
            "output": "1. The primary pancreatic lesion is stable to minimally decreased in size. \nLymphadenopathy and celiac axis fat stranding are stable.\n\n2. Stranding and nodularity in the anterior lower abdomen is likely\npostsurgical in nature, but warrants attention on follow-up."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. The patient is status post SMV\nreconstruction.   There is minimal calcium burden in the abdominal aorta and\ngreat abdominal arteries.\n\nLOWER 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. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Again seen is pneumobilia similar to ___ secondary to hepaticojejunostomy.  The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: Patient is status post pancreaticoduodenectomy.  No evidence of\nlocal recurrence.  The remaining pancreas is atrophic with unchanged mild\npancreatic ductal dilatation.  No significant 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.  The left\nadrenal gland is minimally thickened without nodularity but unchanged compared\nto prior.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis.  1.5 x 1 cm hypoattenuated\nlesion in the lower pole of the left kidney (series 3, image 51) likely a cyst\nis unchanged.  Scattered subcentimeter hypoattenuating lesions in the right\nkidney are too small to characterize.  There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient status post pancreaticoduodenectomy with\ngastrojejunostomy, pancreaticojejunostomy, and hepaticojejunostomy.  The\nstomach is unremarkable.  The small bowel is normal in caliber and wall\nthickness without evidence of obstruction.  The rectum and sigmoid colon\ndemonstrate wall thickening with surrounding fat stranding concerning for\nproctocolitis.  Wall thickening in the distal ascending and transverse colon,\npartially exaggerated by underdistention, is also concerning for possible\ncolitis.  The appendix is normal.  A 1.2 cm mesenteric lymph node adjacent to\nthe liver  (series 3, image 43) has equivocally increased in size compared to\n___.  Immediately caudal is another lymph node previously measuring\n0.9 cm (series 3, image 48) that has slightly increased in size now measuring\n1.1 cm.  Another lymph node at the same level (series 3, image 50) measuring\n0.8 cm is unchanged.  Additional subcentimeter mesenteric lymph nodes around\nthe SMV are mildly more prominent compared to prior.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Diffuse wall thickening of the urinary bladder is partially\nexaggerated by underdistention of the bladder.  The distal ureters marker\nprobe.  There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno 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. \nDegenerative disease of the thoracolumbar spine is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post Whipple procedure and portal vein reconstruction without\nevidence of local recurrence.\n2. Multiple previously found prominent mesenteric lymph nodes are equivocally\nlarger compared to prior, but nonspecific in appearance.  Attention on\nfollow-up is recommended.\n3. Wall thickening from distal ascending colon to the rectum is concerning for\nproctocolitis.\n4. Please see separate dictation performed on the same day for detailed\nevaluation of the chest."
        },
        {
            "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. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Again seen is pneumobilia in the left\nhepatic lobe, similar to prior, and secondary to hepaticojejunostomy.  The\ngallbladder is is resected.\n\nPANCREAS: Patient is status post Whipple procedure.  The remnant 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.\n\nADRENALS: The 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 1.0 cm hypodense arising from the lower pole the left kidney is not\nsignificantly changed, likely representing a cyst.  Scattered additional\nsubcentimeter cortical hypodensities in the right kidney are too small to\ncharacterize, however likely represent cysts.  There is no evidence of stones\nor hydronephrosis.  There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post distal gastrectomy and\ngastrojejunostomy.  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.  A 1.5 cm mesenteric node adjacent to the SMV is not significantly\nchanged from prior (4:122).  Smaller adjacent nodes measuring 1.0 cm and 0.8\ncm are not significantly changed (4:123, 125).  Additional tiny nodes\nsurrounding the SMV are not significantly changed.  Hazy appearance of the\nomentum is stable.\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 and seminal vesicles are normal.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. Patient is status\npost portal vein and SMV reconstruction. The portal vein, splenic vein and SMV\nare patent.\n\nBONES: There are multilevel degenerative changes in the lumbar spine, 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 evidence of local recurrence status post Whipple with vascular\nreconstruction.\n2. Multiple mesenteric lymph nodes are not significantly changed compared with\n___.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic 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: 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 mild central and extrahepatic\nbiliary duct dilatation with common bile duct measuring 1.3 cm which smoothly\ntapers to the level of the ampulla.  No calcified stone or large periampullary\nmass identified.  The gallbladder is top-normal without stones or gallbladder\nwall thickening.\n\nPANCREAS: There is mild pancreatic duct dilatation measuring up to 0.4 cm\n(06:37). The pancreas otherwise has normal attenuation throughout, without\nevidence of focal lesions.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 stomach is largely distended and fluid-filled.  Small\nbowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are within normal limits.  The appendix is not\nwell visualized however no secondary signs of acute appendicitis.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Urinary bladder is mildly thick-walled and trabeculated with a 0.9 x\n0.8 cm left bladder diverticulum (6:116) consistent with chronic bladder\noutlet obstruction.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  Seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small amount of fat is seen within the left spermatic cord.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Mild pancreatic duct dilatation, as well as intrahepatic and extrahepatic\nbiliary duct dilatation with common bile duct measuring up to 1.3 cm, which\nsmoothly tapers to the level of the ampulla.  No calcified stone or\nperiampullary mass identified.  Common etiologies include sphincter of Oddi\ndysfunction and ampullary stenosis, however differential include small\nperiampullary mass given dilatation of both the pancreatic and biliary ducts.\n\nRECOMMENDATION(S):  Correlation with ERCP findings is recommended."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis re-demonstrated.  There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is re-demonstration of moderate\nintrahepatic biliary ductal dilatation which is similar in size and character\ncompared to prior study, with substantial dilatation of the common bile duct\nwhich measures up to 2.5 cm proximally and tapers down abruptly at the\nampulla.  Mild thickening is visualized at the region of the ampulla which\nmeasures up to 1.6 x 0.9 cm (3:75) which may correlate with duodenal\nthickening visualized on EUS and could represent benign stricture versus mass.\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 and with stable diffuse dilatation of the main pancreatic duct\nmeasuring up to 1 cm proximally, similar in size compared to prior.  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 bilateral subcentimeter renal hypodensities are visualized which\nlikely represent renal cysts though are too small to characterize.  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: Percutaneous gastrojejunostomy tube remains in place and\nterminates within the proximal jejunum.  The stomach and first portion of the\nduodenum are distended with air the remainder of the duodenum is collapsed\naround the GJ to and difficult to assess with no focal lesions identified. \nJejunal and ileal 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/LYMPH NODES: There is re-demonstration of a 1 cm porta hepatis\nlymph node (3:62) with prominent mesenteric lymph nodes though no additional\nlymphadenopathy by CT size criteria within the abdomen or pelvis.\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\nVASCULAR: There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and contains calcifications.\n\nBONES: There 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 periampullary soft tissue thickening measures up to 1.6 x 0.9 cm may\ncorrelate with duodenal thickening visualized on EUS.\n2. Intrahepatic and extrahepatic biliary ductal dilatation similar in degree\nwhen compared with study of ___.\n3. Unchanged pancreatic ductal dilatation measuring up to 1 cm.\n4. Stable 1 cm porta hepatis lymph node with no solid organ metastatic disease\nidentified within the abdomen or pelvis.  No new enlarged or prominent lymph\nnodes identified within the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with overlying\natelectasis, left greater than right.  There is no 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 ductal dilatation.  Pneumobilia is present, likely related to the\npatient's prior hepaticojejunostomy.  The common bile duct is dilated up to\n1.7 cm, unchanged since prior.  The gallbladder is surgically absent.\n\nPANCREAS: A 2.6 x 2.5 cm hypodense mass with indistinct borders adjacent to\nthe pancreatic head is again difficult to distinguish from the adjacent\nduodenum.  It previously measured 2.4 x 1.8 cm.  The pancreatic ductal\ndilatation up to 1.1 cm is not significantly changed since 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: There are new bilateral percutaneous nephrostomy tubes present in\nsatisfactory position.  Bilateral double-J catheters are also present and\nunremarkable.  There is no suspicious focal renal lesion.  Excreting contrast\nis symmetric bilaterally.\n\nGASTROINTESTINAL: The patient is post Roux-en-Y hepaticojejunostomy.  The\npercutaneous jejunostomy tube has been removed.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits apart from a substantial stool burden.  The\nappendix is normal.\n\nPELVIS: The urinary bladder is not well assessed but grossly unremarkable. \nThere is increased abdominopelvic ascites, moderate in extent.\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.  The IVC is collapse suggesting hypovolemia.\n\nBONES: There 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 amount of abdominopelvic ascites\n2. Interval placement of bilateral percutaneous nephrostomy tubes in\nsatisfactory position with no evidence of hydronephrosis.\n3. Grossly unchanged and indistinct hypodense mass adjacent to the pancreatic\nhead and duodenum.\n4. Collapsed IVC suggestive of hypovolemia\n5. Small bilateral pleural effusions and subjacent atelectasis, similar to ___."
        },
        {
            "input": "VASCULAR:\nThere is a large high density fluid collection centered medial to the left\nkidney and extending inferiorly along the left psoas muscle, with smaller\ncomponent extending to the left pelvic sidewall, low pelvis.  Hyperdense\nportion of the hematoma measures 6.3 cm x 6.6 cm x 9.4 cm today, has enlarged\ncompared with prior exam from ___ when it measured 5.5 cm x 5.5 cm\nx 5.9 cm.  Along the periphery of this hematoma there are two curvilinear high\ndensity foci (3b:280 and 278) which likely represent neovascularity, tiny area\nof active extravasation is unlikely, cannot be absolutely excluded.  There is\nmildly increased attenuation of the upper margin of hematoma on post contrast\nimages.  In addition, there is 1.5 cm low-attenuation lesion in the medial,\nlower margin of the left kidney, in contiguity with the hematoma.  Consider\nexophytic renal mass, such as AML as source of hemorrhage.\n\nThere is moderate atherosclerotic burden in the abdominal aorta.  Of note, a\nreplaced right common hepatic originating SMA is noted.  There is mild\nnarrowing of the proximal superior mesenteric artery.  Mild narrowing of the\nleft common iliac artery.  Atherosclerotic changes, calcifications.\n\nLOWER CHEST: There is bibasilar atelectasis.  Heart size is top normal.  There\nis no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a irregular rounded lesion in segment VI with peripheral nodular\nenhancement measuring 2.3 x 1.8 cm (3B: 243) which most likely represents a\ncavernous hemangioma.  There is a hypoattenuated rounded lesion in segment 2\nmeasuring 2.9 x 2.3 cm (3B:  220) which most likely represents a simple cyst. \nAdditional tiny cyst inferior tip of the right hepatic lobe.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains contrast but is otherwise 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:  There is mild left-sided hydroureter which is likely secondary to\ncompressive obstruction of the previously described large left perinephric\nhematoma.  There is mild left hydroureteronephrosis, with left ureter\ndecompressed distal to the perinephric hematoma.  Delayed left nephrogram. \nThe left renal vein, left renal artery is patent.  Normal right kidney.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There are multiple clustered retroperitoneal lymph nodes\nlargest measuring 0.8 cm short axis in the left periaortic lesion.\n\nPELVIS: The urinary bladder is normal.  .\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nBONES: There is grade 1 anterolisthesis of L5 over S1 and bilateral L5 pars\ndefects.  There is moderate degenerative change at L5-S1 with intervertebral\ndisc space narrowing and spurring.  Small focus of sclerosis involving right\nninth rib, indeterminate, likely benign bone island.\n\nSOFT TISSUES: There is fat only containing bilateral inguinal hernia,\nperiumbilical hernia.",
            "output": "1. Large left-sided perinephric hematoma has increased in size.  2 curvilinear\nfoci along the periphery suggest neovascularity, tiny focus of active\nextravasation is unlikely, cannot be excluded. Consider exophytic renal mass,\nsuch as AML as source of hemorrhage.\n2. Mild left-sided hydroureter, delayed nephrogram likely due to compression\nfrom large left-sided perinephric hematoma.\n3. Left periaortic borderline 0.8 cm lymph node at the level of the left\nkidney, indeterminate.  ."
        },
        {
            "input": "Lungs: Please see the report of the CT chest performed on the same day for\ndetails on the chest.\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 has been surgically removed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: The previously described ill-defined hypodensity in the pancreatic\nhead has decreased in size, measuring 1.2 cm x 1.2 cm, previously 3.0 cm x 2.0\ncm, and again makes contact with the splenoportal confluence as before with\nless than 180 degrees of contact. There is no contact with the gastroduodenal\nartery on today's examination.\n\nThere is stable pancreatic duct dilatation measuring up to 1.4 cm in the body\nas previously described. Stable atrophy of the pancreatic tail.\n\nThere is redemonstration of previously described dilation of several side\nbranch pancreatic ducts with a cystic branch dilation in the pancreatic body\nmeasuring up to 1.4 cm, series 3, image 27.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Small hypodensities are seen both kidneys, too small to characterize,\nbut most likely cortical cysts. 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 is surgically absent.\n\nGastrointestinal: The bowel is within normal limits, except for colonic\ndiverticulosis.  There is no evidence of bowel dilatation or obstruction.\n\nVascular: There are mild to moderate atherosclerotic calcifications of the\nabdominal aorta. Circumaortic left renal vein.\n\nThere is stable hazy soft tissue surrounding the celiac axis and common\nhepatic artery, with less than 180 degrees of contact.\n\nThe portal vein and hepatic veins are patent.\n\nLymph nodes:\n\nThe previously described common hepatic artery and portacaval lymph nodes have\ndecreased in size, measuring up to 1.0 cm, series 3, image 90.\n\nAn enlarged oblong left pelvic sidewall structure is seen measuring 2.9 cm x\n1.1 cm slightly more conspicuous compared to previously, series 3, image 163,\nlikely representing an abnormal lymph node or the left adnexa. No follicles\nare seen.\n\nBone and soft tissues: There is no suspicious bone lesion. Grade 1\nanterolisthesis of L4 over L5. Stable 2.7 cm anterior abdominal wall soft\ntissue scarring seen on series 3, image 139, unchanged compared to ___. Stable umbilical and supraumbilical hernias containing fat.",
            "output": "1. Interval decrease in size of the pancreatic mass, with slight decrease in\nsize of the common hepatic artery and portacaval lymph nodes. There is\npersistent contact with the splenoportal confluence as described before and\nstable hazy soft tissue surrounding the celiac axis and common hepatic artery,\nwith less than 180 degrees of contact.\n\n2. Enlarged left pelvic sidewall structure measuring 2.9 cm x 1.1 cm, likely\nrepresenting an abnormal lymph node or the left adnexa. Recommend pelvic MR\nfor further evaluation.\n\n3. Stable dilatation of the pancreatic duct dilatation up to 1.4 cm in the\nbody of the pancreas in stable dilated side branches as detailed above.\n\nRECOMMENDATION(S):  Recommend pelvic MRI for further characterization of the\nleft pelvic sidewall structure."
        },
        {
            "input": "VASCULAR:\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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is worsening extrahepatic bile duct\ndilatation, with obliteration of the common bile duct in the pancreatic head\nwhere it appears hyperenhancing.  The central intrahepatic bile duct\ndilatation has increased.  The gallbladder is resected.\n\nPANCREAS:\nPANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): ill-defined hypoattenuating\nSize (maximal axial dimension in cm): 1.2 x 1.5 cm, previously measuring 1.3 x\n1.3 cm and again contacts the portal confluence with less than 180 degrees of\ncontact.  There is less than 180 degree of tumor contact with the common\nhepatic artery approximately 1 cm beyond its origin with encasement of the\nproper hepatic artery and at the origin of the GDA.  There appears to be\nincreased confluence of soft tissue stranding within adjacent small lymph node\nin this area, unclear if this is treatment effect versus tumor.\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\nSMA involvement: absent\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: present at roughly 1 cm beyond its origin\nwith encasement (more than 180 degrees) of the proper hepatic artery as well\nas encasement of the GDA at its origin.\nSolid soft-tissue contact:  <=180\u00b0\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: present.  The proper\nhepatic artery is very short and there is extension of tumor throughout its\nlength and at the origin of the right and left hepatic arteries.\n\nVariant anatomy: none, conventional hepatic arterial anatomy.\n\nVenous evaluation\nMPV involvement: present at the confluence.\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, at the confluence\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: There is increased more confluent soft tissue\nstranding surrounding a small lymph node and the common hepatic artery,\nunclear if this is due to treatment effect versus tumor.\nOther extrapancreatic disease (invasion of adjacent structures): present into\nduodenal bulb wall (601:46).\n\nThere is persistent pancreatic ductal dilation of the pancreatic body\nmeasuring up to 1.6 cm, similar to prior.  Atrophy of the pancreatic tail is\nstable.\n\nThere is re-demonstration of previously described dilation of several side\nbranch pancreatic ducts with a cystic branch dilatation measuring up to 1.4\ncm, again similar to 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 a 1.9 x 1.9 cm hypodense lesion in the right interpolar region,\nlikely renal cysts, similar to prior.  Additional subcentimeter hypodensities\nare too small to characterize but also likely represent cortical cysts.  There\nis no evidence of stones, or hydronephrosis. There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Extensive diverticulosis is noted throughout the\ncolon. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM:\n\nPELVIS: The urinary bladder is decompressed.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  In the area of the vaginal\ncuff, there is a subcentimeter rim enhancing collection (2; 211), new since\nprior, and is unclear if it is sequelae of recent prior diverticulitis without\nevidence of active diverticulitis or whether this originates from the vaginal\ncuff.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is similar to prior.  Moderate\ndegenerative changes in the right hip are again seen.\n\nSOFT TISSUES: There is again a 2.8 x 1.4 cm hypodensity at the umbilicus and\nto the right of the umbilicus, consistent with soft tissue scarring previously\nseen on MRI.  Stable umbilical and supraumbilical fat containing hernias.",
            "output": "1. Redemonstration of the ill-defined 1.5 cm pancreatic head mass with\npancreatic duct dilation with tumor contact with the common hepatic artery 1\ncm beyond its origin with more than 180 degree encasement of the proper\nhepatic artery and origin of the right and left hepatic arteries and\nencasement with near occlusion of the gastroduodenal artery.  There is also\ncontact with the splenoportal confluence of less than 180 degrees.  Invasion\ninto the wall of the duodenal bulb is again demonstrated.\n2. There appears to be overall increased confluent soft tissue stranding in\nthe periportal region from the common hepatic artery region about a previously\ndiscrete lymph node, which may represent treatment effect versus tumor.\n3. Worsening extrahepatic bile duct dilatation, with obliteration of the\ncommon bile duct in the pancreatic head and appears hyperenhancing and may be\ndue to scar related to treatment effect or tumor involvement.  The central\nintrahepatic bile duct dilatation has increased slightly.\n4. Interval new subcentimeter rim enhancing fluid collection in the area of\nthe vaginal cuff, is unclear if this is sequelae of prior recent\ndiverticulitis versus originating directly from the vaginal cuff.  No evidence\nof active diverticulitis.  Correlation with pelvic exam is recommended.\n\nRECOMMENDATION(S):  Pelvic exam to evaluate small fluid collection at the left\napex the vaginal cuff.\n\nClose follow-up of bilirubin and liver enzymes with the new CBD narrowing and\nupstream bile duct dilation."
        },
        {
            "input": "Minimal atelectasis at each lung base.\n\nThere has been short-term worsening of intrahepatic and extrahepatic biliary\ndilatation associated with stricturing, perhaps occlusion, in the pancreatic\nhead, which presumably reflects an underlying mass that is not explicitly well\ndemonstrated on routine imaging.  No apparent short-term change in the\npancreas, however.  Marked dilatation of the main pancreatic duct with abrupt\ncutoff in the neck is a stable finding over the short term, however. \nPancreatic tail is atrophic.  No definite change in the pancreatic head\nitself.  The gall bladder is absent with what appears to represent a dilated\nsomewhat prominent cystic duct remnant.  The spleen is normal in size and\nappearance.  Left adrenal is slightly thickened, as before, but doubtful in\nsignificance.  Medium-size simple cyst is unchanged in the interpolar left\nkidney.  Two subcentimeter hypoattenuating foci in the left kidney are too\nsmall to characterize, but doubtful in clinical significance.\n\nStomach is unremarkable.  small bowel appears normal.  Sigmoid diverticulosis\nis moderate in severity.\n\nBladder shows mild inflammatory change.  Bladder is mostly empty.  Uterus is\nabsent.  Trace free-fluid.  Structure suggesting a normal left ovary remains. \nNo definite visualization of a right ovary.  Atherosclerotic changes are\nmoderate in severity.  Major vascular structures appear widely patent.\n\nThere are no suspicious bone lesions.  Moderate degenerative changes affect\nlower lumbar facet joints, probably explaining mild unchanged\nspondylolisthesis of L4 on L5.  Right hip joint shows moderate degenerative\nchanges.",
            "output": "1.  Findings suggest cystitis.\n\n2.  Short-term worsening of biliary dilatation consistent with worsening\ndistal obstruction associated with suspected neoplastic disease in the\npancreatic head."
        },
        {
            "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: 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. \nThere is an ill-defined 7 mm hypodense lesion in the approximate segment V of\nthe liver, with additional smaller lesion in segment VI, which are essentially\nunchanged compared to the most recent prior of ___.  There is no\nevidence of new or enlarging focal lesions.\nInterval placement of a metallic common bile duct stent with near complete\nresolution of the previously visualized intrahepatic biliary ductal\ndilatation, now with presence of predominantly left-sided pneumobilia and\ntrace grade minimal biliary ductal dilatation.\nThe gallbladder is absent.\n\nPANCREAS: Interval resection of the hypodense pancreatic neck lesion with\noverall decreased size of the pancreatic head/neck and surgical clips in\nplace, consistent with recent excisional biopsy.\nHazy hypodense soft tissue completely surrounds the common hepatic artery and\nportal vein, which density has decreased compared to prior study ___.\nThere is persistent marked dilatation of the main pancreatic duct, measuring\nup to 19 mm, with unchanged abrupt cutoff at the neck, and atrophy of the\npancreatic body.\nPeriportal and portacaval lymph nodes are below 1 cm in short axis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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. \nUnchanged bilateral subcentimeter renal cysts measuring up to 8 mm in the left\ninterpolar region.  There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Marked sigmoid\ndiverticulosis, as before, without evidence of acute diverticulitis.  The\nremainder of the colon and rectum are within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVESSELS: Scattered atherosclerotic calcifications of the aorta and its major\nbranches.\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 is status post hysterectomy.  No adnexal masses\nvisualized.\n\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.  Unchanged spondylolisthesis of L4 on L5. \nMultilevel degenerative changes of the thoracolumbar spine.  Unchanged right\ngreater than left hip joint degenerative changes.",
            "output": "1. Interval resection of the pancreatic neck/head lesion with decreased\ndensity of the hazy soft tissue that surrounds the portal vein and common\nhepatic artery, consistent with known adenocarcinoma.\n2. Interval placement of a CBD metallic stent with near complete resolution of\nthe previously visualized intrahepatic biliary ductal dilatation.\n3. No evidence of distant metastases in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: Multiple scattered pulmonary nodules in the visualized lower\nlobes, grossly similar in appearance to prior study from ___,\nconcerning for metastases.  Minimal atelectasis is noted in the lung bases.\nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a new hypodensity within hepatic segment ___ measuring 6 mm (3:32),\nnot seen on previous studies.  There is stable appearance of a 4 mm\nhypodensity within hepatic segment VI (3:44), too small to characterize but\nunchanged since at least ___.  A common bile duct stent is again\ndemonstrated, with stable appearance of pneumobilia suggestive of stent\npatency.  Persistent mild intrahepatic biliary ductal dilatation is unchanged.\nThe gallbladder is surgically absent.\n\nPANCREAS: There is redemonstration of an ill-defined mass in the pancreatic\nneck measuring 2.1 x 1.6 cm (3:43), unchanged from prior study.  There is\nsimilar a broad cutoff of the pancreatic duct with persistent severe upstream\ndilatation measuring up to 2.1 cm (3:43), previously 1.8 cm.  Fiducial markers\nare again noted in the tumor bed.  Ill-defined soft tissue near the pancreatic\nhead measures 3.2 x 2.9 cm (3:41), previously measuring 3.1 x 2.8 cm.  Similar\nto the prior study, this soft tissue density abuts the portal confluence in\ncauses slit like narrowing of the main portal vein (3:40).  Persistent\nencasement of the common hepatic artery is again demonstrated, with likely\nencasement of the GDA which is no longer visualized.  Diffuse stranding\nsurrounding the pancreatic head is similar to prior study, essentially\ninseparable from the duodenal bulb.\n\nThere is persistent cystic dilatation of a side branch pancreatic duct\nmeasuring 1.5 cm (3:42).\n\nSPLEEN: There is a new wedge-shaped hypodensity at the anterior aspect of the\nspleen (3:38), concerning for a splenic infarct.  The spleen otherwise shows\ntop normal size and 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 stones, solid renal lesions, or hydronephrosis. \nStable 2.0 cm simple cyst at the interpolar region of the right kidney.  Few\nsubcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, likely compatible with simple cysts.  There are no urothelial\nlesions in 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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The appendix is not visualized, however no secondary signs of\ninflammation in the right lower quadrant.\n\nRETROPERITONEUM: The previously demonstrated portacaval and periportal lymph\nnodes are no longer well characterized due to infiltrating soft tissue. \nStable appearance enlarged aortocaval lymph nodes, with the largest measuring\n1.3 cm (3:56).\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: Status post hysterectomy.  No adnexal mass.\n\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes lumbar spine.  Mild anterolisthesis of L4\non L5 is chronic and likely secondary to degenerative change.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "1. New 6 mm segment 4A lesion, concerning for metastasis.\n2. New splenic infarct.\n3. Stable appearance of an ill-defined mass in the pancreatic neck/proximal\nbody and ill-defined soft tissue in the pancreatic head surrounding the CBD\nstent, with persistent severe upstream pancreatic ductal dilatation, and\nassociated slit-like narrowing of the portal vein and encasement of the common\nhepatic and gastroduodenal arteries.\n4. Stable scattered pulmonary nodules, concerning for metastases.\n5. Stable enlarged aortocaval lymph node."
        },
        {
            "input": "LOWER CHEST: Chest findings 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nTip of an abdominal drain which traverses the left ventral abdominal wall\nterminates in the left upper quadrant.\n\nMinimal pneumoperitoneum about the liver and upper abdomen (02:45, 54) is\nlikely postsurgical.\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 is status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is improved vascularization of the left kidney with small\nresidual laceration along the posterior left interpolar cortex.  Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram.  No\ndefinite active arterial or venous extravasation of contrast.  There is no\nhydronephrosis.  Ureteric evaluation is limited without delayed phase imaging.\nMild left perinephric and periureteral hematoma has decreased compared to\nprior.\n\nGASTROINTESTINAL: Tip of percutaneous gastrostomy tube terminates in the body\nof the stomach.  The stomach is predominantly fluid-filled.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon is largely decompressed otherwise unremarkable.  The appendix is not\nvisualized.\n\nPELVIS: Apparent bladder wall thickening is likely due to underdistention. \nAir within the bladder is presumably related to recent catheterization.  The\ndistal ureters are unremarkable. There is minimal free fluid within the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.  Condom catheter encases the distal penis.\n\nLYMPH NODES: There is no retroperitoneal or 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 segmental rib fractures involving the visualized left seventh\nthrough twelfth ribs are unchanged in alignment.  There is no evidence of\nworrisome osseous lesions.\n\nSOFT TISSUES: Patient is status post interval abdominal closure with skin\nstaples which overlie the midline laparotomy.  Subcutaneous emphysema along\nthe anterior left abdominal wall is likely postsurgical.  Air and fluid about\nthe penile shaft is likely related to condom catheter.  There is extensive\nventral subcutaneous edema/stranding.",
            "output": "1. No new fluid collections or localizing source of infection within the\nabdomen or pelvis.\n2. Improved vascularization of the left kidney with small residual parenchymal\nlaceration.  Small residual left perinephric and periureteral hematomas have\nimproved as well.\n3. Unchanged alignment of multiple segmental left rib fractures.\n4. Patient is status post splenectomy.\n5. Air within the bladder is presumably related to recent catheterization. \nCondom catheter in situ.\n6.  For chest findings reference is made to CT chest report of the same day"
        },
        {
            "input": "LOWER CHEST: A left chest tube is been removed.  Left lower lobe pneumonia has\nimproved. Pneumomediastinum has decreased.  Right basilar consolidation is\nsimilar.  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 is not seen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A left perinephric/periureteral hematoma continues to evolve, and\nprogressively decreased in size.  Left renal laceration is also\nre-demonstrated (02:38).\n\nGASTROINTESTINAL: Postoperative pneumoperitoneum has resolved.  A left upper\nabdominal drain has been removed.A percutaneous gastrostomy tube is in place\nin the stomach.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon is unremarkable.  There is a rectal\ntube.\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 unremarkable.\n\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: Re-demonstration of multiple displaced left rib fractures, completely\ndescribed on the trauma CT from ___.\n\nSOFT TISSUES: Abdominal wall postsurgical changes are re-demonstrated.  Left\nlower abdominal wall subcutaneous gas is probably related to subcutaneous\ninjection.  Subcutaneous edema in the left lower extremity is improving.",
            "output": "1. No new fluid collection or other focal source of infection in the\nabdomen/pelvis.  Interval removal of percutaneous drainage catheter.\n2. Improvement of left lower lobe pneumonia.  Interval removal of left chest\ntube.\n3. Evolving left perinephric/periureteral hematoma."
        },
        {
            "input": "LOWER CHEST: A right basilar consolidation appears slightly improved.  A left\nlower lobe consolidation also appears slightly improved, and may reflect a\ncombination of infection and pulmonary contusion.  No pleural or pericardial\neffusions.\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 decompressed, 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 patient is status post splenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A left renal laceration is again seen (05:33).  The left perinephric\nand periureteral hematoma has resolved.  The right kidney appears normal.  No\nhydronephrosis of either kidney.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is in place.  A\ngastrojejunostomy tube terminates within the jejunum.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits.\n\nPELVIS: The bladder is unremarkable.  There is no free fluid in the pelvis.\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.  No atherosclerotic disease\nis noted.\n\nBONES: Multiple, displaced left-sided rib fractures demonstrate periosteal new\nbone formation and mild callus, suggestive of interval healing.  No other\nacute fractures are identified.  No worrisome osseous lesions.\n\nSOFT TISSUES: Postsurgical changes within the anterior abdominal wall. \nSubcutaneous edema within the left lower extremity has improved.",
            "output": "1. No new intra-abdominal fluid collections.\n2. Slight interval improvement in right and left lower lobe consolidations,\nthe left of which may reflect a combination of infection and pulmonary\ncontusion.\n3. Redemonstrated left renal laceration, with interval resolution of left\nperinephric and periureteral hematoma.\n4. Interval healing of multiple, displaced left-sided rib fractures."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Slightly heterogeneous attenuation of the liver with non\nopacification of the hepatic veins is likely due to phase of contrast.  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 measures 13.1 x 9.6 x 5.2 cm for a calculated volume of 409\nmL, top-normal.  There is normal attenuation throughout without evidence of\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 nephrogram. \nA subcentimeter hypodensity in the lower pole of the left kidney is too small\nto characterize but statistically likely a cyst.  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.\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 surgical clips are seen in the right inguinal region.  There\nis no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is incidental note of a circumaortic left renal vein.  There\nis no abdominal 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": "Top-normal spleen measuring up to 13.1 cm without focal splenic lesion.  No\nintra-abdominal or pelvic lymphadenopathy, or other acute findings within the\nabdomen or pelvis.\n\nNOTIFICATION:  Wet read findings discussed with ___, MD by ___\n___, MD via telephone at 16:29 on ___, 2 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.  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, without evidence of focal\nlesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size, measuring 13.3 cm, and is normal in\nattenuation, 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 hydronephrosis.  A 7 mm hypodensity in the lower pole of the left\nkidney (02:35) is too small to characterize, statistically likely a cyst. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness.  The colon is unremarkable.  The appendix\nis normal in caliber without evidence of fat stranding.  Hyperdensity within\nthe splenic tip (02:51) may represent a tiny appendicolith.\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 or retroperitoneal lymphadenopathy. \nScattered mesenteric lymph nodes measure up to 5 mm, not pathologically\nenlarged, and are unchanged from prior.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber.  The\nmajor intra-abdominal branches of the aorta are patent.  Portal vasculature is\npatent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Surgical clips are again noted in the right inguinal region.",
            "output": "1. No acute process within the abdomen or pelvis.  No evidence of mesenteric\nischemia.\n2. Top-normal spleen size at 13.3 cm, unchanged.\n3. No lymphadenopathy in the abdomen or pelvis."
        },
        {
            "input": "CT ABDOMEN:  The lung bases are clear. The visualized portions of the heart\npericardium are normal.\n\nThe liver enhances homogeneously. The small liver hypodensities, of which the\nmost prominent ones are seen in segment 4 a measuring 1.8 x 1.3 cm and in\nsegment 8 measuring 1.1 x 0.8 cm, which did not demonstrate concerning\nfeatures likely represent benign lesions such as cysts versus biliary cyst\nadenomas. There is no intrahepatic biliary duct dilatation. The gallbladder is\nunremarkable. The portal vein is patent. The pancreas, spleen, and adrenals\nare normal. The kidneys enhance symmetrically and there is no hydronephrosis.\nA 2.6 cm cystic lesion in the upper pole of the right kidney does not show\ncomplex features.\n\nAlthough not well distended, there is apparent wall edema within the gastric\nbody raising the possibility of gastritis. The small large bowel are grossly\nunremarkable.  The appendix is seen and is not inflamed. There is no\nportacaval, mesenteric and retroperitoneal lymphadenopathy. There is no free\nair or free fluid.  The aorta is not aneurysmal. The main intra-abdominal\nvessels are grossly patent.\n\nCT PELVIS: The urinary bladder is decompressed, which limits assessment. The\nthere is no pelvic wall or inguinal lymphadenopathy. A 2.6 cm left adnexal\ncyst is present. A 1.1 cm enhancing fibroid is seen in the left aspect of the\nuterus.\n\nOSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for\nmalignancy.",
            "output": "1.  Although not particularly well distended, there is apparent wall edema of\nthe stomach raising possibility of gastritis.\n\n2.  A 2.6 cm left adnexal cyst in this postmenopausal patient should be\nfurther assessed with ultrasound on a nonemergent basis.\n\nUpdated wet read was discussed with the ___ resident physician just after\nattending review."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  5 mm\nhypodense lesion in the left lobe of the liver is too small to characterize\nbut may represent a hepatic 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: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: There is subtle edema of distal ileum within the right lower\nquadrant (series 601, image 37), concerning for enteritis.  No bowel\nobstruction is seen.  Fluid is seen in some loops of small bowel.  The right\ncolon and transverse colon are collapsed, difficult to exclude mild wall\nthickening.  The appendix 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 normal.\n\nLYMPH NODES: There are scattered prominent mesenteric lymph nodes, including a\ncluster in the right lower quadrant, which are not enlarged by CT size\ncriteria, however appear increased in number (for example 601:31).  These may\nbe reactive due to ongoing enteritis or relate to mesenteric adenitis.\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. Mild wall edema of distal small bowel may relate to enterocolitis. \nAscending and transverse colons are collapsed, difficult to exclude mild\nthickening/mild colitis.\n2. Nonspecific scattered prominent mesenteric lymph nodes are not enlarged by\nCT size criteria.  These may be reactive due to ongoing enteritis or relate to\nmesenteric adenitis or possibly be related to the patient's history of HIV\n\nNOTIFICATION:   The updated findings and impression were discussed with Dr.\n___, M.D. over the telephone by ___, M.D. at 10:53 p.m. on\n___."
        },
        {
            "input": "CHEST: There is minimal dependent atelectasis on the right.. The heart is\nnormal in size and there is no evidence of pericardial effusion.\n\nABDOMEN: The liver enhances homogeneously and is without focal lesions. The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is normal and without\ngallstones.\n\nThe spleen and adrenal glands are unremarkable. There is an accessory spleen\nadjacent to the hilum.  The pancreas enhances homogenously and is without\nfocal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There is\na 1.3 cm simple cyst in the lower pole of the left kidney (02:42).. There is\nno hydronephrosis. The ureters are normal in caliber and course to the\nbladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance.  The small bowel is unremarkable. Extensive\ncolonic diverticulosis is noted. There is fat stranding adjacent to the cecum\nsurrounding an inflamed diverticulum (02:54), consistent with acute\ndiverticulitis, without extraluminal air or fluid collection. The appendix is\nsurgically absent..\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches contain calcifications and are normal in course and caliber. There\nare small mesenteric lymph nodes in the right lower quadrant which are likely\nreactive in nature (02:48).\n\nPELVIS: The bladder is well distended and normal.  There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "Acute cecal diverticulitis. No extraluminal air or drainable fluid collection.\nPatient is status post appendectomy."
        },
        {
            "input": "Bilateral, mild effusions without appreciable adjacent atelectasis. The heart\nis normal in size and there is no evidence of pericardial effusion.\n\nABDOMEN:\nThe liver is diffusely hypoattenuating without focal abnormality. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder, pancreas, and bilateral adrenal glands\nare normal.  The spleen is surgically absent, and a numerous surgical clips\nare noted within the left upper quadrant. The kidneys enhance symmetrically\nand are without suspicious solid mass.  Multiple, bilateral peripelvic cysts\nare again noted.\n\nThe stomach is dilated but otherwise grossly unremarkable in appearance.  The\npatient is status post completion of a total colectomy with ileosigmoid\nanastomosis. Postsurgical changes and surgical sutures are noted within the\naddendum anastomosis. There is no evidence of rectal contrast extravasation to\nsuggest leak. The majority of the small bowel is mildly dilated and\nfluid-filled, measuring up to approximately 3.7 cm in maximum diameter and\nsuggestive of postoperative ileus.\n\nFree intra-abdominal fluid measuring slightly denser than simple fluid ___\nHounsfield units) is noted predominantly surrounding the anastomotic site,\nwith increased peritoneal enhancement suggestive of irritation. Small foci of\npneumoperitoneum of are seen immediately inferior to the right hemidiaphragm,\nand may be postsurgical in nature. There is no retroperitoneal lymphadenopathy\nby CT size criteria.  The aorta and iliac branches contain calcifications and\nare normal in course and caliber. The celiac trunk and SMA are grossly patent.\n\nPELVIS:\nThe urinary bladder is grossly unremarkable. There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. Status post completion of a total colectomy with ileosigmoid anastomosis.\nNo evidence of rectal contrast extravasation to suggest overt anastomotic\nleak.\n2.  Moderate amount of perianastomotic intraperitoneal fluid with surrounding\nperitoneal hyperenhancement consistent with inflammation; infection cannot be\nexcluded.\n3.  Small volume pneumoperitoneum, likely postsurgical.\n4.  Diffuse, mild dilation of the small bowel, likely representing persistent\nileus.\n5.  Mild-moderate, bilateral simple pleural effusions with adjacent\natelectasis.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to ___, PA at\n4:12pm on ___."
        },
        {
            "input": "LOWER CHEST: Lung bases, visualized pleural spaces, and lower mediastinal\nstructures are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse low-attenuation of the liver parenchyma, consistent\nwith liver steatosis.  No gross morphologic features of cirrhosis.  No focal\nparenchymal lesions.  Portal and hepatic veins patent.  Normal gallbladder. \nNo intrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions.  No peripancreatic fat stranding.  No main duct\ndilatation.\n\nSPLEEN: The spleen is not enlarged (11 cm).  There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Normal kidneys.  No focal parenchymal lesions.  No hydronephrosis.\n\nGASTROINTESTINAL: Normal stomach and small bowel.  Uncomplicated colonic\ndiverticulosis, centered on the sigmoid colon.  Unremarkable large bowel\notherwise.  Normal appendix in the right lower quadrant.\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nPELVIS: Unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: Normal prostate gland and seminal vesicles.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.  Mildly bulky lymph nodes at the root of the mesentery remain\nnormal by CT measurement criteria.\n\nVASCULAR: Abdominal aorta normal in caliber.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.",
            "output": "1. Diffuse low-attenuation of the liver parenchyma, consistent with liver\nsteatosis.  No gross morphologic features of cirrhosis.\n2. No acute pathology otherwise identified in the abdomen and pelvis.\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 MR ___, in conjunction with a GI/Hepatology\nconsultation.  *\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. \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 tiny 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 focal cortical scarring in the medial left kidney with parenchymal\ncalcification, likely sequela of prior infection or inflammation.  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 (601:21).\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 and 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.  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: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:  Evaluation of the intra-abdominal organs is limited without\nintravenous contrast.  The unenhanced liver is unremarkable.  Hyperdensity\nwithin the gallbladder may represent small sludge without wall edema or\npericholecystic fluid.  The unenhanced spleen, pancreas and bilateral adrenal\nglands are normal.  There is no hydronephrosis, renal stone or contour\naltering renal mass.  There is no perinephric stranding or perinephric fluid\nidentified.  Mild hyperdensity at the bilateral renal medulla can be a normal\nfinding.\n\nThe small and large bowel are normal in course and caliber without\nobstruction.  There is no free fluid and no free air in the abdomen.  The\nabdominal aorta is normal in caliber throughout.  No enlarged mesenteric or\nretroperitoneal lymph nodes are identified.\n\nPELVIS: The bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  Small free pelvic fluid is within the physiologic\nrange. The unenhanced uterus and ovaries are unremarkable with a physiologic\n2.5 cm left ovarian cyst.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "1.  Limited study without IV contrast.  No acute intra-abdominal abnormality. \nSpecifically, no evidence of ileitis or intra-abdominal abscess.\n2.  Gallbladder sludge without evidence of acute cholecystitis.\n3.  Mild hyperdensity at the bilateral renal medulla can be a normal finding\nrelated to dehydration."
        },
        {
            "input": "LOWER CHEST: There is mild right basilar atelectasis, similar to prior. \nVisualized lung fields are otherwise clear.  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.  Small accessory spleen 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. The colon and\nrectum are within normal limits.  A few scattered colonic diverticula are\nnoted 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: Status post hysterectomy and bilateral\nsalpingo-oophorectomy.  The previous fluid collection superior to the vaginal\ncuff 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild anterolisthesis of L4 on L5 has slightly increased from prior, likely\ndegenerative in etiology in the presence of extensive facet arthrosis.\n\nSOFT TISSUES: Scattered subcutaneous soft tissue in the perianal region may\nreflect postoperative changes.  Fat containing umbilical hernia is noted.",
            "output": "1. No acute process within the abdomen or pelvis to explain the patient's\nreported symptoms.  Normal appendix.\n2. Resolution of previously seen postoperative fluid collection superior to\nthe vaginal cuff.\n3. Slight interval increase in mild anterolisthesis of L4 on L5, likely\ndegenerative in etiology."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Subsegmental atelectasis is mild in the right base.  Otherwise\nunremarkable lungs.  There is no pleural effusion.\n\nABDOMEN:\nHEPATOBILIARY: A large mildly thick walled collection is anterior to the left\nhepatic lobe, which is compressed and displaced posteriorly and inferiorly,\ncranial to the spleen and wrapping around it to the left and extending into\nthe left paracolic gutter, measuring roughly 20 x 13 x 10 cm.  No definite fat\nnecrosis, hemorrhage or gas in the collection. The liver otherwise\ndemonstrates homogenous attenuation throughout.  There is no evidence of\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nPANCREAS: There are at least 3 other peripancreatic fluid collections, the\nbiggest in the pancreatic head measures 5.8 x 3.7 x 3.4 cm with a satellite\ndaughter measuring 2 x 1.4 x 1.6 cm (4: 66 and 71) a third collection is seen\naround the pancreatic tail and measures 6 x 1.9 x 7 cm (04:44). No definite\nfat necrosis, hemorrhage or gas in the collections.  The pancreas however, has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is within normal limits.  A 6 x 3.4 x 4.7 cm\nleft adrenal adenoma is noted.\n\nURINARY: 2.2 x 2.5 x 1.7 cm simple cortical cyst arises from the upper pole of\nthe left kidney.  No hydronephrosis.  Kidneys enhance normally.\n\nGASTROINTESTINAL: Dobhoff feeding tube terminates just distal to the ligament\nof Treitz.  There are multiple fluid filled and dilated loops of small bowel\nmeasuring up to 5 cm with a transition point as the bowel herniates into an\numbilical hernia with a narrow neck of 1.1 cm.  The hernia also contains\nsimple fluid.  There is upstream obstruction and decompressed bowels distally\nto this point.  There is normal enhancement of the small bowel throughout\nwithout evidence of ischemia.  There is interloop fluid and mild mesenteric\nedema.  The appendix is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.  There is left upper quadrant omental stranding.\n\nModerate amount of ascites in the abdomen and pelvis appears simple.\n\nLYMPH NODE: No evidence of abdominopelvic lymphadenopathy.\n\nPELVIS: The bladder appears unremarkable.  There is simple free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Umbilical hernia containing a small bowel loop and causing\nobstruction is described above.",
            "output": "1. Incarcerated umbilical hernia containing small bowel loop and causing high\ngrade small bowel obstruction.  No evidence of ischemia.\n2. Multiple homogeneous peripancreatic fluid collections likely subacute\nsequelae of prior pancreatitis.  The pancreas enhances normally and there is\nno findings suggestive of pancreatic necrosis.\n3. Moderate ascites.\n4. 6 cm left adrenal adenoma.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:55 pm, 1 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.  There is a small right posterior\nBochdalek hernia containing fat (02:12).\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: Diffuse coarse calcifications throughout the atrophic pancreatic\nparenchyma as well as within the main pancreatic duct consistent with chronic\npancreatitis, overall unchanged in appearance dating back to ___. \nThere is diffuse main pancreatic ductal dilatation to 1.1 cm, with intraductal\ncalculi unchanged from prior.  No peripancreatic stranding or fluid\ncollections, to suggest an acute component over chronic 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 appearance of cortical thinning at the superior left renal pole\nis unchanged consistent with scarring.  A left interpolar 1.2 cm simple cyst\nis unchanged.  The normal nephrograms bilaterally without hydronephrosis or\nperinephric stranding.  No focal lesions or stones.\n\nGASTROINTESTINAL: The stomach 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 appendicitis are demonstrated.  There is a moderate sized\nstool ball within the rectum.\n\nPELVIS: Overlying streak artifact from the bilateral hip prostheses limits\nassessment bladder rectum.  No free fluid is definitively visualized.\n\nREPRODUCTIVE ORGANS: Evaluation of reproductive organs limited secondary to\nstreak artifact.  Within this limitation, the prostate is unremarkable.\n\nLYMPH NODES: No lymphadenopathy by CT size criteria.\n\nVASCULAR: There is a moderate amount of calcified atherosclerotic plaque\nthroughout the abdominal aorta without aneurysmal dilation.  Focal narrowing\n(up to 50%) at the origin of the celiac artery noted (602:35).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDeformities multiple lower left lateral ribs and the posterior right ninth rib\nlikely reflect prior trauma.  A left total hip arthroplasty and a right\nintertrochanteric gamma nail are within normal limits without signs of\nperihardware complication.\n\nSOFT TISSUES: Soft tissue stranding overlying the coccyx, to be correlated\nwith clinical exam findings for inflammation at this site otherwise no soft\ntissue abnormality.",
            "output": "1. No acute abdominopelvic findings to correlate with the patient's symptoms. \nThe appendix is not visualized, however no secondary signs of appendicitis are\ndemonstrated.  Large stool burden noted throughout the colon without bowel\nobstruction.\n2. Changes related to chronic pancreatitis including diffuse pancreatic\nparenchymal atrophy; main pancreatic ductal dilation to 1.1 cm with the\ndiffuse coarse pancreatic parenchymal and ductal calcifications, which appear\nunchanged from the prior study from ___. No signs of superimposed acute\npancreatitis or peripancreatic fluid collections."
        },
        {
            "input": "LOWER CHEST: There is a small right and trace left pleural effusion with\ncompressive atelectasis.  Stable cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  8.5\nx 7.1 x 7.2 cm heterogeneous mass in segment ___ of the liver, has increased\nfrom 7.4 x 6.0 x 5.9 cm on ___, and 4.5 x 3.2 x 3.1 cm on ___.  0.4 cm hypodensity in the caudate lobe remains too small to\ncharacterize.\n\nThere is a moderate amount of perihepatic fluid, measuring above simple fluid.\n\nThere is no evidence of intrahepatic biliary dilatation.  There is mild\nprominence of the common bile duct to approximately 0.8 cm, similar in\nappearance to the study from ___. 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.  There is a moderate 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 solid renal lesions.  There is a 1.7 cm intermediate\nattenuating (46 ___ lesion in the interpolar region of the right kidney is\nunchanged since ___ (series 3, image 33).\n\nThere is no perinephric abnormality.  There is no hydronephrosis or\nhydroureter.  Bladder is underdistended but otherwise normal.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nThere is a diverticulum arising from the second portion of the duodenum,\nprojecting medially, unchanged compared to prior.  The patient is status post\nsmall bowel resection.  Anastomotic material is seen in the mid abdomen. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement.\nThe colon and rectum are within normal limits. The appendix is normal.\n\nMesentery: Again seen are innumerable nodules within the mesentery that\ndemonstrate peripheral enhancement with central hypoattenuation, which may\nreflect internal necrosis.  There is increased attenuation to the mesentery,\nwhich may reflect mesenteric infiltration or an inflammatory process.\n\nOmentum/Peritoneum: There is nodular studding of the omentum consistent with\nextensive carcinomatosis.  There appears to have been a slight interval\nincrease in the number and size of nodules consistent with interval\nprogression of disease.  For example, one of the larger omental nodules\nmeasures 1.3 cm in diameter, previously measuring 1.1 cm (series 3, image 39).\n\nPELVIS:  There is a moderate amount of fluid in the paracolic gutters\nbilaterally, which is new since the prior study on ___.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: There is extensive mesenteric lymphadenopathy as described above.\nThere is no retroperitoneal, pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  The superior\nmesenteric artery, inferior mesenteric artery, and celiac trunk appear patent.\nThe portal vein and hepatic veins are patent.  There is no abdominal aortic\naneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: The left spermatic cord is absent, with a surgical clip seen in\nthe left inguinal canal.  The abdominal and pelvic wall is otherwise within\nnormal limits.",
            "output": "1. Progression of disease manifested by interval increase of hepatic\nmetastasis, increased mesenteric lymphadenopathy and peritoneal carcinomatosis\nand new moderate volume ascites.\n2. Stable 1.7 cm indeterminate right renal lesion, likely a\nhemorrhagic/proteinaceous cyst.  This could be further assessed with a renal\nultrasound."
        },
        {
            "input": "LOWER CHEST: Small left pleural effusion with overlying compressive\natelectasis.  Trace right pleural effusion.  No pericardial effusion. \nModerate cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: Evaluation of the hepatic parenchyma is slightly suboptimal\nsecondary to adjacent metal streak artifact.  Within these confines, the liver\ndemonstrates homogenous attenuation throughout.  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.  Multiple calcific densities scattered\nthroughout the splenic parenchyma may reflect sequelae of prior granulomatous\ndisease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Evaluation of the right kidney is suboptimal secondary to adjacent\nmetallic beam hardening artifact.  Within these confines, 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. 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: The uterus and bilateral adnexae are grossly 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild body wall anasarca.  There is a 2.6 x 3.0 x 0.8 cm mildly\nrim enhancing fluid collection posterior to the coccyx with mild surrounding\nsoft tissue inflammatory changes.  There is no definite evidence of\nintrapelvic extension.  No decubitus ulceration is seen.",
            "output": "1. 3.0 cm mildly rim enhancing fluid collection posterior to the coccyx is\nwithout evidence of intrapelvic communication or skin ulceration.  Findings\nmay reflect a bursitis however, further evaluation with dedicated\ncontrast-enhanced pelvic MRI is recommended to exclude an abscess.\n2. Otherwise, no acute findings in the abdomen or pelvis to account for\npatient's symptoms.\n3. Small left and trace right pleural effusions.\n4. Diverticulosis without evidence of diverticulitis.\n5. Mild body wall anasarca.\n\nNOTIFICATION:  The updated findings were discussed with ___, R.N.\nby ___, M.D. on the telephone on ___ at 9:24 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "VASCULAR:  Extensive calcified and noncalcified plaque are seen involving the\nimaged portion of the descending thoracic aorta, as well as the abdominal\naorta.  Similar to prior is an intramural hematoma involving the SMA appears\nsimilar in size over the interval (4:63).  For example on series 4 a image 68,\ntransverse measurement of 14 mm is stable.  No signs of rupture.  The celiac\nartery, bilateral single renal arteries, inferior mesenteric artery, and\nbilateral common iliac arteries are patent.\n\nLOWER CHEST:  Areas of atelectasis are seen in the bilateral bases and\nlingula, with mucus plugging seen within associated lower lobe small airways. \nThere is a trace left pleural effusion.  The heart is not enlarged.  There is\nno pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  Two small areas of peripheral hypodensity within the liver\nwere not present on the prior study, and are felt to represent transient\nperfusion abnormalities (4b:225).  Otherwise the liver demonstrates\nhomogeneous enhancement.  There is no intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits, without calcified stones\nor gallbladder wall thickening.\n\nPANCREAS:  Two small hypodense lesions measuring up to 9 mm seen within the\nbody of the pancreas and statistically likely represents a side branch IPMNs\n(4b:223, 226).  Lobulated rim enhancing hypodense lesion adjacent to the tail\nof the pancreas measures 2.3 x 1.5 x 1.4 cm (4b:220, 605b:121) and is\nassociate with very mild surrounding fat stranding.  Overall this appears\ngrossly unchanged as compared ___.  The pancreas otherwise enhances\nhomogeneously.  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 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 small hiatal hernia.  The stomach is under\ndistended, but grossly normal.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout.  There is diverticulosis of the\nsigmoid colon, without evidence of diverticulitis.  No evidence of colonic\nwall thickening.  Normal appearance of the rectum.  Appendix is not\nvisualized.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS:  Uterus is not visualized.  No adnexal mass lesions are\nidentified.\n\nBONES AND SOFT TISSUES:  There is been prior hardware fixation across an\nintertrochanteric fracture of the right femur.  Multiple areas of heterotopic\nossification and bony fragments are seen within the region of the right\nfemoral head and neck.  Fractures are seen involving the right acetabulum. \nOld healed fractures are seen involving the bilateral inferior and superior\npubic rami.  A 5 x 2.1 x 5.4 cm rim enhancing low-density collection is seen\nadjacent to the greater trochanter of the right femur appears similar in size\nas compared to ___.\n\nAn umbilical hernia containing fat is noted.\nA spinal stimulator device is present.\n\nMultiple compression deformities are seen involving the lower thoracic and\nlumbar spine, similar to prior.  Patient is undergone prior kyphoplasty of L2\nand L3.  Bones appear diffusely demineralized.",
            "output": "1. Intramural hematoma involving the SMA, appears stable when compared to CT\nperformed at an outside hospital on ___.  No evidence of rupture\n2. Multiple additional findings are unchanged from prior exam.\n\nRECOMMENDATION(S):  A 5 x 2.1 x 5.4 cm rim enhancing low-density collection is\nseen adjacent to the greater trochanter of the right femur. Recommend\ncorrelation with physical exam and labs for evidence of infection/abscess.\n\nNOTIFICATION:  Updated wetread #1 was discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 8:27pm, 120 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST: The quality of the study is limited by motion artifact related to\nbreathing.  Within this limitation there is mild dependent atelectasis. There\nis no focal consolidation.  Stable cardiomegaly. Dense atherosclerotic\ncalcifications. Pacemaker/AICD wire is partially visualized terminating in the\napex of the right ventricle. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  Small calcific density in segment III\nlikely represents a calcified granuloma.  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 pancreatic ductal dilatation or peripancreatic stranding.\n\nSPLEEN: The spleen is borderline enlarged, measuring approximately 12.5 cm in\ndiameter.  The spleen is normal in attenuation throughout without evidence of\nfocal lesion.  There is a 2 cm accessory splenule anterior to the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys demonstrate mild cortical atrophy but are symmetric size\nwith normal nephrogram.  There is no evidence of solid renal lesions.   There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThere are multiple simple renal cysts in the bilateral kidneys.  The largest\nof which includes a 3.3 cm cyst arising from the superior pole of the right\nkidney.  There is an exophytic 2.5 cm simple renal cyst arising from the\nsuperior pole of the left kidney.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding.  There\nare multiple colonic diverticuli with hyperdense peripheries.  The appendix is\nnot visualized.\n\nThere is increased attenuation of the abdominal mesentery with resultant\nindistinctness of the mesenteric vessels.  This is most prominent surrounding\nthe course of the superior mesenteric artery and superior mesenteric vein\n(series 2, image 39).  There is no evidence of mesenteric lymphadenopathy.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Dense calcified and noncalcified atherosclerotic plaques are seen\nthroughout the aortoiliac vessels.  There is no abdominal aortic aneurysm.\n\nThe celiac axis, superior mesenteric artery, renal arteries, and inferior\nmesenteric artery appear patent.  There are atherosclerotic calcifications in\nthe proximal left renal artery without evidence of focal stenosis. \nAtherosclerotic calcifications are seen in the superior mesenteric artery\n(series 2, image 34).\n\nThere is a peripheral filling defect in the superior mesenteric vein, prior to\nthe confluence with the splenic vein that likely present a nonocclusive\nthrombus (series 2 image 35 through 38; series 601 image 25).\n\nBONES: There is moderate to severe thoracolumbar spine degenerative change\nwith osteophytosis and degenerative disc disease.  Degenerative change of the\nfemoroacetabular joints bilaterally.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Increased attenuation of the abdominal mesentery.  The differential for\nthis finding includes inflammation, infection, and neoplastic infiltration as\ncan occur with lymphoma.  There is no evidence of mesenteric lymphadenopathy\nor lymphadenopathy elsewhere in the abdomen or pelvis.\n2. Nonocclusive thrombus in the superior mesenteric vein prior to the\nconfluence with the splenic vein.\n3. Dense atherosclerotic disease.\n4. Diverticulosis without evidence of diverticulitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:14 pm."
        },
        {
            "input": "VASCULAR:\n\nPatient is post endovascular aorto bi-iliac graft.  Eccentric mural thrombus\nalong the inner surface of aortic graft has increased compared to ___, leading to lumen narrowing.  The lumen of aortic stent measures 1.8 x\n1.7 cm (3:79), narrow or than before (previously 1.9 x 1.8 cm).  Outer wall of\nthe stented aorta measures 3.2 cm in diameter, stable.\n\nThe right and left common iliac artery aneurysms measure 2.7 cm and 2.6 cm,\nrespectively, not significantly changed from before.  There is increased\neccentric mural thrombus in bilateral common aortic aneurysms.  Left iliac\nartery lumen is narrowed to 8 mm in diameter (3:106).\n\nFor more detailed measurements, please refer to 3D imaging lab report.\n\nHeavy calcifications cause severe bilateral common femoral artery stenosis\nproximal to the origin of bilateral femoral bypass grafts, similar to before. \nBilateral internal iliac arteries are completely occluded.\nThere is severe calcium burden in the abdominal aorta and great abdominal\narteries.\n\nLOWER CHEST: Mild centrilobular emphysema is noted in bilateral lung bases.\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.  2.1 cm lesion at the gallbladder fundus is\nunchanged and consistent with adenomyomatosis.  Gallbladder contains a\npunctate hyperdense gallstone.\n\nPANCREAS: 0.8 cm hypodensity in the pancreatic head is unchanged compared to\n___ and likely benign.  The pancreas has normal attenuation throughout,\nwithout evidence of focal lesions or pancreatic ductal dilatation. There is no\nperipancreatic stranding.\n\nSPLEEN: 0.6 cm hyperenhancing lesion in the spleen is unchanged and likely a\nhemangioma.  Spleen is not enlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple hypodense lesions are identified in bilateral kidneys,\nmeasuring up to 5.0 cm.  Larger lesions are compatible with simple renal\ncysts, however many millimetric lesions are too small to be fully\ncharacterized.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is not visualized.  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.\n\nREPRODUCTIVE ORGANS: Prostate is unremarkable.\n\nBONES: Patient is post posterior L5-S1 spinal fusion and L4-5 laminectomy. \n2.1 x 1.6 cm lucent lesion with punctate air in L4 vertebral body is larger\ncompared to ___ (previously, 0.9 cm).\n\nSOFT TISSUES: Fat containing bilateral inguinal hernias are small. \nHyperdensities in left lower abdominal wall are likely related to prior\nsurgery.",
            "output": "1. Bilateral common iliac aneurysms demonstrate increased mural thrombus\ncompare to ___.  Left common iliac artery lumen is narrowed to 8 mm in\ndiameter.\n2. Mural thrombus along the abdominal aortic stent is slightly increased\ncompared to ___, leading to slightly decreased lumen size.\n3. Heavy calcifications causing severe stenosis of bilateral common femoral\narteries, proximal to bilateral femoral bypass graft origins, are similar to\nbefore.\n4. 2.1 cm lucent lesion in L4 vertebral body is larger compared to ___.  The\nfinding may be degenerative, however infection cannot be ruled out.  Consider\ntagged WBC nuclear scan and/or spine surgery consult for further evaluation.\n5. Unchanged gallbladder adenomyomatosis.\n\nRECOMMENDATION(S):  Consider tagged WBC nuclear scan and/or spine surgery\nconsult for further evaluation.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:29 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CTA CHEST:\n\nThe aorta and its major branch vessels are patent, with no stenosis,\nocclusion, dissection, or aneurysmal formation.  The pulmonary arteries are\nwell opacified to the subsegmental level, with no filling defect within the\nmain, right, left, lobar, segmental or subsegmental pulmonary arteries. The\nmain and right pulmonary arteries are normal in caliber, and there is no\nevidence of right heart strain.\n\n13 mm right supraclavicular lymphadenopathy is stable since prior study from\n___ 11 mm, image 4:23).  Mediastinal and right perihilar\nlymph nodes are also stable. There are no axillary lymphadenopathy. The\nthyroid gland appears unremarkable.\n\nThere is no pericardial effusion.  Bilateral pleural effusion is mild, with\ntiny overlying bibasilar atelectasis.\n\n3 mm right lower lobe nodule (image 4:42), right 4 mm ___ triangular\nnodule (image 4:79) and left apical 4 mm nodule (image 6:26) are stable.  \nRight apical scarring is also unchanged. The airways are patent to the\nsubsegmental level.\n\nDiffuse ground glass opacities are again seen, given diffuse anasarca, may\nreflect mild fluid overload.\n\nCT ABDOMEN AND PELVIS:\n\nLIVER: The liver enhances homogeneously.  There is no intra-hepatic or\nextra-hepatic ductal dilatation.  Mild periportal edema is new.   The\ngallbladder is normal, without wall thickening or pericholecystic fluid. The\nportal vein is patent. Similar to prior study from ___, the splenic\nvein is occluded.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS:  In the region of the pancreatic tail, an ill-defined soft tissue\nmass is again seen, with near encasement of the SMA and left renal vein. 2\nfiducial markers within this mass are in unchanged locations.\n\nADRENALS: The adrenal glands are normal.\n\nKIDNEYS: Mild left hydronephrosis is stable.  Left extra-renal pelvis is also\nseen.  Of note, there is no distinct fat plane between the left ureteropelvic\njunction and left psoas muscle (image 10:35), new since ___ but\nunchanged from ___, and tumor involvement at this region cannot be\nexcluded.   The kidneys otherwise demonstrate symmetric nephrograms and\nexcrete contrast promptly.  Bilateral renal cysts are stable, the largest is\nin the right upper pole measuring 28 mm TV x 30 mm AP x 28 mm CC.\n\nGI: The esophagus, stomach, and proximal small bowel loops are dilated.  There\nis relative narrowing of the duodenum as it passes through the aorta and SMA\n(image 10:39), and distal to that the proximal jejunal loops are dilated up to\nthe transition point in left mid/lateral quadrant (image 10:46, 14:10, 13). \nAt the transition point, there is abnormal soft tissue thickening, which again\ncould reflect possible tumor involvement. There is no free fluid or free air\nin the abdomen.  No pneumatosis is detected.  Significant diverticulosis is\nwithout signs of acute diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with scattered\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymphadenopathy.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymphadenopathy is detected. There is no pelvic free fluid.\n\nBONY/SOFT TISSUE STRUCTURES:  Extensive dystrophic subcutaneous calcifications\nin the anterior abdomen is unchanged, likely from injection granulomatous\nchanges versus myositis ossificans.  Diffuse subcutaneous edema is also\nrelatively unchanged.   No focal bony lesion suspicious for malignancy\npresent.",
            "output": "1.  No pulmonary embolism.\n2.  Small bowel obstruction, with transition point in the left mid/lateral\nquadrant where there is focal soft tissue thickening.  No free air.  No\npneumatosis.\n3.  Unchanged pancreatic body/tail mass with near encasement of the SMA and\nleft renal vein.\n4.  Stable mild left hydronephrosis since ___, with possible tumor\ninvolvement between the left UPJ and left psoas muscle.\n5.  Splenic vein occlusion, unchanged since ___.\n6.  Stable pulmonary nodules since ___, as above.\n7.  Stable supraclavicular and mediastinal lymph nodes since ___, as\nabove.  No lymphadenopathy in the abdomen or pelvis.\n\n\n\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 1:27 ___, 60 minutes after the images were reviewed."
        },
        {
            "input": "LUNG BASES: Please see dictation for separately reported CT Chest examination.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion. There is no\nintrahepatic biliary ductal dilation. The portal vein is patent.  There is no\nevidence of gallbladder wall thickening or stones.\n\nAgain seen in the body of the pancreas is a relatively homogeneous\nhypoenhancing/hypoattenuating lesion which measures 3.5 cm in maximum axial\ndiameter. Two adjacent metallic density foci are new since prior study,\ncompatible with fiducials. There is approximately 8 mm of upstream pancreatic\nductal dilation (series 9, image 22), similar to prior. There is no evidence\nof CBD dilation.  There is near circumferential, greater than 180 degrees of\nsolid soft tissue contact of the lesion with the proximal SMA (series 5, image\n59). Similar to prior CT from ___, the splenic vein is occluded. The\nportal vein and SMV are not involved, and without evidence of thrombus.  New\nsince prior study is apparent attenuation and narrowing of the left renal vein\nat the level of the mass (series 5 images 60 and 61), suggestive of tumor\ninvolvement with this vessel from progressive posterior local extension.\nNonvisualization of the distal left gonadal vein on delayed images suggests\nocclusion of this vessel.\n\nThere is no splenomegaly or focal splenic lesion. A 1.7 cm circular density at\nthe splenic hilum is compatible with a small splenule. The adrenal glands are\nnormal. Multiple bilateral simple renal cysts are unchanged since ___, measuring up to 3.3 cm on the right and 2.0 cm on the left. Otherwise,\nthere are normal symmetric nephrograms.  There is new mild left hydronephrosis\nwith a prominent left extrarenal pelvis, possibly due to some degree of left\nureteropelvic junction obstruction.  There is no evidence of tumor extent near\nthe left renal collecting system. There is no right hydronephrosis.\n\nOral contrast extends to the distal small bowel. Non-dilated loops of small\nbowel are normal in course and caliber. There is no evidence of wall\nthickening or obstruction. There is rectosigmoid diverticulosis without\nevidence of diverticulitis. Otherwise, the colon is unremarkable. The appendix\nis not directly visualized, however, there are no secondary signs of\nappendicitis.\n\nThere is mild atherosclerotic calcification of the abdominal aorta, which is\nwithout aneurysm or dilation. Major tributaries, including the celiac axis,\nSMA, bilateral renal arteries, and ___ appear patent.\n\nA minimally prominent periaortic lymph node is unchanged since prior,\nmeasuring 10 mm in short axis (series 5, image 71), and appears normal\nmorphologically. Otherwise, there is no retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria. There is no free intraperitoneal air or\nfluid.\n\nCT PELVIS:\nThe imaged pelvic organs including the bladder are unremarkable. There is no\npelvic sidewall or inguinal lymphadenopathy. There is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is a moderate amount of dependent subcutaneous soft tissue edema. \nCalcified subcutaneous soft tissue along the anterior lower abdominal wall\nlikely represents injection granulomatous change versus myositis ossificans,\nunchanged from prior. There is moderate degenerative change of the imaged\nthoracolumbar spine, with intervertebral osteophytes and facet joint\nhypertrophy which is most prominent along the lower lumbar spine. There is\nminimal/grade 1 L4-5 anterolisthesis. Otherwise, alignment is normal. There\nare no concerning focal lytic or sclerotic osseous lesions identified.",
            "output": "1. Mild interval enlargement/progression of 3.5 cm\nhypoenhancing/hypoattenuating pancreatic body mass, which demonstrates near\nencasement of the proximal SMA, with unchanged 8 mm upstream pancreatic duct\ndilation. The tumor extent appears to be more prominent posteriorly, reaching\nas far back as the left renal artery, with resultant new narrowing and\nattenuation of the left renal vein at the level of the mass.  New occlusion of\nthe left gonadal vein.  Stable splenic vein occlusion.\n2. New mild left hydronephrosis, possibly due to some degree of left\nureteropelvic junction obstruction. No evidence of tumor extension to involve\nthe left renal collecting system.\n3. No evidence of distant intra-abdominal or intrapelvic metastasis.\n4. Rectosigmoid diverticulosis.\n5. Please see separate report for intrathoracic findings from same-day CT\nchest."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffusely nodular and shrunken liver, consistent with known\ncirrhosis.  The main, left and right portal veins are opacified with contrast\nbut diminutive.  No evidence of venous thrombosis.  There is no evidence of\nfocal lesions on this nondedicated study.  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: Mild splenomegaly, measuring 14.1 cm (601:32), previously 14 cm. It\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. \nMultiple cortical renal cysts in the right kidney, with the largest measuring\nup to 1.6 cm (02:19), stable from ___.  There is no evidence of\nsuspicious 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 is unremarkable.  No large adnexal masses\nbilaterally.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Redemonstration of gastric\nand periaortic, lumbar varices (601:27). 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. Cirrhotic liver with evidence of portal hypertension.  No evidence of\nportal vein thrombus.\n2. Stable 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 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 diffusely distended.  There is no distal\nhydroureter.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a skin defect along the lower anterior abdominal wall\ncompatible with known recent cesarean section.  No evidence of surrounding\nabnormal fluid collection concerning for abscess.  Note is made of a small fat\ncontaining umbilical hernia.",
            "output": "Skin defect and postsurgical changes along the lower anterior abdominal wall\ncompatible with recent cesarean section, but without surrounding fluid\ncollection or abscess."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: No bowel obstruction or bowel wall thickening is seen.  The\nstomach is relatively collapsed.  The appendix 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": "No acute intra-abdominal or intrapelvic pathology."
        },
        {
            "input": "CHEST:\n\nThe left lung base demonstrates scattered ground-glass and nodular opacities.\nThere is a small left pleural effusion and a large right pleural effusion with\nassociated collapse of the right lower lobe as well as atelectasis of the\nright middle lobe, unchanged from prior.  There is a small pericardial\neffusion\n\nABDOMEN:\nThe patient is status post liver transplant. There is expected pneumobilia,\nunchanged from prior. The complex subcapsular lesion at the anterior aspect of\nthe right hepatic lobe has increased in size compared to the prior study now\nmeasuring 2.3 x 4.1 cm, previously 2.2 x 1.7 cm. The pancreas and adrenal\nglands are unremarkable.  There is splenomegaly measuring up to 22 cm. A 1.8\ncm cyst in the upper pole of the right kidney is unchanged. Smaller\nhypodensities in the bilateral kidneys are too small to characterize. The\nkidneys present symmetric nephrograms and excretion of contrast with no focal\nlesions, stones or hydronephrosis.\n\nThe small bowel is dilated to 4.4 cm, fluid filled with air-fluid levels with\na transition point in the left lower quadrant (2:70). Distal to this\ntransition point the small bowel is completely decompressed.  There is no\nretroperitoneal or mesenteric lymphadenopathy by CT size criteria.  There is a\nmoderate amount of ascites.  There is enhancement of the peritoneum, which is\nsimilar in appearance to ___.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  Ascites tracks into the pelvis. A surgical clip is\nnoted in the right hemipelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.  An intra\nmedullary rod and gamma nail are partially visualized in the left femur.",
            "output": "1. High-grade small bowel obstruction with transition point in the left lower\nquadrant.\n2. Status post liver transplant. A complex subcapsular lesion at the anterior\naspect of the right hepatic lobe has increased in size since ___.\nThis could represent a subcapsular inflammatory reaction; although, infectious\nprocess or tumor are on the differential.  Recommend attention on followup.\n3. Ground-glass and nodular opacities in the left lower lobe could represent\naspiration or atypical infection.\n4. Enhancement of the peritoneum raises the possibility of peritonitis.\n5. Persistent splenomegaly, ascites and large right pleural effusion as well\nsmall pericardial effusion.\n\nNOTIFICATION:  Change in wet read paged to Dr ___ by Dr ___ at 22:10\n___."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal. The kidneys enhance normally and excrete\ncontrast briskly. There are no solid renal lesions or hydronephrosis. The\nstomach and duodenum are normal. The small bowel and large bowel are normal in\ncaliber.  While the  jejunum is relatively collapsed, it appears to be\ndiffusely thick-walled (series 2, image 33).  The appendix is air-filled and\nnormal caliber.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The prostate and seminal vesicles are\nunremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. Normal appendix.\n2. While the jejunum is relatively collapsed, it appears to be diffusely\nmildly thick-walled which may be due to infectious enteritis.  No significant\nfat stranding."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is ___\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A 1.1 cm hypodensity the left hepatic lobe likely corresponds\nto the hyperechoic lesion seen in the left hepatic lobe seen on ultrasound.  A\n1.3 cm hypodensity in hepatic segment V is incompletely characterized on the\ncurrent exam.  A 8 mm hypodensity in hepatic segment IVB is too small to\ncharacterize.  There\n is ___ evidence of intrahepatic or extrahepatic biliary dilatation.\n\nThere is a cystic upper quadrant structure likely representing the\ngallbladder, though located more medially than typically expected.  The second\nportion of the duodenum appears compressed posteriorly and medially without\nupstream obstruction (series 602, image 31, series 2, image 23), and appears\nseparate.  The wall of this structure appears thin, however, there is an\ninterruption along the posterosuperior aspect (series 601, image 26, series 2,\nimage 22), with confluent soft tissue density material and fat stranding\nextending inferiorly and posteriorly (2:26, 602:26).  The CBD is not well\nseen.\n\nPANCREAS: The main pancreatic duct is dilated and tortuous throughout the\ncourse of the pancreas measuring up to 8 mm in the pancreatic head and 5 mm in\nthe pancreatic tail, tapering rapidly at the head without evidence of a\ndiscrete mass.  Pancreas does not appear particularly atrophic.  Numerous\ncystic-appearing foci with associated calcifications are noted in the uncinate\nprocess (02:24).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a 1.5 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 ___ evidence of focal renal lesions or hydronephrosis.  There are ___\nobstructing renal stones.  There is ___ perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The proximal duodenum appears\ncompressed by the gallbladder.  Remainder of the duodenum is at the upper\nlimit of normal in caliber and fluid-filled.  Otherwise, small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  The\ncolon and rectum are unremarkable.  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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is ___ retroperitoneal or mesenteric lymphadenopathy.  Note\nis made of a conspicuous gastrosplenic lymph node (02:24).  There is ___ pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is ___ abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is ___ evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Dilated and tortuous main pancreatic duct tapering rapidly at the head,\nwith numerous cystic foci throughout the parenchyma and a cluster of\ncalcifications throughout the uncinate process, compatible with sequela of\nprior pancreatitis.  ___ CT evidence for active/acute pancreatitis.  Consider\nendoscopic ultrasound for further evaluation of the pancreatic head to exclude\nan underlying lesion.\n2. Cystic lesion with mass affect on the duodenum, with interrupted wall\nsuperiorly and posteriorly (series 601, image 26) and adjacent soft tissue\ndensity extending posteriorly and inferiorly, with fat stranding.  ___\nradiopaque ductal stones are identified.  This could represent contained\nruptured cholecystitis, which could be consistent with the reported chronicity\nof symptoms.  There is ___ intra or extrahepatic bile duct dilation.  MRCP\ncould be considered for further assessment of anatomy, fluid versus enhancing\ncomponents to exclude the possibility of a neoplasm, and for stones.\n3. Scattered hepatic hypodensities are incompletely evaluated on the current\nexam as described above.\n\nRECOMMENDATION(S):\n1. MRCP for evaluation of the gallbladder and biliary anatomy.\n2. EUS for evaluation of the pancreatic head as well as the gallbladder.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. of the\nmedicine service by ___, M.D. on the telephone on ___ at 11:09 am,\n10 minutes after discovery of the findings. There has been ___ history of\ncholecystectomy per discussion with Dr. ___ MD documentation was\navailable from the ED, where the study was ordered, at the time of\ninterpretation."
        },
        {
            "input": "LOWER CHEST: Small right greater than left bilateral pleural effusions are\npresent.  There is bibasilar atelectasis.  There is a small hiatal hernia. \nThere are coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is periportal edema and possible\nmild intrahepatic biliary ductal dilatation.  There is perihepatic and\npericholecystic fluid.  The gallbladder itself is unremarkable.\n\nPANCREAS: There is an approximately 1.9 x 1.3 cm cystic structure within the\nhead of the pancreas (series 2, image 25).  Otherwise, the pancreas is\nunremarkable.\n\nSPLEEN: The spleen shows normal size 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 renal cortices is noted.  There is no \nhydronephrosis.  No focal renal lesion.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Although the sigmoid\ncolon is only partially distended, there appears to be bowel wall edema\ninvolving the sigmoid colon as well as the rectum.  There is perirectal and\npresacral edema.  The appendix is not seen.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Vascular calcifications seen surrounding the uterus.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis moderate volume ascites.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is diffuse osteopenia.  Degenerative changes are seen in the\nlower lumbar spine, with disc height loss most severe at L1-L2 and L2-L3. \nThere is retrolisthesis of L2 on L3.  Evidence of old rib fracture involving\nthe right posterior tenth rib.\n\nSOFT TISSUES: Stranding in the soft tissues is consistent with anasarca.",
            "output": "1. Although the bowel wall is partially collapsed, there appears to be bowel\nwall edema involving the sigmoid colon and rectum, concerning for\nproctocolitis.\n2. Widespread anasarca.  Small bilateral pleural effusions.\n3. A 1.9 cm cystic structure within the head of the pancreas for which\nnonemergent MRCP could be considered."
        },
        {
            "input": "LOWER CHEST: Patchy opacities at the bilateral lung bases are similar to the\nrecent prior study.  Patient is status post drainage of a left pleural\neffusion, midllyt decreased  in size compared to the prior study.  A\nintercostal approach pigtail drainage catheter is demonstrated at the\nposterior and inferior aspect of the collection.  Intracardiac leads are again\ndemonstrated which intake and left posterior intercostal approach terminating\nnear the left atrium (series 2, image 14).  Additional AICD leads are\npartially imaged terminating near the right atrium and intraventricular\nseptum.  No pericardial effusion.  Findings are better characterized on recent\nchest CT.\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: Severe fatty atrophy of the pancreas with calcifications within the\nremnant pancreas. The main pancreatic duct is not seen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  Hypodensities\nalong the bilateral renal cortices at the represent simple cysts, measuring up\nto 2.5 cm on the left.  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 or fat stranding. The\nappendix is normal.  A loop of small bowel demonstrated within a right\ninguinal hernia which appears nonobstructed.\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.  Extensive atherosclerotic\ndisease is noted.  There is ectasia of the bilateral common iliac arteries to\n1.3 cm (series 2, image 61).\n\nBONES: Diffuse degenerative changes are noted.  There is mild anterior height\nloss of the T12 vertebral body (series 602, image 37).  There is mild\nanterolisthesis of L4 over L5.  No suspicious osseous lesions.  There is\ndiffuse bony demineralization.\n\nSOFT TISSUES: There is a right inguinal hernia containing a nonobstructed loop\nof small bowel and some mesenteric fat (series 2, image 86).",
            "output": "1. Interval decrease of a moderate-sized pleural collection status post\npigtail drainage catheter.  The pigtail drainage catheter appears in\nappropriate position.\n2. Bilateral lung base opacities again seen, likely secondary to aspiration\npneumonia, given the distribution.  Findings are better characterized on the\nchest CT performed a day prior.\n3. Within the limits of a nonenhanced scan, no soft tissue mass lesions or\nlymphadenopathy to suggest abdominopelvic malignancy.\n4. Anterior height loss of the T12 vertebral body is mild.  Chronicity is\nindeterminate however no prevertebral hematoma or adjacent stranding to\nindicate acute process.  There is mild anterolisthesis of L4 over L5.\n5. A small right inguinal hernia contains a nonobstructed loop of small bowel\nand mesenteric fat.\n6. Diverticulosis.\n7. Ectasia of the bilateral common iliac arteries to 1.3 cm.  Extensive\natherosclerotic calcification throughout the abdominal aorta and its branches."
        },
        {
            "input": "LOWER CHEST: There has been interval resolution of the previously described\nopacities in the bilateral lung bases.  There is a small residual effusion\nwith thickened peripheral rim in the left lung base, improved from prior\nstatus post removal of the left pigtail catheter.  Cardiac leads which\ntraversed the left lung base are again seen along the left ventricular wall. \nTips of AICD leads terminate in the right atrium and right ventricle, as\nexpected.  There are severe coronary artery calcifications.  There is 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 mildly distended but otherwise unremarkable.\n\nPANCREAS: There is severe fatty atrophy of the pancreas with calcifications\nwithin the remnant pancreas.  The main pancreatic duct is not definitively\nseen, as on 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  Hypodensities\nthroughout the bilateral renal cortices, consistent with simple cysts, measure\nup to 2.4 cm on the left and are unchanged.  There are relatively isodense\nmildly latest structures arising from left kidney at the upper pole measuring\n9 mm (3:34) and measuring 7 mm at the lower pole (4:29).  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.  Periampullary duodenal\ndiverticulum is noted.  There is mild sigmoid diverticulosis without evidence\nof acute diverticulitis.  There is a large rectal stool ball, markedly\nincreased in size since the study of ___.  Thickening of the rectal\nwall inferiorly could be due to underdistention, especially given the absence\nof perirectal fat stranding, although stercoral colitis not excluded.\n\nPELVIS: A large amount of air within the bladder is likely due to Foley\ncatheterization.  The distal ureters are unremarkable.  There is no free fluid\nin 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 though the infrarenal\nabdominal aorta is ectatic measuring up to 2.6 cm in diameter, unchanged. \nExtensive atherosclerotic disease is again noted.  Ectasia of the bilateral\ncommon iliac arteries measuring up to 1.3 cm (3: 61, 64) is unchanged.\n\nBONES: Mild anterior height loss of the T12 vertebral body appears similar to\nprior.  No new fractures.  Mild anterolisthesis of L4 on L5 is unchanged. \nMultilevel degenerative changes, most pronounced at the L3-4 and L5-S1 levels\nwhere there is bone-on-bone loss of disc space, appears similar to prior. \nThere is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Small fat and fluid containing right inguinal hernia is again\nseen.",
            "output": "1. Large rectal stool ball without evidence of bowel obstruction.  Thickening\nof the inferior rectal wall could be due to underdistention given the absence\nof perirectal inflammation, although stercoral colitis can not be excluded.\n2. Air within the bladder is likely due to Foley catheterization.  Correlation\nwith urinalysis is recommended to exclude infection.\n3. Interval removal of left chest tube with persistent but improved small left\npleural effusion.  Peripheral rim appears similar to prior.\n4. Isoattenuating exophytic subcentimeter lesions arising from the left kidney\nare incompletely characterized, potentially complex cysts.  Consider nonurgent\nfollow-up to further assess.\n5. Diverticulosis without acute diverticulitis.\n6. Stable ectasia of the bilateral 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: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  The gallbladder is surgically absent. \nSubsequently, there is mild, stable prominence of the central biliary tree. \nOtherwise, no 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: The kidneys are of 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. Diverticulosis of the sigmoid 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\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: Moderate degenerative changes in the lumbar spine.  Wedge deformity of\nL4 and L1 vertebral bodies, similar to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of hydronephrosis or hydroureter.  No nephrolithiasis\nidentified.\n2. Gallbladder surgically absent.  Mild, stable prominence of central biliary\ntree likely relates to post cholecystectomy state.\n3. Diverticulosis without evidence of acute diverticulitis.\n4. Moderate atherosclerotic calcification.\n5. Moderate degenerative changes. Wedge deformity of L4 and L1 vertebral\nbodies."
        },
        {
            "input": "LOWER CHEST: There is a 6 mm solid pulmonary nodule.  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 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.  No peripancreatic fluid collections identified.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a right adrenal gland nodule measuring 2.5 x 1.6 cm,\nincompletely characterized but grossly unchanged from prior study dated ___.\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.\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 colonic diverticulosis without evidence\nof wall thickening or pericolonic stranding.  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 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 are stable compression deformities of the L4 and L1 vertebral\nbodies, not substantially changed from prior study.  Otherwise, there is no\nevidence 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 intra-abdominal or intrapelvic process.  Specifically, no evidence\nof pancreatitis or colitis.\n2. Diverticulosis without evidence of diverticulitis.\n3. Right adrenal gland nodule measuring 2.5 cm, grossly unchanged from prior\nstudy dated ___.  While stability favors a benign process, nonemergent\ndedicated CT or MRI could be performed for further evaluation as clinically\nindicated.\n4. 6 mm solid pulmonary nodule in the lingula.  CT follow-up in ___ months is\nrecommended.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is  evidence\nof steatosis:  48 ___ on contrast scan (normal >100HU)There is no evidence of\nfocal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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.  There 2 mild\nnew hyperdense cyst in the left kidney, likely cysts\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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is not visualized.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is fat containing right inguinal hernia.  There is no  lymph node\nenlargement.\n\nPELVIS:\nThe urinary bladder wall is thickened.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nThe prostate is not enlarged but contains calcification.\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  Left hip replacement is noted.",
            "output": "1. No evidence of neoplastic disease in the abdomen pelvis\n2. Hepatic steatosis\n3. Sigmoid diverticulosis with no signs of diverticulitis\n4. Left hip replacement."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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\nfluid-filled and mildly prominent in the left upper quadrant.  Fluid is seen\nwithin the colon as well, which is collapsed or distally.  No convincing\npericolonic stranding is identified.  The appendix 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:  There is a small fat containing umbilical hernia.",
            "output": "Fluid is seen within the small bowel loops and in the colon, and may be\nconsistent patient's history of diarrhea.  No other specific findings to\nexplain patient's symptoms."
        },
        {
            "input": "LOWER CHEST: Indeterminate left lower lobe nodule measuring 5 mm in diameter\n(previously 2 mm) (series 4, image 4).  4 mm nodule in the right lower lobe is\nincompletely imaged on the current study (previously measuring 6 mm) (Series\n4, image 1).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis the 5 mm hypodense lesion in the right hepatic lobe, stable, most likely\nconsistent with simple cysts versus biliary hamartoma (04:22).  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.  Small splenule appreciated along superior surface\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post surgical removal of the right kidney. The left\nkidney is of normal size with normal nephrogram.  There is a stable 2 cm\nexophytic nonenhancing hypodense lesion off the posterior cortex of the\ninterpolar region of the left kidney (04:29), likely a simple cyst.  There are\nadditional 1.2 cm and 0.7 cm exophytic nonenhancing hypodense lesions of the\nanterior cortex of the lower region of the left kidney (4:40, 34).  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 normal.  Diverticulosis\nwithout evidence of bowel wall thickening or active inflammation.\n\nPELVIS: There is multifocal bladder wall thickening demonstrating enhancement\ninvolving the left inferior, left superior, anterosuperior as well as right\nlateral bladder walls, the largest polypoid mass being in the left inferior\nbladder wall measuring 2.3 x 2.8 x 5.5 cm (4:71, 7:33).  No evidence of extra\nvesicular spread.  There are also multiple areas of ureteral wall thickening\nextending as proximal as the left renal pelvis.  (04:44).  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. \nStable fracture of the superior endplate of L1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Multiple enhancing polypoid lesions in the bladder as well as left\nureteral thickening concerning for multifocal papillary TCC.  No definite\nextra vesicular spread.\n2.  Indeterminate pulmonary nodules, 1 appearing"
        },
        {
            "input": "LOWER 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\npreviously 0.5 cm hypoattenuating lesion within segment VI, previously\ncharacterized as a possible biliary hamartoma is not visualized on current\nnon-contrast 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: Status post right nephrectomy for TCC.  No evidence of soft tissue\nabnormality in the nephrectomy bed.\n\nThe left ureter is diffusely thickened, worsened compared to prior, with a new\ncircumferential expansile lesion toward its mid third, that measures\napproximately 7 cm length (601:38), with interval development of mild to\nmoderate hydroureteronephrosis.\n\nThere has been interval placement of a percutaneous nephrostomy tube.\n\nThere is a left posterior interpolar hypodense exophytic lesion demonstrating\nintermediate density (series 2, image 73), measuring up to 2.2 cm, similar in\nsize to the ___ examination, but not present on the CT from ___.  A 1.7 cm left lower pole hypodense lesion is more consistent with a\nsimple cyst (series 2, image 86).  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 not visualized.\n\nPELVIS: Status post excisional biopsy intraluminal bladder lesion.  The\nurinary bladder is decompressed, limiting its evaluation for discrete\nintraluminal or wall lesions.  There is no evidence of gross expansile, within\nthe limitations of this noncontrast enhanced study.  No evidence of\nintraluminal bladder hematoma.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Multiple subcentimeter retroperitoneal lymph nodes are not\nsignificantly changed when compared to prior.  For example a left periaortic 8\nmm in short axis lymph node is unchanged when compared to prior, (series 2,\nimage 85).  There is no retroperitoneal or mesenteric lymphadenopathy by size\ncriteria.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Stable compression deformity of T12.  Diffuse osteopenia.  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. Interval excisional biopsy of intraluminal bladder lesion (papillary\nurothelial carcinoma) on ___.  The lack of IV contrast and\nbladder decompression, limit the evaluation of known multifo"
        },
        {
            "input": "Please refer to chest CT report for thoracic details.\n\nNo focal hepatic lesions.  Decompressed gallbladder. Mild fatty pancreatic\natrophy without main ductal dilatation.  Normal spleen adrenals.\n\nNo hydronephrosis. Bilateral renal atrophy is noted. Numerous bilateral\nhypodense renal lesions, largest 4.1 cm upper pole right kidney. Multiple\nother hypodense bilateral renal lesions are noted, similar to prior, possible\ncysts.\n\nContrast within stomach.  Right lower abdomen colocolonic anastomosis.  Normal\nTI.\n\nA 2.8 x 2.1 cm node (series 5 image 93) is noted anterior to the aortic\nbifurcation, prior 1.8 x 1.7 cm, immediately adjacent to the IMV, anterior to\nureter. Additional smaller lymph nodes measuring 1 cm is seen superior to it\n(series 4, image 87). No other enlarged abdominopelvic nodes.\n\nNo focal bladder wall thickening. Defect contains bilateral direct inguinal\nhernias, the right containing an anterior bladder diverticulum within its\nneck. No free pelvic fluid.  Small amount of fluid in the right inguinal\nhernia. Calcific tendinopathy of bilateral hamstrings origins.\n\nDegenerative changes of the spine.",
            "output": "-Enlarged lymph node adjacent to the caudal IMV, worrisome for\nresidual/recurrent disease. This is anterior to the left ureter, without\nupstream hydroureter.  No other discrete abdominopelvic adenopathy.\n-Fat containing direct bilateral inguinal hernias, the right also containing a\nbladder diverticulum within its neck.\n- Other findings as detailed above."
        },
        {
            "input": "ABDOMEN:Please see the dedicated chest CT report for further details regarding\nintrathoracic findings. The non contrast appearance of the liver is\nunremarkable.  The gallbladder, pancreas, spleen and adrenal glands\nunremarkable.  Bilateral renal hypodensities are likely cysts the largest\narising from the right upper pole measuring 3.7 x 3.7 cm. Hyperdense cysts are\nnoted within the right kidney likely hemorrhagic. The stomach, small an\nintra-abdominal large bowel are unremarkable.  There is no free fluid or free\nair within the abdomen. Again seen is a low density lymph node in the left\nlower abdomen anterior to the ureter measuring 3.0 x 2.4 cm (series 2, image\n89) slightly enlarged since the previous exam. A smaller 6 mm lymph node\nsuperiorly is also unchanged since the prior study. The aorta is of normal\ncaliber without evidence of aneurysm or significant atherosclerotic disease.\n\nPELVIS: There are bilateral inguinal hernias with the right containing a small\nbladder diverticulum. Fluid is noted in the right inguinal hernia. The bladder\nis otherwise unremarkable. The rectum and sigmoid colon are unremarkable. The\nprostate gland.  Has a calcification but is otherwise normal. There is no free\nfluid, free air lymphadenopathy.\n\nOSSEOUS STRUCTURES: There are no concerning lytic or sclerotic lesions. There\ndegenerate changes in the lower lumbar spine. A catheter tip is noted coiling\nwithin the anterior subcutaneous soft tissues in the left abdomen.",
            "output": "1.   Lymph node anterior to the left ureter is minimally enlarged since the\nprior study. No new lymphadenopathy.\n2.  Bilateral fat containing inguinal hernias  with the right also containing\na bladder diverticulum."
        },
        {
            "input": "Please see the dedicated chest CT report from the same day for thoracic\nfindings.\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 and excrete contrast symmetrically and\nare without suspicious 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\nnot visualized. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum. The aorta and\niliac branches are normal in course and caliber. The celiac trunk and SMA are\ngrossly patent.\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 visualized and normal in appearance.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Nonacute CT examination of the abdomen and pelvis. Specifically, no\nidentified source of fevers and night sweats.\n2. Please see the dedicated chest CT report from the same date for thoracic\nfindings."
        },
        {
            "input": "No hepatic lesion is demonstrated. The portal and hepatic veins are patent.\nThe gallbladder is unremarkable. The spleen is normal size. There is no\npancreatic mass or ductal dilatation. The adrenal glands are unremarkable. \nThere is no hydronephrosis involving either kidney.\n\nAtheromatous calcification is seen involving the abdominal aorta and iliac\narteries.  There are scattered uncomplicated colonic diverticula.\n\nRight pelvic lesion adjacent to the proximal sigmoid colon (series 4, image\n98) has increased in size from the prior examination measuring 3.4 x 2.4 cm\n(previously 2.8 x 1.8 cm) measured in a similar fashion.\n\nThere is no ascites. The bladder is unremarkable. Small fat containing\nperiumbilical hernia is again noted.  No osseous lesion is demonstrated.",
            "output": "1. Slight interval increase in size of right pelvic mass now measuring 3.4 x\n2.4 cm\n2. No new lesion is identified within the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  Noncalcified and calcified\nplaques cause severe narrowing of the celiac trunk.  Calcified plaques cause\nsevere narrowing of the SMA.  The distal celiac artery and SMA are patent.\n\nLOWER CHEST: There are bilateral small pleural effusions with compressive\natelectasis.  Otherwise no focal consolidation in the lung bases.  There is\nsmall 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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 sigmoid diverticulosis without evidence\nof diverticulitis.  Otherwise the remaining colon rectum are unremarkable. \nThe appendix is unremarkable..  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: The uterus is unremarkable.  No adnexal mass.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again seen is a 20.1 x 8.0 x 25.5 cm (TV by AP by CC) left\nrectus sheath hematoma which is similar in size compared to less than 1 hour\nprior.  No definite evidence of dural extravasation.  Small foci hyperdensity\nprominent in the portal venous phase (series 4, image 104 and 116) could\nrepresent active hemorrhage, likely venous in origin.  Surrounding\nsubcutaneous stranding/edema is noted.  No new foci of hemorrhage involving\nsoft tissue.",
            "output": "1. Redemonstration of large 20.1 x 0.0 x 25.5 cm left rectus sheath hematoma\nsimilar in size compared to less than 1 hour prior.  No evidence of active\narterial bleeding.  2 punctate foci of hyperdensity on portal venous phase\ncould represent acute hemorrhage likely venous in origin.  No new foci of\nhemorrhage within the abdomen pelvis.\n2. No additional acute process within the abdomen and pelvis.\n3. Small residual pericardial effusion post pericardiocentesis.\n4. Bilateral small pleural effusions with associated compressive atelectasis.\n5. Severe atherosclerotic disease involving the visualized vasculature in the\nabdomen pelvis with severe stenosis of the base of the celiac trunk and SMA."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  Other than an accessory right\nrenal artery, abdominal vascular anatomy is conventional.  A recanalized\nparaumbilical vein is seen.\n\nLOWER CHEST:\n\nPlease refer to the 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. \nAgain seen is expected pneumobilia related to the biliary stent. No focal\nlesion is identified. The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.  Intraluminal locules of air are also\nconsistent with biliary stent placement.\n\nPANCREAS: Again seen is an ill-defined mass within the uncinate process, with\na fiducial seed in place.  The mass is unchanged in size compared to ___, now measuring 2.1 x 2.8 cm on coronal view (604b:34, previously 2.6 x\n2.6), but decreased compared to ___.  This mass continues to abut the\nSMA and SMV. Regional lymph nodes are decreased in size, now measuring up to 6\nmm (for example, a lymph node just inferior to the left renal vein at 5:119,\npreviously measuring 10 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: 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.  The colon and rectum are within normal limits. A\nnormal, air filled appendix is visualized.\n\nRETROPERITONEUM: Retroperitoneal lymph nodes are decreased in size, as\ndescribed above in the pancreas section.\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: A calcified fibroid within the uterus is unchanged.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "Unchanged size of the pancreatic uncinate process mass.  Decreased size of\nregional lymph nodes."
        },
        {
            "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:  Since the prior CT on ___, there has been interval\nplacement of a longer biliary stent coal axially within the pre-existing\nmetallic stent.  There is expected post- stenting pneumobilia and air within\nthe gallbladder.  Air is also seen at the level of the confluence of ducts and\nupper common bile duct on the noncontrast images, however on later\ncontrast-enhanced images, there is ill-defined hyperdensity both at the level\nof the upper common bile duct (___), and within the the lumen of the\ngallbladder where the density appears entirely intraluminal.  This most likely\nrepresents reflux of duodenal contents, which includes orally administered\nhigh density contrast.  The duodenum does not appear obstructed.  Degree of\nmild prominence of intrahepatic bile ducts on the left is similar to prior\nstudies.  The liver parenchyma otherwise demonstrates homogeneous attenuation\nthroughout.  Portal venous system is patent.\nPANCREAS:  The ill-defined hypodense mass in the pancreatic head/uncinate\nprocess measures 2.3 x 2.9 cm on the coronal images (601 b: 26), which may be\nslightly larger compared the measurements of 2.1 x 2.8 cm on the prior study\nin ___.  Again, it abuts the posterior aspect of the SMA and SMV, which\nis best appreciated on the sagittal images (602b:40), but there is no evidence\nof intraluminal narrowing.  Dilated pancreatic duct is grossly stable in size\ncompared to the prior study.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Incidental note is made of a 14 mm 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 stones, focal renal lesions or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  Oral contrast is seen within the esophagus.  The stomach is\ngrossly unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. Appendix is not visualized.\n\nRETROPERITONEUM:  There are several scattered retroperitoneal lymph nodes, the\nlargest of which is a right para-aortic lymph node measuring 9.5 mm in short\naxis (5:115), previously 5.8 mm (5:119, prior study).  There is also an\nadditional ___ lymph node (5:106) that measures 6.4mm, previously\n4.6mm.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The celiac axis,\nSMA, bilateral renal arteries and ___ are patent.  Internal and external iliac\narteries are patent but have visible calcified atherosclerotic plaque.  There\nis mild focal ectasia of the right common iliac artery measuring up to 1.3 cm\nin diameter (5:154).\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.\n\nREPRODUCTIVE ORGANS: The posteriorly tilted uterus contains scattered\ncalcifications, likely due to fibroids.  No adnexal masses are identified.\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes are seen throughout the thoracolumbar spine,\nincluding minimal retrolisthesis of L3 on L4.  There are proliferative\nosteophytes around the femoral heads. There are no lytic or sclerotic lesions\nthat are concerning for malignancy.   There is a very small fat containing\numbilical hernia.  Abdominal and pelvic wall is otherwise within normal\nlimits.",
            "output": "1.  Very slight interval increase in size of ill-defined pancreatic head\nadenocarcinoma, which abuts the posterior aspect of the SMA and SMV without\nvascular narrowing or evidence of wall invasion.  Mildly enlarging\nretroperitoneal lymph nodes.\n2.  Interval co-axial placement of a longer metallic biliary stent within the\npreviously existing metallic biliary stent which now ends within the duodenal\nlumen. Expected post stent pneumobilia and air within the gallbladder and\nevidence of reflux of duodenal contents into upper common bile duct and\ngallbladder.  Stable appearance of mild predominately left hepatic ductal\ndilation.\n3.  Atherosclerosis including peripheral arterial vascular disease.\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.  There is a small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is unchanged pneumobilia.  The\ndistal end of the metallic stent appears to abut the inferior wall of the\nduodenum, as seen on the prior CTA, and is in unchanged position.  Soft tissue\ndensity and fluid in the biliary stent remains unchanged.  Mild to moderate\ndilatation of the intrahepatic bile ducts, as well as the common bile duct, is\nunchanged.  The gallbladder is mildly distended with no adjacent fat\nstranding.  Small amount of pericholecystic fluid is present.\n\nPANCREAS: Compared with the prior CTA, there has been no significant change in\nthe ill-defined pancreatic uncinate process mass, for which exact measurements\nare difficult to obtain.  It continues to abut the posterior aspect of the SMA\nand SMV (2:29), with mild peripancreatic stranding.  Upstream pancreatic\nductal dilatation has improved.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  An accessory spleen is unchanged (2:9).\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: The stomach is moderately well distended and unremarkable\nunremarkable.  Previously noted edema and wall thickening involving the third\nportion of the duodenum have improved, but remain persistent.  Diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening and fat\nstranding.  The appendix is normal.  No free air or free fluid is present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified uterine fibroids are unchanged.\n\nLYMPH NODES: Previously described aortocaval lymph node now measures 2.0 x 0.8\ncm, and is grossly unchanged.  Multiple enlarged peripancreatic lymph nodes\nare also unchanged.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted with ectasia of the infrarenal abdominal aorta.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Mild to moderate degenerative changes of the lumbar spine,\nmost pronounced at L2-L3, L3-L4, and L4-L5 are again seen, with endplate\nsclerosis, disc space narrowing and osteophytosis.  There is unchanged grade 1\nretrolisthesis of L3 on L4.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1.  No new intra-abdominal or intrapelvic process to correlate with the\npatient's new pain.\n\n2.  The metallic biliary stent abuts the inferior wall of the duodenum, as\nseen on the prior CTA from ___.  Pneumobilia and mild to moderate\nintrahepatic and common bile duct dilatation are unchanged.  Soft tissue\ndensity and fluid within the biliary stent also is unchanged.\n\n3.  Ill-defined, but grossly unchanged pancreatic uncinate process mass with\nmultiple peripancreatic lymph nodes and unchanged aortocaval node. \nPeripancreatic stranding has minimally improved.\n\n4.  Previously noted edema and wall thickening of the third portion of the\nduodenum have improved.\n\n5.  No CT evidence of pyelonephritis."
        },
        {
            "input": "LOWER 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.  Perfusional anomalies within segment 5 is\nappreciated.  A CBD stent is in situ, with pneumobilia, confirming patency. \nThe gallbladder contains sludge, as well as air from reflux.\n\nPANCREAS: Ill-defined pancreatic mass centered in the uncinate process is once\nagain identified.  There is heterogeneous soft tissue that abuts the duodenum.\nThe body and tail of the pancreas is only minimally atrophic.  The main\npancreatic duct is within the upper limits of normal measuring up to 3 mm. \nMultiple borderline enlarged peripancreatic and retroperitoneal lymph nodes\nare present, overall unchanged compared to previous.  The largest of these\nmeasure 0.9 cm in short axis.\n\nThere is persistent infiltrative soft tissue that abuts the SMA less than 180\ndegrees, with no associated distortion.  There is also soft tissue\ninfiltration that abuts branch mesenteric vessels from the SMA, including the\nIPDA.  The celiac axis is free of disease.  There is focal stenosis at the\nceliac origin, with mild associated poststenotic dilatation however.  The GDA\nis also free of disease.  There is conventional hepatic arterial branching.\n\nThere is infiltrative soft tissue that abuts the SMV, less than 180 degrees,\nwithout associated distortion.  The main portal vein and splenic vein are\npatent.  Mild stranding is seen along the posterior aspect of the duodenum,\noverall decreased compared 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 no evidence of stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.  The bladder is unremarkable.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Duodenal involvement is\ndescribed above.  No evidence of bowel obstruction.  The imaged small bowel\nloops are within normal limits, with no evidence of focal thickening or\ndilatation.  Normal appearance of the large bowel loops, as well as normal\nappendix in the right lower quadrant.  No free air or free fluid is\nappreciated.  No mesenteric lymphadenopathy.\n\nPELVIS:  There is a fibroid uterus.  No pelvic lymphadenopathy.\n\nBONES: Degenerative changes within the spine, with ring osteophytes in the\nleft hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Ill-defined mass in the pancreatic uncinate process is overall similar to\nmarginally improved compared to previous.  There is persistent soft tissue\ncontact less than 180 degrees of the SMA, first jejunal branch, and IPDA. \nPersistent contact less than 180 degrees of the SMV, without associated\ndistortion.\n2. Similar appearance of multiple peripancreatic and retroperitoneal lymph\nnodes.\n3. CBD stent which appears patent, with pneumobilia."
        },
        {
            "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: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild pneumobilia with mild intrahepatic biliary ductal\ndilatation.  Scattered regions of enhancement throughout the right lobe are\nnoted.  A CBD stent is in place.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: Within the uncinate process there is a hypoenhancing mass which has\noverall decreased in size compared to prior measures up to approximately 2.4\ntimes 1.5 cm, previously measuring up to 2.4 x 2.2 cm.  The mass abuts the\nposterior aspect of the SMA and SMV with less than 180 decreased contact. \nRemainder the vascular structures are intact down uninvolved.  The mass\ncontacts the third portion of the duodenum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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: Multiple prominent peripancreatic and portal caval lymph\nnodes are similar to prior.\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. \nSevere multilevel degenerative changes of the spine are again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval decrease in size of mass in the uncinate process with continued\nabutment of the SMA and SMV.  Mass continues to abut the third portion of the\nduodenum.  Multiple prominent though nonenlarged peripancreatic and portal\ncaval lymph nodes are stable.\n2. Scattered foci of enhancement within the right lobe of the liver are likely\nperfusional, however cholangitis can have a similar imaging appearance and\nclinical correlation is recommended.\n3. Please see separate chest CT report for chest 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: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There are three new hypoattenuating lesions within the liver,\nmeasuring 2.0 cm in segment II (3:85), 1.2 cm in segment III(3:105) and 0.7 cm\nin segment VI (03:107).  Lesion within segment IV abutting the left portal\nvein measures 2.7 x 2.2 cm (3:94), previously 1.7 x 1.5 cm.  Moderate\npneumobilia is unchanged.  No intrahepatic biliary ductal dilatation.  CBD\nstent in situ.  The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS:  There is a hypoattenuating lesion involving the uncinate process of\nthe pancreas, measuring 15 x 13 mm, previously 20 x 13 mm (3:123), with\ninvolvement of the adjacent SMA (3:119).  There is no involvement of the\nceliac axis.  No additional focal pancreatic lesions identified. The remaining\npancreatic parenchyma demonstrates normal attenuation.  The main pancreatic\nduct measures approximately 3 mm, 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.\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 are multiple prominent mesenteric lymph nodes,\nincluding enlarged GDA node (3:118), para-aortic lymph node (3:118), and porta\nhepatis lymph node (3:114), minimally changed since prior CT from ___.  There are no new or pathologically enlarged lymph nodes.\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: Calcified fibroid uterus.  No adnexal abnormalities\nidentified.\n\nBONES:  Multilevel, moderate to severe degenerative changes of the\nthoracolumbar spine, worst at L2-L3.  No acute fracture identified.  No\nconcerning lytic or blastic lesion.\n\nSOFT TISSUES:  Small fat-containing umbilical hernia.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple new hypoattenuating lesions in liver segments II, III and VI, with\ninterval increase in size of hypoattenuating mass in segment IV, concerning\nfor hepatic metastases.\n2. Interval decrease in size of uncinate mass involving the SMA, with stable\nenlarged GDA, porta hepatis and para-aortic nodes.\n3. Unchanged moderate pneumobilia.  No intrahepatic biliary duct dilatation.\nCBD stent in appropriate position, unchanged.\n4. Please see separate, same-day CT chest report for further 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.  A\nsubcentimeter right hepatic lobe hypodensity is too small to characterize. \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 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. The colon and\nrectum are within normal limits. The appendix is not definitively visualized;\na candidate for the appendix appears unremarkable.  There are no secondary\nfeatures of 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 within normal premenopausal limits.  There\nis a 4.7 cm right adnexal cyst.\n\nLYMPH NODES: A couple of subcentimeter mesenteric lymph nodes are noted in the\nright ileocolic area, but not fulfilling radiological diagnostic criteria for\nmesenteric adenitis.  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": "The appendix is not definitively visualized.  A candidate for the appendix\nappears unremarkable.  There are no secondary features of appendicitis.\n\nA couple of subcentimeter mesenteric lymph nodes are noted in the right\nileocolic area, likely reactive, but not fulfilling radiological diagnostic\ncriteria for mesenteric adenitis.\n\nNo acute intra-abdominal or pelvic pathology 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. \nHypodensities abutting the falciform ligament are likely secondary to focal\nfat.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nunremarkable.  Main portal vein 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys 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 no obstructing nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable, not well assessed on CT.  There\nis no small bowel obstruction.  The colon and rectum are within normal limits.\nThe appendix is not definitively visualized given the paucity of\nintra-abdominal fat. Oral contrast media has not reached the large bowel by\nthe time of the study. There is no evidence of fat stranding, peritoneal\nthickening or free fluid in the right lower quadrant.\n\nPELVIS: The urinary bladder is mildly thickened, correlation for cystitis is\nrecommended.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Visualized reproductive organs are better assessed on\nprior pelvic ultrasound. There is a right corpus luteal cyst.\n\nLYMPH NODES: There is no 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 not definitively visualized given the paucity of\nintra-abdominal fat.  Oral contrast media has not reach large bowel at the\ntime of the exam.  There is no evidence of fat stranding, peritoneal\nthickening or free fluid in the right lower quadrant.\n2. Corpus luteal cyst in the right ovary may help explain the patient's\nsymptoms."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nSub cm hypodensities within the liver have increased in size from ___, but\nwere demonstrated as cystic on a ___ ultrasound. There is focal fatty\ninfiltration in segment 4B. The liver otherwise enhances homogeneously. The\nportal venous system is patent. Pneumobilia seen within nondilated left\nintrahepatic bile ducts. The gallbladder surgically absent.  Extrahepatic\nbiliary ducts are not dilated.\n\nThe spleen and adrenal glands are unremarkable. The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nPostsurgical changes from a gastric sleeve procedure noted. The distal\nesophagus is normal without a hiatal hernia. .  The small and large bowel are\nnormal in caliber and without evidence of wall thickening. The appendix is not\nvisualized but there are no secondary signs of appendicitis within the right\nlower quadrant.. Colonic diverticulosis is present without evidence of\ndiverticulitis. The small bowel projects lateral to the ascending colon and\ncecum, new from ___.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum. Stranding is seen within the subcutaneous tissues\nat the site of prior trocar sites. No drainable fluid collection identified.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Mild multilevel degenerative changes including mild\nretrolisthesis of L5-S1 and L3- L4. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. Pneumobilia within the left intrahepatic bile ducts probably related to\nsphincteroctomy performed prior to 2011postcholecystectomy.\n2. Normal postoperative appearance after gastric sleeve. No intra-abdominal\nfree fluid or free air. Normal appearance of the small and large bowel.\n\nNOTIFICATION:  Findings discussed with Dr. ___ the telephone by Dr.\n___ on ___ at 17:15, 10 min after they were made."
        },
        {
            "input": "LOWER 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 right kidney is resected.  The left kidney is within normal\nlimits apart from the simple cyst in upper pole.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.  Small bowel is seen predominantly in the\nright abdomen with colon in the mid and left abdomen, likely due to status\npost right nephrectomy.  The appendix 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: Stable sclerotic bone lesions.\n\nSOFT TISSUES: Umbilical hernia with the Richter hernia of colon without\nevidence of strangulation or obstruction.",
            "output": "1. No evidence of new metastatic disease in the abdomen and pelvis.\n2. Stable sclerotic bone lesions, known metastases.\n3. Enlarged prostate.\n4. Umbilical hernia containing colon without evidence of strangulation or\nobstruction."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse low-attenuation liver parenchyma in keeping with\nhepatic steatosis. There is no evidence of focal 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: Patient is status post right nephrectomy.  There is a 1.2 cm rounded\nsoft tissue nodule within the nephrectomy bed which remains unchanged.  Within\nthe upper pole of the left kidney is a stable 2.9 cm simple renal cyst. \nExtending from the lower pole is a simple exophytic 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. 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. Left hemipelvis lipomas is unchanged.\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 meeting CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerotic osseous lesions within the sacrum, left pelvis, left medial\nacetabulum and right proximal femur are unchanged from prior, in keeping with\nknown osseous metastatic disease.  No new suspicious osseous lesions\nidentified within the abdomen and pelvis.\n\nSOFT TISSUES: Midline anterior abdominal wall incisional scar is intact. Bowel\ncontaining umbilical hernia is unchanged.",
            "output": "1.  Hepatic steatosis.\n2. No new metastatic disease within the abdomen and pelvis.\n3. Unchanged sclerotic osseous metastasis without pathologic fracture.\n4. Prostatomegaly\n5. Please see same day chest CT for detailed intrathoracic findings."
        },
        {
            "input": "CHEST:\n\nImages of the lower chest show farther increase to the size of the left lower\nlobe mass.\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 homoenous hypo-attenuation throughout\ncompatible fatty infiltration.  Liver attenuation contrast is 60 ___ (normal\nover 100 ___.  There is 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.\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 left kidney is of normal size with normal nephrogram and prompt\nexcretion of contrast.  There is no  focal solid renal lesions or\nhydronephrosis.  There is a 19 mm cyst in the upper pole with no interval\nchange.\n\nPost right nephrectomy with no evidence of recurrence in the renal bed\n\nRETROPERITONEUM/ MESENTERY there is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. No omental mass and no free fluid\n\nVASCULAR:  The abdominal aorta and great vessels in the abdomen pelvis are\nnormal.  There is no aneurysm\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. \nThe prostate is not enlarged\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "Status post right nephrectomy with no evidence of local recurrence or\nmetastatic disease in the abdomen and pelvis"
        },
        {
            "input": "Please refer to the dedicated CT chest report from today's date for the\nthoracic findings.\n\nABDOMEN:\n\nThe liver demonstrates hypoattenuation throughout, compatible with steatosis,\nand is otherwise without focal abnormality. The portal venous system is\npatent. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder, pancreas, spleen, and bilateral adrenal glands\nare unremarkable. The left kidney demonstrates a normal nephrogram and\nexcretes contrast promptly. There is a 1.9 x 2.0 x 1.7 cm simple cyst in the\nupper pole, without interval change. The patient is status post right\nnephrectomy, with no evidence of recurrent disease in the renal bed.\n\nThe stomach is filled with oral contrast and is grossly unremarkable in\nappearance. The small and large bowel are normal in caliber and without\nevidence of wall thickening.  There are 2 fat-containing ventral abdominal\nwall hernias. Several small lymph nodes along the celiac axis are present, but\nhave been stable for several years, based on CT torso from ___. There\nis no retroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches are normal\nin course and caliber. The celiac trunk and SMA are grossly patent.\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.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of recurrent malignancy or metastatic disease in the abdomen\nand pelvis.\n2. Status post right nephrectomy.\n3. Please refer to the dedicated CT chest report from today's date for\nthoracic 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 liver demonstrates homogenous attenuation 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 patient is status post right nephrectomy. The left kidney is of\nnormal size with normal nephrogram.  1.9 x 1.9 x 2.1 cm cyst in the superior\nleft kidney is stable from prior exam. There is no evidence of stones or\nhydronephrosis. There are no urothelial lesions in the kidney or ureter. There\nis no perinephric abnormality.\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 by size criteria.\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The portal vein is\npatent.  An accessory left renal artery is noted.\nSOFT TISSUES:  There is mild rectus diastasis. Multiple tiny fat-containing\nventral hernias lie superior to the umbilicus.\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. \nPhleboliths in the pelvis.\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES:\nThere is no evidence of suspicious lesions.  Sclerotic lesions in the right\nproximal femoral diaphysis and right iliac bones are likely bone islands and\nare stable from prior exam. Degenerative changes are again seen throughout the\nspine.",
            "output": "No evidence of recurrent or metastatic RCC in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis and left lower lobe\nbronchiectasis, with mild scarring.  No pleural effusions.  A right-sided\nBochdalek's hernia transmits fat.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is mild intrahepatic biliary\ndilatation in the setting of prior cholecystectomy.  No extrahepatic biliary\nductal dilatation is present.  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.  Previously described pancreatic cystic lesions on MRCP are not\nidentified by CT.\n\nSPLEEN: The spleen shows normal size and 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 has multiple cortical defects and is atrophic when\ncompared with the left, compatible with scarring from prior infection or\ninfarction.  A simple cyst in the right lower pole measures 3.1 cm (2:28). \nThere is no hydronephrosis.  Subcentimeter hypodensities in the left kidney\nare too small to characterize by CT, but are also statistically likely cysts. \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.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized, likely due to prior\nhysterectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 process to correlate with the\npatient's pain.\n\n2.  Post cholecystectomy.\n\n3.  Normal appendix.\n\n4.  Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR:\nThere is moderate calcium burden in the abdominal aorta and great abdominal\narteries.\n\nThe patient is status post repair of a fusiform infrarenal abdominal aortic\naneurysm.  The stent extends from the origin of the bilateral renal arteries\nto the aortic bifurcation with stents in the bilateral common iliac arteries\nand the right proximal external iliac artery.  There is heavy calcification at\nthe origin of the right proximal internal iliac artery but its branches appear\npatent. The stents are patent.  There is no evidence of endoleak.  The maximum\ndiameter of the infrarenal abdominal aortic aneurysm sac just above the level\nof the iliac bifurcation is 2.7 cm (Series 5, image 241) and at the level of\nthe common iliac arteries 4.5 x 5.4 cm (series 5, image 276).  A tiny punctate\ncalcification in the anterior left aspect of the aneurysmal sac at the level\nof the iliac bifurcation corresponds to calcification on the unenhanced\nportion of this exam (series 5, image 258).  The celiac axis, SMA, and renal\narteries are patent.\n\n MEASUREMENTS 3D IMAGING LAB:\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 5.2 x 4.9 cm\nDiameter (Center-line): 5.3 cm\nVolume:\n\n-Aneurysm: 87.6 ml\n-Renal to Aortic bifurcation: 129.7 ml\n-Renal to Iliac bifurcation: 162.3 ml\nENDOLEAK: no\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.8 cm.\nLength distal graft to iliac bifurcation: Right: 2.9 cm; Left: 2 cm.\n\nLOWER CHEST:\nA 5-mm pulmonary nodule in the right middle lobe is unchanged since at least\n___, favoring benign etiology (series 5, image 44).  A 4-mm right middle lobe\npulmonary nodules also unchanged (series 602b, image 51).  A 4-mm right lower\nlobe pulmonary nodules unchanged since at least ___ (series 5, image\n72).  A left lower lobe subpulmonary micronodule is of doubtful clinical\nsignificance and is also unchanged (series 2, image 8).  Coronary artery\ncalcifications are extensive. The heart is normal in size. No evidence of a\npleural pericardial effusion.  The imaged lower thoracic aorta is normal in\ncaliber with mild-to-moderate noncalcified atherosclerosis.  There is a small\nfat-containing left posterior diaphragmatic hernia with adjacent atelectasis\nin the left lower lobe (series 5, image 164, 159 ; series 602B, image 104). \nAtelectasis in the anterior segment of the left lower lobe is mild.\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 contains stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.  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. \nThere is an 1.5-cm simple cyst in the left lower renal pole cortex (series 5,\nimage 251).  There small right parapelvic cyst.  A 7-mm stone in the right\nupper renal pole is nonobstructing (1033 ___ series 2, image 22).  A punctate\nstone in the right lower renal pole and another punctate stone in the left\nmidpole are also nonobstructing (series 2, image 34, 28).  No evidence of\nconcerning focal renal lesions, hydronephrosis, or perinephric abnormality.\n\nGASTROINTESTINAL:  A hiatal hernia is small to moderate in size.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThe colon and rectum are within normal limits.  No bowel obstruction, free\nair, or intra- abdominal fluid collection. No evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: No evidence of retroperitoneal lymphadenopathy.  No\nretroperitoneal hematoma.\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 prostate gland is within normal limits.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.  Multilevel\ndegenerative changes of the lumbosacral spine are severe. Moderate\nanterolisthesis of L5 on S1 with spondylolysis is unchanged (series 602b,\nimage 77).  Mild retrolisthesis of L2 on L3 is also unchanged, likely\ndegenerative.  Levoconvex scoliosis of the lumbosacral spine is severe. \nDegenerative changes in both hips are moderate. The bones are diffusely\ndemineralized.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post stent for intrarenal abdominal aortic aneurysm repair without evidence\nof endoleak. Measurements are as above.\n2. Multiple pulmonary nodules, stable.\n3. Moderate to small hiatal hernia.\n4. Bilateral nonobstructing renal stones, largest 7 mm in the right upper\npole.\n5. Severe degenerative changes in the lumbosacral spine as above.\n6. Small fat containing left posterior diaphragmatic hernia."
        },
        {
            "input": "LOWER CHEST: There is mild bilateral dependent atelectasis.  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 or\nextrahepatic biliary dilatation.  The gallbladder is decompressed, with mild\ngallbladder wall edema, this can be seen in the setting of hepatocellular\ndysfunction or third-spacing related to heart failure..\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 by CT but\nstatistically likely represent cysts.  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. Extensive\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. Probable appendix seen in the right lower\nquadrant (02:53), without dilatation or surrounding inflammatory changes.\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: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes of the spine are re-demonstrated, with\nminimal retrolisthesis of L2 on L3, grade 1 anterolisthesis of L4 on L5 and\ngrade 1 retrolisthesis of L5 on S1, similar to prior.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. There is extensive diverticulosis of the sigmoid colon, without wall\nthickening or fat stranding to suggest diverticulitis.\n2. Mild gallbladder wall edema can be site in the setting of past thyroid\ndysfunction or third spacing, correlate with liver function tests.\n3. No acute intra-abdominal process to explain the patient's symptoms."
        },
        {
            "input": "Partially visualized small right pleural effusion with passive atelectasis. \nMild left base atelectasis.\n\nProbable hepatic steatosis.  No focal liver lesions.  Mild central\nintrahepatic ductal dilation is demonstrated, without significant extrahepatic\nbiliary dilation.  2 large gallstones are demonstrated within the gallbladder\nneck.  The gallbladder is mildly prominent with mild mural thickening, however\nwithout significant pericholecystic stranding.  Normal pancreas without main\nductal dilation.  Normal spleen and adrenals.\n\nNo hydronephrosis.  Multiple foci of renal scarring are noted in the right\nkidney.  No suspicious renal lesions.\n\nContrast within the stomach.  Moderate diverticulosis of the colon is\ndemonstrated, without definite diverticulitis.  No small bowel dilation.\n\nMarked atherosclerosis of normal caliber abdominal aorta.  Replaced right\nhepatic artery arising from the SMA.  No retroperitoneal or mesenteric\nadenopathy.  There is a small amount of stranding and fluid within the left\nlower quadrant.\n\nNo focal bladder wall thickening.  Small amount of free fluid is demonstrated\nadjacent to the rectum, nonspecific.  No pelvic adenopathy.  Anteverted\nuterus.\n\nDegenerative changes the spine are noted with marked facet arthropathy and\ndegenerative endplate changes.",
            "output": "-Cholelithiasis with mild gallbladder mural thickening and no significant\npericholecystic stranding, possibly representing resolving cholecystitis. \nCystic duct patency is demonstrated by recent HIDA scan.\n-Small amount of fluid within the left lower quadrant and pelvis, nonspecific\nfinding.\n-Marked colonic diverticulosis without definite diverticulitis.\n-Partially visualized small right pleural effusion.\n-Multiple foci of right renal scarring."
        },
        {
            "input": "LOWER 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 scattered subcentimeter round hypodensities\nthat are too small to characterize, likely representing simple hepatic cysts\nor biliary hematomas, stable from ___.  There is no evidence of suspicious\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. \nAgain visualized is a 2.3 cm simple renal cyst in the left midpole, grossly\nstable dating back to ___.  Additional similar but too small to characterize\nhypodensities are seen bilaterally, grossly stable dating back to ___. There\nis no evidence of suspicious focal renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Redemonstration of 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.\nRedemonstration of brachytherapy seeds 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.  Moderate atherosclerotic\ndisease of the thoracic arch and abdominal aorta is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic degenerative changes of the spine is seen, including a prominent\nanterior bridging osteophyte from L2-3 vertebral bodies.\n\nSOFT TISSUES: Right inguinal hernia contains nonobstructed loops of small\nbowel.  The left inguinal hernia contains nonobstructed loops of large bowel. \nThere is no abnormal wall enhancement, thickening to suggest incarceration.",
            "output": "1. No evidence of metastatic disease within the abdomen and pelvis.\n2. Stable bilateral inguinal hernias containing nonobstructed bowel loops."
        },
        {
            "input": "LOWER 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 new low-density lesions throughout the\nboth hepatic lobes measuring up to 1.1 cm (series 4, image 42) compatible with\nmetastatic disease.\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: Multiple bilateral renal cysts are unchanged.  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 and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are seen at the region of 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are bilateral large inguinal hernias containing\nnonobstructed loop of sigmoid colon on the left and small bowel on the right..",
            "output": "1. Interval development of innumerable new liver lesions compatible with\nmetastases.\n2. Bilateral large inguinal hernias containing nonobstructed loop of sigmoid\ncolon on the left and small bowel on the right.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings"
        },
        {
            "input": "LOWER CHEST: Redemonstration of severe interstitial lung disease/fibrosis in\nthe imaged lower lobes.  No pleural or pericardial effusions.  Partially\nimaged subcarinal lymphadenopathy.\n\nABDOMEN:\n\nHEPATOBILIARY: Heterogeneous appearance of the liver with many new and\nincreased low-density lesions.  These measure up to 3.0 cm.  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, the largest to the left in the mid third measuring up\nto 2.0 cm (08:32).  New hyperdense focus along the left mid renal cortex of 11\nmm somewhat wedge-shaped although it may be a new cyst.  Differential\ndiagnosis includes small infarct, however.  Metastasis is also possible, focus\nof infection seems unlikely.  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. Bilateral inguinal\nhernias are unchanged, the right one containing nonobstructed small bowel in\nthe left one containing non-obstructed sigmoid.  Sigmoid diverticulosis is\nmoderate.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple radiotherapy seeds are noted within the\nprostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Small retrocrural lymph nodes are\nnoted measuring up to 2.0 cm (8:8), unchanged.  An increased, enlarged common\nhepatic and artery lymph node suggests metastatic disease.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Numerous lytic metastatic lesions are relatively subtle on CT without\nclear recent change.  Superior endplate compression fracture of T12 shows no\ndefinite change.\n\nSOFT TISSUES: Small 1.8 cm soft tissue nodule in the anterior midline upper\nabdominal wall, stable.",
            "output": "1. Worsening metastatic disease in the liver.  Increased retroperitoneal\nlymphadenopathy.  This is compared to early ___.  Numerous small bony\nmetastases that are somewhat difficult to compare to ___ since they are not\nvery well visualized on CT.\n2. Small indeterminate new hypodense focus in the liver.  Metastatic disease\nor infection seems unlikely.  New small cyst is possible but a very small new\narea of ischemia/infarct is favored."
        },
        {
            "input": "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 atrophic with nodular contours consistent with\ncirrhosis.  Within segment IV B is a hypodense lesion with peripheral nodular\nenhancement suggesting hemangioma, better characterized on a prior MRI. \nWithin the caudate lobe there is a hypodense lesion measuring up to 1.6 cm,\nbetter characterized as a hemangioma on a prior MRI.  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: At the interpolar region of the left kidney is a well-circumscribed\nhypodensity collecting represents a 1.7 cm simple renal cyst.  There are a few\nsubcentimeter punctate hyperattenuating foci of the left kidney which\nrepresent nonobstructing renal stones.  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.  Colonic\ndiverticulosis is noted.  At the level of the sigmoid colon, there is mild\nstranding noted inferiorly abutting the bladder wall best seen on series 602,\nimage 47 as well as series 601 image 28.  This appearance may reflect a mild\ndiverticulitis with secondary bladder 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 are numerous small retroperitoneal lymph nodes that do not\nmeet CT criteria for lymphadenopathy and may be reactive.  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.  There is a patent umbilical vein.\n\nBONES: Moderate multilevel degenerative changes including osteophytosis,\nintervertebral disc space narrowing and vacuum phenomena.  No acute fracture.\n\nSOFT TISSUES: A small fat containing ventral hernia.",
            "output": "1. Diverticulosis with probable mild acute diverticulitis along the mid\nsigmoid colon.  Of note, there is likely mild inflammation along the adjacent\nbladder wall.  No evidence of fistula formation.\n2. Cirrhotic liver with sequelae of portal hypertension.  Hepatic lesions in\nsegment 4B and segment 1 previously characterized as hemangiomas are\nre-demonstrated.\n\nNOTIFICATION:  An e-mail was sent to the ED QA nurses to communicate changes\nfrom the preliminary 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 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\nThere is new extensive mesenteric and peritoneal disease with the largest\nmasses along left abdomen.  Findings accompanied by moderate amount of\nascites.\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. There is new extensive mesenteric and peritoneal metastatic disease with\nthe largest masses along left abdomen. Findings accompanied by moderate amount\nof ascites."
        },
        {
            "input": "Lungs: Please see the report of the CT chest performed on the same day for\nmore details..\n\nLiver: Diffusely decreased attenuation of the liver, consistent with fatty\ndeposition. No suspicious liver lesion.\n\nBiliary: There is minimal left central intrahepatic bile duct dilatation,\nminimally improved compared to previously. The gallbladder as been surgically\nresected, with hepaticojejunostomy.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Previous Whipple procedure with resection of the pancreatic head,\nneck, uncinate process, and first and second portions of the duodenum. There\nis no pancreatic duct dilatation. The pancreas is again markedly atrophic in\nthe body and the proximal tail. The pancreaticojejunal anastomosis is\nunremarkable. A fiducial marker is seen near this.\n\nAdrenal glands: Unremarkable.\n\nUrinary: The kidneys are unremarkable. There is no hydronephrosis.\n\nPelvis: There is limited evaluation of the pelvis due to streak artifact from\nthe bilateral total hip arthroplasties.\n\nGastrointestinal: Previous gastrojejunostomy and duodenectomy with Roux-en-Y\ngastrojejunostomy and pancreatico- and hepaticojejunostomy.\n\nColonic diverticula are seen. There is significant fecal loading within the\nwhole colon. There is no evidence of bowel dilatation or obstruction.\n\nVascular: There are moderate atherosclerotic calcifications of the abdominal\naorta. A stable small region of chronic dissection is seen in the abdominal\naorta on series 2, image 158.\n\nThe portal vein and hepatic veins are patent. A retroaortic left renal vein is\nseen.\n\nLymph nodes: There are no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion.  Moderate\ndegenerative disc disease is seen in the lumbar spine.\n\nPostsurgical changes are seen in the anterior abdominal wall.\n\nPrevious bilateral total hip arthroplasty.\n\nA new 2.5 cm x 2.6 cm x 4.3 cm rim enhancing lesion is seen in the left\niliacus muscle.",
            "output": "1. New 2.5 cm x 2.6 cm x 4.3 cm rim enhancing lesion in the left iliacus\nmuscle, could represent abscess vs metastasis.\n\n2. No evidence of recurrence in the surgical bed.\n\n3. Minimal left central intrahepatic bile duct dilatation, minimally improved\ncompared to previously\n\n4. Hepatic steatosis as seen before."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Redemonstration of diffuse hepatic steatosis.  No focal liver\nlesions are seen.  The hepatic and portal veins are patent.  Patient is post\nhepaticojejunostomy.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is post Whipple's.  Nonspecific stranding in the surgical\nbed is unchanged.  No nodular lesions are seen.  The remnant pancreas remains\nvery atrophic.  There is no main pancreatic duct dilatation.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are unremarkable.\n\nGASTROINTESTINAL: Patient is post gastrojejunostomy.  Small and large bowel\nloops are normal in caliber.  The appendix is fluid-filled but not abnormally\ndilated and there is no surrounding fat stranding to suggest acute\ninflammation (3:122).\n\nPELVIS: Artifact from bilateral hip prostheses limits evaluation of the\npelvis.\n\nLYMPH NODES: No enlarged abdominal lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Moderate to severe\natherosclerotic disease is noted.  A short segment of chronic dissection of\nthe abdominal aorta is unchanged (03:135).\n\nBONES: No suspicious osseous lesions or acute fracture. Patient is post\nbilateral total hip arthroplasties.\n\nSOFT TISSUES: Previously seen fluid in the left iliopsoas bursa has resolved. \nA previously seen fluid collection in the region of the right adductor muscle,\nposterior to the right proximal femur (3:221) is smaller at 1.3 cm, previously\n3 cm, possibly resolving bursa fluid.  A 3.7 cm rim enhancing fluid collection\nabutting the right posterior acetabulum is new (3:188) and likely represents a\ndistended joint effusion.",
            "output": "1. Post Whipple's without evidence of locally recurrent or new metastatic\ndisease in the abdomen or pelvis.\n2. 3.7 cm rim enhancing fluid collection abutting the right posterior\nacetabulum is new and likely represents a distended joint effusion.\n3. Interval resolution of previously seen fluid in the left iliopsoas bursa\nand improvement in previously seen fluid in the region of the right adductor\nmuscle, likely also representing resolving bursal/joint fluid.\n4. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic 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: 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: There is redemonstration of postsurgical changes of a Whipple\nprocedure without evidence of abnormal soft tissue nodularity in the surgical\nbed.  Mild fat stranding in the surgical bed and retroperitoneum is grossly\nunchanged.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\nGASTROINTESTINAL: Patient has undergone Whipple procedure.  The gastrojejunal\nanastomosis lies in close association with the anterior abdominal wall with\nsome associated mural thickening, similar to previous examination, without\nevidence of obstruction/stenosis.  There is mild stranding within the\noverlying subcutaneous tissues, most likely related to scarring.  Small bowel\nloops otherwise demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is\nnormal.\n\nRETROPERITONEUM: No pathologically enlarged lymph nodes are visualized.\n\nPELVIS: Visualization of intrapelvic structures is limited by severe streak\nartifact from bilateral total hip arthroplasties.  The urinary bladder and\ndistal ureters are grossly unremarkable.  No free fluid is identified within\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Obscured by streak artifact.\n\nBONES: Bilateral total hip arthroplasties have been performed.  Previously\ndescribed fluid collection posterior to the right hip joint has resolved. \nThere are peripherally enhancing collections posteromedial to the bilateral\ninferior trochanters, which may represent bursitis.\n\nSOFT TISSUES: There has been interval development of an incisional hernia\ncontaining a short segment of small bowel without evidence of\nobstruction/strangulation (2:159) a small Richter hernia (2:186) is also most\nlikely postsurgical in nature.",
            "output": "1. Stable postsurgical changes related to Whipple procedure without evidence\nof local recurrence or metastatic disease within the abdomen or pelvis.\n2. Interval development of an anterior abdominal wall midline incisional\nhernia containing a short segment of small bowel and an additional small\nmidline Richter hernia just below the level of the umbilicus without evidence\nof obstruction/strangulation."
        },
        {
            "input": "PELVIS: Rectal contrast is seen to the level of the partially imaged ascending\ncolon.  The partially visualized small and large bowel are unremarkable.  The\nappendix is normal.  The urinary bladder and distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.  Imaging status post rectal contrast administration\ndemonstrates no fistulous tract between the rectum and vagina.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES:Moderate degenerative changes of the lower lumbar spine noted.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Partially imaged ventral abdominal wall hernia repair changes\nnoted.",
            "output": "No evidence of a fistulous tract between the rectum and vagina upon rectal\ncontrast administration."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  Small simple\nhypodense lesion in the upper pole of the left kidney most likely represents a\nsimple 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. The appendix is normal.  No evidence of fat\nstranding to suggest omental infarction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis which is likely.\n\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.  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.  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 abdominopelvic pathology, specifically no evidence of\nappendicitis.\n2. No evidence of fat stranding in the omentum to suggest omental infarction."
        },
        {
            "input": "VASCULAR:\nAbdominal aorta is normal in caliber, is minimal atherosclerotic disease.\n\nCeliac artery is patent.  Right hepatic artery is replaced to the superior\nmesenteric artery (SMA).  The lateral segmental branch of the left hepatic\nartery arises from the left gastric artery, while the medial segmental branch\narises from the proper hepatic artery.\n\nSuperior mesenteric artery, bilateral renal arteries and inferior mesenteric\nartery are patent.\n\nExtensive esophageal varices.  There are also extensive upper abdominal\nvarices, including a splenorenal shunt.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, consistent with cirrhosis. \nNo arterially enhancing lesions suspicious for hepatocellular carcinoma are\nidentified.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Cholelithiasis.  Gallbladder wall edema is likely due 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: Spleen is mildly enlarged, measuring up to 13.9 cm.  No focal lesions\nare 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 a 6 mm hypodensity in the lower pole of the left kidney that is too\nsmall to characterize, but statistically likely represents a cyst (3b: 179). \nThere is no evidence of stones, focal renal masses, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is evidence of portal gastropathy.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nColonic diverticulosis.  Colon and rectum are otherwise unremarkable.  Normal\nappendix.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland and seminal vesicles are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse subcutaneous edema.",
            "output": "1. No arterially enhancing lesions meeting OPTN criteria for hepatocellular\ncarcinoma.\n2. Cirrhotic liver morphology.\n3. Sequela of portal hypertension including splenomegaly, esophageal and upper\nabdominal varices, and small volume ascites.\n4. Right hepatic artery is replaced to the SMA.  Lateral segmental branch of\nthe left hepatic artery arises from the left gastric artery.  Medial left\nhepatic artery arises from the hepatic artery proper.\n5. Cholelithiasis.\n6. Mild cardiomegaly."
        },
        {
            "input": "LOWER 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. \nPreviously described scattered hypodense metastatic lesions are essentially\nnot perceptible on this examination.  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 left ovary are visualized and appear\nunremarkable.  The right ovary is visualized with a 1.4 x 1.8 cm cyst which is\nlikely physiologic.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic lymphadenopathy.  There are bilateral inguinal lymph nodes which\ndo not meet size criteria for adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: There are multiple lytic lesions in the pelvis and vertebral bodies\nwhich are appear unchanged from prior examination.  No fracture is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Metastatic liver lesions are no longer perceptible.\n2. Stable metastatic lytic lesions in the spine and pelvis.  No fracture is\nidentified."
        },
        {
            "input": "LOWER CHEST: There is trace right pleural effusion and mild right basilar\natelectasis.  The heart is enlarged.  There is a small pericardial effusion,\npartially imaged, which appears similar to the prior study from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation.  There is no\nevidence 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.  A 3.1 cm accessory spleen is noted.\n\nADRENALS: The right adrenal gland is normal in size and shape.  The left\nadrenal gland contains a 1.7 cm nodule (02:22).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.3 cm heterogeneously enhancing lesion at the lower pole of the left kidney\nis noted (601:49).  Bilateral renal cysts are noted measuring up to 2.1 cm on\nthe right.  Subcentimeter hypodensities in bilateral kidneys are 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. Diverticulosis of\nthe colon is noted, without evidence of wall thickening and fat stranding.\n\nPELVIS: The urinary bladder is under distended and there is a 9 mm left\nposterolateral bladder diverticulum..  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is a 1.5 cm porta hepatis lymph node, likely reactive. \nMultiple subcentimeter a few subcentimeter portacaval and aortocaval lymph\nnodes are noted (02:29, 02:35).  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Bilateral common iliac\narteries are ectatic measuring up to 1.6 cm.  Extensive atherosclerotic\ndisease is noted well as dense calcification at the origins of the celiac\ntrunk, SMA, bilateral renal arteries.  The main portal vein is patent.  The\nproximal IVC is dilated.\n\nBONES: L2 and L3 vertebroplasty changes and moderate L4 compression fracture\nare again noted, unchanged since study from ___.  Chronic right\neleventh and twelfth posterior rib fractures and chronic right L1 transverse\nprocess fracture are noted.  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. Heterogeneous attenuation of the liver.  Findings may be secondary to\ncongestive heart failure in the setting of cardiomegaly and a dilated proximal\nIVC.  Less likely acute hepatitis.\n2. Small pericardial effusion.\n3. 2.3 cm heterogeneously enhancing left renal lesion.  Findings concerning\nfor RCC.  Further evaluation with renal MRI is recommended if not previously\nworked up.\n4. 1.7 cm indeterminate left adrenal nodule.  Further evaluation with\ndedicated adrenal CT is recommended if not previously worked up.\n5. No biliary ductal dilatation.\n\nRECOMMENDATION(S):  Dedicated renal MR and dedicated renal CT if not\npreviously worked up.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:45 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions.  There is mild\nbibasilar atelectasis.  Increased small septal thickening in the lung bases\nlikely represent volume overload.  The heart is enlarged.  Redemonstrated\nsmall pericardial effusion.  There are cardiac leads partially visualized.\n\nABDOMEN:\n\nHEPATOBILIARY: There is decreased attenuation of the liver, compatible with\nhepatic steatosis.  There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  There is trace\nperihepatic free fluid.  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 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 1.4\ncm left adrenal gland nodule (series 2, image 21), unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.8 cm heterogeneously enhancing left kidney lesion, unchanged\ncompared to prior.  There are bilateral renal cysts redemonstrated.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis throughout the colon without diverticulitis.\n\nPELVIS: The urinary bladder is notable for a 0.8 cm left superolateral\ndiverticulum.  There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Prominent porta hepatic lymph nodes are likely reactive, for\nexample a 0.8 cm lymph node is noted, which has decreased in size (series 2,\nimage 31).\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is apparent intramural\nnew thrombus along the right infrarenal abdominal aorta (series 2, image 36). \nExtensive atherosclerotic disease is noted.  There is atherosclerotic disease\nat the takeoff of the celiac trunk, SMA, and bilateral renal arteries without\nocclusion.  The bilateral common iliacs are ectatic, measuring up to 1.5 cm on\nthe right and 1.3 cm on the left.\n\nBONES: There is no evidence of worrisome osseous lesions.  Patient is status\npost L2 and L3 vertebroplasty.  There is a moderate compression deformity of\nthe L4 vertebral body, unchanged.  Chronic right eleventh and twelfth\nposterior rib fractures are redemonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\ndiffuse anasarca.",
            "output": "1. No definite acute intra-abdominal pathology.\n2. Trace ascites.\n3. Unchanged 2.8 cm heterogeneously enhancing left renal lesion, with\ndifferential diagnosis including renal cell carcinoma.  Further evaluation\nwith renal MRI is recommended if not already performed.\n4. Unchanged indeterminate 1.4 cm left adrenal gland nodule.\n5. Redemonstrated pericardial effusion.\n6. Hepatic steatosis.\n\nRECOMMENDATION(S):  Nonurgent renal MRI."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Dense consolidations are noted\nat the lung bases bilaterally.\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 adrenal glands are bilaterally thickened, without evidence of a\ndiscrete nodule.\n\nURINARY: The kidneys are of normal and symmetric size.  Simple cysts in the\nright kidney measure up to 2.2 cm in the right upper pole.  Several additional\nsubcentimeter hypodensities are too small to characterize.  There is no\nhydronephrosis.  There is no nephrolithiasis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a percutaneous gastrostomy (PEG) tube within the\nlumen of the stomach.  Small bowel loops demonstrate normal caliber and wall\nthickness throughout.  Extensive colonic diverticulosis noted.  A moderate\namount of pneumoperitoneum, most likely a sequela of recent percutaneous\nprocedure.  No ascites.\n\nPELVIS: Urinary bladder is collapsed around a Foley catheter.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is 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.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Pronounced dextroscoliosis of the lumbar spine with severe\ndegenerative changes are re-demonstrated.  Evaluation of the soft tissues is\nnotable for diffuse body wall edema.",
            "output": "1. Moderate amount of pneumoperitoneum, compatible with recent PEG placement. \nThe PEG tube is appropriately positioned within the lumen of the stomach.\n2. Extensive diverticulosis.\n3. Diffuse body wall edema.\n4. Dense bibasilar consolidations.  Please refer to the same-day chest CT\ndictation for details on intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Subpleural reticular densities and paraseptal emphysema are noted\nin the lower lobes.  No focal consolidation.  There is no pleural effusion. \nThe heart is mildly enlarged.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has homogeneous attenuation.  There is no biliary\nductal dilatation.  The gallbladder is unremarkable.\n\nPANCREAS: The pancreas appears atrophic and has no lesions or ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is not enlarged. There are no focal lesions.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: 2.1 cm simple cyst at the upper pole of the right kidney.  Probable 8\nmm simple cyst in the lower pole of the left kidney.  Other cortical\nhypodensities are too small to characterize.  Otherwise, the kidneys are\nnormal size and largely symmetric. There are no renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There small hiatal hernia.  The stomach is unremarkable. \nSmall bowel loops largely have normal caliber and enhancement.\nThere is trace fluid surrounding a segment of the sigmoid colon demonstrating\nextensive diverticulosis, mucosal hyperemia, and mild wall thickening,\nsuggestive of acute diverticulitis.  A segment of small bowel adjacent to\nthese loops (series 601, image 29; series 601, image 22) also appears mildly\nedematous.  The trace fluid extends superiorly along the right paracolic\ngutter there are no drainable collections or evidence of free air.\n\nPELVIS: The urinary bladder is within normal limits.  There is a trace amount\nof free fluid in the pelvis surrounding the sigmoid colon as noted above..\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  The adnexa are unremarkable.\n\nLYMPH NODES: There are several prominent but not pathologically enlarged\nretroperitoneal and mesenteric nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild-to-moderate scattered\natherosclerotic disease is noted.\n\nBONES: There are extensive multilevel degenerative changes are demonstrated in\nthe thoracolumbar.  There is a grade 1 anterolisthesis of L4 over L5.  There\nare no worrisome lesions or acute fractures.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted.  Otherwise,\nthe soft tissues are unremarkable.",
            "output": "Possible mild uncomplicated sigmoid diverticulitis, versus focal enteritis of\nsmall bowel loops adjacent to these sigmoid loops, with trace fluid but no\norganized drainable collections."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  There may be a string of\nopacification of the proximal celiac trunk (7b:88).  There is apparent\nocclusion of the proximal splenic artery and poor visualization of the common\nhepatic artery though excess re-left hepatic artery and replaced right hepatic\nartery are seen. The right hepatic artery fills off the SMA.  Patient is\nstatus post SMA stenting, with patent SMA.  The ___ is patent.  There is\nmoderate atherosclerotic narrowing of the bilateral renal arteries, right\ngreater than left.  There are segments of at least moderate stenosis of the\nright common and external iliac arteries.  There is severe narrowing of the\nright superficial femoral artery and at least moderate narrowing of the left\nsuperficial femoral artery.  The portal vein, splenic vein, and SMV are\npatent.\n\nLOWER CHEST: There are new small to moderate bilateral nonhemorrhagic pleural\neffusions, mucosal secretions and adjacent compressive atelectasis at the lung\nbases.  Hypoattenuation of the blood pool relative to the myocardium is\nsuggestive of underlying anemia.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a new 2.3 x 2.0 cm wedge-shaped hypodensity with cortical sparing in\nthe inferior right hepatic lobe, consistent with necrosis (4:65).  Multiple\nadditional hepatic hypodensities are not significantly changed from prior, the\nlarger consistent with hepatic cysts, and multiple which are too small to\ncharacterize, however likely represent hepatic cysts or biliary hamartomas. \nAgain seen is a dystrophic calcification within the left lobe, unchanged. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nPatient has undergone interval cholecystectomy, with a surgical drain\nterminating in the gallbladder fossa.  There is trace nonhemorrhagic\nperihepatic 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 majority of the spleen is nonenhancing, similar to prior and\nconsistent with infarct (4:22).\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 peripheral\nwedge-shaped areas of hypoattenuation bilaterally, worst in the right lower\npole, consistent with infarct.  There is no evidence of stones, focal renal\nlesions, or hydronephrosis. There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are multiple loops of ilium and jejunum which\ndemonstrate wall thickening and edema, however are slightly improved from\nprior.  There are colonic diverticula, with no evidence of acute\ndiverticulitis.  A rectal tube is present.  Appendix is not visualized.  There\nis no evidence of mesenteric lymphadenopathy.  There is no pneumatosis or\nportal venous gas.  There has been interval resolution previously seen\nintraperitoneal air.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: A Foley catheter is present in the decompressed bladder which contains\nair.  The distal ureters are unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is a small amount of simple free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca.  Surgical staples overlie the\nanterior abdominal wall.",
            "output": "1. Multiple loops of ileum and jejunum which demonstrate wall thickening\nedema, slightly improved from prior.\n2. Patent SMA status post stenting.  There may be a string of opacification of\nthe lumen of the celiac axis with apparent occlusion of the proximal splenic\nartery and poor visualization of the common hepatic artery though excess\nre-left hepatic artery and replaced right hepatic artery are seen.\n3. New area of necrosis in the inferior right hepatic lobe\n4. Near complete infarct of the spleen, similar to prior.\n5. Bilateral small renal infarcts.\n6. New small to moderate bilateral nonhemorrhagic pleural effusions and\nadjacent compressive atelectasis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 4:36 pm, 15 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\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: There is no evidence of hydronephrosis, renal mass or hydroureter. \nThere are punctate densities in the right kidney suggesting nonobstructing\ncalculi.\n\nGASTROINTESTINAL:  Patient is status post partial gastrectomy and\ngastrojejunostomy. There is significant bowel wall thickening and surrounding\nfat stranding involving small bowel loops at and immediately distal to the\nanastomotic site. The stomach itself is not particularly distended but also\nhas a thickened wall. There is no evidence of gastric outlet or small bowel\nobstruction. There is no obstruction. Colon and rectum are within normal\nlimits. Appendix contains air, has normal caliber without evidence of fat\nstranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The main portal\nvein, splenic vein and SMV are patent.\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: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "1.  Significant wall thickening involving the remaining stomach and proximal\nsmall bowel beginning at and extending from the gastrojejunostomy anastomosis\nwith surrounding inflammation suggesting gastroenteritis. No evidence of\ngastric outlet obstruction.\n2.  Diverticulosis without evidence of diverticulitis.\n3.  Nonobstructing right renal calculi."
        },
        {
            "input": "LOWER CHEST: Imaged lung bases are clear.  No pleural or pericardial effusion.\nThere is no evidence of pleural or pericardial effusion.  Port-A-Cath tip\nterminates in the cavoatrial junction.\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 2 mm renal calculus in the upper pole of the\nright kidney, and a smaller 1 mm stone within the right interpolar region\n(601b:34).  No hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL:  Patient is status post subtotal distal gastrectomy with\ngastrojejunostomy. Please note, the gastrojejunostomy site is poorly assessed\ngiven lack of IV contrast and crowding of adjacent bowel loops at this site.\nThere is contrast within the duodenum (afferent limb) which is dilated up to\n4.6 cm.  This finding which is new from prior could reflect delayed transit at\nthe efferent limb though contrast is seen within the distal small bowel and\ncolon.    The colon and rectum are within normal limits.  The appendix is\nnormal.  There is no free fluid within the abdomen or pelvis.  No convincing\nevidence for internal hernia.  Jejunostomy tube is in place.\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 masses are\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.  An IVC filter is in place.\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. Dilated and contrast filled duodenum, which represents the afferent limb\nstatus post Roux-en-Y gastric bypass.  Findings may reflect delayed transit at\nthe efferent limb though contrast is seen within distal small bowel and large\nbowel loops.\n2. Non-obstructing right renal calcului measuring up to 2 mm.\n\nNOTIFICATION:  Updated results were communicated by Dr. ___ to Dr ___ in\nperson on ___ at 11PM, 1 minute after discovery."
        },
        {
            "input": "VASCULAR:\n\nAgain seen is a fusiform transrenal aneurysm with endograft stenting and\nbilateral iliac stenting.  The aneurysm sac measures maximally 7.1 cm\n(previously 7.3 cm).  There is interval resolution of air within the aneurysm\nsince the prior examination.  There is mild calcium burden in the abdominal\naorta and great abdominal arteries.\n\n POST EVAR EVALUATION\nANEURYSM Transrenal\nDiameter (Cross-sectional): 7.1 x 6.8 cm\nDiameter (Center-line): 6.8 x 6.9 cm\nVolume:\n\n1. Aneurysm: 227 ml\n2. Renal to Aortic bifurcation: 269 ml\n3. Renal to Iliac bifurcation: 759 ml\nENDOLEAK: no\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 0 cm.\nLength distal graft to iliac bifurcation:  Right:  1 mm; Left:  6 mm.\n\nThere is no change in appearance of the stent or stent location although the\nprevious examination was performed at an outside institution and precise\nmeasurements from 3D formatting are not available.\n\n\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  Defibrillator\nwire is present.  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 pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\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 endoleak.\n2. Unchanged appearance and location of stents.\n3. Unchanged or slightly smaller aneurysm sac, detailed above."
        },
        {
            "input": "Chest is reported separately.\n\nSmall hepatic cyst is identified in the fourth segment of the liver.  No\nsuspicious liver lesions.  There is no biliary dilatation.  Many small to\nmedium size rim calcified stones are identified in the gallbladder.  There is\nno significant biliary dilatation.  The spleen is normal in size and\nappearance.  The pancreas appears normal.  Adrenals are also unremarkable. \nHypoattenuating focus in the interpolar right kidney of 7 mm in diameter is\ntoo small to characterize but doubtful in clinical significance.  Right lower\npole contains two non-obstructing stones, the larger measuring 7 mm.  Small\nstone in the left mid kidney measures 2-3 mm.  No evidence for hydronephrosis,\nperfusion defects, solid masses on either side.\n\nStomach and small bowel are unremarkable. Sigmoid diverticulosis is moderate\nin severity. Appendix appears normal.\n\nBladder, uterus and adnexa appear normal.  There is no free fluid or free air.\nNo enlarged lymph nodes are identified.  Major vascular structures appear\nwidely patent.\n\nThere are no suspicious bone lesions.  Sclerotic focus in the left ilium is\nconsistent with a benign bone island.",
            "output": "No CT evidence of malignancy.  Cholelithiasis."
        },
        {
            "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 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 a couple of punctate, nonobstructing renal calculi in the left\ninterpolar and lower pole kidney.  There are multiple bilateral subcentimeter\nhypodensities, which are too small to characterize, but statistically likely\nrepresent simple cysts.  A 1.2 cm region of hypodensity in the left lower pole\nkidney is not fully characterized on the current study (601:19).  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. Scattered\ndiverticulosis is noted.  There is a short segment of thickened distal sigmoid\ncolon (601:21) with mild adjacent fat stranding, concerning for acute\ndiverticulitis.  While the bowel may simply be tortuous, it is difficult to\nexclude a small intramural fluid collection.  There is no evidence of\nperforation.  The appendix 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.  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 sigmoid diverticulitis without evidence of perforation.  However, it\nis difficult to exclude a small intramural collection.\n2. Punctate non-obstructing renal calculi in the left kidney.\n3. A 1.2 cm hypoattenuating focus in the left lower pole kidney is\nincompletely characterized on the current study.  A non-urgent renal\nultrasound may be obtained for further evaluation.\n\nRECOMMENDATION(S):  Non-urgent renal ultrasound for indeterminate left lesion."
        },
        {
            "input": "LOWER CHEST: Mild dependent bibasilar atelectasis.  Visualized lung fields are\notherwise within normal limits.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable appearance of a punctate hypodensity within the right hepatic lobe\n(02:25), unchanged from prior study and likely compatible with 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. \nFew punctate nonobstructing stones are again demonstrated in the left kidney. \nMultiple subcentimeter hypodensities are too small to characterize, though\nlikely compatible with simple 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.  Few small bowel loops in the lower pelvis demonstrate mild\nhyperemia of the bowel wall, likely due to secondary inflammation.  Scattered\ndiverticulosis is noted.  Extensive wall thickening and hyperemia of sigmoid\ncolon with adjacent fat stranding and phlegmonous changes, consistent with\nacute diverticulitis and worse compared to prior study from ___. \nNo definite organized fluid collection identified.  Few nearby scattered\nlocules of air are concerning for possible perforation.  Extensive phlegmonous\nchange spans nearly 10 cm segment posterior to the sigmoid colon, extending\ninto the left hemipelvis.  The appendix measures 5 mm in diameter and appears\nmildly hyperemic, however likely due to secondary inflammation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small amount\nof free fluid and phlegmonous change noted 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.  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 worsening of sigmoid diverticulitis compared to prior study from\n___, now with increased hyperemia and surrounding phlegmonous\nchange, with few nearby scattered locules of air from perforation.  No well\norganized collection.  Recommend surgical consultation.\n2. Few punctate non-obstructing stones within the left kidney.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:56 am, approximately ___\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are scattered, subcentimeter, hypodense lesions in both hepatic lobes,\nmost likely representing cysts or small hamartomas.  A small focus of fatty\ninfiltration is also noted.  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 hypodense lesion is seen in the upper pole of the right kidney, most likely\nrepresenting a simple cyst.  A smaller hypodense lesion is seen in the lower\npole of the left kidney, also most likely representing a cyst.  There is no\nperinephric abnormality or hydronephrosis.  No obstructive urinary tract\ncalculi are identified.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There are\nnumerous colonic diverticuli.  In the region of the proximal ascending colon,\nthere is colonic wall thickening and mild pericolonic fat stranding\nsurrounding a diverticulum, consistent with acute diverticulitis.  There is no\nadjacent drainable fluid collection or extraluminal air.  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 enhances heterogeneously, with multiple\nintramural lesions, compatible with fibroids.  No adnexal masses are\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.\n\nBONES: 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 diverticulitis of the ascending colon."
        },
        {
            "input": "VASCULAR:\n\nThe patient is status post endovascular AAA and right common iliac aneurysm\nrepair.  Aortic and bilateral iliac graft components are present, as well as\nSMA and left renal artery stents.  The celiac, SMA and left renal arteries are\npatent.  There is also a stent across an accessory left renal artery, which is\npatent.  The right kidney is diminutive in size, likely congenital.\n\nThere is no evidence of endoleak.  The aneurysm sac measures up to 5.6 x 4.9\ncm in cross-section, versus 5.6 x 5.2 cm on the pre-EVAR study of ___.\n\nThere is multifocal mild stenosis of left and right external iliac arteries,\nas well as the right common femoral and proximal SFA.  There is minimal\nnarrowing in the left CFA .\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. \nThere is a 2.7 cm circumscribed hypodense lesion adjacent to the gall bladder\nfundus, likely a cyst.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor 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 right kidney is diminutive in size.  A few small calcifications\nin the left renal pelvis appear to be vascular.  There are few small cortical\nhypodensities, incompletely characterized due to size but likely cysts.  There\nis no hydronephrosis.\n\nGASTROINTESTINAL: The bowel is grossly unremarkable.\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 a trace of\nnonspecific 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: There is a stable appearance of multifocal midline abdominal\nwall hernias containing fat and partial loops of bowel with no evidence of\ncomplication.",
            "output": "Status post endovascular repair of AAA.  No evidence of endoleak or other\ncomplication."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.\n\nLYMPH NODES: Multiple conspicuous pelvis sidewall and inguinal lymph nodes are\nnonspecific.  The largest of which measures up to 1.4 cm across the short axis\nin the right inguinal region.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: No acute fractures or traumatic subluxation.  Slight cortical\nirregularity at the posterior aspect of the left inferior pubic ramus may\nreflect a remote injury (2:89).\nFixation hardware across the right sacroiliac joint.  A partially imaged left\nfemoral neck and head fixation device is present.  No evidence of hardware\nrelated complications.  Multiple well corticated osseous fragments cranial to\nthe greater trochanter likely represents dystrophic calcifications.\n\nSOFT TISSUES: The left gluteal maximus is expanded by a 5.5 x 3 cm hyperdense\ncollection consistent with a intramuscular hematoma (2:87).  There is\nsubstantial soft tissue swelling overlying the left gluteal region.",
            "output": "1. Large left gluteal intramuscular hematoma.\n2. No acute fracture or traumatic subluxation.\n3. Fixation device within the right sacroiliac joint and proximal left femur. \nNo evidence of hardware related complications.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:44 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 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. \nExtrarenal pelvises are noted bilaterally.  Multiple subcentimeter\nhypodensities in the left kidney are too small to characterize, but likely\nrepresent cysts.  There is no evidence of solid renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post total\ncolectomy with diverting ileostomy to the right lower quadrant.  Two\nsmall-bowel anastomosis are seen in the right hemiabdomen.  There is diffuse\nfecalization of the distal small bowel loops, however this is unchanged from\nprior.  Mildly distended loops at the anastomosis is unchanged (3:44). There\nis no abrupt change in caliber or upstream distension concerning for\nobstruction.  The previously seen fluid collection in the in the right\nanterior abdomen, immediately behind the mid abdominal wall, appears resolved.\nThe ileostomy loop appears slightly narrowed as it traverses through the\nabdominal wall, best seen on the sagittal view, series 5 image 37, compared to\nprior.  There is also mild fat stranding of the surrounding fat.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall amount of simple free fluid in the pelvis, within physiological range\nfor patient's age.\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: Postsurgical changes related to right lower quadrant ileostomy\nand ventral laparotomy.",
            "output": "1. There is mild narrowing of the distal small bowel loop as it exits through\nthe abdominal wall.  It is uncertain if this is secondary to a stricture or an\nadhesion.  While there are no distended small bowel loops, in increase in\nfecalized small bowel materials in this region suggests slow passage.\n2. Previously seen abdominal fluid collection is resolved.\n3. Please see separately reported \"extravasation event\" note in OMR.  The\nstudy remains diagnostic.\n\nRECOMMENDATION(S):  Provide printout instructions for extravasation event\nprior to discharge.\n\nNOTIFICATION:  The extravasation event was discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 2:43 pm, 40 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 suspicious focal lesion.  There is mild prominence of the central\nintrahepatic bile ducts in the CBD measures up to 8 mm, likely secondary to\nprior cholecystectomy..  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  The main pancreatic duct is prominent measuring up to 4 mm in\nthe pancreatic head, similar to prior (5:44).  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is dilatation of the right renal pelvis with a morphology suggestive of\nwith chronic right UPJ obstruction.  There is no nephrolithiasis or\nureterolithiasis.  There is no hydroureter.  There is no evidence of solid\nrenal lesions.  Subcentimeter hypodensities within bilateral kidneys are too\nsmall to characterize but are statistically likely to be simple cysts.  There\nis no perinephric abnormality.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Right lower quadrant\nileostomy.  Compared to prior narrowing of the ileostomy loop at the level of\nthe anterior abdominal wall has progressed, however there is no evidence of\nobstruction and oral contrast has passed into the ileostomy (5: 80, 83).  Mild\ndistension of the loops of small bowel at the anastomosis, is likely\npostsurgical and has improved compared to prior study.  The remaining small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement.  The\npatient is status post proctocolectomy.  The appendix is surgically absent.\n\nPELVIS:  There is small volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality is\nseen.\n\nLYMPH NODES: Mesenteric lymph nodes adjacent to the right lower quadrant\nileostomy have decreased in size compared to prior measuring up to 7 mm,\npreviously 9 mm (5:84).  There is no retroperitoneal lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted. There is no\nabdominal aortic aneurysm.\n\nBONES: Sclerosis is noted along the right SI joint suggestive of sacroiliitis,\nsimilar to prior.  There is no acute fracture or destructive osseous lesion.\n\nSOFT TISSUES: A right lower quadrant end ileostomy and scarring following\nventral laparotomy are noted.",
            "output": "1. Interval worsening of narrowing of the ileostomy loop as it exits through\nthe RLQ anterior abdominal wall without evidence 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 a 1.1 cm hypodensity in segment VI (06:25).  This has increased in\nsize from the prior study in ___, but was previously characterized as a\ncyst or hamartoma on the MRCP performed in ___. there is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: Previously noted area of walled-off necrosis adjacent to the\npancreatic tail has substantially decreased in size status post\ncystgastrostomy.  There is minimal residual stranding and hypodensity in this\nregion, with heterogeneous appearance of the adjacent pancreatic tail.  The\npancreatic head, neck, and body are unremarkable in appearance, without ductal\ndilation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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.  No ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable in appearance.  No adnexal masses\nare 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.  Minimal atherosclerotic\ndisease is noted.  Persistent occlusion of the splenic 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. Significant interval decrease in size of walled off necrosis post\ncystgastrostomy.\n2. Mild residual peripancreatic fat stranding, with heterogeneous enhancement\nof the adjacent pancreatic tail.\n3. Persistent splenic vein occlusion."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 and large bowel loops\nare normal in caliber.  The colon and rectum are within normal limits. The\nappendix is normal (601:29).\n\nPELVIS: The urinary bladder is unremarkable.  There is small volume free fluid\nin the cul-de-sac.\n\nREPRODUCTIVE ORGANS: An IUD is seen within the uterus and appears well\nsituated.  A 3 cm cyst in the left ovary is most likely physiologic.  Trace\nfree fluid is within physiological range.\n\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 for acute findings in the abdomen or pelvis.  Normal appendix."
        },
        {
            "input": "ABDOMEN:\n\nThe lung bases are clear.  There is persistent diffuse decreased enhancement\nof the liver, as seen previously.  There is evidence of hepatomegaly.  A tiny\n6 mm hypodense focus is identified in segment 4A of the liver (02:15), too\nsmall to characterize. A 1.3 cm area of relative ___ in segment 7\n(02:21), likely relates to perfusion abnormality. No intrahepatic or\nextrahepatic biliary ductal dilatation. The portal veins and hepatic veins are\npatent. Slightly decreased attenuation of the caudate lobe is noted (___:21),\nin keeping with perfusion abnormalities. Other areas of heterogenous decreased\nattenuation are also identified (02:25, 36, 42). Cholecystectomy clips are\nidentified. The pancreas and adrenal glands are unremarkable. The spleen is\nminimally enlarged measuring 13.5 cm.  A few esophageal varices are\nidentified. Kidneys demonstrate symmetric enhancement and excretion of\ncontrast. No hydronephrosis. No ascites. No mesenteric or retroperitoneal\nlymphadenopathy. The stomach is unremarkable. The caliber of small and large\nbowel is within normal limits. The air-filled appendix is unremarkable (2:69).\n\nPELVIS:\n\nUrinary bladder is unremarkable. The uterus and adnexal structures are within\nnormal limits. Small amount of free fluid is identified within the cul-de-sac,\nlikely physiologic (2:81). No inguinal or pelvic lymphadenopathy.\n\nOSSEOUS STRUCTURES:\n\nNo suspicious osteolytic or osteoblastic lesions are identified.",
            "output": "*Persistent diffuse decreased enhancement of enlarged liver, with scattered\nareas of heterogenous decreased attenuation throughout the hepatic parenchyma\nincluding the caudate lobe.  Splenomegaly and few esophageal varices relate to\nsequelae of portal hypertension. Findings are in keeping with provided history\nof alcoholic hepatitis and/or steatohepatitis. No overt features of cirrhosis\nidentified. Future follow-up CT scans do not require imaging of pelvis.\n*6 mm hypodense focus in segment 4A of the liver is too small to characterize.\n*Small amount of free fluid within the cul-de-sac, likely physiologic."
        },
        {
            "input": "CHEST: On the prior CT, there is heterogeneous soft tissue at the medial\naspect of the right lung base, which measures 5.5 x 3.5 cm, with surrounding\ncollapse of the right lower lobe and a small nonhemorrhagic right pleural\neffusion.  The heart is mildly enlarged with a small pericardial effusion and\nexuberant mitral annular calcification.\n\nABDOMEN:\nThe liver is normal in size with no focal hepatic lesions. The gallbladder is\nunremarkable. The pancreas and spleen are normal. The adrenal glands are\nmildly thickened bilaterally, but did not contain lesions.\n\nThere are areas of hypoattenuation throughout the kidneys bilaterally, with\nmore focal areas of low attenuation centrally within these hypoattenuating\nregions (on the right 02:33,28, and on the left 02:27,35), concerning for\npyelonephritis with possible developing abscesses. Multiple bilateral cortical\nhypodensities, in part represent renal cysts. There is no hydronephrosis.\n\nThere is a small hiatal hernia. The stomach is decompressed. The small bowel\nis normal in caliber with no evidence of obstruction. There is evidence of\nprior right partial colectomy, and the residual colon contains a moderate\namount of stool, and is mostly decompressed. There is no mesenteric or\nretroperitoneal lymphadenopathy. There is no free fluid or free air in the\nabdomen.\n\nPELVIS: The urinary bladder demonstrates a slightly thickened wall. The uterus\nis not appreciated, possibly surgically absent. No adnexal masses are seen.\nThere is no pelvic free fluid or lymphadenopathy.\n\nVESSELS:  The aorta demonstrates moderate atherosclerotic calcification\nwithout aneurysmal dilatation. There is minimal ectasia of the infrarenal\nabdominal aorta up to 2.2 cm (02:37). Iliac vessels bilaterally contain\nmoderate atherosclerotic plaque.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. 5.5 x 3.5 cm soft tissue density in the right lower lobe with surrounding\nright lower lobe collapse, should be correlated with prior history of lung\ncancer and remote imaging to assess for long-term change.  Superimposed\ninfection and or atelectasis is noted.\n2.  Regions of hypoenhancement within the kidneys bilaterally worrisome for\npyelonephritis with more focal central areas of lower attenuation in the\nkidneys concerning for developing abscesses.\n3.  Diffuse atherosclerotic calcification of the abdominal aorta and iliac\nvessels.\n\nUpdated wet reading was discussed with Dr. ___ by Dr. ___\ntelephone at 19:40."
        },
        {
            "input": "LOWER CHEST: A moderate left pleural effusion is intermediate in density, and\nincreased in density from ___.  Small right low-density pleural\neffusion is unchanged from 2 months prior.\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 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal cysts noted.  No hydronephrosis.  Renal cortical\nthinning, mild, 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.\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: Unchanged 3.2 cm infrarenal abdominal aortic aneurysm.  Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal superficial fat stranding, likely\npostprocedural.",
            "output": "1. Moderate left pleural effusion is apparently low to intermediate in density\nand increased in density from ___, potentially somewhat above\nsimple fluid attenuation.  This could be artifactual, but if there is concern\nfor the possibility of a hemothorax component, then CT angiography may be\nconsidered.\n2. Unchanged, 3.2 cm saccular infrarenal aortic aneurysm."
        },
        {
            "input": "LOWER CHEST: Unchanged moderate left and small right pleural effusions.  Mild\nassociated bibasilar atelectasis.  Heart is moderately enlarged.  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 contains gallstones as well as small amount of\nsludge.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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.  Indeterminate 9 mm\nlesion arising exophytically from the lower pole of the left kidney (601:42,\n2:39).  Simple cyst measuring up to 1.4 cm in the upper pole the right kidney\nand up to 3.4 cm in the upper pole left kidney are noted.  Nonobstructive 5 mm\nstone is noted in the lower pole of the left kidney.  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. Colonic anastomosis in the transverse colon appears\nunremarkable.\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: Infrarenal abdominal aortic aneurysm measures up to 3.2 x 2.8 cm,\nunchanged.  Extensive 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. \nPostsurgical changes noted along the right groin.",
            "output": "1. Stable moderate left and small right pleural effusions.  No retroperitoneal\nhematoma.\n2. Stable 3.2 cm infrarenal abdominal aortic aneurysm.\n3. Indeterminate 9 mm lesion arising from the lower pole of the left kidney\ncan be further evaluated with renal ultrasound on nonemergent basis.\n\nRECOMMENDATION(S):  Nonemergent renal ultrasound."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Portal and hepatic veins patent.  Normal\ngallbladder.  No intrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (7 cm). There is a millimetric accessory\nspleen in the left upper quadrant\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Mild lobulation/scarring of the left renal cortex.  Bilateral\nperipelvic cysts.  No hydronephrosis.  The right ureter is mildly prominent,\nlikely on a background of peristalsis, as it can be followed back to the right\nUVJ, without an obstructive process.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small duodenal diverticulum.  Small\nbowel otherwise unremarkable.  Uncomplicated sigmoid diverticulosis.  Large\nbowel otherwise within normal limits.\n\nPELVIS: Urinary bladder unremarkable.\n\nREPRODUCTIVE ORGANS: Densely calcified rounded focus posterior to the uterus,\npotentially representing a calcified exophytic fibroid.  An alternative\nconsideration is that of a calcified pelvic lymph node.  Unremarkable uterus. \nNo adnexal abnormality.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Mild aortoiliac atherosclerosis.  Abdominal aorta non-aneurysmal. \nMajor branch vessels patent.\n\nBONES: No acute or focal destructive osseous lesions.  Multilevel degenerative\ndisc disease lumbar spine.\n\nSOFT TISSUES: Small paraumbilical hernia.  Abdominal and pelvic wall\nunremarkable otherwise.",
            "output": "1. No abdominopelvic metastasis or lymphadenopathy.\n2. Note that findings pertaining to the chest will be reported separately."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Portal and hepatic veins patent.  Normal\ngallbladder.  No intrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is mildly atrophic.  There are no focal\npancreatic parenchymal lesions.  No main duct dilatation.\n\nSPLEEN: Spleen is not enlarged (7 cm).  There are no focal splenic lesions. \nOf note is a tiny accessory spleen in the left upper quadrant (series 2, image\n44).\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Kidneys have a lobulated appearance, chronic.  There are tiny\nbilateral renal cortical cysts.  No concerning renal parenchymal lesions. \nThere is mild prominence of the right ureter extending from the right renal\npelvis to the level of the UVJ.  No obstructing cause is identified.  No\nabnormal urothelial enhancement.  Appearance is essentially unchanged from the\nstudy performed in ___.  There is associated mild prominence of the\nright renal renal pelvis, without calyceal dilatation.  There is no\nnephrolithiasis.  No left-sided hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: Normal stomach and small bowel. Moderate volume of stool\nthroughout the rectum.  Uncomplicated scattered sigmoid and descending\ndiverticula.  Large bowel otherwise unremarkable.\n\nPERITONEUM: No intra-abdominal free air or free fluid.  No peritoneal or\nomental nodularity.\n\nPELVIS: Unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: Grossly normal uterus.  No gross adnexal abnormality.\n\nLYMPH NODES: Stable peripherally calcified nodular density has changed\nposition relative to the study performed in ___.  It is now located\nposterior and to the right of the urinary bladder, and to the right of the\nuterus.  This exhibits no concerning features. Differential considerations\ninclude a exophytic calcified fibroid, calcified lymph or calcified focus of\nomental/epiploic infarction.  There are no pathologically enlarged inguinal,\npelvic, retroperitoneal, peripelvic, or mesenteric lymph nodes.\n\nVASCULAR: Abdominal aorta is normal in caliber.  There is mild background\naortoiliac atherosclerosis.  Origins of major branch vessels including the\nceliac axis, SMA, renal arteries, and ___ are patent.  Portal vein, portal\nconfluence, SMV, and splenic vein patent.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Abdominal and pelvic\nwall otherwise unremarkable.",
            "output": "1. No evidence of metastatic disease to the abdomen or pelvis.\n2. Note that findings pertaining to 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: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Hepatic and portal veins are patent.  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: Lobulated kidneys, unchanged.  Bilateral cortical hypodensities\nstable and remain too small to characterize but likely cysts.  No suspicious\nrenal lesion.  Previously described mild prominence of the right mid ureter is\nless accentuated on today's exam.  No hydronephrosis or renal stones.  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 or fat\nstranding. The appendix is not visualized.\n\nPELVIS: Unremarkable urinary bladder.  There is no free fluid in the pelvis. \nPeripherally calcified density (2:203) is stable dating back to ___. \nOn today's exam it is seen left posterolateral to the bladder, previously\nright posterolaterally, likely a torsed epiploic appendagitis.  No concerning\nfeatures.\n\nREPRODUCTIVE ORGANS: Grossly normal uterus.  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 changes of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Small\nfat containing umbilical hernia.  Small calcific density in the left gluteal\nsubcutaneous tissue, unchanged, likely granuloma.",
            "output": "1. No 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 suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There are bilateral extrarenal pelves without frank\nhydronephrosis.  Lobulated contour to the kidneys is re-demonstrated. \n-----bladder-----\n\nGASTROINTESTINAL: The stomach is collapsed and thus not well assessed.  A\ndiverticulum arises from the third portion of the duodenum and measures\napproximately 3 cm.  No bowel obstruction or bowel wall thickening is seen. \nThere is colonic diverticulosis without acute diverticulitis.  A linear\nhigh-density is seen within the proximal descending colon which was likely\ningested.  The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An exophytic partially calcified fibroid is again seen\narising from the left aspect of the uterus, and measures approximately 2.8 x\n1.4 cm, series 2, image 194.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nStable small subcentimeter retroperitoneal lymph nodes are noted. 1 There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Re-demonstrated lumbar spine degenerative changes include multilevel\nosteophytes, some endplate irregularity at L4-L5, and mild disc space\nnarrowing at L2-L3. no concerning osteoblastic or lytic lesion is identified.\n\nSOFT TISSUES: Again seen coarse calcification in the subcutaneous fat of the\nleft gluteal region, possibly granuloma from prior injection or other trauma. \nA small fat containing umbilical hernia is re-demonstrated.",
            "output": "1. No CT findings of metastatic disease in the abdomen or pelvis.  Stomach\ncollapsed and not well assessed.\n2. Partially calcified uterine fibroid again seen.\n3. Colonic diverticulosis without acute diverticulitis.\n4. Please refer to concurrent chest CT for thoracic findings."
        },
        {
            "input": "LOWER CHEST: Please see same-day chest CT for detailed intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.  No biliary ductal\ndilatation.\n\nPANCREAS: Homogeneous enhancement without main duct dilation.\n\nSPLEEN: No splenomegaly or focal splenic lesions.\n\nADRENALS: No adrenal nodules\n\nURINARY: Stable lobulated contour of both kidneys may be congenital fetal\nlobulations or scarring secondary to prior ischemic/infectious insult.  The\nkidneys are otherwise normal and symmetric in size and nephrogram.  Bilateral\nsubcentimeter hypodensities are too small to characterize but likely represent\nrenal cysts.  No hydronephrosis.\n\nGASTROINTESTINAL: Unremarkable stomach and small bowel loops.  Sigmoid and\ndescending colonic diverticulosis without evidence of acute diverticulitis. \nThe appendix is not seen however there are no secondary CT signs of acute\nappendicitis.\n\nPELVIS: Urinary bladder and distal ureters are unremarkable.  No pelvic free\nfluid.\n\nREPRODUCTIVE ORGANS: 2.6 cm calcified mass in the left mid pelvis is\nconsistent with a calcified epiploic appendage, unchanged in size and\nappearance from multiple prior studies.  Unremarkable uterus.  No abnormal\nadnexal masses.\n\nLYMPH NODES: No abdominopelvic or inguinal adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: No aggressive osseous lesions or acute fractures.\n\nSOFT TISSUES: Small fat containing umbilical hernia.",
            "output": "1. No evidence of metastatic disease within the abdomen and pelvis.\n2. Diverticulosis without acute diverticulitis.\n3. Please see same-day chest CT for detailed 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: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation 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 cortical thinning and areas of scarring,\nthough are symmetric size with a 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. Diverticulosis of\nthe descending and sigmoid colon is noted, without evidence of wall thickening\nand fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  A 2.7 cm calcified structure within the pelvis\nadjacent to the sigmoid colon, likely represents a torsed epiploic appendage,\nunchanged from prior.\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 findings of metastatic disease within the abdomen or pelvis.\n2. Diverticulosis without findings of diverticulitis.\n3. Please refer to same-day CT chest for characterization of 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 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 unremarkable besides bilateral cortical scarring. \nBilateral extrarenal pelvises are seen.  No hydronephrosis.  No focal lesion.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is an uncomplicated\nduodenal diverticulum.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Few uncomplicated colonic\ndiverticulosis.\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.  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. Small\nuncomplicated umbilical hernia.",
            "output": "1. No abdominopelvic metastasis.\n2. Please refer to separate chest CT done the same day for 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 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.  There is mild wall thickening\nof several jejunal small bowel loops which otherwise appear unremarkable.. \nThere is mild colonic wall thickening and hyperemia most conspicuous at the\nascending, descending and sigmoid colon, compatible with colitis.  The\nterminal ileum is unremarkable.  There is slight asymmetric thickening along\nthe left side of the anus which may correspond to the reported history of a\nperianal abscess.\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: 7 mm bony exostosis noted at the posterior aspect of the right iliac\nwing.  The sacroiliac joints are unremarkable.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild colonic wall thickening and hyperemia most conspicuous at the\nascending, descending and sigmoid colon, compatible with reported inflammatory\ncolitis.  No evidence of complication.  Normal appearing terminal ileum.\n2. 7 mm exostosis at the posterior aspect of the right iliac wing may\nrepresent a small osteochondroma.  No suspicious features.\n3. Possible phlegmonous change/tiny left perianal abscess."
        },
        {
            "input": "LOWER CHEST: There is a small left-sided simple pleural effusion.  A trace\nright-sided pleural effusion is likely present as well.  Bibasilar atelectasis\nis 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.  A small focus of air is seen within the\ngallbladder with a small focus of pneumobilia, which is expected post ERCP. \nThe gallbladder 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 focal\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.  There is significant fat\nstranding surrounding the proximal and mid portion of the duodenum.  This\nextends along the right pericolic region.  Small free fluid is seen in the\npelvis.  There is no free air.  The colon and rectum are within normal limits.\nThe appendix is not definitively visualized.  However, there are no\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are unremarkable.\n\nLYMPH NODES: Reactive lymph nodes are seen in the mesentery, particularly in\nthe right upper quadrant.  There 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Significant mesenteric fat stranding, particularly surrounding the proximal\nand mid portion of the duodenum without definite CT findings of pancreatitis."
        },
        {
            "input": "There is an evolving hematoma expanding the left gluteus maximus proximally\nwith extension distally along the lateral thigh longitudinally expanding the\nvastus lateralis muscle down to the level of the distal femur measuring\napproximately 3.5 cm in maximum transverse dimension by 7.5 cm in maximum\nanterior-posterior dimension by approximately 41.4 cm in craniocaudal\ndimension.  Several tiny bubbles of air are noted within the anti dependent\nportion of the collection (series 4, image 160).  There is no retroperitoneal\nextension of the hematoma.  No retroperitoneal or peritoneal fluid collection\nis seen.\n\nThere has been revision left hip total arthroplasty.  The prosthesis appears\nwell seated.  There is no evidence of hardware loosening or fracture.  There\nis no periprosthetic fracture.  There is redemonstration of an approximately\n3.6 cm  \"C\" shaped metallic density within the left lateral thigh subcutaneous\nsoft tissues (series 7b images 88 -96) and a free screw posterior to the\nproximal aspect of the femoral component (series 9b, image 173) as seen on the\nprior radiographs.  A surgical staple line is seen over the lateral left\nthigh.\n\nThere is probable diffuse osteopenia.  No fracture is seen.  There is no\nperiosteal reaction or erosive change.  Osseous irregularity at the anterior\naspect of the proximal right tibia is incompletely evaluated on the current\nexam and may correspond to degenerative change or to sequela of old trauma\n(series 3, image 300).\n\nThere is no dislocation.  There are mild to moderate degenerative changes at\nthe right femoral acetabular joint.  The sacroiliac joint spaces appear well\nmaintained.  Moderate degenerative changes are noted within visualized\nportions of the lower lumbar spine.\n\nLimited evaluation of the pelvis demonstrates no gross abnormality.  Probable\nprior hysterectomy.  A small amount of anti dependent air is noted within the\nurinary bladder likely related to recent Foley catheter removal.  No free\nfluid is seen within the pelvis.  There is no significant pelvic or inguinal\nlymphadenopathy.\n\nVascular calcifications are seen throughout the pelvis and bilateral lower\nextremities.\n\nThere is subcutaneous soft tissue edema throughout the left lower extremity. \nNote is made of moderately severe atrophy of the semimembranosus muscle in\nboth legs.",
            "output": "1. Large intramuscular hematoma expanding the left gluteal and vastus\nlateralis muscles measuring approximately 41.4 x 7.5 x 3.5 cm (craniocaudal by\nanterior-posterior by transverse).\n2. Status post revision left total hip arthroplasty without evidence of\nhardware complication.  Redemonstration of an approximately 3.6 cm  \"C\" \nshaped metallic density within the subcutaneous soft tissues of the lateral\nleft thigh and a free screw posterior to the proximal femoral component\nraising the question of retained foreign bodies, as seen on prior radiographs.\n3. Mild to moderate right femoral acetabular joint osteoarthritis.\n4. Moderate degenerative changes within visualized portions of the lower\nlumbar spine.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:31 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST:  A 5 mm left lower lobe pulmonary nodule (2:1), and a 3 mm right\nlower lobe pulmonary nodule (2:5) are unchanged from the prior study of ___.\nThe partially assessed lung bases are otherwise clear. There is no pleural or\npericardial effusion.\n\nLIVER: The liver enhances homogeneously without intrahepatic biliary duct\ndilation. Multiple well circumscribed hypodensities are seen throughout the\nliver, the largest of which is in segment II measuring 1.2 x 1.0 cm with a\nmeasured density compatible with a simple cyst (2:1 is.  Additional lesions\nare too small fully characterize but likely represent additional simple cysts\nor biliary hamartomas. The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: Mild thickening of the left adrenal gland is unchanged from prior\nstudy of ___. The adrenal glands are otherwise unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly.  A use 1.0 x 0.5 cm hypodensity arising from the anterior interpolar\nregion of the left kidney (02:27) is too small to fully characterize, but does\nnot meet criteria for simple cyst and is new from the prior study. MRI could\nbe performed for further characterization if clinically indicated. There is no\nhydronephrosis.\n\nGI: The stomach is mildly distended without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction.  A duodenal diverticulum is unchanged\nfrom the prior study of ___. A normal appendix is visualized. There is\ncolonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with diffuse atherosclerotic\ncalcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS:  Cystic structures are seen within bilateral ovaries measuring 1.8\ncm on the right and 1.2 cm on the left (2:61). The urinary bladder appears\nnormal. No pelvic wall or inguinal lymph node enlargement by CT size criteria\nis seen. There is no pelvic free fluid.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. No evidence of adenopathy or mass.\n2. New 1 cm left renal lesion, which is too small to fully characterize but\ndoes not meet criteria for simple cyst.\n3. Bilateral ovarian cystic lesions measuring 1.8 and 1.2 cm, respectively.\n4. Stable pulmonary nodules and duodenal diverticulum.\n\nRECOMMENDATION(S):\n1. Bilateral ovarian cystic lesions, larger than 1 cm, should be evaluated by\nultrasound in this postmenopausal female.\n2. MRI should be performed to further evaluate new left renal 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:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A\nsubcentimeter hypodensity within the liver is too small to fully 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 enhances homogeneously without evidence of focal mass\nlesions, ductal dilatation, or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Note is made of 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 subcentimeter cyst is seen within the interpolar region 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 sigmoid colon is noted, without evidence of wall thickening or fat\nstranding.  The appendix 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 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 large fat containing paraumbilical hernia.",
            "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Please see separate chest CT report for details of intrathoracic findings."
        },
        {
            "input": "There is bibasilar atelectasis.  Patient is status post aortic valve\nreplacement. There is no pericardial effusion.\n\nNon contrast-enhanced liver, pancreas and spleen are normal.\n\nThere is biliary sludge in the gallbladder without signs of acute\ncholecystitis.\n\nLeft adrenal nodule is again seen. The right adrenal gland is normal.\n\nThere are no radiodense stones in the kidneys, ureters, or bladder. There is\nno hydronephrosis. A foley is noted in the urinary bladder.\n\nStomach and bowel loops are normal.  Ventral hernia with loops of bowel are\nagain seen.  There is no obstruction. There is colonic diverticulosis without\nevidence of diverticulitis.  There is no free fluid or free air in the abdomen\nor pelvis.\n\nThe aorta is normal in caliber, with moderate atherosclerotic calcifications.\n\nHyperdense blood interdigitates throughout the left inguinal fat, relating to\nrecent vascular access, unchanged since prior study.  No hematoma is seen in\nthe intraabdominal, retroperitoneal, or upper thigh regions.\n\nThere is no mesenteric, retroperitoneal, pelvic sidewall, or inguinal\nlymphadenopathy.\n\nInjection granulomas in the anterior subcutaneous soft tissue.\n\nStatus post right hip total arthroplasty.  Severe degenerative changes are\nagain seen in the lumbosacral spine. No focal bony lesion suspicious for\nmalignancy present.",
            "output": "1.  No identifiable cause for recent hematocrit drop.  No new RP hemorrhage\ndetected.\n2.  Blood interdigitating throughout the left inguinal fat, from prior\nvascular access, is 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. \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 is mildly enlarged measuring 14.3 cm in craniocaudal\n___.  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: 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.  Trace\nnonhemorrhagic free fluid within the pelvis, nonspecific.\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: Small fat containing left inguinal hernia.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Trace pelvic free fluid is nonspecific and of unclear etiology, but not a\n\"normal finding\" in a male patient.\n\n2.  Mild splenomegaly."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal aorta and great abdominal arteries.  Evaluation of the SMA is\nlimited due to motion artifacts but the proximal SMA appears patent.  The\nceliac trunk and ___ appear patent.  There is no evidence of venous occlusion.\nThere is severe atherosclerotic disease of the iliac arteries bilaterally,\ncausing severe stenosis (50-99%) of the right common iliac artery, external\niliac artery, and right common femoral artery.  The patency of the right\nsuperficial femoral arteries stent is difficult to assess.  On the left, there\nare scattered focal severe stenosis of the iliac and femoral arteries, and\nocclusion of the left superficial femoral artery.\n\nLOWER CHEST: There are moderate right and small left pleural effusions. \nSubsegmental atelectasis is seen at the right lung base.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is small, without evidence of focal lesions.\n\nADRENALS: There is mild nodularity of the left adrenal gland, unchanged\ncompared to ___.  The right adrenal gland appears unremarkable.\n\nURINARY: Both kidneys appear mildly atrophic, with peripheral wedge shaped\nareas of hypoenhancement suggestive of striated nephrograms.  Nonobstructing\ncaliceal stones are seen within the left kidney.  There is no hydronephrosis. \nThe renal veins are patent.  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.  There is apparent wall thickening of the\ncecum/right colon, which is likely related to under distention.  The appendix\nis not visualized.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Mild free fluid is seen\nwithin the pelvis.\n\nREPRODUCTIVE ORGANS: A heterogeneously enhancing lesion is seen likely\ninvolving the lower uterine segment and vagina measuring 6.1 x 4.6 x 9.1 cm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is extensive subcutaneous edema, in keeping with anasarca.",
            "output": "1. No evidence of mesenteric ischemia or bowel abnormalities to explain the\npatient's symptoms.\n2. Bilateral striated nephrograms.  This may be secondary to the phase of the\ninjected contrast, but clinical correlation is recommended to rule out acute\npyelonephritis.\n3. Heterogeneously enhancing lesion within the lower uterine segment/vagina. \nCorrelation with endovaginal ultrasound is recommended.\n4. Extensive atherosclerotic disease with severe stenosis involving the iliac\nand femoral arteries bilaterally, with complete occlusion of the left\nsuperficial femoral artery.\n5. Moderate right and small left pleural effusion.\n\nRECOMMENDATION(S):  An endovaginal ultrasound is recommended for further\nevaluation of a large heterogeneously enhancing vaginal/uterine lesion.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 14:37 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: There is trace bibasilar atelectasis.  Otherwise, 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. There is mild central intrahepatic\nbiliary dilatation.  Common bile duct measures 7 mm.  The gallbladder is\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: There is mild splenomegaly measuring 13.3 cm in craniocaudal\ndimension.  There are no suspicious 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: Artifact related to high density barium from the prior upper\nGI study and from lumbosacral orthopedic hardware limits evaluation of the\ndistal abdomen and pelvis. Patient is status post placement of a gastric band\nwhich appears in appropriate position as seen on the upper GI study performed\nearlier on the same date.  No evidence of gastric prolapse.  Oral contrast\nmedia passes readily through the lap band and into the small bowel.  There is\nno small bowel obstruction.  The colon and rectum are unremarkable where well\nvisualized.  The appendix is normal.  No free fluid in the abdomen.\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 prominent retroperitoneal and mesenteric nodes are\nnonspecific and not enlarged by CT size criteria.  No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post posterior fusion from L4 through S1 and L4-L5\nlaminectomy.  No acute fractures or worrisome osseous lesions.\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. Gastric lap band appears well-positioned without evidence of prolapse. \nOral contrast media passes beyond the lap band into the small bowel without\nevidence of obstruction.\n3. Mild central intrahepatic biliary dilatation and prominence of the CBD are\nlikely related to prior cholecystectomy."
        },
        {
            "input": "URINARY: Limited evaluation of the kidneys are notable for a 2.7 x 1.9 cm\n(3:9) hyperdense exophytic right lower pole lesion.  No frank right\nhydronephrosis on these limited views.\n\nGASTROINTESTINAL: Visualized 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 colon and rectum\nare 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 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 pelvic wall is within normal limits.  No retroperitoneal,\nmuscular or soft tissue hematoma.",
            "output": "1. No hematoma.\n2. 2.7 cm hyperdense exophytic right lower pole renal lesion may represent a\nhemorrhagic or proteinaceous cyst.\n3. Diverticulosis without evidence of acute diverticulitis.\n\nRECOMMENDATION(S):  Recommend non urgent renal ultrasound for further\nevaluation of right lower pole renal lesion."
        },
        {
            "input": "LOWER CHEST: There is mild basilar atelectasis. No pleural effusion, nodule,\nor mass.  The heart is top-normal in size. There is no pericardial effusion. \nLeads from a pacemaker device are partially imaged.\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 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.  The spleen shows normal\nattenuation throughout, without evidence of focal lesions.  Note is made of a\nsmall 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 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 throughout the abdominal aorta, with more severe\ncalcification seen at the origin of celiac trunk.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing upper abdominal ventral wall hernia,\nthe small fat containing umbilical hernia, and a fat containing left inguinal\nhernia.",
            "output": "1. No acute process within the abdomen or pelvis.\n2. Cholelithiasis.\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: There is diffuse hypoattenuation of the liver consistent with\nsteatosis.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is not\ndistended and poorly characterized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 calculus in the left renal lower pole.  There is\nmild to moderate left hydronephrosis and hydroureter.  The right kidney is\ngrossly unremarkable.  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. 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 left ovarian 8.9 x 11.1 x 12.1 cm lesion\ncorresponding to the previously ultrasound described endometrioma versus\nhemorrhagic cyst, demonstrating intermediate density (30 Hounsfield units).  A\nthickened wall is demonstrated.  There is mass effect displacing the urinary\nbladder and likely compressing the left distal ureter.  The uterus and right\novary 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. Intermediate-density homogeneous left ovarian 8.9 x 11.1 x 12.1 cm lesion\nwith a thickened wall, compressing the left distal ureter, which causes left\nmild to moderate hydronephrosis and hydroureter.  This lesion corresponds to\nthe ultrasound findings and could represent a hemorrhagic cyst, endometrioma,\nor neoplasm.\n2. Small hiatal hernia.\n3. Left renal lower pole punctate calculus."
        },
        {
            "input": "LOWER CHEST: There is minimal subsegmental atelectasis in the right lower lobe\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 relatively hypoenhancing comparison to the splenic\nparenchyma, suboptimally evaluated but raising the possibility of steatosis. \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 demonstrate normal and symmetric size.  There is\nunchanged hydroureteronephrosis on the left, similar in appearance to the\nprior and possibly the sequelae of pelvic endometriosis.  There is subtle\ngeographic hypodensity within the upper pole of the left kidney, new from\nprior (14:40).  No perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  No small bowel obstruction.\nThe colon and rectum are within normal limits. The appendix is not well\nvisualized.\n\nPELVIS: There is moderate to large amount of intrapelvic free fluid which\ninterdigitates within loops of small large bowel within the pelvis and some of\nwhich demonstrates a loculated appearance with peripheral enhancement (12:59).\nExtensive intrapelvic stranding is noted.  The bladder appears decompressed. \nThe bladder wall is stretched around the Foley catheter, to a certain presence\nof a bladder leak a CT cystogram is recommended (15:39, 12:80)\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable in appearance. No right adnexal\nlesion. The patient is status post resection of a large left endometrioma.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Mild atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A surgical defect and abdominal wall staples are noted within\nthe lower midline abdomen.",
            "output": "1.  The urinary bladder is collapsed and the Foley balloon is directed to the\nright of the retropubic space-this appearance is either due to a collapsed\nbladder and stretching of the bladder wall surrounding the Foley balloon or an\nextraluminal position of the Foley catheter-presence of an associated bladder\nleak should be confirmed by a CT cystogram.\n2.  There are multiple rim enhancing loculated fluid collections in the right\nhemipelvis and pouch of ___, with the largest in the right lower quadrant\nmeasuring 9.2 x 5.8 x 17 cm in size (12:63/14:21) -concerning for infectious\nfluid collections.  There is trace presacral free fluid.\n3.  Unchanged left hydroureteronephrosis dating back to ___.  The\nchronicity of this finding suggests that the etiology may be pelvic\nendometriosis, once the acute condition is resolved, an MRI pelvis may be\nobtained to look for ureteric involvement by deep infiltrating endometriosis..\n4.  Small hiatal hernia.\n5.  Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  1.  CT cystogram to look for bladder injury.\n2.  ___ consult for drainage of pelvic abscesses.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 4:57 pm, 5 minutes after\ndiscovery of the findings.  Findings were also discussed by ___,\nMD with ___ at 6:40 p.m."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar dependent atelectasis.  Otherwise,\nvisualized lung fields are within normal limits.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is diffusely hypoattenuating compared to the spleen,\nwhich may represent 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 focal renal lesion.  Unchanged hydroureteronephrosis is noted on\nthe left with interval placement of a ureteral stent.  There is no perinephric\nabnormality.\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: There are multiple likely communicating rim enhancing pelvic fluid\ncollections including a 6.2 x 3.9 cm rim enhancing fluid collection (02:57) in\nthe anterior pelvis, which abuts the uterine fundus and demonstrates a\nthickened wall with extensive fat stranding., a 4.3 x 7.9 cm collection in the\nleft posterior pelvis (02:66) adjacent to the left ureter, and a 2.9 x 2.3 cm\nfluid collection in the right posterior pelvis (601:35).  The overall amount\nof pelvic fluid is decreased compared to prior with the collections appearing\nmore loculated and organized compared to prior.  The urinary bladder is\nunremarkable.\n\nREPRODUCTIVE ORGANS: The endometrium appears mildly prominent which may relate\nto 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.  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. Multiple rim enhancing pelvic fluid collections, including a 6.2 cm\nanterior collection with a thick wall and extensive fat stranding and a 7.9 cm\ncollection of the posterior pelvis adjacent to the left distal ureter.  The\noverall volume of pelvic fluid appears decreased compared to ___.\n2. Interval placement of a left ureteral stent with persistent mild to\nmoderate hydroureteronephrosis.\n3. Mildly prominent endometrium, given presumed premenopausal state, may\nrelate to menstrual cycle."
        },
        {
            "input": "LOWER CHEST:\nThere is minimal bibasilar dependent atelectasis.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously.  The portal vein\nand its branches; hepatic veins are patent.\nThe gallbladder is partially 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: Again visualized is a left-sided nephroureteral stent.  Please note,\nthe proximal pigtail of this stent is located at the left pelvis ureteric\njunction with persistent mild left hydronephrosis.  There is mild urothelial\nthickening of the left ureter, related to presence of a stent.  Tiny locules\nof air are seen within the left renal pelvis and lower pole collecting system,\nlikely related to recent minute Foley placement.\nNo right hydronephrosis.\nNo solid enhancing renal masses on either side.\n\nGASTROINTESTINAL: Small hiatus hernia.\nNo bowel obstruction.  Normal appendix.\n\nLYMPH NODES: No enlarged lymph nodes seen in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The distal end of the\nnephroureteral stent is noted within the urinary bladder.  A tiny locule of\nair is seen within the urinary bladder, related to recent Foley placement.\n\nThere are 2 percutaneous drainage catheters, 1 each extending from the right\nand the left anterior pelvic wall.  Both collections have resolved completely.\nNo residual/new fluid collections seen in the pelvis.\n\nThe uterus is anteverted and appears unremarkable.  The patient is post left\nsalpingo-oophorectomy.  The right ovary is located posterior to the uterus\nwith single right ovarian cyst measuring 3.1 x 1.9 cm in maximum transaxial\n___ (4:65).  Please note, this cyst that was previously described as a\nright posterior pelvic collection is likely within the right ovary.\nTrace free fluid seen in the presacral space.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\nPostsurgical changes project over the midline pelvis.",
            "output": "1. Interval complete resolution of bilateral pelvic fluid collections status\npost percutaneous drainage.\n2. No new drainable fluid collections noted in the pelvis.\n3. A left nephroureteral stent is noted in situ.  The proximal pigtail of this\nstent terminates at the pelvis ureteric junction with persistent mild left\nhydronephrosis.  There is urothelial enhancement throughout the left ureter\nwith mild left periureteric stranding of fat , related to presence of stent."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases are clear.  There is partially visualized\nextensive calcification of the mitral annulus and coronary arteries. There is\na small pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is minimal intrahepatic biliary\ndilatation.  No extrahepatic biliary ductal dilatation. Main portal vein is\npatent.  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 left adrenal gland is unremarkable.  Within the right adrenal\ngland there is a 14 x 0.7 mm fat density lesion, compatible with a\nmyelolipoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is an indeterminate 11 mm lesion in the upper pole of the right kidney\nmeasuring 25 ___ units (07:38).  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable, not well assessed on\nCT.  There is no small bowel obstruction. There are pan-colonic diverticula\npredominantly involving the sigmoid colon. There is a long segment of\nasymmetric thickening and fat stranding involving the distal descending colon,\nproximal and mid sigmoid colon.  The overall appearance is more extensive in\ncomparison to ___.  The degree of bowel wall thickening and\nirregularity is out of proportion to the degree of associated fat stranding\nand is concerning for an underlying neoplasm.  No enlarged local lymph nodes\nare identified.  Anterior to the proximal sigmoid colon abutting the anterior\nabdominal wall there is a new 2.0 x 1.4 cm focus of enhancing soft tissue\nlikely representing phlegmon (05:54).  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are normal for the patient's age.\n\nLYMPH NODES: No lymphadenopathy within the abdomen or pelvis.  Scattered\nconspicuous mesenteric nodes are likely reactive in etiology.\n\nVASCULAR: No abdominal aortic aneurysm.  Extensive calcified atherosclerotic\nplaque\nis seen to involve the abdominal aorta and the iliac branches.\n\nBONES: Superior height loss of the L1 vertebral body is new in comparison to\n___.  Irregularity at the superior endplate of the T11 vertebral\nbody is unchanged and may reflect a Schmorl's node.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive asymmetric wall thickening and pericolonic stranding involving\nthe distal descending colon, proximal sigmoid colon and mid sigmoid colon. \nThe overall appearance is slightly progressed in comparison to ___.  While these findings may represent persistent diverticulitis, the\nfindings remain suspicious for an underlying neoplasm.\n2. Anterior to the proximal sigmoid colon abutting the anterior abdominal wall\nthere is a new 2.0 x 1.4 cm focus of enhancing soft tissue, likely\nrepresenting phlegmon.\n3. Compression deformity of the L1 vertebral body is new in comparison to ___ but without CT evidence of acuity.\n4. 14 mm right adrenal myelolipoma.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 17:33 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. \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: There is a 5 mm focal hyperdensity, possibly an intraductal stone at\nthe pancreatic tail with an upstream area of hypodense heterogeneity measuring\n2.1 x 1.2 cm, which may reflect a dilated duct.  The remainder of the pancreas\nis normal.\n\nSPLEEN: Spleen is enlarged measuring 14.7 cm in the axial plane.  No focal\nsplenic lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are normal in size with normal nephrograms.  There are\nbilateral nonobstructing renal calculi measuring up to 7 mm (series 5, image\n33).  A 3.1 cm simple left renal cyst appears benign.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild wall\nthickening of the cecum, transverse and sigmoid colon, as well as focal areas\nof the descending colon and rectum.  Mild adjacent pericolonic fat stranding\nand small focus of fluid along the rectal wall on the right lateral aspect are\nnoted (series 5, image 77).  Findings are compatible with proctocolitis.  The\nappendix is borderline enlarged measuring up to 7 mm, however this is likely\nsecondary to the colonic inflammation.  Some mesenteric stranding is\ndemonstrated centrally, however this may be secondary to prior lymphoma.\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.\n\nVASCULAR: Focal infrarenal outpouching near the bifurcation measuring up to\n2.3 cm (series 5, image 45).  Mild atherosclerotic disease is noted.  There is\nsome stranding along the periaortic lymph nodes consistent with treatment\nchanges from prior lymphoma.\n\nBONES: There are 6 non-rib-bearing lumbar type vertebral bodies with the\nlowest rib-bearing vertebral body designated as T12 and partial lumbarization\nof the S1 vertebral body.  Multilevel degenerative changes are demonstrated at\nthe lumbar spine most predominantly at L4 and S1, with mild height loss. \nThere is moderate height loss at T11, as seen on the prior MRI.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Median\nsternotomy wires are noted.",
            "output": "1. Mild proctocolitis, with multiple areas of inflammation involving the\ncecum, transverse colon, sigmoid and descending colon as well as the rectum. \nSmall amount of free fluid.\n2. Mild mesenteric and periaortic fat stranding is likely related to prior\ntreated lymphoma.\n3. 5 mm focal hyperdensity within the pancreatic tail, which may represent a\nstone within the pancreatic duct with an adjacent upstream hypodense\nheterogeneous lesion at the pancreatic tail measuring 2.1 x 1.2 cm, possibly a\ndilated duct or cystic lesion.  Findings are new from ___ and\nrecommend further evaluation with MRCP on a nonemergent basis.\n4. Splenomegaly, not substantially changed since ___.\n5. Osseous changes include similar anterior height loss of the T11 vertebral\nbody, as well as compression deformities of L4 and S1, which may be secondary\nto treated lymphoma.\n\nRECOMMENDATION(S):  Nonemergent MRCP."
        },
        {
            "input": "LOWER CHEST:  Right hemidiaphragm is chronically elevated.  A left lower lobe\npleural-based rounded opacity is unchanged, likely benign (2:20).  Right lower\nlobe dependent atelectasis is again seen.  There are diffuse coronary artery\ncalcifications.  No pleural 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 or\nextrahepatic biliary dilatation.  Surgical clips in the gallbladder fossa\ndenote prior cholecystectomy.\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: Multiple bilateral renal hypodensities, likely simple cysts, are\ngrossly unchanged.  Bilateral peripelvic cysts are also unchanged.  The\nlargest cyst in the upper pole of the left kidney measures 7.0 x 6.9 cm\n(2:39).  No perinephric abnormality or concerning renal lesion is identified.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. The rectum contains a large amount of stool and\nmeasures 8.1 cm in diameter (2:83).  This is very similar to the prior CT from\n___. Appendix contains air, 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.  The suprarenal aorta\nmeasures 2.8 cm which is unchanged. There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nPELVIS: Urinary bladder is distended.  The prostate and seminal vesicles are\nunchanged in appearance. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES: Severe degenerative changes of the lumbar spine,\nincluding intervertebral disc space narrowing and vacuum disc phenomenon is\nagain seen in stable.  There is grade 1 retrolisthesis of L2 on L3 and L3 on\nL4, as seen previously.  Bridging osteophytes are unchanged. Patient is post\nright inguinal hernia repair.",
            "output": "1. 8.1 cm stool ball in the rectum.  No evidence of small bowel obstruction or\ndiverticulitis.\n2. Distended bladder.\n3. Unchanged marked 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: The liver demonstrates homogenous attenuation throughout. \nAgain seen is a 7.7 cm hemangioma in segment VII.  Other subcentimeter tiny\nhemangiomas are unchanged seen on images 57, 58, 48 and 71.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis surgically removed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Uncomplicated 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.  The\nsoft tissue at the porta hepatis decreased in size since prior measuring today\n1.9 x 3.1 cm (series 4, image 64), previously measuring 3.6 x 2.4 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": "1. Interval decrease in size in the soft tissue around the porta hepatis\nbiopsy proven IgG 4 disease.\n2. Please refer to separate chest CT done the same day 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. \nRedemonstration of 5 liver hemangiomas, with largest on the right lobe\nmeasuring 8.0  X 6.6 cm.  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 6.5 cm 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: The soft tissue at the porta hepatis decreased in size since\nprior measuring today 14 x 21 mm (series 2, image 63) compared with 19 x 31 mm\npreviously.  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 decrease in size of the soft tissue around the porta hepatis\nbiopsy-proven IgG 4 disease.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Partially imaged asymmetric ground-glass patchy opacity of the\nleft base may represent atelectasis, or alternatively pneumonia in the\nappropriate setting.  There is no evidence of pleural or pericardial effusion.\nCardiac device leads are only 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 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 13 mm left interpolar renal cyst.  Otherwise, 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. Diverticulosis of\nthe colon 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 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. \nMultilevel degenerative changes of the visualized thoracolumbar spine are\nnoted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Partially imaged asymmetric left basilar ground-glass pulmonary opacities\nmay represent atelectasis or alternatively pneumonia in the appropriate\nclinical setting.\n2. No acute abdominopelvic process.\n3. Specifically, no evidence of appendicitis, nephrolithiasis, obstructing\nureteral stones or hydronephrosis.\n4.  Diverticulosis without evidence of acute diverticulitis.\n5. 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 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 base and the midportion of the appendix\nis dilated measuring up to 9 mm with hyperemic mucosa, compatible with acute\nappendicitis.  Extensive fat stranding is noted around the inflamed portion of\nthe appendix.  However, there is no discrete, rim enhancing fluid collection\nor evidence perforation.  Mesenteric lymph nodes measuring up to 8 mm in the\nshort axis in the left lower quadrant are likely reactive.\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 grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Acute, uncomplicated appendicitis.  No perforation or drainable fluid\ncollection.  Reactive lymphadenopathy."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions.  Atelectasis is\nnoted at the lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant.  The liver\ndemonstrates heterogeneous attenuation with somewhat geographic areas of lower\nattenuation measuring 25 Hounsfield units in the segments as 8 7 and 6.  A\ndrain is identified surrounding the liver transplant 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: The kidneys are enlarged and contain multiple cysts, some with\ncalcifications consistent with post cystic kidney disease.  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.  Oral contrast is identified\ndown to pelvic small bowel loops.  There is no oral contrast in the colon yet.\nThere is no focal fluid collection.  The colon and rectum are within normal\nlimits.\n\nPELVIS: The patient is status post renal transplant in the right iliac fossa. \nA drainage catheter is seen surrounding the kidney.  There is a 8.8 x 5.1 cm\nhyper dense fluid collection posterior to the kidneys on series 2 ___ 58. \nThis measures 61 ___ consistent with hematoma.  The kidney contains a ureteral\nstent this is in adequate position and there is no hydronephrosis.  More\ninferiorly on series 2, ___ 76 days is second hyper dense area measuring 4.5 x\n3.2 cm also measuring 75 ___ consistent with hematoma.\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 a healed fracture of the right inferior pubic ramus on series 2 ___\n95\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post liver transplant with low-density areas in several segments of\nthe liver concerning for infarcts and raising the possibility of hepatic\nartery thrombosis.  Recommend repeat liver Doppler ultrasound to assess for\nflow in the if attic artery\n2. Status post renal transplant in the right iliac fossa with 2 perinephric\nhematomas as described above\n3. No evidence of intra-abdominal abscess\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:56 pm, 1 minutes after\ndiscovery of the findings."
        },
        {
            "input": "There is right lung base atelectasis. There is no pleural or pericardial\neffusion.\n\nIn the left omentum, again seen is a 2.6 x 3.6 cm soft tissue density lesion\nsurrounded by fat, stable since prior study and is likely focal fat necrosis.\n\nPatient is status post distal pancreatectomy, splenectomy, and\ncholecystectomy. There is intra-hepatic biliary dilatation, stable since prior\nstudy but is new since prior to cholecystectomy and is likely postsurgical\nrelated.\n\nLeft adrenal medial limb nodule is stable. The right adrenal gland is normal.\n\nThe kidneys are normal with symmetric nephrograms. A 3.2 cm x 3.2 cm bladder\ndiverticulum is incidentally noted.\n\nThe stomach and bowel loops show no evidence of obstruction.  No bowel wall\nthickening is seen.  A small fat-containing ventral hernia is seen at the\nlevel of L4. The appendix is normal. There is no free air or free fluid in the\nabdomen or pelvis. Prominent mesenteric and inguinal lymph nodes are again\nnoted, however they are not enlarged.\n\nThe aorta is normal in caliber. Patient is status post aorto-bifemoral bypass.\n\nL5-S1 spinal hardware is again seen without evidence of bony or hardware\nfracture. There are no suspicious bony lesions.",
            "output": "1.  Patient is status post pancreatic tail resection, splenectomy and\ncholecystectomy with stable post-surgical-related intra-hepatic ductal\ndilatation.\n2. No acute intraabdominal process.  Normal appendix.  No diverticular\ndisease.\n3. Stable 2.6 x 3.6 cm left omental soft tissue density structure with\nsurrounding fat, likely focal fat necrosis.\n4. Small supraumbilical ventral fat containing hernia at the level of L4.\n5. Stable left adrenal nodule."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar atelectasis.  Coronary arterial\ncalcifications are noted.  5 mm right lower lobe pulmonary nodule (2:4) is new\nsince ___.\n\nABDOMEN:\n\nThe right abdomen touches the gantry, causing artifact that obscures\nassessment of the right lower quadrant.  The soft tissues of the right abdomen\nare also incompletely imaged.\n\nHEPATOBILIARY:  The liver is homogeneously 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 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.  Again seen is an\nintermediate density lesion in the interpolar region of the right kidney,\nmeasuring approximately 6.4 cm in greatest dimension, not significantly\nchanged since recent examination, and correlating to a complex cystic mass\nseen on MR.  ___ asymmetric ___ perinephric stranding is noted. \nThere is no hydronephrosis or urinary tract calculus.\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 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multilevel degenerative changes are seen throughout the lower\nthoracic and lumbar spine, worst at L5-S1.",
            "output": "1. Grossly unchanged appearance of right renal complex cystic mass, better\ncharacterized on the previous MR.\n2. No acute abnormality identified.  Specifically, no hydronephrosis or\nnephroureterolithiasis.\n3. Hepatic steatosis.\n4. 5 mm right lower lobe pulmonary nodule, new compared to the previous chest\nCTA from ___.  Dedicated chest CT is recommended for further assessment.\n\nNOTIFICATION:  Impression #4 discussed with Dr. ___ at 5:12pm, ___ by Dr. ___ by phone."
        },
        {
            "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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is is resected.  Multiple\nsurgical clips 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: The kidneys are of normal and symmetric size with normal background\nnephrogram.  Again seen is a heterogenously enhancing, centrally hypodense\npartially exophytic mass, measuring up to 7.0 x 5.7 cm, not significantly\nchanged compared to ___, though direct comparison is somewhat\nlimited due to lack of contrast from prior scan (03:36).  There was minimal\nwashout and no significant central opacification on delayed imaging.  Fiducial\nmarker in place.  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. Colon and rectum are within normal limits. \nAppendix is not visualized.  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: The uterus appears remarkable the ovaries are not\nwell-seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the thoracic and lumbar spine seen.\n\nSOFT TISSUES: Small fat containing umbilical hernia is seen.",
            "output": "1. 7.0 cm heterogeously enhancing, centrally hypodense right renal mass,\nconcerning for a renal cell carcinoma has not significantly changed in size.\n2. No evidence of distant metastatic disease."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild-to-moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  Focal narrowing\nof the main portal vein is similar to prior (4:104), with multiple\ncollaterals.\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. \nThere are scattered small hypodense lesions, too small to characterize, likely\nrepresenting cysts or hamartomas.  There is moderate pneumobilia of the\nintrahepatic and extrahepatic ducts, consistent with recent ERCP, with CBD\nstent in place.  The gallbladder is contains small layering stones and a small\namount of air.\n\nPANCREAS: The pancreas head and tail has normal attenuation throughout,\nwithout evidence of focal lesions.  The body of the pancreas is\nhypoattenuating.  There is a predominantly air-filled pocket along the lesser\ncurvature of the stomach with a small amount of fluid which is decreased\nconsiderably from prior study, measuring 2.2 x 3.3 cm in largest dimension in\nthe axial plane (4:102), previously 2.8 x 5.2 cm, status post removal of Axios\nstent.  A tract extends superiorly from this collection to a heterogeneous\ncollection of complex soft tissue and air in the left subphrenic space, which\nmeasures 3.8 x 7.4 cm, new from prior.  Additional collections of air and\nfluid extend inferiorly along the fascial planes, which are decreased in size\nfrom prior.  For example, a 0.9 x 0.4 cm rim enhancing collection of fluid\nanterior to the left kidney previously measured 2.0 x 0.8 cm (04:35). \nPeripancreatic stranding has decreased.  There is prominence of the main\npancreatic duct in the pancreatic tail, measuring 3 mm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  A 0.7 cm\nhypodensity along the posterior margin is too small to characterize, likely\nrepresenting 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 stones or hydronephrosis.  A 1.9 cm cyst in the lower\npole of the left kidney is slightly increased from prior, previously 1.0 cm. \nMultiple additional bilateral hypodensities are too small to characterize. \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.  There is diverticulosis of the colon without\ndiverticulitis.  There 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. There is no\nevidence of pelvic or inguinal lymphadenopathy. There is trace free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is again seen, with bilateral pars\ninterarticularis lysis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. A now predominantly air-filled pocket along the lesser curvature of the\nstomach with a small amount of fluid has decreased considerably from prior\nstudy.  A tract extends superiorly from this collection to a new 7.4 x 3.8 x\n4.8 cm left subphrenic collection of complex soft tissue and air, most likely\nrepresenting a phlegmon.  Areas of hyperdense tissue within the collection may\nrepresent clot, however given the lack of a  non-contrast series , presence of\nenhancing soft tissue cannot be completely excluded. The previously noted\nAxios stent has been removed.\n2. Presence of an underlying pancreatic mass cannot be evaluated on this\nstudy.\n3. The patient is status post ERCP with CBD stent placement, with expected\npneumobilia.\n4. Focal narrowing of the main portal vein is similar to prior, with multiple\ncollaterals.\n5. Cholelithiasis without evidence of cholecystitis.\n6. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings."
        },
        {
            "input": "LOWER CHEST: Again seen is a 1.0 cm right lower lobe pulmonary nodule (4:3),\nunchanged.  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 similar moderate intrahepatic\nbiliary ductal dilatation.  The gallbladder remains distended and contains\nlayering hyperdense material, likely representing gallstones and/or sludge.\n\nPANCREAS: There is a new 0.6 x 0.3 x 1.4 cm hyperdensity within the distal\ncommon bile duct with upstream dilatation.  Re-demonstrated are multiple\nperipancreatic fluid collections.  There has been interval placement of a\ncysto gastrostomy stent, with oral contrast seen within the more medial\nperipancreatic collection.  There has been interval decrease in size in the\ndominant, encapsulated collection currently measuring 10.4 x 5.8 cm,\npreviously 15.3 x 11.7 cm (04:26).  There are foci of gas within the dominant\ncollection secondary to communication with the stomach, with superinfection\nnot excluded.  There is a similar, small tongue like projection arising from\nthe inferior margin of the dominant cystic collection extending to the right\n(04:44).  A second fluid collection adjacent to the pancreatic tail is\nunchanged, if not minimally decreased in size, currently measuring 6.2 x 2.7\ncm, previously 6.3 x 3.1 cm (04:39).  The third fluid collection in the left\nhemiabdomen is slightly decreased in size currently measuring 3.6 x 1.5 cm,\npreviously 3.7 x 2.7 cm (04:50).  Similar prior, there is minimal remnant\npancreatic parenchyma in the head/uncinate process, which enhances normally.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 1.2 cm hyperdense, exophytic cyst is again seen arising from the lower pole\nof left kidney (04:46).  There are multiple bilateral hypodensities, some\nwhich are too small to characterize, but statistically likely represent simple\ncysts.  There is no evidence of hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Aside from interval cysto gastrostomy stent placement, a\nthere is soft tissue stranding about the stomach antrum right upper quadrant,\npossibly centered in the Portal region..  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Possible pericolonic\ninflammatory stranding of the descending: Adjacent to the loculated Fluid\ncollection 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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Similar to prior, there are multiple prominent retroperitoneal\nnodes measuring up to 8 mm in the left periaortic region, likely reactive. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is similar, severe narrowing of the main portal vein at the\nporta hepatis (04:29) without complete occlusion.  There are numerous gastric\nand mesenteric varices.  There is no abdominal aortic aneurysm.  Mild\natherosclerotic disease is noted.\n\nBONES: Re-demonstrated is bilateral L4 pars interarticularis lysis with grade\n1 anterolisthesis of L4 on L5.  There are no aggressive osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New 1.4 cm hyperdense in the distal common bile duct with upstream biliary\ndilatation, concerning for choledocholithiasis and biliary obstruction. \nRecommend clinical correlation for possible developing cholangitis.\n2. Persistent distension of the gallbladder with multiple layering calculi.\n3. Soft tissue stranding about the right upper quadrant, possibly centered in\nthe periportal region.  Given presence of gallbladder distension\ncholelithiasis, recommend clinical correlation for cholecystitis.\n4. Interval decrease in size in the dominant peripancreatic collection status\npost cyst gastrostomy stent placement. The additional fluid collections are\nsimilar, if not decreased, in size.  Multiple foci of air within the dominant\ncollection, presumably secondary to communication with the stomach.  However\nsuperinfection is not excluded.\n5. Unchanged severe compression of the main portal vein with gastric and\nmesenteric varices.\n6. Similar degree of intrahepatic biliary ductal dilatation.\n7. Unchanged 1.2 cm hemorrhagic cyst arising off the lower pole of the left\nkidney.\n8. Unchanged 1 cm right lower lobe pulmonary nodule.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:37 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lung Bases:  There is diffuse bilateral airspace opacities and areas of\nconfluent consolidation at the lung bases bilaterally.  Bronchiectasis is\nnoted at bilateral lung bases.  Findings are concerning for multifocal\npneumonia.  No pleural effusion.\n\nAbdomen: Common bile duct is dilated upto 1.9 cm in diameter. Pancreatic duct\nis mildly dilated to 4 mm without evidence of pancreatitis. No obvious\nintrahepatic biliary duct dilation is noted. Gallbladder is absent. There is\nsmall amount of ascites.  Small bowel loops are mildly dilated up to 3.3 cm\nfrom proximal jejunum.  Possible transition point is noted midline above the\npubic symphysis. (602b:39).\nThe liver, spleen, and adrenal gland are unremarkable.  Kidneys are\nunremarkable.   The stomach and duodenum are unremarkable. Colon is normal\ncaliber. The appendix is unremarkable.\nNG tube is in place with its distal tip in the stomach.\nThere is moderate to heavy atherosclerotic mural calcification of the\nabdominal aorta and bilateral common iliac arteries. Heavy calcification is\nnoted at the origins of the celiac trunk, SMA, and bilateral renal arteries. \nNo lymphadenopathy is identified.\n\nPelvis:  Foley catheter is noted in the bladder.\n\nBones/ soft tissue: No worrisome lytic or blastic  lesion is seen.   \nSubcutaneous gas in the lower abdomen is likely related to possible\nsubcutaneous injections.",
            "output": "1.  Mildly dilated small bowel loops could be secondary to ileus or partial\nobstruction. Followup is recommended.\n\n2. Dilated common bile duct and pancreatic duct. If there is clinical concern\nfor biliary obstruction, consider MRCP for better evaluation.\n\n3.  Small amount of ascites.\n\n4.  Bronchiectasis and multifocal airspace opacities at bilateral lung bases,\nconcerning for multifocal pneumonia."
        },
        {
            "input": "LOWER CHEST: There are trace bilateral pleural effusions, right greater than\nleft.  There is bibasilar atelectasis.  Additionally, there is heterogeneous\nenhancement of the peripheral aspect of the right basilar atelectasis,\nconcerning for a right basilar pneumonia.  Please see dictation from\nconcurrent CT chest for full description of intrathoracic 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 ductal dilatation, with common bile duct measuring\napproximately 8 mm immediately proximal to the ampulla.  There is dilation of\nthe hepatic veins with mild periportal edema.  The gallbladder is not\nvisualized.  There is trace volume, serous 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: Patient is status post gastric bypass.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis an atypical appearance of intraluminal contrast at the splenic flexure,\nwhich probably reflects laminar flow.  No convincing suggestion of underlying\ncolitis.  The appendix is normal.\n\nPELVIS: There is air within the anterior aspect of the urinary bladder, likely\ndue to recent catheterization.  Foley catheter appears in situ.  Bladder is\notherwise 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.  Right ventricular Impella traverses from the right common femoral\nvein into the right ventricle with tip projecting out of the field of view.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is at a small left inguinal hernia.  Patient is status\npost bilateral breast augmentation.",
            "output": "1. Trace bilateral pleural effusions, right greater than left.  Heterogeneous\nenhancement of the peripheral aspect of the right basilar atelectasis is\nconcerning for underlying right basilar pneumonia.  Please see separate\ndictation from concurrent CT chest for full description of intrathoracic\nfindings.\n2. Mild intrahepatic and extrahepatic biliary ductal dilatation without\nobstructing process, which is not clearly identified. If clinically indicated,\nconsider MRCP.\n3. Atypical appearance of intraluminal contrast at the splenic flexure likely\nrepresents laminar flow and incomplete mixing.\n4. Evidence of right heart failure includes dilated hepatic veins, periportal\nedema, and trace abdominal ascites."
        },
        {
            "input": "LOWER CHEST: There is a small left partially loculated pleural effusion,\nslightly increased compared to prior CT dated ___.  Otherwise, the\nlung bases appear clear.  A 7.2 cm x 4.9 cm left anterior mediastinal mass, is\nincompletely visualized, however appears similar to prior exam where it\nmeasured 7.4 cm x 5.3 cm.  No soft tissue plane is visualized between it and\nthe main and left pulmonary artery.  Additional epicardial soft tissue nodule\nmeasures 2.7 cm x 1.9 cm (series 2: Image 14), similar to prior exam.  Within\nthe paramediastinal region of the left lower lobe there are areas of soft\ntissue density bronchiectasis which in the setting of cancer may reflect post\ntreatment changes, similar to prior exam.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  Mild\nprominence of the common bile duct may relate to post cholecystectomy state. \nThe gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter. \nWell-circumscribed hypoattenuating lesion is demonstrated within the inferior\npole of the left kidney and likely represents a simple renal cyst.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness. The colon and rectum are within normal limits.  Moderate stool\nburden.  The appendix is not visualized.\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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Multilevel degenerative changes are seen.  Sclerotic lesion within the\nL1 vertebral body (series 602: Image 43) is again seen, consistent with\nmetastatic disease better demonstrated on prior PET scan performed ___. \nNo additional bony lesions are demonstrated.  Degenerative changes are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild prominence of the common bile duct may relate to post cholecystectomy\nstate.  Correlate with LFTs.  Otherwise, no definite acute CT findings seen in\nthe abdomen or pelvis.\n2. Slight interval increase in partially imaged small loculated left pleural\neffusion since most recent exam dated ___.\n3. Stable size of partially visualized left anterior mediastinal mass.\n4. Again seen soft tissue density within the paramediastinal region of the\nleft lower lobe with areas of traction bronchiectasis which is nonspecific,\nbut may represent post treatment changes.\n5. Stable size of enlarged cardiophrenic lymph node."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Two similar-sized left-sided\npericardial lymph nodes are seen, wall one which measures 21 x 29 mm\n(previously 20 x 27 mm), and an adjacent one which measures 19 x 15 mm\n(previously 20 x 14 mm).\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.  Slight prominence of the common duct seen on the prior study is\nno longer evident today.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is somewhat atrophic but 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 kidneys are of normal and symmetric size.  There is a cystic\nlesion of the lower pole of the left kidney measuring approximately 4.3 x 3.3\nx 3.7 cm.  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.  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 has a nodular contour suggestive of fibroids. \nThe visualized reproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There are multiple enlarged periaortic lymph nodes.  The largest\nis a left periaortic node measuring 1.8 x 2.4 x 2.9 cm (series 3, image 56),\nnot appreciably changed.  There is a right-sided node measuring 1.2 cm in\ndiameter (series 3, image 60).  These nodes are similar in size to ___.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There are multilevel degenerative changes of the thoracolumbar spine. \nThere is near complete sclerosis of the L1 vertebral body consistent with\nknown metastatic disease, similar in appearance to ___.  There are\nno new bone lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There is periaortic lymphadenopathy which is unchanged in size from ___.  There are no new enlarged lymph nodes.  Similar pericardial\nadenopathy.\n2. Metastatic lesions to the L1 vertebral body are unchanged from ___.  There are no new lesions.\n3. Thoracic findings are reported separately."
        },
        {
            "input": "LOWER CHEST: Please refer to intrathoracic findings on the detailed chest CT\nreport from the dedicated chest CT performed concurrently on the same day.\n\nABDOMEN:\nThe left hemidiaphragm remains significantly elevated relative to the right\nside, possibly related to phrenic nerve palsy.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nPneumobilia is noted in the left lobe.  No focal liver lesions identified\nwithin limitations of this noncontrast enhanced exam.  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 is not enlarged.  There is a subtle hypodensity within the\nspleen causing a convex margin at the splenic hilum and measuring\napproximately 4 x 3.1 cm (2:91), that is not completely characterized due to\nlack of intravenous contrast.\n\nADRENALS: No adrenal nodules.\n\nURINARY: Left renal lower pole cyst measuring 3.8 x 3.1 cm is stable.  No\nhydronephrosis seen on either side.\n\nGASTROINTESTINAL: 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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again visualized are enlarged left para-aortic lymph nodes with\nno significant change when remeasured at a comparable level on the prior exam.\nA dominant node measures approximately 1.9 x 2.7 x 2.7 cm in size (2:122). \nThis node demonstrates inseparable fat planes with the adjacent aorta.  No new\nlymphadenopathy seen in the retroperitoneum or pelvis.\n\nVASCULAR: The abdominal aorta is tortuous without aneurysmal dilation. \nModerate atherosclerotic disease is noted.\n\nBONES: Multilevel degenerative changes of the lumbar spine noted.  Again\nvisualized is complete sclerosis involving the L1 vertebral body consistent\nwith the known metastatic disease similar to prior.  No pathologic fractures\nor compression deformity seen.  No new focal suspicious lesions identified in\nthe visualized bones.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable size of left para-aortic lymphadenopathy, unchanged dating back to\n___.  No new abdominal or pelvic lymphadenopathy.\n2. Similar appearance of metastatic lesions to the L1 vertebral body with no\npathologic fracture.  No new osseous lesions identified.\n3. The contour of the spleen appears convex at the hilum with a possible\nhypoattenuating lesion at this site, incompletely characterized due to lack of\nintravenous contrast.  This appearance is similar to the prior exam.\n4. Please refer to intrathoracic findings on the detailed chest CT report from\nthe dedicated chest CT performed concurrently 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: Normal hepatic morphology.  The liver otherwise 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 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 attenuation throughout.  Redemonstration of a\n4.1 x 2.3 cm region of convexity at the splenic hilum, difficult to\ncharacterize in the absence of intravenous contrast, but similar to\nattenuation from the spleen and stable 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.  Exophytic simple renal\ncyst within the left inferior pole measures up to 4 cm.  There is no\nsuspicious renal lesions within the limitations of an unenhanced scan.  There\nis no hydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The left hemidiaphragm is elevated.  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 uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: Redemonstration of multiple enlarged left para-aortic lymph\nnodes, largest measuring 2 cm across the short axis (4:101), similar dating\nback to at least ___.  There is no discernible fat plane between the\nlymph node with the aorta. There is no pelvic or inguinal lymphadenopathy.  7\nmm nodule anterior inferior to the spleen measuring 7 mm likely representing\nan enlarging omental nodule/lymph node.\n\nVASCULAR: Tortuous abdominal aorta with no abdominal aortic aneurysm. \nModerate atherosclerotic disease is noted.\n\nBONES: Complete sclerosis of the L1 vertebral body, in keeping with known\nmetastatic disease.  No evidence of pathological fractures.  Moderate\ndegenerative changes of the imaged spine, most prominent at the L2-3 level.\n\nSOFT TISSUES: Supraumbilical fat containing hernia, with a neck size of 1.6\ncm.",
            "output": "1. Stable left para-aortic lymphadenopathy, not substantially changed from\n___.\n2. 7 mm nodule anterior inferior to the spleen measuring 7 mm is new/increased\ncompared to prior imaging and most likely represents an enlarging metastatic\nomental nodule/lymph node as this was not previously seen.  Less likely it\ncould represent a small accessory spleen previously obscured by the colon, but\nthis is less likely.\n3. Similar appearance of known sclerotic metastatic lesion to the L1 vertebral\nbody.  No evidence of pathologic fracture.  No 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 decreased attenuation throughout,\ncompatible with steatosis.  There is a stable small hemangioma or vascular\nmalformation noted within the right hepatic lobe (series 2, image 13).  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.\nd\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere appears to be a duplicated left renal collecting system.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post total\ncolectomy with diverting ileostomy in the right lower quadrant.  There is a\nstable peristomal hernia in the right lower quadrant.  No evidence for bowel\nobstruction.  Again noted are duodenal diverticuli, unchanged/similar.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Known fibroid uterus again deep in the pelvis.  No\nadnexal abnormality seen. 4\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 along the partially imaged spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Postoperative changes status post total proctocolectomy with stable right\nlower quadrant ileostomy and parastomal hernia.  No evidence for bowel\nobstruction.  No acute cause for patient's pain."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There are\nextensive mitral annular calcifications.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN: Trace free fluid most notably in the right paracolic gutter is\ndecreased from prior.\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: There is diffuse pancreatic atrophy.  There is no pancreatic ductal\ndilation.  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 kidneys are atrophic, right greater than left.  There\nis no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There has been interval near\nresolution of  mesenteric fat stranding centered about the second and third\nportions of the duodenum.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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: An infrarenal abdominal aortic aneurysm measures up to 4.0 x 3.3 cm,\nsimilar to prior.  Right periaortic soft tissue prominence is unchanged. \nModerate to severe atherosclerotic disease is noted, most notably at the\norigin of the right renal artery.  The infrarenal IVC is chronically occluded,\nwith collaterals noted in the retroperitoneum.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTransitional lumbosacral vertebral body.  Grade 1 retrolisthesis of L1 on L2.\n\nSOFT TISSUES: Diffuse anasarca.  Subcutaneous injection granulomas.  Small fat\ncontaining umbilical hernia.",
            "output": "1. No new lymphadenopathy. Stable right periaortic soft tissue prominence.\n2. Near resolution of inflammatory process surrounding the duodenum and\ndecrease of fluid in the right pericolic gutter, now minimal.\n3. Stable 4 cm infrarenal abdominal aortic aneurysm.\n4. Chronically occluded infrarenal IVC."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion. Please see a separate report discussing findings within\nthe thorax.\n\nABDOMEN:\n\nProminent para-aortic lymphadenopathy inferior to the renal veins (series 2,\nimage 66, 73 and 75) have  decreased in size, now measuring 3.2 x 2.3 cm,\npreviously 4.4 x 2.8 cm.  The circumferential para-aortic soft tissue mass\ncontinues to abut the anterior and right lateral surfaces of the abdominal\naorta.  Given noncontrast technique, cannot assess for intraluminal extension\nor ulceration, though there is no evidence of new fluid collection or new\naortic aneurysm. As before, there is a hazy appearance to the mesentery with\nno enlarged mesenteric lymph nodes, findings which can be seen with lymphoma.\n\nNoncontrast evaluation of the intra-abdominal solid organs is limited.\n\nThe liver is normal in size with no focal lesions. The gallbladder is normal\nwith no radioopaque gallstones. The pancreas is normal with no peripancreatic\nfat stranding or fluid collections. The spleen is normal in size and\nhomogeneous in attenuation. The adrenal glands are normal in size and\nmorphology. The kidneys are normal in size with no evidence of hydronephrosis,\nstones, or focal lesions.\n\nThe distal esophagus and stomach are normal. The small and large bowel are\nnormal in caliber with no wall thickening. There are scattered sigmoid\ndiverticula without evidence of diverticulitis. The appendix isnormal. There\nis no intraabdominal free air or free fluid.  Fat containing umbilical hernia\nis small.\n\nPELVIS: The urinary bladder is largely decompressed, grossly normal. The\nuterus and adnexae are not visualized. Minimally prominent pelvic sidewall\nlymph nodes are smaller than prior examination, and still not enlarged by CT\nsize. No free pelvic fluid is identified.\n\nVESSELS: The aorta contains mild atherosclerotic calcification and measures 5\nmm at its largest dimension, in the infrarenal portion.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Interval  decrease in size of para-aortic lymphadenopathy with no new lesions\nidentified.  Cannot assess for aortic invasion or ulceration in the setting of\na noncontrast examination, although there is no evidence for new fluid\ncollection or aneurysm.  Minimally prominent pelvic sidewall lymph nodes are\nnot enlarged by CT size criteria, and have decreased in size since the prior\nstudy.."
        },
        {
            "input": "CHEST:\n\nFor details regarding the chest, please see dedicated chest CT report\n\nABDOMEN:\n\nEvaluation of the solid organs and tissues is limited without intravenous\ncontrast. The liver has a normal noncontrast appearance with no focal lesions\nor intrahepatic biliary dilatation. The gallbladder, pancreas, spleen and\nadrenal glands are unremarkable.  The kidneys have a normal noncontrast\nappearance without stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  There is diverticulosis without evidence of diverticulitis The\nappendix is  visualized and there is no evidence of appendicitis.  No ascites,\nfree air or abdominal hernia.  The abdominal aorta demonstrates moderate\natherosclerotic calcifications. An infrarenal abdominal aortic aneurysm\nmeasures 3.3 x 3.3 cm, unchanged dating back to ___.\n\nThe previously seen misty mesentery is somewhat less conspicuous. The\nperiaortic lymphadenopathy has decreased with the largest node now measuring\n3.1 x 0.8 cm, previously 2.9 x 1.8 cm (3:65).\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.",
            "output": "1. Interval slight decrease in periaortic adenopathy with no new\nlymphadenopathy identified.\n2. Stable infrarenal abdominal aortic aneurysm measuring 3.3 x 2.3 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. \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 right kidney is smaller in size than the left as previously. \nThere has been further resolution of the right hydronephrosis and nephrogram\nappears more symmetrical today than the previous scan.  Slight delay of\nexcretion from the right remains but improved since the previous exam..  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. 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: Right para-articular soft tissue mass encasing the renal IVC is\nagain seen measuring 1.5 cm  transverse by 6.3 cm in length (image 601; 38)\nthis has not changed appreciably since the previous exam.  There is no\nmesenteric lymph node enlargement..  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is stable infrarenal abdominal aortic aneurysm measuring 3.9\ncm in greatest diameter..   occlusion of the infrarenal IVC is seen. \nCollaterals in the left para-aortic region reconsidered venous drainage into\nthe suprarenal IVC via left gonadal vein into left renal 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. Stable right the para-aortic confluent mass with no significant change\nsince ___.  No new lymph node enlargement.\n2. Stable abdominal aortic aneurysm, 3.9 cm\n3. Occlusion of the infrarenal IVC and reconstitution of venous drainage into\nthe right suprarenal IVC via left para-aortic collaterals to left renal vein\n4. Further resolution of 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 liver demonstrates homogenous attenuation throughout. \nThere is suggestion of several small subtle hypodensities in the liver which\nwere not previously seen (02:44,38,56; 601:47,26,40).  For example, a lesion\nat the hepatic dome measures 14 mm (02:30).  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 right kidney is asymmetrically small compared with the left,\nunchanged.  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\ntrace free fluid in the pelvis, new from prior.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Soft tissue density along the right side of the aorta is not\nsignificantly changed from prior (2:72).  There is no retroperitoneal\nlymphadenopathy.  A 9 mm mesenteric lymph node is borderline enlarged, however\nis increased in size from prior, previously measuring up to 6 mm (2: 60).  A\nright pelvic sidewall lymph node is decreased in size from prior, currently\nspanning up to 8 mm compared with 13 mm previously (2:97).  There is no pelvic\nor inguinal lymphadenopathy.  Haziness of the mesentery is similar to prior.\n\nVASCULAR: An infrarenal abdominal aortic aneurysm measuring up to 3.9 cm is\nnot significantly changed.  Moderate atherosclerotic disease is noted.  There\nis unchanged occlusion of the infrarenal IVC with unchanged collaterals\ndraining into the suprarenal IVC via the left gonadal vein and left renal\nvein.\n\nBONES: Mild degenerative changes the spine are not significantly changed. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.",
            "output": "1. Suggestion of several new subtle hepatic hypodense lesions, not well\nevaluated on single phase CT, for which MRI liver or PET scan is recommended.\n2. Borderline enlarged mesenteric lymph node is slightly increased in size\nfrom prior.\n3. Stable right periaortic soft tissue with unchanged occlusion of the\ninfrarenal IVC.\n4. New trace free fluid in the pelvis.\n5. 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 PET 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 contains sludge but is otherwise unremarkable\n\nPANCREAS: There is fatty replacement of the pancreas.  No suspicious solid\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: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidney's are mildly atrophic, specifically the right kidney. \nIncreased perinephric stranding is seen bilaterally, presumably reflective of\nmedical renal disease.  There is no evidence of focal renal lesions within the\nlimitations of an unenhanced scan.  There is no hydronephrosis.  There is no\nnephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is diverticulosis within\nthe sigmoid colon.  Furthermore, there is a segment of sigmoid colon spanning\napproximately 10 cm and demonstrating a pericolonic stranding and inflammation\ncentered around several inflamed appearing diverticula.  There is no macro\nperforation or fluid collection identified.  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 mass.\n\nLYMPH NODES: Unchanged soft tissue density along the right side of the aorta\n(02:37).  There is no retroperitoneal lymphadenopathy.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: Infrarenal abdominal aortic aneurysm measures up to 3.8 cm and is\nnot significantly changed since prior.  Moderate atherosclerotic disease is\nnoted.  Known occlusion of the infrarenal IVC with collaterals draining into\nthe suprarenal IVC via the left gonadal vein and left renal vein is not well\nevaluated on this noncontrast study.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are noted throughout the lumbar spine.\n\nSOFT TISSUES: There is mild anasarca.  A tiny fat containing umbilical hernia\nis present.  A small amount of subcutaneous emphysema in the anterior\nabdominal wall is likely reflective of recent injections.",
            "output": "1. Acute uncomplicated sigmoid diverticulitis.\n2. Other additional findings described above are not significantly changed\nsince the CT scan of the abdomen and pelvis dated ___"
        },
        {
            "input": "LOWER CHEST: There is mild subsegmental atelectasis in the visualized left\nlung base.  There is no pleural effusion.  There is severe mitral annular\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypoattenuation of the hepatic parenchyma relative to the spleen is 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: There is moderate diffuse fatty atrophy of the pancreas.  There is\nno 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: There is moderate diffuse cortical thinning of the right kidney.  The\nleft kidney is normal in size.  Bilateral nephrograms are normal.  The right\nmid ureter is inseparable from the right ___ soft tissue stranding\ndetailed below, without obstruction.  There is no evidence of solid renal\nlesions or hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber.  There is fat\nstranding centered about the second and proximal third segments of the\nduodenum and central mesentery.  There is sigmoid diverticulosis, without\nfindings of acute diverticulitis.  The colon is otherwise unremarkable.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent and 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 severe atherosclerotic disease.  There is an infrarenal\nabdominal aortic aneurysm measuring up to 3.8 x 3.3 cm, unchanged compared to\nCT of the abdomen/pelvis from ___ (02:37).  Again seen is soft\ntissue prominence along the right aspect of the infrarenal abdominal aorta, in\nkeeping with sequelae of treated lymphoma, with associated mild tethering of\nthe duodenum.  There is new mesenteric fat stranding centered about the second\nand proximal third portions of the duodenum, the right ___ soft tissue\nprominence, and chronically occluded IVC.  The portal and mesenteric veins are\npatent.  There is unchanged chronic occlusion of the infrarenal IVC with\nretroperitoneal collaterals.  Moderate atherosclerotic disease is noted.\n\nBONES: Ill-defined sclerotic lesion in the posterior right ilium is similar to\nprior, and did not demonstrate FDG avidity on PET/CT from ___. \nThere is a transitional lumbosacral vertebral body.  There are moderate disc\ndegenerative changes at L1-2, with slight retrolisthesis of L1 on L2.\n\nSOFT TISSUES: Subcutaneous nodules with overlying skin thickening in the\nperiumbilical region likely represent injection sites.",
            "output": "1. Redemonstration of soft tissue prominence along the right aspect of the\ninfrarenal abdominal aorta, in keeping with sequelae of treated lymphoma, with\nassociated mild tethering of the duodenum.  New mesenteric fat stranding\ncentered about the second and proximal third portions of the duodenum, the\nright ___ soft tissue prominence, and chronically occluded IVC. \nFindings could reflect duodenitis or other nonspecific infectious or\ninflammatory process.\n2. 3.8 x 3.3 cm infrarenal abdominal aortic aneurysm.\n3. Sigmoid colonic diverticulosis without evidence of acute diverticulitis.\n4. Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: There are bilateral pleural effusions with associated\natelectasis, new since ___.  There is no evidence of pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is fatty but 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: Again seen 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: Again seen is moderate diffuse cortical thinning of the right kidney.\nThe left kidney is normal in size.  Bilateral nephrograms are normal.  There\nis no evidence of solid renal lesions or hydronephrosis.  Proximal right\nureter remains inseparable from the right periaortic soft tissue stranding. \nThere is no evidence of obstruction.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is otherwise\nunremarkable.  Is interval decrease in the stranding at the second and third\nsegments of the duodenum and mesentery.  Small bowel loops are distended\nwithout a transition point.  There is no evidence of perforation. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of perihepatic, right paracolic gutter and pelvic free fluid\nwhich is new since ___.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is a 1.4 cm left common iliac lymph node and an adjacent\n1.1 cm left common iliac node.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Again seen is moderate to severe atherosclerotic disease.  The\ninfrarenal abdominal aorta again measures up to 3.3 x 3.8 cm.  Again seen is\nlow density soft tissue prominence along the right aspect of the infrarenal\nabdominal aorta consistent with sequela of treated lymphoma.  There is mild\ninvolvement of the duodenum as described above.  There is decreased mesenteric\nfat stranding surrounding second and proximal third portions of the duodenum\nsince ___.  Again seen is prominence of the right periaortic soft\ntissue and a chronically occluded infrarenal IVC.  There is no evidence of\ncontrast extravasation or aortic wall defect.  The portal and mesenteric veins\nare patent.\n\nBONES: Stable sclerosis of the posterior right ilium similar to prior imaging.\nAgain seen is a transitional lumbosacral vertebral body.  There is moderate\ndegenerative disease at L1-2 with mild retrolisthesis of L1 on L2.\n\nSOFT TISSUES: Nodular soft tissue thickening in the periumbilical region is\nlikely related to prior injection.  Increased stranding of subcutaneous soft\ntissues is suggestive of anasarca/third spacing.  Small fat containing\numbilical hernia.",
            "output": "1. No evidence of perforation/leak of the duodenum.  There is decreased fat\nstranding compared to ___, suggesting an improving/resolving\ninflammatory process.\n2. New small amount of perihepatic/right paracolic gutter/pelvic free fluid,\nwhich is likely reactive.\n3. Distended small bowel loops are suggestive of developing ileus.  Please\ncorrelate clinically.\n4. There are enlarged left common iliac lymph nodes measuring up to 1.4 cm in\nshort axis which are nonspecific, these are unchanged since ___,\nand without FDG avidity above that of liver, on PET CT from ___. \nThese could be reactive, but lymphomatous involvement cannot be excluded.\n5. New bilateral pleural effusions with associated atelectasis. An underlying\ninfectious process can't be excluded.\n6. Interval development of anasarca/third spacing.\n7. Persistent soft tissue prominence of the right aspect of the infrarenal\nabdominal aorta consistent with sequela from treated lymphoma.  The aortic\nwall is intact.\n8. Abdominal aortic aneurysm measuring 3.8 x 3.3 cm is stable.\n9. The IVC is chronically occluded."
        },
        {
            "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: Again seen is atelectasis of the posterior right costophrenic\nangle, with more prominent volume loss in the right lower lobe compared to\nprior.  There is bronchial wall thickening and bilateral lower lobes with\nbronchiectasis, with improved mucous plugging compared prior.  Few tiny\nnodules predominantly centrilobular seen in the bilateral lower lobes,\nsimilar.  There is mild atelectasis in the left lower lobe, similar.  There is\nno pleural effusion.  There are coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild diffuse fatty liver.  There is cholelithiasis. \nNo biliary dilatation.  Patent hepatic, portal veins.\n\nPANCREAS: Normal pancreas.\n\nSPLEEN: Normal\n\nADRENALS: Normal\n\nURINARY: Normal bilateral kidneys.  No hydronephrosis.\n\nGASTROINTESTINAL: There is small esophageal hiatal hernia.  Status post total\ncolectomy, ileoanal anastomosis.  Stomach is not distended today.  Just\nproximal to the J-pouch, and right lower quadrant, there is approximately 10\ncm length of small bowel with mild mucosal thickening, mild hypervascularity,\nconsistent with active inflammation, with luminal narrowing.  There may be\nfistulous connection between this inflamed segment of small bowel and bowel\nloop immediately above it, just medial to the external iliac vessels series 3B\nimage 322 -317, coronal image 80.  Proximal to inflamed bowel loop there are\ndilated small bowel loops in the right abdomen, with most dilated loop\nmeasuring 6 cm, compared with 8 cm on MRI ___.  There are high\nattenuation contents within dilated small bowel loop just underneath right\nhepatic lobe series 2, image 38, which may represent ingested contents,\npossibly contrast or blood products.  There is no evidence of active contrast\nextravasation or hypervascularity near by or in the upper abdomen.  .  There\nis small volume mesenteric fluid in the right lower quadrant.  There is\nindeterminate wall thickening of right lower quadrant abdominal wall, may be\nreactive or inflammatory.  No pneumatosis.  No free air\n\nRETROPERITONEUM: There are few enlarged right lower quadrant lymph nodes,\nlargest measures 1.6 cm short axis, indeterminate, possibly reactive,\ncontinued follow-up recommended.\n\nPELVIS: Trace pelvic fluid.  No bladder abnormality.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: Degenerative changes spine, hips\n\nSOFT TISSUES: Postoperative changes of anterior abdominal wall, with abdominal\nwall diastases is stable.  Spine stimulator in place.",
            "output": "1. Active inflammation involving short segment small bowel just proximal to\nthe J-pouch.  Suggestion of fistula between this inflamed loop and adjacent\nsmall bowel loop.  Small bowel dilatation proximal to the inflamed small bowel\nloop has mildly improved since prior MRI.  Area of high attenuation within\nlumen of dilated small bowel in the right upper quadrant, nonspecific and\nindeterminate, may represent blood products; this bowel loop may be in\npotential fistulous communication with inflamed right lower quadrant bowel\nloop.\n2. There is small volume right mesenteric fluid.\n3. Indeterminate enlarged right lower quadrant lymph nodes, largest measures\n1.6 cm, possibly reactive, continued follow-up recommended."
        },
        {
            "input": "LOWER CHEST: Multiple calcified pulmonary nodules and masses are again noted,\nin keeping with patient's known ___ syndrome.  A small left pleural\neffusion is new. Increased nodular opacities the bilateral lung bases raise\nconcern for infection, less likely atelectasis. Coronary artery calcifications\nare of unknown hemodynamic significance. No pericardial effusion.\n\nABDOMEN:  Evaluation of the intra-abdominal organs is limited without\nintravenous contrast. The unenhanced liver is mildly enlarged but otherwise\nunremarkable.  Layering hyperdensity within gallbladder is sludge or stones.\nThe spleen is enlarged anteroposteriorly to 15.3 cm in keeping with known\nmyelodysplastic syndrome/CMML. The unenhanced pancreas and bilateral adrenal\nglands are normal.\n\nThere is mild right hydronephrosis. A right nephroureteral stent is noted with\npigtails in the renal pelvis and bladder. Small amount of hyperdensity within\nthe right collecting system may be residual contrast from a prior study.\n\nThe patient is status post left nephrectomy with anterolateral skin staples\nand a surgical drain in the nephrectomy bed.  A large hematoma with areas of\nhyper- and hypodensity occupies the entire left nephrectomy bed. It is\ndifficult to measure given the lobulated nature but measures approximately\n15.6 x 14.8 x 24.3 cm (5:48, 8:30).  The hematoma exerts mass effect on\nadjacent structures, pushing the left adrenal gland anteriorly, the spleen\nsuperiorly and displacing the duodenum and small bowel. It pushes the\ndescending colon anteriorly and surrounds the splenic flexure, which is\ndifficult to visualize. The hematoma extends along the entire length of the\nright psoas muscle to the inguinal canal. Foci of air within the hematoma as\nwell as the lateral abdominal muscles are presumably postsurgical.\n\nThere is no bowel obstruction. Nasoenteric tube ends within the stomach. The\nabdominal aorta is not aneurysmally dilated with moderate atherosclerotic\ncalcifications along its course. Evaluation for lymphadenopathy is\nsignificantly limited by the large hematoma. A left para-aortic lymph node is\n11 mm (05:53), similar to the preoperative CT from ___.  Non\nhemorrhagic ascites is noted in the right hemi-abdomen.\n\nPELVIS: A Foley catheter is within the bladder. The right nephroureteral stent\ndistal pigtail is coiled within the bladder.  The rectum and sigmoid colon are\ngrossly unremarkable.  Prostate is unremarkable. Free fluid in the\nrectovesicular pouch, with some layering hyperdensity suggesting blood\nproducts (5:88) is noted. Evaluation for pelvic and inguinal lymphadenopathy\nis limited, but no enlarged lymph nodes are identified.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  A 10mm nonaggressive appearing lesion with a sclerotic rim in the\nleft iliac wing (5:70) is unchanged from ___. There is diffuse\nbody wall edema.",
            "output": "1.  Status post left nephrectomy with massive hematoma in the left nephrectomy\nbed as detailed above extending into the left psoas muscle. The hematoma\ncauses mass effect on the intra-abdominal structures.  A surgical drain is\nwithin the hematoma.\n2.  Splenomegaly, in keeping with known myelodysplastic syndrome/CMML.\n3.  Multiple calcified pulmonary hamartomas are compatible with known ___\nsyndrome.  Nodular bibasilar opacities have increased since ___,\nconcerning for infection, less likely atelectasis.\n4.  Anasarca with body wall edema, non-hemorrhagic intra-abdominal ascites and\nsmall left pleural effusion.\n5.  Gallbladder sludge or layering stones."
        },
        {
            "input": "LOWER CHEST: New peribronchovascular nodular and ground-glass opacities in the\nleft lung base are concerning for an infectious/inflammatory process possibly\ndue to aspiration (02:12) there is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nScattered hypodensities which are too small to characterize are overall\nsimilar to prior CT in ___.  Several hepatic cysts are minimally\nlarger than in ___ but still simple measuring up to 4.6 cm in the right\nhepatic lobe and 3 cm in the caudate lobe.  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.  Nonobstructive renal calculi in the upper pole the left\nkidney measure up to 3 mm.  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.  Apparent wall thickening in the ascending colon is likely due\nto underdistention although this area is incompletely assessed.  The appendix\nis not visualized.  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 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.  There is at least moderate narrowing of the infrarenal\nabdominal aorta just proximal to the bifurcation due to calcified\natherosclerotic plaque (02:36).  Low-density blood pool suggests anemia.\n\nBONES: There 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 lung base infectious/inflammatory process possibly due to aspiration.\n2. No definite acute intra-abdominal process.\n3. Appendix not definitely visualized but no secondary signs of appendicitis.\n4. Severe atherosclerotic disease.\n5. Low-density blood pool suggests anemia."
        },
        {
            "input": "LOWER CHEST: Left lower lobe consolidation is persistent, but minimally\nimproved.  There is no pleural effusion.  The heart is mildly enlarged with\ncalcifications along the right coronary artery.  There is no pericardial\neffusion.  Relative hyperdense appearance of the intraventricular septum is\nlikely related to patient's anemic state.\n\nABDOMEN:\n\nHEPATOBILIARY: There are multiple hypodensities in the liver, better seen on\nthe contrast-enhanced CT from ___.  The largest hypodensity measures\n5.1 x 3.5 cm.  Otherwise, there is no evidence of concerning 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.  Nonobstructing renal stones in the upper pole of the left\nkidney measure up to 5 mm.  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.\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 no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.  Calcified 6 mm splenic aneurysm is noted (02:17).  As\npreviously noted, there is marked narrowing of the aorta just proximal to the\naortic bifurcation due to coarse calcification extending into the lumen\n(02:41), but the luminal narrowing is not substantially changed from prior\nexam on ___.  However, patency is not evaluated on the current\nmodality due to lack of intravenous contrast.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent but minimally improved left lower lobe pneumonia since ___.\n2. No acute intraabdominal or intrapelvic abnormalities.\n3. Severe abdominal aortic calcifications with marked narrowing, not\nsubstantially changed from prior exam.\n4. Nonobstructing left upper pole renal calculi measuring up to 5 mm."
        },
        {
            "input": "Lung bases clear.  Post sternotomy.\n\nPneumobilia within the left more than right lobes is similar to prior. \nThrombosis of a posterior right portal venous branch appears similar to prior,\nbetter characterized on multiphasic CT.  Remainder of the portal venous system\nis patent.  Gallbladder is decompressed with suspected mild hyperemia and mild\ngallbladder wall edema.  No radiopaque gallstones.  Foci of gas likely present\nwithin the cystic duct.\n\nNo main pancreatic ductal dilation.  An ill-defined hypodense 6 x 10 mm focus\nwithin the pancreatic neck/body likely represents a resolving pseudocyst, much\nsmaller than ___.  An additional 2.4 x 2 cm hypodense focus within the\nanterior pararenal space adjacent to the pancreatic tail likely represents an\nimproving pseudocyst.\n\nNormal spleen and adrenals.\n\nNo hydronephrosis.  No suspicious renal lesions.\n\nContrast within the stomach.  Stool within colon.  Normal appendix / TI.  No\nsmall bowel dilation.\n\nNormal caliber abdominal aorta.  No retroperitoneal or mesenteric adenopathy.\n\nAnteverted uterus.  Small amount of free pelvic fluid.  A probable corpus\nluteum within the right ovary is noted.  No focal bladder wall thickening.  No\npelvic adenopathy.\n\nPresumed injection granulomas within the anterior subcutaneous fat.\n\nNo suspicious osseous lesions.",
            "output": "-No significant change from CT scan performed 5 hours earlier.\n-Ill-defined hypodensity within the pancreatic neck/body and hypodensity\nwithin the anterior pararenal space adjacent to pancreatic tail, likely\nresolving pseudocysts, smaller than earlier prior studies.\n-Decompressed gallbladder demonstrating mild gallbladder wall edema and\npossible mild hyperemia.  Nonspecific findings, without evidence of acute\nobstruction.  This could represent an element of chronic cholecystitis.  HIDA\nscan could be obtained, if clinically warranted.\n-Pneumobilia is new since ___, correlate for interval sphincterotomy.\n-Thrombosis of a posterior branch of the right portal vein is again likely\npresent.  No main portal veins are patent.\n- Other findings as detailed above."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac artery, SMA, ___,\nand bilateral renal arteries are patent.  Of note, there is a replaced left\nhepatic artery arising from the left gastric artery.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The\nappendix is unremarkable.  There 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.  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. No acute process within the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: Partially imaged consolidative ___ opacities in the right\nlower lung could relate to a mild pneumonia or other small airways disease. \nMinimal left base atelectasis seen.  There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Common bile duct appears borderline to\nmildly dilated; correlate with LFTs.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 is relatively collapsed.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. No\nbowel obstruction or bowel wall thickening is seen.  The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  Small amount of pelvic free\nfluid is seen, slightly more than typically seen for physiologic free fluid.\n\nREPRODUCTIVE ORGANS: There is a 2.5 cm involuting right ovarian corpus luteum.\nThe uterine myometrium is heterogeneous and contains multiple uterine\nfibroids, measuring up to at least 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.  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. Normal appendix.\n2. 2.5 cm involuting right ovarian corpus luteum with small amount of pelvic\nfree fluid, greater in amount than typically seen with just physiologic fluid,\npossibly related to rupturing corpus luteum.\n3. Partially imaged consolidative ___ opacities in the right lower\nlobe are nonspecific, but could relate to a mild pneumonia, or other small\nairways disease.\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 is nodular consistent with a cirrhotic morphology.. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  A replaced hepatic artery is seen\noriginating from the left gastric.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 simple renal cysts are seen measuring 3.8 cm on the left\nand 1.9 cm on the right.  There is stable right UPJ dilation.  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 grossly normal\nlimits (note vascular findings below).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Demonstrated is a right ovarian vein draining into a severely\ndilated SMV as part of a large portosystemic shunt.  Intramural thrombus is\nminimally worse compared to prior.  Large periuterine varices demonstrating no\ninterval change compared to prior study.  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.",
            "output": "1. Cirrhotic liver with no evidence of focal liver lesions.\n2. Large portosystemic shunt between the SMV and right ovarian vein is\nunchanged.  Mild increase in size of a small focus of thrombus within the\nextensive shunt vasculature.\n3. Stable chronic UPJ dilation."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits.  A focus of hyperenhancement along\nthe periphery of segment VIII is unchanged in comparison to the ___\nexamination, likely a vascular shunt (series 2, image 98).  There is focal\nhypodensity abutting the falciform ligament, which is more pronounced in\ncomparison to the origin examination, also likely perfusional (series 2, image\n125).  No new focal liver lesions are detected.\n\nThere is no intra or extrahepatic bile duct dilation.  A metallic CBD stent\nhas replaced a plastic stent seen on the ___ examination (series 2,\nimage 141), with expected mild pneumobilia.  No intrahepatic bile duct\ndilation is detected.  No radiopaque ductal stones are seen.\n\nSevere pancreatic duct dilation is again seen, measuring up to 8 mm (series 2,\nimage 122), slightly increased since the ___ examination.  Again seen\nis an abrupt transition point at the pancreatic head, where there is an\nill-defined 2.6 x 2.3 cm hypodense mass (series 2, image 130), which appears\nless defined in comparison to the prior examination, also measuring slightly\nsmaller.  There is decreased contact of the mass against the upper SMV and\nportal confluence, although there remains focal mild to moderate attenuation\n(series 2, image 124).  A distal branch of the GDA is encased anteriorly\n(series 2, image 130), similar to the prior examination.\n\nThere is mild nonspecific stranding at the celiac trunk and proximal SMA,\nminimally changed from prior (series 2, image 118).\n\nModerate pancreatic body and tail atrophy is again seen.\n\nThe spleen size is within normal limits.  There are no focal splenic lesions.\n\nA 2.1 x 2.1 cm left adrenal nodule is again seen, measuring low density on the\n___ noncontrast CT examination, most compatible with an adenoma, and\nremaining unchanged in size (series 2, image 120).  A 0.7 x 1.0 cm right\nadrenal nodule is also unchanged, and also appears hypodense on the prior\nnoncontrast CT examination, remaining most compatible with an adenoma (series\n2, image 101).\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  Bilateral small renal hypodense lesions, likely cysts,\nremains stable since the prior examinations.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.\n\nThere is no mesenteric, inguinal, or intrapelvic lymphadenopathy, and no\nascites.  Prominent retroperitoneal lymph nodes are again seen, none meeting\nstrict cross-sectional criteria for adenopathy (series 2, image 130), and\nremaining unchanged from the prior examinations.  A 5 mm hepatic artery node\nis decreased in size since ___, previously 8 mm (series 2, image\n117).\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  Moderate atherosclerotic\ncalcifications are demonstrated, without flow limiting stenosis or dissection.\nThere is an accessory left hepatic artery arising from the left gastric\n(series 2, image 106).\n\nThe bladder is moderately distended, and appears normal.  The prostate is\nnormal in size.\n\nThere are no osseous lesions concerning for malignancy or infection.  Moderate\nlumbar spondylosis is again demonstrated (series 602, image 62).",
            "output": "1. Interval decrease in size of a pancreatic head mass, now currently\napproximately 2.6 x 2.3 cm.  Continued contact against the upper SMV and\nportal confluence with mild-to-moderate attenuation, similar to prior. \nUnchanged encasement of the distal GDA.\n2. Minimally changed mild stranding surrounding the celiac trunk and proximal\nSMA.\n3. Accessory left hepatic artery arising from the left gastric.\n4. No new abdominopelvic metastasis or lymphadenopathy.\n5. Small vascular shunt or flash filling hemangioma along the periphery of\nhepatic segment VIII.\n6. Unchanged bilateral adrenal adenomas.\n7. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  Accessory left hepatic\nartery arising from the left gastric artery.\n\nFat stranding surrounding the celiac axis appears slightly more compared to\nprevious examination.  No evidence of celiac axis stenosis.\n\nLOWER CHEST: Included lower lungs demonstrate moderate centrilobular\nemphysematous changes\n\nABDOMEN:\n\nHEPATOBILIARY: The liver shows overall homogeneous parenchymal density.  There\nis redemonstration of a focus of arterial enhancement in segment 8 (3:95),\nlikely a vascular shunt or a flash filling hemangioma.  No new focal hepatic\nlesio.  The portal and hepatic veins remain patent.  Moderate pneumobilia\npersists related to the patent biliary ductal stent.  Small amount of gas is\nalso identified within the gallbladder which otherwise demonstrates layering\nfluid/sludge.  No evidence of acute cholecystitis.\n\nPANCREAS: There is redemonstration of severe diffuse pancreatic ductal\ndilatation, measuring up to 8 mm in diameter, stable since previous\nexamination.  Minimal surrounding pancreatic parenchyma exists in the\npancreatic body and tail.\n\nA small focus of hypoenhancement is identified in the pancreatic head at the\nlevel of the MPD cutoff (3:119), now measuring 1.0 x 0.8 cm where it\npreviously measured 2.3 x 1.3 cm.  The superior mesenteric vein remains in\nclose proximity, with less than 50% contact.  Intervening fat plane is\nsuggested.  However the SMV remains narrowed where it passes posterior to the\nmain pancreatic duct (3:114).  The GDA is also in close proximity without\ndefinite involvement.\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A heterogenous 2 cm left adrenal nodule remains unchanged, noted to\nbe an adenoma on previous noncontrast examinations.  A 1 cm right adrenal\nnodule is also unchanged, previously noted to be an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, or hydronephrosis.  Several hypodense lesions\nin bilateral kidneys are again noted, likely cysts.  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. Colon and rectum are within normal limits. There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no pathologic lymphadenopathy.  Previously described\nprominent nonenlarged lymph nodes are again noted, 3:124, 3:107).\n\nIncreased fat stranding is noted surrounding the celiac axis compared to prior\nexamination of ___.\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 gland is stable in appearance.  Seminal vesicles\nshow mild right-sided asymmetric prominence, similar to prior examination..\n\nBONES: No suspicious appearing osseous lesion is identified.  Moderate\ndegenerative changes of the thoracolumbar spine are present, likely\naccentuated by the dextroscoliotic curvature of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval decrease of pancreatic head mass, now measuring 1.0 x 0.8 cm;\ncontact to the superior mesenteric vein has decreased to less 50%.\n2. Fat stranding surrounding the celiac axis and proximal SMA is slightly more\napparent compared to the prior exam.\n3. Accessory left hepatic artery arising from the left gastric artery."
        },
        {
            "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 demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Re-demonstrated is a focus of arterial\nhas mid in segment 8 consistent with a flash filling hemangioma (series 3,\nimage 92).  Interval decrease in pneumobilia due to a biliary stent.  No\nevidence of intra or extrahepatic biliary duct dilation.  Intraluminal\ngallbladder gas is unchanged from prior.  The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: There is significant main pancreatic duct dilation measuring up to 8\nmm, unchanged since prior.  There is minimal pancreatic parenchyma around the\nbody and tail.  Re-demonstrated is a region of hypodensity measuring\napproximately 0.8 x 0.7 cm within the pancreatic head at the proximal aspect\nof the main pancreatic duct (series 3, image 113), not significantly changed\nfrom prior.  The origin and proximal GDA are free of tumor and there is a fat\nplane separating the SMV.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal adenomas measuring up to 1.8 cm are unchanged from\nprior.\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: 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 is trabeculated.  The distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is small volume fluid in the pelvis.\n\nVASCULAR: Large calcified plaque in the proximal right common iliac origin\ncausing moderate stenosis.  Persistent stranding of the SMA and celiac axis is\nunchanged compared to prior.  There is no abdominal aortic aneurysm.  There is\nmoderate calcium burden in the abdominal aorta and great abdominal arteries.\n\nREPRODUCTIVE ORGANS: Prostate fiducials 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. No appreciable change in pancreatic head mass now measuring 0.8 x 0.7 cm. \nThe GDA and SMV are free of tumor.  No lymphadenopathy or evidence of\nmetastatic spread.\n2. Unchanged appearance of bilateral adrenal nodules measuring up to 1.8 cm,\nconsistent with adenomas\n3. Moderate stenosis of the proximal right common iliac due to a large\ncalcified plaque.\n4. Please see dedicated CT of the chest for thoracic findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrates right lung base\nconsolidation, concerning for aspiration, and a small right pleural effusion. \nThere is no evidence of pericardial effusion.\n\nABDOMEN: There is trace ascites.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Left\nlobe predominant moderate pneumobilia is stable.  There has been interval\nremoval of a metallic biliary stent.  The gallbladder is surgically absent.\n\nPANCREAS: Status post pylorus preserving pancreaticoduodenectomy and fiducial\nplacement.  The remnant pancreas is atrophic.  Soft tissue stranding around\nthe celiac axis is overall similar to prior.  New edema somewhat limits\nevaluation of the resection bed.\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 demonstrates a 2.0 cm adrenal nodule, indeterminate but stable.\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 a 1.0\ncm right midpole simple renal cyst.  Additional bilateral subcentimeter\nhypodensities are too small to characterize.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Status post hepaticojejunostomy; otherwise, the stomach is\nunremarkable.  There is wall thickening and hyperemia surrounding the jejunum\ndistal to the hepaticojejunostomy anastomosis.  Colonic wall thickening and\nhyperemia is noted of the transverse colon (marked) and sigmoid colon (mild)\nwith mucosal hyperenhancement suggestive of an infectious process.\n\nPELVIS: Status post TURBT for bladder cancer, with surgical clips overlying\nthe bladder floor into the prostate. There is asymmetric thickening of the\nbladder wall, likely due to a combination of chronic outlet obstruction and\npreviously treated bladder cancer.  There is a small amount of free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Surgical clips project into the prostate, as described\nabove.\n\nLYMPH NODES: There is mesenteric stranding, with reactive appearing mesenteric\nand retroperitoneal lymph nodes.  For example, a left para-aortic lymph node\nmeasures up to 7 mm in short axis (2:29).  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted, resulting in severe narrowing of the SMA and mild narrowing\nof the celiac axis.  The portal vein, splenic vein, and SMV are patent;\nnarrowing of the splenic vein just distal to the portal confluence is\nunchanged (2:22).  The left renal vein is narrowed and partially attenuated\njust anterior to the aorta.\n\nBONES: Degenerative changes are seen in the lumbar spine, most notably at\nL2-L3 where there is prominent anterior osteophytosis.\n\nSOFT TISSUES: There is a fat containing right inguinal hernia.",
            "output": "1. Interval pylorus preserving pancreaticoduodenectomy and pancreatic fiducial\nplacement.\n2. Severe colitis involving the transverse colon and mild colitis of the\nsigmoid colon, and segmental jejunitis, just distal to the\nhepaticojejunostomy.  There is trace free fluid in the upper abdomen and\npelvis.  These findings are suggestive of an infectious process.  No evidence\nto suggest ischemic bowel disease.  No evidence of bowel leak.\n3. Right lung base consolidation concerning for aspiration/pneumonia. Small\nright pleural effusion.\n4. Left renal vein is narrowed and partially attenuated just anterior to the\naorta.  Attention on follow-up.\n5. Additional findings described in detail above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:23 pm."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  The focus of arterial hyperenhancement\nseen on the CT dated ___ is not visualized on today's exam,\nlikely due to the timing of the contrast bolus.  Mild intrahepatic biliary\nductal dilatation, similar to prior.  Interval resolution of the previously\nseen pneumobilia.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post pylorus preserving pancreaticoduodenectomy\nand fiducial placement.  The remainder of the pancreas is atrophic.  The\npancreatic duct in the body and tail is dilated measuring up to 9 mm (series\n5, image 118), similar to prior.  Air is noted in the pancreatic duct. 1 No\nfocal masses are identified.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Stable bilateral adrenal nodules measuring 0.8 x 0.7 cm on the right\n(series 5, image 101) and 2.1 x 1.8 cm on the left (series 5, image 111).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nIn the interpolar region of the right kidney, there is redemonstration of a\ncyst and a subcentimeter hypodensity, which is too small to further\ncharacterize but likely also a cyst.  There is no evidence of solid renal\nlesions.   There is no perinephric abnormality.  There is no hydronephrosis or\nhydroureter. Patient is status post TURBT with surgical clips again seen along\nthe bladder floor.  The bladder wall is irregular and mildly thickened,\npossibly due to a combination of chronic outlet obstruction and previously\ntreated bladder cancer, as before.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\nhepaticojejunostomy and pylorus sparing Whipple procedure.  The visualized\nsmall bowel loops demonstrate normal caliber, wall thickness, and enhancement.\nThe colon and rectum are within normal limits. The appendix is not visualized.\n\nPELVIS:  Small volume free fluid is seen in the pericolic gutters and pelvis. \nThere is diffuse anasarca of the subcutaneous and intra-abdominal fat.\n\nREPRODUCTIVE ORGANS: Postsurgical clips again seen in the prostate. \nOtherwise, unremarkable.\n\nLYMPH NODES: Similar to prior exam, there are prominent but not pathologically\nenlarged mesenteric and retroperitoneal lymph nodes.  For example, there is\nredemonstration of an 8 mm left periaortic lymph node (series 5, image 123)\n(previously 7 mm).  No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Diffuse anasarca.  The abdominal and pelvic wall is intact.",
            "output": "1. No suspicious masses in the abdomen or pelvis seen to suggest recurrence or\nmetastatic disease.\n2. Redemonstration of postsurgical changes from prior pylorus preserving\npancreaticoduodenectomy.\n3. Irregular mild bladder wall thickening likely represents a combination of\nchronic outlet obstruction and prior therapy.\n4"
        },
        {
            "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 atelectasis is noted in the left lung base associated with a\nBochdalek hernia.  There is minimal right pleural effusion.  There may be\nemphysema, but difficult to evaluate with the limited views of the chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis a 2.5 cm rim enhancing lesion, in segment 8, likely hemangioma or possibly\narteriovenous shunt, difficult to characterize on this single phase study. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation, there\nis pneumobilia secondary to the presence of a biliary stent which appears\nappropriately positioned.  The gallbladder has mildly edematous walls, likely\ndue to the pancreatic disease.\n\nPANCREAS: There is 3.0 x 2.0 x 1.7 cm hypoattenuating mass (TR x AP x CC)\ninvolving the head of the pancreas.  The pancreatic duct is dilated measuring\nup to 9 mm wide.  The pancreatic tail and body are atrophic.  Mild\nperipancreatic fat stranding surrounding the head of the pancreas.  Largest\nlymph node in the porta hepatis measures 8 mm (series 2, image 24).\n\nThere is no encasement of the SMA, SMV and main portal vein.  The\ngastroduodenal artery is close to the lesion but with nonspecific fat\nstranding around the vessel.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is 12 mm nodule in the right adrenal gland, there is a 20 mm\nnodule on the left adrenal gland.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis.  Bilateral cysts are seen\nlargest measuring 13 mm on the left.  There are no urothelial lesions in the\nkidneys or ureters. 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. There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nSmall retroperitoneal lymph nodes up to 7 mm short axis.\n\nPELVIS: The urinary bladder is heavily distended and distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nsclerotic lesion is seen in the left iliac bone, likely cystic or due to\nfibrous dysplasia.  Right convex scoliosis of the lumbar spine.  Degenerative\nbony changes are seen in the lumbar spine and both hips.\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): 3.0 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 (stent\nin place)\n\nArterial evaluation\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: Accessory LEFT hepatic artery from the left gastric.\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: 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",
            "output": "1. A pancreatic head lesion concerning for adenocarcinomas, with atrophy of\nthe tail and body of the pancreas and dilation of the pancreatic duct.  A\nbiliary stent is noted.  There is no definite vascular involvement.  Haziness\naround the GDA is noted, difficult to discern with confidence whether this is\ntumoral or inflammatory nature.\n2. Hepatic lesion, likely a hemangioma or vascular shunting.\n3. Bilateral adrenal nodules, most commonly adenomas.  If indicated, these may\nbe evaluated by dedicated MRI."
        },
        {
            "input": "LOWER CHEST:\nThere are small bilateral pleural effusions and mild bilateral lung base\ncompressive atelectasis.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver is diffusely hypodense on this contrasted enhanced\nexam raising possibility of steatosis.\nThe gallbladder contains gallstones without evidence of cholecystitis.  There\nis no intra or extrahepatic biliary duct dilation.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY: The kidneys are unremarkable.  There is no hydronephrosis.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.  There is possible\nfatty deposition in the cecal wall, which could reflect chronic inflammatory\nprocess.\nAppendix has thickened wall and is mildly enlarged, measuring up to 8 mm in\ndiameter.  The appearance of appendix is is new since ___ but similar to\nprior CT on ___ or MRI on ___.  There is no surrounding fat stranding.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder has mild wall thickening with mild surrounding fat stranding. \nThere are few calcified fibroids in the uterus.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1.  Mildly thickened bladder wall, which could be a sign of urinary tract\ninfection. Please correlate clinically with urinalysis.\n\n2.  Mildly enlarged appendix with wall thickening, which is new since ___ but\nsimilar compared to prior CT on ___ and MRI on ___.  The findings may\nrepresent chronic appendicitis.\n\n3.  Diverticulosis without evidence of diverticulitis.\n\n4.  Small bilateral pleural effusions and mild compressive bilateral lung base\natelectasis."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal.\n\nThe kidneys enhance normally and excrete contrast briskly. There are no solid\nrenal lesions or hydronephrosis.  There is a subcentimeter right renal\nhypodensity which is too small to characterize (2:44).  There is an exophytic\n18 mm intermediate-density cyst in the lower pole of the left kidney (2:47).\n\nThe stomach and duodenum are normal. The small bowel is normal in caliber,\nwithout wall thickening or mass.  There is sigmoid colonic diverticulosis with\nacute inflammatory changes in a segment of sigmoid colon, without free air or\nadjacent fluid collection, consistent with acute diverticulitis (601b:30).\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The prostate and seminal vesicles are\nunremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. Simple acute sigmoid diverticulitis.  No evidence of perforation or\nabscess. Recommend colonoscopy after resolution of symptoms.\n2. 18 mm exophytic intermediate density cyst in the lower pole of the left\nkidney, likely represents a proteinaceous or hemorrhagic cyst, but more\ndefinitive characterization with outpatient ultrasound is recommended."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.  No definite evidence of active\nextravasation, particularly of the lateral left lower anterior abdominal wall.\n\nLOWER CHEST: Mild, dependent, subsegmental atelectasis.  There is no pleural\nor pericardial effusion.  Acute, minimally displaced fracture of the\nanterolateral right fifth rib (2:2), better assessed on the prior study.\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.  Cholelithiasis, without evidence of acute\ncholecystitis.\n\nPANCREAS: 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 diminutive in size, but demonstrates normal attenuation\nthroughout.  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 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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed around a Foley catheter and not well\nassessed.  Hyperdense material within the bladder is likely excreted contrast\nfrom prior administration.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  Moderate pelvic free fluid has increased from prior.\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable.\n\nBONES AND SOFT TISSUE: Grade 1 anterolisthesis of L4 on L5 is stable. \nMultiple acute fractures are not significantly changed from prior.  These\nfractures include displaced fractures of the transverse processes of left\nL3-L5 and right L5; comminuted bilateral sacral fractures; and comminuted\nfractures of the bilateral iliac wings.  Multiple foci of air associated with\nthe bilateral iliac wing fractures, along with hematomas of the lateral lower\nanterior abdominal walls are not significantly changed.  The previously seen\nfocal hyperdensity within the left lower anterior abdominal wall is not\nevident on this study.",
            "output": "1. No definite evidence of active arterial extravasation within the abdomen or\npelvis.\n2. Interval increase in volume of pelvic hematoma.\n3. No significant change in multiple acute fractures of the pelvis, with\nassociated hematomas, described in further detail above.\n4. Bladder decompressed around a Foley catheter.  Consider CT cystogram to\nexclude bladder injury.\n\nRECOMMENDATION(S):  Consider CT cystogram"
        },
        {
            "input": "LOWER CHEST: Trace right pneumothorax is likely stable from prior chest CT\n(2:6 2:4).  Trace pleural fluid and minimal atelectasis are noted in the lung\nbases.  A small pericardial effusion is nonhemorrhagic although minimally\nincreased from prior chest CT on ___. Slight waist and superior hump\nin the hepatic dome was not appreciated prior chest CT from ___ but\nwith maintained fat planes with the diaphragm arguing against diaphragmatic\ninjury (604:40).\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.  There is vicarious excretion of contrast\ninto the gallbladder which contains stones. No 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Ureters fill with intravenous contrast to the level bladder\nexcept for a short segment on the right as it crosses the iliac vessels. No\nevidence of extravasation.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  In the pelvis, the sigmoid colon wall appears\nthickened, edematous, and hypoenhancing relative to other bowel (303: 104). \nThere is surrounding edema in the mesentery.  No pneumoperitoneum.  The\nremaining colon and rectum are within normal limits.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nOnly mild extent of the pelvic hematoma.\n\nPELVIS: Overall stable moderate hemoperitoneum in the pelvis most notable\nadjacent to the colon.  Substantial hematoma in the presacral space.  Likely\nhematoma anterior to bladder in the space of Retzius.  The bladder contains a\nFoley catheter and high-density material likely due to residual intravenous\ncontrast, but is not fully distended or evaluated for injury on this\nexamination.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nVASCULAR: No evidence of active extravasation.  There is no abdominal aortic\naneurysm.  There is minimal calcium burden in the abdominal aorta and great\nabdominal arteries.  Separate origin of the left gastric artery from the\naorta.  Accessory left hepatic artery from the left gastric artery.\n\nBONES: Multiple acute fractures appear similar.  For example, left transverse\nprocess fractures of L3 through 5, extensively comminuted displaced fractures\nof the bilateral iliac wings with soft tissue locules of gas extending to the\nskin on the left suggesting this is an open fracture (301:106), comminuted\ndisplaced fractures of the bilateral sacral ala which involve the neuroforamen\nwith several fracture lucencies appearing to extend into the sacroiliac joints\nwhich are not widened, and a displaced fracture of the S2 vertebral body. No\ndefinite new fracture is identified.  A 1.5 cm sclerotic focus in the left the\nsacrum is redemonstrated (301:95). Unchanged grade 1 anterolisthesis of L4 on\nL5 and mild retrolisthesis L5-S1.\n\nSOFT TISSUES: Extensive edema in the anterior pelvic wall, some of which is\nhigh-density compatible hematoma is overall unchanged.  No active\nextravasation.  Mild flank edema.  Scattered foci of gas in the anterior\nbilateral pelvic walls compatible with traumatic laceration are\nredemonstrated. A punctate hyperdensity adjacent the left iliac crest injury\nlikely reflects small osseous fragment (2:62).",
            "output": "1. Overall stable moderate pelvic hemoperitoneum, presacral hematoma, anterior\nabdominal wall hemorrhage, and hematoma in the space of Retzius.  No active\nextravasation. Please see separate report from cystogram obtained 15 minutes\nafter this study for bladder evaluation.\n2. Multiple displaced and comminuted fractures in the pelvis and sacrum are\nnot appreciably changed. Left iliac wing fracture is likely open. The sacral\nfractures likely extending into sacroiliac joints and sacral neuroforamina.\n3. A punctate hyperdensity adjacent the left iliac crest injury likely\nreflects a small osseous fragment, less likely a tiny foreign body (2:62).\n4. Edematous sigmoid colon with wall thickening, mesenteric edema, and\nrelative ___ may be reactive to the hemoperitoneum although\nunderlying bowel injury is not excluded. No pneumoperitoneum.\n5. Stable trace right pneumothorax."
        },
        {
            "input": "The bladder is well distended with contrast without evidence of extraluminal\ncontrast to suggest bladder injury.  It contains a Foley catheter and a single\nlocule of air is compatible with recent instrumentation.  High-density linear\nstructures posterior to the bladder were present on prior noncontrast\nexamination performed 15 minutes prior and likely represent phleboliths or\ncalcifications (601:33).\n\nThe visualized left ureter is well opacified with contrast without evidence of\ninjury.  The right distal ureter is not visualized with abrupt cutoff at the\nlevel of the uterus (601:25; 602:32).  However, on CT 15 minutes prior, the\ndistal right ureter is opacified by contrast except for a very short segment\nas it crosses the iliac vessels (303:130 through 101 on that study).  There is\nno surrounding extravasation of extraureteral contrast or definite ureteral\nwall thickening on either study.\n\nThe remainder of the examination is overall stable from CT 15 minutes prior,\ndescribed in detail on report from that study.",
            "output": "1. No evidence of bladder injury.\n2. Right distal ureter is not seen on this study but was well opacified onto\nthe studies 20 minutes prior without evidence of extraluminal contrast.  These\nfindings suggest the right ureter is not injured and the appearance on this\nstudy is due to peristalsis or timing.\n3. Please see separate report from CT of the abdomen and pelvis 15 minutes\nprior detailing the soft tissue and osseous 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 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 and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: Foley catheter seen terminating in the bladder.  The urinary bladder\nand distal 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: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post open reduction and internal fixation for\nbilateral iliac fractures.  The fixation screw passes significant streak\nartifact in the pelvis, limiting evaluation.  Retrolisthesis of L5 on S1. \nAnterolisthesis of L4 on L5.\n\nSOFT TISSUES: Mild postoperative and posttraumatic edema seen in the proximal\nbilateral lower extremities.",
            "output": "1. Mild postoperative and posttraumatic edema seen in the proximal bilateral\nlower extremities.  There is no drainable fluid collection or evidence of\nabscess.  No findings in the abdomen or pelvis are concerning for infection.\n2. Post-traumatic fractures iliac fractures and postsurgical changes after\nsacroiliac fixation.\n3. Please see separate same day CT chest report for description of the\nthoracic findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Mild aortic annular and coronary\nartery calcifications are noted diffusely.\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: Punctate calcification is seen within the pancreatic head, possibly\nrepresenting the sequela of prior pancreatitis.  The pancreas has otherwise\nnormal attenuation 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 spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.7 cm indeterminate left adrenal nodule.  The right\nadrenal gland is normal in size and shape.\n\nURINARY: The kidneys appear atrophic bilaterally.  There is no suspicious\nrenal 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. Diverticulosis of the colon is\nnoted, without evidence of wall thickening or fat stranding.\n\nPELVIS: The urinary bladder is collapsed and contains Foley catheter.  There\nis 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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLucencies with thickened trabecula noted within the vertebral bodies at\nmultiple levels, compatible with hemangiomas.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No hydronephrosis or obstructing stones identified.\n2. Diverticulosis without evidence of diverticulitis.\n3. Indeterminate 1.7 cm left adrenal nodule.  This likely reflects a benign\nadrenal adenoma, but follow-up adrenal CT can be considered in 12 months if no\nprior cross-sectional studies are available for comparison."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis. No large pleural effusion.\nCoronary artery calcifications are noted. There is mitral annulus\ncalcification.  Small pericardial effusion. There is left greater than right\nasymmetric breast tissue, correlation with mammography is recommended.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a somewhat microlobulated contour of the hepatic parenchyma\nsuggestive of underlying cirrhosis.  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: A 1.1 cm left adrenal nodule is consistent with a benign adrenal\nadenoma (3:26). The right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal symmetric size though mildly atrophic\nbilaterally.  There are no suspicious renal lesions within limitation on\nunenhanced study.  There is mild bilateral hydroureteronephrosis to the level\nof the bladder.  No nephrolithiasis.  No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No small bowel obstruction. \nThere is a large colonic stool burden.  The colon is highly redundant with\nmultiple scattered diverticula without evidence of diverticulitis.  The\nappendix is normal.  There is a large stool ball within the rectum with some\nassociated perirectal stranding and fluid concerning for stercoral proctitis\n(3:81).  There is mild nonspecific fluid and peritoneal thickening in the\nright pericolic gutter (3:69).\n\nPELVIS: A Foley catheter seen within the bladder however the bladder remains\ndistended.  Mild stranding around the anterior aspect of the bladder is\nnonspecific but could represent cystitis (3:69).\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: No intra-abdominal or intrapelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: No worrisome osseous lesion or acute fracture.  There are multiple\nvertebral hemangiomas, largest at L4 and L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large stool ball within the rectum with surrounding stranding and fluid\nconcerning for stercoral proctitis.  Disimpaction is recommended.\n2. Foley catheter seen within the bladder however the bladder remains\ndistended and there is upstream mild hydroureteronephrosis, likely due to\nreflux.  Correlation for Foley dysfunction is recommended.  In addition, mild\nstranding around the anterior aspect of the bladder may reflect cystitis and\ncorrelation with urinalysis is needed.\n3. Asymmetric left greater than right breast tissue, correlation with breast\nexam and mammography is suggested."
        },
        {
            "input": "The inferior epigastric arteries are patent bilaterally.\nPerforators:\nLEFT:\nBranching pattern: Type 1\nPerforators:\n2.5 mm, 70 mm to the left and 10 mm above the umbilicus, (series 605, image\n51)\n1.0 mm, 40 mm to the left and 9 mm below the umbilicus, (series 605, image 56)\n1.2 mm, 82 mm to the left and 10 mm below the umbilicus, (series 605, image\n57)\n1.0 mm, 63 mm to the left and 43 mm below the umbilicus, (series 605, image\n63)\n\n\nRIGHT:\nBranching pattern: Type 2\nPerforators:\n2.4 mm, 31 mm to the right and 10 mm above the umbilicus, (series 605, image\n51)\n1.4 mm, 61 mm to the right and 6 mm above the umbilicus, (series 605, image\n52)\n1.4 mm, 93 mm to the right and 6 mm above the umbilicus, (series 605, image\n52)\n1.4 mm, 56 mm to the right and at the level of the umbilicus, (series 605,\nimage 55)\n2.2 mm, 64 mm to the right and 63 mm below the umbilicus, (series 605, image\n67)\n2.2 mm, 26 mm to the right and 75 mm below the umbilicus, (series 605, image\n70)\nAbdomen and pelvis:\n\nThere is moderate dependent atelectasis at the lung bases.  There is no\npericardial or pleural effusion.  The heart size is top-normal.\n\nThe liver density is within normal limits.  A 4 mm segment II and 3.1 x 2.8 cm\nsegment VII lesion are well-circumscribed, likely representing cysts, the\nlatter demonstrating gradual growth since ___.  No concerning hepatic lesion\nis detected.  The liver density is within normal limits.  There is no intra or\nextrahepatic bile duct dilation.  The patient is post cholecystectomy.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  No focal gastrointestinal lesion is detected.  The\nappendix appears normal.\n\nThe uterus is normal in size.  No concerning adnexal lesions are detected.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  There is a replaced right hepatic\nartery arising from the SMA (series 2, image 58).\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. ___ vessels, detailed above.\n2. No abdominopelvic lymphadenopathy or metastasis."
        },
        {
            "input": "LOWER CHEST:\n\nBilateral pleural effusions with adjacent atelectasis are better described on\nchest CT report obtained concurrently, along with other intrathoracic\nfindings.  .\n\nABDOMEN:\n\nGENERAL:  No intra-abdominal free air or free fluid is detected.\n\nHEPATOBILIARY:  There is a 1.4 x 1.4 cm hypodensity in hepatic segment a\nVI/VII (02:54), not significantly changed since the prior study no enhancing\nhepatic lesion is identified.  There is mildly heterogeneously hypoenhancing\nhepatic parenchyma along the gallbladder resection site.  There is no intra or\nextrahepatic biliary ductal dilation.  The gallbladder is surgically absent.\nPANCREAS: Fatty replacement of the pancreatic head is noted.  No focal\npancreatic lesions of concern are 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: There is a prominent parapelvic cyst on the right, and multiple small\nperipelvic cysts on the left.  Otherwise, the kidneys enhance symmetrically\nand excrete contrast promptly, with no evidence of hydronephrosis or\nobstructing stone.  There is mild perinephric edema, not significantly\nchanged.  Otherwise, no perinephric abnormality is detected.\nGASTROINTESTINAL:  The patient is post laparotomy for small bowel obstruction,\nwith slices of adhesions.  The previously demonstrated small bowel obstruction\nobserved on the prior outside CT from ___ has resolved.  Currently,\nabdominal loops of small bowel are normal in course and caliber with no\nevidence of obstruction.  Administered enteric contrast reaches the level of\nthe rectum.  Scattered colonic diverticular disease is noted, with no evidence\nof diverticulitis.\nRETROPERITONEUM:  There is no retroperitoneal or mesenteric lymphadenopathy. \nMild mesenteric stranding and edema is within expected limits following recent\nsurgery.\nVASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  Prominent venous\ncollaterals are noted along the left lateral anterior abdominal wall soft\ntissues, extending from the lower chest (02:32), and draining into the left\ncommon femoral vein (2:113).  Other prominent venous collaterals in the upper\nabdomen empty into the supra hepatic IVC (02:43).  These are likely related to\ncentral venous stenosis on the left, better seen on the concurrent chest CT.\n\nPELVIS:\n\nThe urinary bladder is decompressed by a Foley catheter, with a small amount\nof anti-dependent air (02:105).  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.  Fluid is noted in the\nright inguinal canal, and fat in the left inguinal canal.\n\n\n\nBONES AND SOFT TISSUES:\n\nMultilevel, multifactorial degenerative changes are noted throughout the\nvisualized thoracolumbar spine, with no focal lesion of concern for osseous\ninfection or malignancy.  Diffuse soft tissue edema is noted within the\nbilateral flanks and all wall, along with linear scarring underlying vertical\nskin staple line related to prior laparotomy.",
            "output": "1. Interval resolution of small bowel obstruction following laparotomy with\nlysis of adhesions.  No focal fluid collection or abscess is identified in the\nabdomen or pelvis.\n2. Indeterminate 1.4 cm right hepatic lobe hypodensity and slightly\nheterogeneously enhancing parenchyma along the gallbladder fossa is unchanged\ncompared to the recent prior outside CT, but could be further assessed with\nMRI or ultrasound non emergently, if clinically indicated.\n3. Diverticulosis, with no evidence of diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal aorta and great abdominal arteries.  There is significant\nnarrowing at the origin of the celiac axis.  The SMA graft is occluded.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  A 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 is distended without 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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: An approximately 30 cm segment of small bowel, starting at\nthe level of the ligament of Treitz, demonstrates a hypoenhancing wall with\nbowel wall edema, consistent with hypoperfusion.  In the mid jejunum (2a: 90)\nthere appears to be a small diverticulum or a contained perforation.  This\nportion of the jejunum also demonstrates a hypo enhancing wall.  The appendix\nis not definitively visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nBONES: Multilevel degenerative changes are seen throughout the lumbar spine\nand at both hips.  No acute is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Occluded SMA graft with evidence of hypoperfusion of an approximately 30 cm\nsegment of proximal small bowel.  A small, contained focus of extraluminal air\nis noted, which may be within a jejunal diverticulum, though a contained\nperforation is not excluded.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with the vascular\nsurgery team on call in personon ___."
        },
        {
            "input": "VASCULAR:\n\nA right common iliac to SMA bypass graft is occluded along nearly its entire\ncourse (601b:47).  Numerous surgical clips are noted around the origin of the\nnative SMA, compatible with prior surgeries including removal of a previous\naorta to SMA bypass graft.  Numerous prominent collaterals arising from the\n___ are again noted.  There is no evidence of small or large bowel\nhypoperfusion.\n\nThere is high-grade stenosis of the celiac trunk at its origin (___). \nThere are dense atherosclerotic calcifications of the origins of the bilateral\nrenal arteries, though degree of luminal narrowing is difficult to ascertain. \nIncidental note is made of a replaced left hepatic artery arising from the\nleft gastric artery.\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST:  There are scattered ground-glass opacities in the mid right\nlower lobe (2:2,3) in a linear distribution, suspect atelectasis, but\nattention on follow-up.  A punctate draining is noted in the anterior left\nupper lobe (2:7).  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 pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThinning of the posterior right renal cortex may reflect prior infectious or\nischemic insult.  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 moderate hiatal hernia is again noted.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis diverticulosis without focal wall thickening or adjacent fat stranding.\nAppendix contains air, has normal caliber without evidence of fat stranding. \nNumerous scattered mesenteric lymph nodes are not pathologically enlarged by\nCT size criteria.\n\nRETROPERITONEUM: Scattered retroperitoneal nodes are not enlarged by CT size\ncriteria.\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: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine, including grade 1 anterolisthesis of\nL4 on L5 and minimal retrolisthesis of L5 on S1, and bilateral SI joints are\nagain noted.\n\nSOFT TISSUES: Extensive postsurgical changes of the midline anterior abdominal\nwall are again noted, including small, fat containing ventral hernias. \nScattered locules of subcutaneous emphysema in the anterior abdominal wall are\nlikely related to medication injection.",
            "output": "1. Occluded right common iliac to SMA bypass graft with prominent ___\ncollateralization and without evidence of large or small bowel ischemia.\n2. High-grade celiac trunk stenosis.\n3. Moderate hiatal hernia.\n4. Diverticulosis.\n5. Focal thinning of the posterior right renal cortex is unchanged likely\nrelated to prior infectious or ischemic insult.\n6. Linear distribution ground-glass-like opacities in the right lower lobe\nlikely represent atelectasis.  Attention on follow-up.\n\nRECOMMENDATION(S):  Linear distribution ground-glass-like opacities in the\nright lower lobe likely represent atelectasis.  Attention on follow-up.\n\nNOTIFICATION:  Above wet reading was discussed with ___, M.D. (vascular\nsurgery consult resident) by ___, M.D. on the telephone on ___ at\n6:40 ___, 5 minutes after discovery of the findings."
        },
        {
            "input": "VASCULAR:\nThe abdominal aorta is normal in caliber, demonstrating extensive\natherosclerotic calcification.  There is high-grade stenosis of the celiac\naxis, unchanged from the prior CT.  The native SMA is thrombosed, and the SMA\n2 right common iliac graft is chronically thrombosed.  The ___ is\nhypertrophied and there is extensive collateralization of the mesenteric\nvessels.  The origin of the renal arteries demonstrate moderate plaque\nbilaterally.  The iliac and common femoral arteries are patent.\n\nLOWER CHEST: There is moderate emphysema and was ache attenuation of the lung\nbases.  No pleural or pericardial effusion.  Heart size is normal.  There is a\nmoderate hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation.  The gallbladder is\nnormal.  No focal hepatic lesions.  No intrahepatic biliary dilation.\n\nPANCREAS: 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 a subcapsular hypodensity which is slightly\nevolved from the prior study, likely an infarct.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric with regards to enhancement.  Cortical\nthinning at the interpolar region of the right kidney suggests prior\ninsult/ischemia.  No hydronephrosis on either side.\n\nGASTROINTESTINAL: The bowel is normal in caliber.  There is normal enhancement\nof small and large bowel loops.  There is sigmoid diverticulosis without\nevidence of active inflammation.  No mesenteric edema or fluid.  No mesenteric\nor 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 grade 1 anterolisthesis L4 on L5 and grade 1 retrolisthesis L5\non S1.  These changes are stable from ___.\n\nSOFT TISSUES: Vertically oriented midline incision in the anterior abdominal\nwall is noted.  No hernia.",
            "output": "1. Chronically occluded native SMA and SMA to right common iliac graft with\nextensive mesenteric collateralization via the ___.  No evidence of small or\nlarge bowel ischemia.\n2. High-grade celiac stenosis, unchanged from the prior study.\n3. Moderate hiatal hernia."
        },
        {
            "input": "LOWER CHEST:\n\nBibasilar atelectasis is present. There is no pleural or pericardial effusion.\nThere is a small hiatal hernia (601b:40).\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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:  Postsurgical changes related to gastric bypass are noted.\nThere is no evidence of bowel obstruction. The colon is unremarkable. The\nappendix is not visualized.\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.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nA large abdominal wound is noted, with abdominal wall mesh repair of ventral\nhernia.  Along the superior aspect of the mesh repair, there is a 6.2 x 1.4 x\n4.1 cm fluid collection with rim thickening and enhancement. No osseous lesion\nworrisome for malignancy is identified. Multi level degenerative changes are\nnoted throughout the lumbar spine.",
            "output": "1. Large anterior abdominal soft tissue defect with 6.2 x 1.4 x 4.1 cm fluid\ncollection along the superior aspect of mesh repair, compatible with abscess.\nNo evidence of intra-abdominal fistulous connection.\n2. No intra-abdominal free fluid or abscess is identified.\n3. Postoperative changes related to sleeve gastrectomy.\n4. Small hiatal hernia."
        },
        {
            "input": "Again seen is bibasilar atelectasis. There is no pleural or pericardial\neffusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\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: 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:Again seen are changes consistent with prior gastric bypass. A small hiatal\nhernia is unchanged.The small and large bowel are within normal limits,\nwithout wall thickening or evidence of obstruction.No appendix is visualized,\nbut there are no secondary signs of acute appendicitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with minimal atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.\n\nSOFT TISSUES:  Again seen is a large anterior abdominal wall wound, with\nabdominal wall mesh repair of a ventral hernia. The previously seen fluid\ncollection with rim thickening and enhancement along the superior aspect of\nthe mesh repair is no longer present, with only residual fat stranding in that\narea. However, there has been interval development of a large fluid collection\nmore inferiorly in the right anterior abdominal soft tissues, measuring 4.1 x\n5.4 x 13.7 cm with subtle rim enhancement. This collection also contains gas,\nalthough it is unclear whether this is related to infection, connection with\nthe open anterior abdominal wall wound, or a combination of the 2. The\nlocation of this fluid and gas collection corresponds to a portion of the\nabdominal wound extending into the right abdominal wall soft tissues on the\nprevious CT.",
            "output": "1. Interval development of a large fluid and gas collection in the right\nanterior abdominal soft tissues measuring up to 13.7 cm. It is unclear whether\nthe gas within the collection is related to infection, connection with the\nanterior abdominal wall wound, or a combination of the 2.  No intra-abdominal\nfluid collection.\n2. Interval resolution of the previously seen fluid collection along the\nsuperior abdominal wall wound.\n3. Redemonstration of the expected postsurgical changes after gastric bypass,\nas well as a small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  A left\nposterior perifissural nodule is likely due to atelectasis (series 2, image\n4).  Additional findings are demonstrated on the right (series 2, image 10). \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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\nThere is a splenorenal shunt of indeterminate significance.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is 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 grossly\nunremarkable.\n\nLYMPH NODES: Some prominent lymph nodes in the right lower quadrant, including\na 1.3 cm short axis right inguinal node.\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: Within the right lower quadrant overlying the right inferior\nrectus abdominus muscle, there is a focal area of soft tissue thickening and\nstranding (series 2, image 67).  There is overlie iron subcutaneous skin\nthickening (series 2, image 64).  The edema and stranding extends up the right\nanterior abdominal wall (series 2, image 46).  No subcutaneous emphysema.  No\nfocal fluid collections.",
            "output": "1. Focal stranding and edema with overlying skin thickening in the right lower\nquadrant overlying the rectus abdominus muscle.  Stranding extends mildly up\nalong the right anterolateral abdominal wall. No evidence of extension into\nthe abdominal wall or into the peritoneum.  No focal fluid collections or\nsubcutaneous emphysema.  Findings suggest a focal soft tissue infection.\n2. Normal appendix.\n3. Splenorenal shunting of unlikely significance in the absence of underlying\nliver disease or portal hypertension."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen: The liver, gallbladder, pancreas and spleen appear normal.  Adrenals\nare normal bilaterally.  The kidneys enhance symmetrically.  Mild fullness of\nthe right renal collecting system without distal obstructing stone.  No signs\nof pyelonephritis.  Abdominal aorta is normal in course and caliber.  Stomach\nand duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is normal.  The colon is thin walled and contains a mild fecal load. \nThe urinary bladder appears mildly thickened which could reflect decompressed\nstate, difficult to exclude cystitis especially given history provided.  Small\nvolume free fluid in the pelvis likely physiologic.  Uterus and ovaries appear\nnormal.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Normal appendix.\n2. Minimally thickened urinary bladder, correlate for cystitis.\n3. No evidence of pyelonephritis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Incidental note is made of a\nright-sided Bochdalek's hernia containing fat.\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 diffuse\ncircumferential wall thickening and mucosal hyperemia extending from the\nrectum proximally to involve the sigmoid colon and descending colon to the\nlevel of the splenic flexure with minimal adjacent fat stranding.  The\nappendix contains calcified appendicoliths, as seen previously, and is\ntop-normal in size measuring up to 6 mm, unchanged.\n\nPELVIS: The urinary bladder is decompressed though there is apparent mild wall\nthickening.  Distal ureters are unremarkable.  There is trace fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Prominent perirectal lymph nodes are likely reactive.  There is\nno additional retroperitoneal or mesenteric lymphadenopathy.  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 tiny umbilical hernia containing fat is noted.",
            "output": "1. Findings compatible with proctocolitis extending from the level of the\nsplenic flexure to the rectum which is likely infectious or inflammatory in\netiology.  Prominent perirectal lymph nodes are likely reactive.\n2. Trace pelvic free fluid."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: 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: A tiny umbilical hernia containing fat is noted.",
            "output": "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. \nUnchanged 3 mm hypodense hepatic lesion, too small to further characterize.. \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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. The colon and rectum are within\nnormal 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: There are several prominent, subcentimeter pericecal lymph nodes\n(for example 2:99, 96, 88).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Sclerotic foci in bilateral femoral heads, iliac, left sacrum, and\nright pubic bones are unchanged compared to ___, likely 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. The appendix is normal.\n2. Prominent pericecal lymph nodes are nonspecific but can be seen with\nmesenteric adenitis.\n\nNOTIFICATION:  The updated findings were emailed to the QA nurses by ___\n___, MD on ___ at 9:15 a.m."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.  No mediastinal air is seen.  No\nextraluminal air in the region of the esophagus is identified.\n\nABDOMEN:\n\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 identified,\nlikely iatrogenic in nature.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 intra-abdominal free air.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThough the appendix is not definitively visualized, there are no secondary\nsigns of appendicitis.\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 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. No extra luminal, periesophageal or perigastric air to indirectly suggest\nesophageal or gastric perforation."
        },
        {
            "input": "CHEST:   The bases of the lungs are clear. Note is made of a small hiatal\nhernia.\nABDOMEN:  The liver is normal without evidence of focal lesions or\nintrahepatic biliary ductal dilatation. The portal vein is patent. The splenic\nvein is patent. The spleen is homogeneous and normal in size. The adrenal\nglands bilaterally are normal. The kidneys bilaterally are normal without\nevidence of focal solid or cystic lesions concerning for malignancy. The\npancreas is normal without evidence of focal lesions or pancreatic ductal\ndilatation.\n\nThe gallbladder is normal without evidence of wall thickening or stones. The\nstomach, duodenum, small bowel is normal without evidence of wall thickening\nor obstruction. There is no retroperitoneal or mesenteric lymphadenopathy. The\ncolon demonstrates moderate fecal loading which is otherwise unremarkable. The\nappendix is normal.\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.\nBONES AND SOFT TISSUES:  There is chronic dysplasia of the left femoral head.\nNo acute fractures identified. No focal lytic or sclerotic lesions concerning\nfor malignancy are identified. There is moderate scoliosis.",
            "output": "1.  No evidence of malignancy.\n\n2.  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 homogenous attenuation throughout. \nHypodensity at the liver dome has not changed since the recent examinations. \nNo other focal hepatic lesions are seen.  Minimal intrahepatic biliary ductal\ndilatation with focal dilatation of the dome is unchanged since the 2 prior\nexaminations.  The common bile duct measures approximately 9 mm, which is\nunchanged since prior examinations.  The gallbladder is absent.\n\nPANCREAS: The patient is status post central pancreatectomy and\npancreaticojejunostomy.  The pancreatic tail is atrophic.  Again seen is a\nhypodense lesion in the pancreatic head, not significantly changed since the\nprior.  Ill-defined soft tissue adjacent to the fiducial markers is also\nunchanged (02:23), and is difficult to measure.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 simple cyst in the upper pole of the right kidney.  There is\nno hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient has undergone\nprior pancreaticojejunostomy.  Right upper quadrant anastomosis is intact,\nwith contrast material passing past this region, through the entire small\nbowel, into the colon.  The small bowel is largely unremarkable.  A prominent\nloop of small bowel in the right upper quadrant measures approximately 3.7 cm\nin diameter, and is nonspecific.  A decompressed loop of small bowel is seen\nin the left lower quadrant (601b:20).  The this may be related to peristalsis.\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: No definite lymphadenopathy is present.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen throughout the thoracolumbar spine,\nparticularly at L4 and 5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable appearance of pancreatic head mass and ill-defined soft tissue.\n2. No evidence of small-bowel obstruction.  Intact jejunal anastomosis."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar dependent atelectasis, without pleural\neffusion.  Heart size is normal, and there is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 7 mm hypodensity along the hepatic dome (2:7) that is too small to\ncharacterize, although dates back to ___ where it was 4 mm, and\nlikely represents a cyst or hamartoma.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post central pancreatectomy, with placement of\nseveral fiducial markers in the resection bed.  No peripancreatic fluid.  The\nknown pancreatic head mass measures approximately 1 cm (02:21), and is little\nfrom the prior study.  There is diffuse haziness/fat stranding throughout the\nmesentery, which appears new from the prior study in ___.  This is a\nnonspecific finding could reflect surrounding inflammation, such as\npancreatitis, or posttreatment change.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 2.5 x 2.6 cm simple cyst in the right upper pole.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\npancreaticojejunostomy.  Mild prominence of the jejunum at the surgical\nanastomosis is likely within normal limits.  Remaining small bowel loops\ndistally demonstrate normal caliber, wall thickness and enhancement\nthroughout.  Colonic loops are normal in caliber, without abnormal wall\nthickening.  The appendix is not visualized, but there are no secondary signs\nof acute appendicitis.  No ascites or pneumoperitoneum.\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. Status post central pancreatectomy and pancreaticojejunostomy.  Ill-defined\npancreatic head mass is little changed from the prior study.\n2. New diffuse mesenteric fat stranding and haziness is nonspecific, but could\nreflect adjacent inflammation, such as from pancreatitis or possibly\npost-treatment changes.\n3. No ascites.  No pneumoperitoneum.\n\nNOTIFICATION:  Final results were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 10:22 AM, 60 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST: There is minimal atelectasis at the lung bases. There is no\nconsolidation or pleural effusion. Heart size is normal with no pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation aside from a sub cm\nhypodensity in the right lobe superiorly (04:15), which is unchanged from\nprior scans and likely represents a biliary hamartoma. There are no concerning\nhepatic lesions. There is no intrahepatic biliary dilation. The portal and\nhepatic veins are patent.  The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure with\npancreaticojejunostomy. The remnant pancreas is atrophic and the pancreatic\nduct is mildly dilated.  Again noted is mild nonspecific haziness in the\nsurgical bed. Hypodensity anterior to the common bile duct may represent the\nhepatobiliary limb of the anastomosis. There are no new soft tissue masses. \nThere is no peripancreatic inflammation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, 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 enhance symmetrically.  There is a\nsimple cyst at the upper pole of the right kidney. There is no hydronephrosis\nor concerning renal lesion.\n\nGASTROINTESTINAL: The distal esophagus, stomach, and small bowel are within\nnormal limits. There is mild small bowel dilation at the jejunojejunostomy, to\nbe expected after surgical anastomosis.  The large bowel is normal with no\nevidence colitis.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed. The prostate is mildly enlarged.\nThere is no pelvic free fluid or pelvic lymphadenopathy.\n\nVESSELS:  The abdominal aorta is normal in caliber with only mild\natherosclerotic calcification.\n\nBONES: Endplate degenerative changes are moderate in severity L4-L5. There is\nno concerning osseous lesion.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Status post Whipple procedure with unchanged mesenteric haziness in the\nregion of the pancreatic head, but no new soft tissue masses, lymphadenopathy,\nor omental soft tissue deposits. No evidence of solid organ metastasis.\nHypodensity anterior to the common bile duct may simply represent the\nhepatobiliary limb of the bowel anastamosis rather than a recurrent soft\ntissue mass.\n2. Stable dilation of the small bowel at the jejunojejunostomy, is an expected\nfinding post surgically due to disruption of the by myenteric plexus."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout,\nexcept for a previously described hypodense millimetric cyst at the hepatic\ndome (2:7).  There is no evidence of focal lesions.  The known common bile\nduct stent is unchanged in position, with trace associated pneumobilia in the\nleft hepatic lobe, suggesting stent patency.  The gallbladder is surgically\nabsent.\n\nPANCREAS: The patient is post central pancreatectomy and Roux-en-Y\npancreaticojejunostomy.  The pancreatic head mass measures at least 6 mm\n(02:22), but is not well assessed due to streak artifact from adjacent\nfiducial markers.  The pancreatic tail is unremarkable without pancreatic\nductal 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. \nA 2.3 cm hypodensity in the upper right renal pole has been previously\ncharacterized as a simple cyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The known\njejunojejunostomy is unremarkable in the left abdomen (2:23).  Compared with\nthe prior study, there is a segment of sigmoid colon which exhibits new wall\nthickening, mucosal hyperemia, and mild adjacent fat stranding (601b:  ___\nand 2:59- 71).  There is no extraluminal free air or drainable fluid\ncollection.  The appendix is not directly visualized, but there are no\nsecondary findings 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 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.  Degenerative\nchanges of the lumbar spine are most pronounced at L4-L5, where there is disc\nspace narrowing, osteophytosis, and endplate sclerosis, unchanged.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1.  Compared with the prior CT, there is new wall thickening, mucosal\nhyperemia, and mild adjacent fat stranding about a segment of sigmoid colon,\ncompatible with sigmoid colitis.  No free intraperitoneal air or drainable\nfluid collection.\n\n2.  Patient is post central pancreatectomy and pancreaticojejunostomy.  The\nknown pancreatic head mass has not changed substantially since the prior CT.\n\n3.  Unchanged positioning of the known common bile duct stent, with trace\nassociated pneumobilia, suggesting stent patency.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 06:38 on ___, 3 min after discovery."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries with calcification at the origin\nof the celiac and SMA arteries.  Mixed atherosclerotic disease is seen in the\nabdominal aorta.  There is severe stenosis of the right renal artery,\nunchanged from prior exam in ___.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Right basilar pleural calcification is again\nnoted.  Coronary calcifications are incidentally identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\ncalcified granuloma in seen in segment 7.  There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains stones, without evidence of gallbladder\nwall thickening or pericholecystic fluid.  There is dilatation of the common\nbile duct as well as the cystic duct, similar to prior exam.  The previously\nnoted soft tissue mass adjacent to the gallbladder is not seen on this exam.\n\n\nPANCREAS: The cystic lesion at the pancreas head, approximately stable\ncompared to prior exam in ___, measuring 2.0 x 1.8 cm. There are no\nsolid or complex components within the lesion concerning for malignancy. \nOtherwise, the pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: A 1.3 x 1.3 irregular hypodense lesion is seen in the spleen, of\ndoubtful clinical significance.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney appears atrophic, unchanged from prior exam.  The\nleft kidney appears normal with normal nephrogram. There is no evidence of\nstones or hydronephrosis.  Several subcentimeter hypodensities are seen in\nscattered in the left kidney, too small to characterize but likely cysts.\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.  The previously noted\npolyp in the splenic flexure is not well visualized on today's exam due to\nfecal burden.\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 grossly unremarkable.  There is no adnexal\nabnormality.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged appearance of left T9 rib fracture.  Moderate multilevel\ndegenerative changes of the lumbosacral spine with grade 1 anterolisthesis of\nthe L3-L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged appearance of cystic lesion at the head of the pancreas and\ndilatation of common bile duct, compared to prior exam from ___,\npossibly representing an IPMN.  There are no solid or complex components\nwithin the lesion to indicate malignancy.\n2. Stable appearance of atrophic right kidney with right renal artery\nstenosis.\n3. Unchanged left old T9 fracture and moderate multilevel degenerative changes\nin the lumbosacral spine.\n\nRECOMMENDATION(S):  Given pancreatic cystic lesion of size 1-2 cm, suggest ___\nyear follow-up MRCP if indicated in the patient's clinical circumstances."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe atherosclerotic\ndisease in the abdominal aorta and great abdominal arteries with both\ncalcified and ulcerated plaque, however in the celiac trunk, superior\nmesenteric artery, a replaced common hepatic artery, left renal artery and\ninferior mesenteric artery are grossly patent.  The right renal artery is\ndiffusely narrowed with associated atrophy of the right kidney, a\nlong-standing finding.  .\n\nLOWER CHEST: There is mild bibasilar atelectasis, 5 mm left lower lobe nodule\nthat is unchanged from ___ consistent with benignity, and pleural-based\ncalcification in the right hemi thorax suggestive of prior asbestos exposure. \nNoncalcified nodule in right middle lobe, also unchanged since ___.  Imaged\nportion of lung bases appear otherwise unremarkable.  Imaged portion of heart\nand pericardium are notable for coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Re- demonstrated within the liver are a calcified granuloma at\nthe hepatic dome, as well as millimetric hypodensities in segment 6, ___, and\n3 compatible with cysts or biliary hamartomas.  A hyper enhancing lesion in\nthe left hepatic lobe laterally measuring 8 mm (04:30) as well as a small\nhyper enhancing focus associated with ___ venous shunting (04:33), are also\nboth unchanged.  No new or concerning focal liver lesions are identified.  The\ngallbladder is full of hyperdense sludge or stones, without evidence of\nenhancing lesions.  Extrahepatic biliary ductal dilation with the common bile\nduct measuring up to 1.5 cm in diameter, is unchanged.  There is no\nintrahepatic biliary ductal dilation.\n\nPANCREAS: The cystic lesion in the pancreatic head seen previously measures\n1.4 x 1.9 x 2.0 cm, and previously measured 1.8 x 2.0 x 2.1 cm, unchanged.  As\nbefore, the appearance of this cystic lesion is most consistent with a IPMN,\nwith no evidence of internal nodularity.  The main pancreatic duct remains\nnondilated.  No enhancing pancreatic masses are appreciated.\n\nSPLEEN: The 1.0 x 1.5 cm lobulated cystic lesion in the spleen with a\nperipheral calcification is unchanged.  No solid splenic masses are\nappreciated.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic.  This appears unchanged.  Lower pole of\nthe right kidney shows slightly less cortical thickening and atrophy in\ncomparison with the upper pole in the setting of an accessory lower pole renal\nartery.  Hypo attenuating lesions in the left kidney are too small to\naccurately characterize but remain unchanged.  Extrarenal pelvis is noted\nbilaterally.\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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae appear unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged (since ___ grade 1 anterolisthesis of L3 on L4 with associated\ndegenerative changes.  .  There is unchanged narrowing of the spinal canal at\nthis level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 1.4 x 1.9 x 2.0 cm cystic lesion in the pancreatic head once again shows\nfeatures consistent with side-branch IPMN.  This is amenable to continued\nsurveillance with MRI in ___ year.  No worrisome features are identified.\n2. Stable lesions in the liver and spleen including hepatic cysts or biliary\nhamartomas and granuloma, focus ___ venous shunting in the left lobe of\nliver, indeterminate but stable hyper enhancing segment 3 nodule, and partly\ncalcified splenic cyst.  No worrisome lesions are identified.\n3. Gallbladder sludge/stones.  Stable extrahepatic biliary dilation without\nevidence of biliary obstruction.\n4. Stable atrophy of the right kidney with right renal artery stenosis partly\nsparing the lower pole due to the presence of an accessory right renal artery.\n5. Similar degenerative change of the lumbar spine with anterolisthesis of L3\non L4 with associated spinal canal narrowing."
        },
        {
            "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 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.  There is some thickening and\nhyperenhancement of the terminal ileal loop adjacent to the inflamed right\novary described below, likely reactive.  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 contains fibroids.  IUD is noted within. \nMulti-septated rim enhancing collection with surrounding inflammatory changes\nis seen within the expected location of the right ovary measures 4.4 x 5.6 cm,\nconsistent with a tubo-ovarian abscess.  Compared to the recent exam dated ___, the fluid component of the right-sided tubo-ovarian abscess\nappears larger.\n\nThe left ovary also appears enlarged with small central hypodensity measuring\nup to 1.6 cm, also concerning for a smaller tubo-ovarian abscess, comparable\nto the prior exam.\n\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: Fat containing umbilical hernia is noted.",
            "output": "1. Multi-septated peripherally enhancing fluid collection with extensive\nsurrounding inflammatory changes in the right adnexal region measuring up to\n5.6 cm concerning for a tubo-ovarian abscess, enlarged in size compared to the\nrecent CT dated ___.  An inflamed loop of distal ileum is seen\nclosely adherent to the right tubo-ovarian abscess in the right lower\nquadrant, without evidence of perforation.  The appendix is visualized\nseparately and appears normal.\n2. Enlargement and central hypodensity within the left ovary measuring 1.6 cm\nis also concerning for a tubo-ovarian abscess; comparable to the prior exam.\n3. Fibroid uterus with an IUD in place within the endometrial cavity that is\ndisplaced to the left by the intramural right-sided fibroid."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal. The kidneys enhance normally and excrete\ncontrast briskly.  Duplicated collecting systems are noted.  There are no\nsolid renal lesions or hydronephrosis. The stomach and duodenum are normal.\nThe small and large bowel are normal in caliber.  There is mild\nhyperenhancement of the terminal ileum.  There is active inflammation of the\nrectum, sigmoid, ascending, and transverse colon up to the hepatic flexure, as\nevidenced by mural edema and mucosal hyperemia. There is a fibro fatty\nproliferation of the colonic mesenteries, consistent with an acute on chronic\nprocess.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. There is no pelvic\nmass. There is no free fluid. There is no pelvic or inguinal lymphadenopathy.\nThe uterus is normal. There is no adnexal abnormality.  There are tubal\nligation devices in the bilateral fallopian tubes.  Bilateral inguinal\nlymphadenopathy is stable from multiple prior examinations.  There is active\ninflammatory phlegmon in the perianal and a left presacral regions (series 4,\nimage 66).\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. Acute on chronic colitis involving the entire colon from the anal verge to\nhepatic flexure.\n2. No evidence of perforation or abscess.\n3. Stable perianal and presacral inflammatory changes."
        },
        {
            "input": "LOWER CHEST: Two pulmonary nodules are seen within the right lung base\nmeasuring up to 2 mm (series 2, images 13 and 15), not visualized on prior\nexam.  The 4 mm nodule previously seen at the right lung base is not\nvisualized on current exam, possibly obscured by adjacent atelectasis. \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 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.  Two punctate nonobstructive stones are seen within the\nleft kidney (series 2, images 66 and 71) measuring up to 2 mm.  There is a\nsmall amount of perinephric stranding around the left kidney.  Additionally,\nthere is periureteral stranding throughout the entire course of the left\nureter.\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: No evidence of ureteral stones bilaterally, however, there is a 2 mm\nrenal calculus in the dependent portion of bladder (series 2, image 160). \nThese finding, in conjunction with left perinephric and left periureteral\nstranding, may suggest a recently passed stone.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post prostatectomy with clips 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are 2 sclerotic foci within the bilateral iliac bones, similar\nappearance to prior remote CT and compatible with bone islands. \nRedemonstration of T11 vertebral body hemangioma.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 2 mm renal stone within the dependent portion the bladder, which, in\nconjunction with left perinephric and periureteral soft tissue stranding, is\nsuggestive of a recently passed left UVJ stone.  Correlate with urinalysis to\nexclude the possibility of these findings related to an infection.\n2. Two additional nonobstructive 2 mm renal stones are seen within the left\nkidney.  No ureteral stones.\n3. Two 2 mm pulmonary nodules are seen within the right lung base, which were\nnot visualized on prior exam.\n\nRECOMMENDATION(S):  1. Recommend correlation with urinalysis to rule out\ninfectious process.\n2.  For incidentally detected multiple solid pulmonary nodules smaller than\n6mm, no CT follow-up is recommended in a low-risk patient, and an optional CT\nfollow-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\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:04 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. \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 is nondistended limiting evaluation of the urinary\nbladder wall.  Distal ureters are unremarkable.  There is no free fluid in the\npelvis.  There is mild stranding and trace free fluid within the pelvis,\ndecreased when compared to most recent prior appear.\n\nREPRODUCTIVE ORGANS: The patient is status post total abdominal hysterectomy\nand bilateral salpingectomy.  There is a well circumscribed hypoattenuating\nstructure with a density of 15 Hounsfield units within the left adnexa which\nmeasures 4.1 x 3.4 cm, unchanged.\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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been interval decrease in fat stranding and edema at\nthe soft tissues of the right lower anterior abdominal wall subadjacent to the\nprior incision.  There has been interval resolution the fluid collections\nwithin the right lower pelvic wall.  Interval decrease in size of the right\nrectus abdominal muscle suggesting resolution of the previously proposed\nintramuscular hematoma.  An umbilical hernia containing fat is noted.",
            "output": "1. Interval resolution of fluid collections within the subcutaneous tissues of\nthe right lower pelvic wall.\n2. Interval resolution intramuscular hematoma within the right rectus\nabdominus muscle.\n3. No interval change of simple left adnexa cyst."
        },
        {
            "input": "CHEST:   Please refer to separate report of CT chest performed on the same day\nfor description of the thoracic findings.\nABDOMEN:  The liver is normal without evidence of focal lesions or\nintrahepatic biliary ductal dilatation. The gallbladder demonstrates stones\nwhich is otherwise unremarkable. The adrenal glands bilaterally normal. The\nkidneys bilaterally are normal. The spleen is homogeneous and normal in size.\nThe pancreas is normal without evidence of focal lesions or pancreatic duct\ndilatation. The stomach, duodenum and small bowel are normal without evidence\nwall thickening or obstruction. There is no retroperitoneal or mesenteric\nlymphadenopathy. There is no intra-abdominal free fluid or free air.\n\nThe colon is normal without evidence of obstruction. There is moderate fecal\nloading.\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.\nBONES AND SOFT TISSUES:  There is no evidence of worrisome lesions.",
            "output": "No lesions concerning for malignancy identified 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.  Periportal edema is noted.  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. \nRight upper pole renal cyst is noted.  Punctate left upper pole nonobstructing\nrenal calculus identified.  There is no evidence of focal suspicious 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. Surgical clips at the base of the cecum\nsuggest prior 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 bilateral adnexae are grossly within\nnormal limits noting probable small fibroid off the anterior mid uterine\nsegment..\n\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": "No acute intra-abdominal process.  No free intraperitoneal air.  No splenic\nlaceration.  Periportal edema likely due to aggressive fluid resuscitation."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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 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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 L5 is appreciated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No CT explanation for the patient's left upper quadrant pain or weight\nloss.\n2. Mild atherosclerotic calcifications of the abdominal aorta."
        },
        {
            "input": "LOWER CHEST: Minimal chronic right perifissural atelectasis/scarring,\npartially imaged, seen dating back to ___.  No new focal\nconsolidation is seen. 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 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 subcentimeter hypodensity in the left lower pole is too small to\ncharacterize, but statistically likely represents a simple cyst.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is not dilated.  Contrast has passed through\n22small bowel and into the proximal colon.  No bowel obstruction or bowel wall\nthickening is seen.  Moderate fecal loading is noted throughout the colon. \nThe appendix is not definitively seen, although there are no secondary signs\nof inflammation.\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 grossly 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 no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes in the lower lumbar spine with\nunchanged grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute CT findings in the abdomen or pelvis.  No bowel obstruction or bowel\nwall thickening.  The stomach is not dilated."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexae are unremarkable for patient age.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence acute fracture.  Severe left hip joint\ndegenerative changes include severe joint space narrowing, severe subchondral\ncystic change, severe subchondral sclerosis, and extensive osteophyte\nformation.  No evidence of worrisome osseous lesions.  A well-circumscribed\nlucent lesion with a densely sclerotic rim and narrow zone of transition in\nthe right iliac bone appears benign.  Left sacroiliac joint degenerative\nchanges include osteophyte formation.\n\nSOFT TISSUES: There is a large, fat containing umbilical hernia.",
            "output": "1. No evidence of left hip fracture.\n2. Severe left hip osteoarthritis.\n3. Large fat containing umbilical hernia noted.  No evidence of complications\nat the hernia site."
        },
        {
            "input": "VASCULAR:\n\nThe complex SMA dissection with mild aneurysmal dilation is re-demonstrated. \nThere has been mild proximal extension of the false lumen to approximately 1.6\ncm from the origin of the SMA with interval partial thrombosis proximally\n(7:71).  Additionally, there has been slight interval expansion of the false\nlumen, but the majority of the false lumen remains unthrombosed and the\ndiameter of the artery is essentially unchanged.  The dissection flaps appear\nsimilar; for example, in the sagittal plane, the proximal portion of the\ndissection flap spans 1.4 cm, unchanged, while the distal portion of the flap\nmeasures 1.9 cm (7:70), previously 1.8 cm.  Additionally, the distal extent of\nthe dissection flap is unchanged without definite involvement of the distal\nbranches.  There has been near resolution of surrounding stranding, now\nminimal.\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. 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. \nA 1.0 cm exophytic, nonenhancing hyperdense lesion (noncontrast ___ 96) arising\nfrom the posterior interpolar region of the left kidney (4:62) is compatible\nwith a hemorrhagic or proteinaceous cyst.  Few other subcentimeter\nhypodensities throughout the bilateral kidneys are too small to characterize\nbut statistically likely represent simple cysts.  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: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding. The appendix is normal.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed, limiting its evaluation.  Fat\nwithin the bladder wall is an incidental finding.  The distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  The seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild retrolisthesis of L5 on S1 is unchanged, likely degenerative in etiology.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "SMA dissection is again noted.  There is mild increase in proximal extension\nof the dissection, with partial thrombosis of this proximal false lumen. \nDistally the false lumen is patent.  There is stable aneurysmal dilatation of\nthe SMA to 1.6 cm in the region of dissection"
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  The colon is unremarkable.  The\nnormal-appearing rectum and sigmoid are filled with air and stool, with no\nwall thickening or diverticular disease of concern.\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.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  There are scattered areas of\ninflammatory fat stranding in the anterior abdominal wall soft tissues, likely\nfrom subcutaneous injections.",
            "output": "No evidence of diverticulitis or other acute pathology in the abdomen or\npelvis."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar atelectasis.  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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is diffuse,\ncircumferential wall thickening and adjacent fat stranding of the entire\ndescending colon, extending from the splenic flexure to its junction with the\nproximal sigmoid colon.  No evidence of pneumatosis, free intraperitoneal air,\nor drainable fluid collection.  Appendix is normal.\n\nPELVIS: The bladder and distal ureters are unremarkable.  Trace pelvic free\nfluid.\n\nREPRODUCTIVE ORGANS: A tampon is in situ.  The uterus otherwise appears\nunremarkable.  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.  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.",
            "output": "Colitis involving the entire descending colon from the splenic flexure to its\njunction with the sigmoid colon, either infectious or inflammatory in etiology\nwith ischemia not excluded.  No evidence of pneumatosis, free intraperitoneal\nair, or drainable fluid collection."
        },
        {
            "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: Mosaic attenuation of the visualized lung parenchyma may be due\nto areas of air trapping.  There is trace left pleural effusion and bibasilar\nsubsegmental atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  2.4\ncm hypoattenuating lesion in segment 4B corresponds to a cyst on the most\nrecent ultrasound.  No other focal liver lesion identified. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis contains stones, without evidence of gallbladder wall thickening 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 stones or hydronephrosis.  A 2 cm cyst again noted in\nthe interpolar left kidney.  A small hypodensity in the interpolar right\nkidney is too small to characterize. 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 a focus of arterial blush within a loop of the mid-distal small bowel in\nthe left lower abdomen (series 3, image 103) which demonstrates pooling of\ncontrast in the delayed phase, suggestive of an area of active hemorrhage\n(3:273).\nA short stenotic segment is noted within the distal sigmoid colon.  Colon and\nrectum are otherwise within normal limits.  Appendix contains air, has normal\ncaliber without evidence of fat stranding.\nThere is no evidence of mesenteric lymphadenopathy.\n\nNo free fluid or fluid collection within the abdomen and pelvis.\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.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: Degenerative changes are noted in the lower thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Active arterial hemorrhage seen within mid-distal jejunum in the left lower\nabdomen.  Interventional radiology consultation is recommended.\n2. Short stenotic segment noted in the distal sigmoid colon.  Correlation with\nrecent colonoscopy report is recommended.\n\nNOTIFICATION:  The findings were discussed with Dr. ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:04 pm, 15 minutes after\ndiscovery of the 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: There is been interval increase in bilateral small pleural\neffusions, left greater than right, with partial atelectasis of the left lower\nlobe.  Incidentally noted are new segmental pulmonary emboli in the right\nlower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: There are no new hepatic lesions.  2 cm cyst in segment 4A of\nthe liver.  Uncomplicated 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. \n2 cm cyst in the interpolar region of the left kidney.  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. Colon and rectum are within normal limits. \nAppendix contains air, has normal caliber without evidence of fat stranding. \nThere is no definite evidence of active contrast extravasation into the small\nbowel on the present study.  The previously seen focus of extravasation within\na judge a loop in the left lower quadrant is no longer seen on this study. \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.  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: Large subxiphoid fat containing hernia is stable..",
            "output": "1. No evidence of active GI hemorrhage.\n2. New segmental pulmonary emboli in the right lower lobe, partially\nvisualized.\n3. Worsening bilateral pleural effusions, left greater than right, with\nsegmental atelectatic changes in the left lower lobe.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:41 pm, 10 minutes\nafter discovery of the findings.  The team had already been informed at the\ntime of scanning by the vascular Interventional Radiology team"
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is a small amount\nof hemoperitoneum in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUES: There is a comminuted, right intertrochanteric hip\nfracture.  There is an associated intramuscular hematoma in the right psoas\nmuscle measuring approximately 4.2 x 5.5 cm.  There is no dislocation.",
            "output": "1. Comminuted, right intertrochanteric hip fracture.  Associated intramuscular\nhematoma in the right psoas muscle."
        },
        {
            "input": "ABDOMEN:\n\nMinor bibasilar atelectasis is noted. The liver demonstrates homogeneous\nenhancement, overall decreased, likely related to hepatic steatosis. No\nconcerning focal hepatic lesions are identified. No intrahepatic or\nextrahepatic biliary ductal dilatation. The gallbladder is unremarkable. The\nportal veins, SMV and splenic vein are patent. The pancreas is atrophic,\nhowever no focal lesions are identified. Spleen and adrenal glands are within\nnormal limits. Both kidneys demonstrate symmetric enhancement and excretion of\ncontrast. No hydronephrosis. No suspicious focal renal lesions are identified.\nNo ascites. The stomach is unremarkable. Caliber of small and large bowel is\nwithin normal limits. Caliber of abdominal aorta is within normal limits. Mild\ncalcified and noncalcified atherosclerosis of the infrarenal abdominal aorta\nis noted. Although the study is not tailored for evaluation of arterial\nstructures, moderate stenosis of the origin of celiac artery is suspected\n(5:29, 8:40). SMA, solitary renal arteries and ___ are patent. No\nretroperitoneal or intraperitoneal lymphadenopathy. The appendix is within\nnormal limits. No focal soft tissue abnormality.\n\nPELVIS:\n\nModerately distended urinary bladder is unremarkable. Multiple brachytherapy\nseeds are identified within the prostate gland. Seminal vesicles appear\nsymmetric. Rectum is within normal limits. No pelvic free fluid. No inguinal\nor pelvic lymphadenopathy. Small bilateral fat containing inguinal hernias are\nnoted.\n\nOSSEOUS STRUCTURES:\n\nModerate multilevel disk degenerative changes of the lumbar spine are evident.\nThere is evidence of bilateral pars defect at the L5 level. Grade 1 anterior\nspondylolisthesis of L5 on S1 is noted. No suspicious osteolytic or\nosteoblastic lesions are seen.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis. No\nlymphadenopathy.\n2. Hepatic steatosis.\n3. Moderate stenosis at the origin of celiac artery.\n4. Small bilateral fat containing inguinal hernias.\n5. Bilateral pars defect at the L5 level, with grade 1 anterior\nspondylolisthesis of L5 on S1."
        },
        {
            "input": "Lower Thorax: There is a stable moderate left pleural effusion with adjacent\natelectasis. There is been an interval decrease in the right pleural effusion\nwhich is now minimal.  There are areas of band atelectasis at the right lung\nbase with an unchanged right lower lobe lateral lung nodule measuring 6 mm.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\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 no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: There are unchanged multiple subtle, tiny hypodensities throughout the\nspleen.  There is no evidence of splenic infarct.\n\nKidneys and Adrenals: There unchanged bilateral subcentimetric hypodense round\nlesions too small to characterize, but likely representing cysts.  There is no\nhydronephrosis bilaterally.The adrenal glands are normal bilaterally.\n\nBowel: The patient is status post total gastrectomy and Roux-en-Y with\nunremarkable anastomoses and no evidence of mechanical obstruction.\n\nPelvis:  The urinary bladder is unremarkable.The prostate gland is within\nnormal limits.\n\nLymph Nodes: There are multiple stable necrotic retroperitoneal lymph nodes,\nas previously described.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unchanged.",
            "output": "No evidence of splenic infarct nor other definite cause radiologically for\nleft upper quadrant pain."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: Adrenal mass described below exerts mass effect on the right\nlobe of the liver.  Areas of relative ___ of the hepatic\nparenchyma adjacent to the large adrenal mass is likely perfusional in nature,\nthough subtle invasion is difficult to exclude.  There appears to be minimal\nassociated intrahepatic biliary dilation in segment 6.  A 1.5 cm hypodense\nlesion at the dome of the liver consistent with a simple cyst, increased in\nsize compared to prior when it measured 5 mm.  Few additional subcentimeter\nhypodensities are too small to characterize, but likely represent simple cysts\nor biliary hamartomas.  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: A large heterogeneously enhancing right adrenal nodule measures 7.6\nx 7.7 x 8.9 cm (TV x AP x CC), increased in size compared to exam in ___ when\nit measured up to 5 cm.  Mass exerts mass effect on the right lobe of the\nliver and there is associated slightly heterogeneous enhancement of the\nadjacent hepatic parenchyma.  Small amount of soft tissue posterior to this\nmass appears unchanged from prior.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis.  Simple cysts are noted in left kidney measuring up to 1.7\ncm in the interpolar region.  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: Uterus contains fibroids.  There is heterogeneous\nappearance of the junction of the myometrium with the endometrium (e.g. \n602:37)..  A 3.3 x 3.9 cm low-density right adnexal lesion which contains a\nsmall amount of fat (e.g.  602:29) as well as a small amount of enhancing\ncomponents is consistent with a dermoid as seen on prior pelvic ultrasound.\n\nLYMPH NODES: Prominent retrocrural lymph nodes are similar to prior.  There is\nno 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. \nMild levoconvex scoliosis of the lumbar spine is noted.  Posterior fusion\nhardware is partially imaged at the lower thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval increase in size of a heterogeneously enhancing 8.9 cm right\nadrenal mass which exerts mass effect on the right lobe of the liver. \nHeterogeneous enhancement of the adjacent hepatic parenchyma is likely\nsecondary to mass effect although early invasion is difficult to exclude. \nThis was previously characterized on MRI as likely representing a nerve sheath\ntumor, though pheochromocytoma could have similar appearance.  Surgical\nconsultation is recommended.\n2. Heterogeneous appearance of the endometrial/myometrial junction.  Recommend\nfurther evaluation with pelvic ultrasound on a non-emergent basis.\n3. 3.9 cm fat containing right adnexal lesion is consistent with a dermoid, as\nseen on prior pelvic ultrasound.\n\nNOTIFICATION:  Updates to the wet read were discussed with Dr. ___ at\n16:03 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 new focal lesions.  1.8 cm cyst at the hepatic dome\nand a tiny 6 mm hypodensity in segment VI are unchanged.\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: Status post right adrenalectomy.  There is hypodense density in the\nsurgical bed measuring 3 x 3.9 cm which could represent a seroma.  There is 8\nmm dense focus within the right psoas muscle (series 6, image 56) showing no\nenhancement.\n\nThe left adrenal is unremarkable.\n\nURINARY: The kidneys are unremarkable besides few cortical cysts, the largest\nmeasuring 2.2 cm.  No hydronephrosis.  There is a right extrarenal 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: The uterus and adnexa are unremarkable.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.  No ascites.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLevoconvex scoliosis of the lumbar spine is noted.  Posterior fusion hardware\nis noted in the thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post right adrenalectomy.  Hypodense density in the surgical bed\nwith no enhancing components.  Attention on follow-up recommended.\n2.   No evidence of abdominal or pelvic metastases.\n3. Please refer to separate chest CT done the same day for 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.  A\nsmall cyst at the liver dome is unchanged.  A 1.8 cm hypoattenuating lesion in\nsegment VI/VII (601:32) is new.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThe portal and hepatic veins 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 surgically absent.  Hypodense material in\nthe surgical bed is smaller, and may reflect involving postoperative changes. \nThe left adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA right peripelvic cyst and left cortical cysts or unchanged.  There is no\nevidence of focal mass lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable.  Small large bowel\nloops are normal in caliber.\n\nPELVIS: The urinary bladder is unremarkable.\n\nThere is a large 20.4 x 10.3 x 15.4 cm heterogeneously enhancing mass in\nabdomen/pelvis (2:47, 601:17), which exerts local mass effects.  This mass is\ndisplaces the transverse colon posteriorly and is inseparable from the right\nuterine fundus (601:19).  Central hypoenhancement within the mass is\nconsistent with necrosis.  This mass appears to invade and cross the ventral\nrectus muscle, with extension into the subcutaneous fat layer (602:40). \nMultiple peritoneal and omental implants are seen throughout the abdomen. \nThere is small volume abdominopelvic ascites.\n\nPatient is post right salpingo-oophorectomy.  A candidate for the left ovary\nappears to be within normal limits (601:22).\n\nLYMPH NODES: A 3.2 x 2.3 cm left pelvic sidewall mass (02:59) likely\nrepresents a lymph node metastasis.\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. \nRedemonstration of S-shaped thoracolumbar scoliosis, with partly imaged\nposterior fusion hardware.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large 20 cm necrotic abdominopelvic mass is new from ___.   The\nmass displaces the transverse colon posteriorly, which suggests a possible\nomental origin, differential diagnosis includes metastatic disease,\nmesothelioma or other soft tissue sarcoma are also included in the\ndifferential diagnosis.\n2. Diffuse peritoneal carcinomatosis.\n3. New 1.8 cm hypoattenuating lesion in hepatic segment VI/VII is suspicious\nfor metastatic disease.\n4. Small amount of ascites new from prior study"
        },
        {
            "input": "There has been interval progression compared to the CT performed ___.\n\nThe large partially necrotic mass centered on the lower abdomen has increased\nin size, now measuring 14.0 x 25.9 x 19.5 cm, previously 9.5 x 20.4 x 13.5 cm.\nThere is tumor extension into the subcutaneous soft tissues of the anterior\nabdominal wall (series 5, image 51).  There has been interval increase in the\nsize of the mesenteric lymph nodes and  peritoneal and omental metastases with\nan index tumor deposit along the right anterolateral abdominal wall now\nmeasuring approximately 5.7 x 4.4 cm, previously 3.8 x 2.1 cm (series 5, image\n42).  Additional tumor deposits are noted along the peritoneal reflection on\nthe right, these have again increased in bulk when compared to the prior CT,\nfor example right paracolic gutter implant measuring approximately 4.6 x 2.3 x\n4.4 cm, previously 2.5 x 1.1 x 1.8 cm (series 5, image 39).\n\nTumor remains inseparable from the uterine fundus (series 8, image 33).  The\nurinary bladder is largely collapsed.  There are apparent enhancing nodular\nfoci along the anterior dome of the bladder, best seen on the sagittal\nprojection, potentially reflecting additional tumor deposits (series 8, image\n37 and 36).  This is new from the prior study.\n\nTumor exercises local mass effect, displacing adjacent loops of bowel.  There\nis new upstream dilatation of the small bowel with an abrupt transition point\nin the left lower quadrant, posterior to the mass (series 5, image 61),\nrelated to tumor compression.  No gross tumor invasion in this location. \nUpstream dilatation is seen to the level of the duodenum.  There is no\nevidence of pneumatosis intestinalis, portal venous gas or free\nintra-abdominal air.  Visualized large bowel is grossly unremarkable.\n\nThere is moderate volume intra-abdominal ascites, which is slightly increased\nfrom prior study.  Fluid measures up to 11 Hounsfield units in attenuation. \nNo organized intra-abdominal fluid collections are seen.\n\nLiver is normal in contour and attenuation.  There is a cyst at the liver dome\nand in the right lobe, unchanged from prior.  Portal and hepatic veins remain\npatent.\n\nNormal gallbladder.  No intrahepatic or extrahepatic bile duct dilatation.\n\nThe spleen is not enlarged but is displaced medially relative to its previous\nposition on the CT performed ___.  Splenic vein is patent.\n\nPancreas is normal in bulk and attenuation.  There is no evidence of main\npancreatic duct dilatation.\n\nThe right adrenal gland is not visualized.  Hyperdense foci within the right\nadrenal bed are unchanged.  There is unchanged thickening of the left adrenal\ngland.\n\nThere are bilateral renal cortical and right peripelvic cysts.  No evidence of\nhydronephrosis.\n\nKnown thoracic rotoscoliosis with associated chest wall deformity.  Surgical\nhardware incompletely visualized in the thoracic spine.\n\nDiffuse subcutaneous soft tissue stranding, likely reflecting fluid overload.\n\nSmall bilateral pleural effusions, larger on the right, with passive\natelectasis, unchanged from prior radiograph..",
            "output": "1.  Marked interval increase in the size of the large necrotic tumor in the\nlower abdomen, and increase in the bulk of multiple more focal areas of tumor\nextension/invasion.  Suspected new tumor deposits along the urinary bladder\nwall, as above.\n2.  New mechanical small-bowel obstruction, with transition point in the left\nlower quadrant, posterior to the mass, and related to local mass effect. No\ngross tumor invasion in this location. No pneumatosis intestinalis, portal\nvenous gas, or free intra-abdominal air.\n3.  Moderate volume ascites, simple in attenuation, is increased compared to\nprior study.\n4.  Small bilateral pleural effusions, larger on the right, with passive\natelectasis, which appear unchanged compared to most recent prior chest\nradiograph.\n\nNOTIFICATION:  Findings reviewed with Dr. ___ at 23:13 on ___."
        },
        {
            "input": "LOWER CHEST: Right pleural thickening versus small right pleural effusion is\nseen in the dependent portion of the right hemithorax, and has been seen on\nprior studies, similar.  Mild, dependent, subsegmental atelectasis of the left\nlung.  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.\n\nPANCREAS: The pancreas has normal attenuation throughout, 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\nmillimetric, focal hypodensity within the spleen (02:18) is too small to\ncharacterize.\n\nADRENALS: The 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.  A\nnonobstructing right renal stone measures 3 mm.  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 normal.\n\nPELVIS: The bladder appears unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  A cystic structure adjacent to\nthe right ovary measures 0.8 cm (2:72) and is stable since ___..  No\nleft 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen at the lumbosacral junction with disc space\nnarrowing, vacuum phenomenon and posterior disc osteophyte with mild to\nmoderately narrows the central canal.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Nonobstructing 3 mm right renal stone.  No hydronephrosis.\n2. Right pleural thickening versus small right pleural effusion.\n3. 0.8 cm cystic structure within the right adnexa, adjacent to the right\novary, possibly a paraovarian or ovarian cyst and stable since ___."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis without consolidation or pleural\neffusion.  Moderate calcifications of the coronary arteries.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous no attenuation throughout,\nwhich may be associated 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 is mildly enlarged.  No focal lesions are\nidentified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Several small hypodensities in the left kidney are too small to\ncharacterize, may reflect cysts.  Otherwise, the kidneys are of normal and\nsymmetric size with normal nephrogram.  8 mm stone is noted in the lower pole\nof the right kidney (series 2, image 51).  There is no evidence of focal renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is noted.  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 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": "-Nonobstructing 8 mm stone in the right kidney.\n-No acute findings in the abdomen and pelvis."
        },
        {
            "input": "LOWER CHEST: Minimal dependent atelectasis.  There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation throughout\nwith mildly irregular contours.  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 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  A 9 x 6 x 4 mm\nstone is again seen in the lower pole of the right kidney.  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.\n\nPELVIS: The urinary bladder is decompressed and distal ureters are\nunremarkable.  There is no free fluid in the pelvis.  Multiple pelvic\ncalcifications are unchanged from prior and represent phleboliths.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  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.  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. Liver steatosis with mild irregular contours.\n2. Redemonstrated nonobstructive 9 mm stone in the lower pole of the right\nkidney.\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 MR ___, in conjunction with a GI/Hepatology\nconsultation\" *\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 show trace bilateral pleural effusions\nwith associated relaxation atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is intrahepatic biliary ductal\ndilatation and common bile duct dilation with mild wall enhancement of the\ncommon bile duct and central intrahepatic biliary ducts.  The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is a 12 mm\nhypodense lesion in the uncinate process, as seen on prior MRI, which most\nlikely represents 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 a 9 mm nonobstructing stone in the interpolar region and additional\npunctate nonobstructing stones in the inferior pole of the left kidney.  There\nis no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality. There is air within the mildly bladder. The distal\nureters are unremarkable\n\nGASTROINTESTINAL: There are postsurgical changes from Roux-en-Y gastric\nbypass.  A metallic clip is seen in the second portion of the duodenum, which\nis likely related to prior endoscopy.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nOTHER: There is a small to moderate amount of free fluid in the abdomen and\npelvis with layering hyperdensity in the pelvis.  There is a small amount of\nfree air in the abdomen, which is likely postsurgical.\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: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Subcutaneous gas is seen along the anterior abdominal wall, most\nlikely secondary to postsurgical changes.",
            "output": "1. Small to moderate amount of free fluid in the abdomen and pelvis with\nlayering hyperdensity in the pelvis, which most likely represents postsurgical\nblood products.  A bile leak could also explain the free fluid but is thought\nto be less likely given the layering hyperdensity.  If there is clinical\nconcern for a bile leak, further evaluation may be performed with HIDA scan.\n2. Unchanged intrahepatic and extrahepatic biliary ductal dilatation with mild\nenhancement of the common bile duct and central intrahepatic bile ducts, which\nis favored to represent postsurgical changes over cholangitis.\n3. Air within the bladder is most likely secondary to catheterization, but\ncould also represent infection in the appropriate clinical context. \nCorrelation with urinalysis is recommended."
        },
        {
            "input": "GALLBLADDER AND BILIARY TREE:\n\nPatient is ___ days status-post laparoscopic cholecystectomy.\n\nCholecystectomy clips are in situ.\n\nThere is no evidence of active contrast extravasation or hemoperitoneum.\n\nThere is however increasing low attenuation fluid in the abdomen and pelvis\n(up to 12 Hounsfield units), as below.\n\nSurrounding the cholecystectomy clips is a simple collection which measures\napproximately 6.0 x 5.4 cm, previously 4.0 x 4.2 cm on the CT of the abdomen\nperformed ___ (series 301, image 59).\n\nThere is increasing fluid around the liver with a discrete pocket measuring\napproximately 3.8  x 11.4 cm (series 301, image 69) on the axial projection,\npreviously 2.4 x 9.3 cm on the MR performed ___.\n\nThis increasing fluid tracks along the right paracolic gutter, measuring up to\n5.4 cm in transverse dimension on the coronal projection, previously 4 cm on\nthe CT performed ___ (series 601, image 39).\n\nAgain re-demonstrated is free pelvic fluid with increasing fluid volume medial\nto the external iliac vasculature (series 301, image 148).\n\nThe CBD is mildly dilated, measuring up to 12 mm in diameter.  CBD\ndemonstrates mild mucosal hyperenhancement.  There is mild central\nintrahepatic bile duct dilatation.\n\nThe cystic duct remnant is identified.  It demonstrates mural enhancement to\nthe level of the surgical clips, with new discontinuity of its wall towards\nits distal aspect, most consistent with dehiscence of the cystic duct remnant\n(series 303, image 56 and series 601 image 48).\n\nOTHER:\n\nLiver is normal in contour and attenuation.  No focal parenchymal lesions\nidentified.  Portal and hepatic veins patent.\n\nThere is a focal hypodensity within the proximal pancreatic body likely\nreflecting focal fat (series 303, image 54).  Pancreas otherwise maintain\nnormal attenuation.  There is no main duct dilatation.\n\nThe spleen is not enlarged (10 cm).  Incidental note is made of two accessory\nspleens in the left upper quadrant.\n\nLeft adrenal gland is minimally bulky, unchanged from prior.  There is nodular\nthickening of the right adrenal gland (series 601, image 69), slightly more\nconspicuous when compared to the study performed in ___.\n\nBilateral renal cortical cysts.  A subcentimeter cyst at the lower pole of the\nright kidney contains punctate mural calcification and measures 9 mm in\ndiameter (series 303, image 77).  There is a simple cyst at the interpolar\nregion of the left kidney measuring up to 9 mm in diameter.  Of note is a\nnon-obstructing 9 mm calculus at the interpolar region of the left kidney. \nSmaller punctate stones are noted additionally at the lower pole of the left\nkidney.  No hydronephrosis or hydroureter.\n\nThere is a surgical suture line at the level of the stomach, present in\nrelation to prior Roux-en-Y surgery.  Multiple loops of bowel are filled with\nfluid and minimally prominent, without transition point.  This is likely on a\nbackground of ileus.  No evidence of mechanical bowel obstruction.  No gross\nabnormality of the large bowel.\n\nInterval improvement of post-surgical pneumoperitoneum seen on the prior CT.\n\nPatient is status-post hysterectomy.  There is no adnexal abnormality. \nUrinary bladder is partially distended.  There is a small residual locule of\nair within the bladder lumen, again likely from catheterization.\nAbdominal aorta is normal in caliber.  No atherosclerotic disease is noted.\n\nThere is no evidence of inguinal, pelvic, retroperitoneal, or periportal\nlymphadenopathy.  Scattered small mesenteric lymph nodes are likely reactive\nin nature.\n\nThere is an intraosseous hemangioma within the L2 vertebral body.  No acute or\nfocal destructive osseous lesions.\n\nThere is diffuse subcutaneous soft tissue stranding, likely on a background of\nthird spacing.  Injection granulomas are noted within the gluteal subcutaneous\nfat bilaterally.",
            "output": "1.  Patient is status post cholecystectomy.\n2.  There is no evidence of active intravenous contrast extravasation or\nhemoperitoneum.\n3.  Increasing fluid collection around the porta hepatis, around the surgical\nclips.  Increasing fluid around the liver, tracking into the right paracolic\ngutter.  Increasing pelvic fluid.  This is present in association with\napparent dehiscence of the cystic duct remnant.  Constellation of findings is\nhighly concerning for bile leak on a background of cystic duct remnant\ndehiscence.  If further imaging is required to confirm the leak, this would be\nbest done with MRCP, using a hepatobiliary agent.\n4.  Multiple loops of bowel are mildly prominent and filled with fluid.  This\nis likely related to ileus.\n4.  Nodular thickening of the right adrenal gland, slightly more conspicuous\nwhen compared to the study performed in ___.  The nature of this finding is\nindeterminate.\n5.  9 mm non-obstructing calculus interpolar left kidney.\n\nNOTIFICATION:  Findings were reviewed with the surgical team in person,\nshortly after the completion of the scan on ___ at 16:15."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  Otherwise the lung bases are\nclear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary ductal\ndilatation, unchanged.  Cholecystectomy clips are in situ.  Surrounding the\ncholecystectomy clips is a simple fluid collection re-demonstrated measuring\n7.5 x 6.5 cm, previously measuring 6.0 x 5.4 cm (series 2, image 26). \nAdditional pockets of fluid adjacent to the main pocket measure up to 2.2 cm\nand are more well organized (series 2, image 28).  There is a 7.3 x 1.9 cm\ndiscrete fluid collection anterior to the liver with new pigtail catheter\nwithin the fluid collection, that appears decreased in size compared to prior\n(series 2, image 33), where it measured up to 11.0 x 4.0 cm.  There is\nsurrounding 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric bypass surgery.  The excluded\nstomach is distended with fluid.  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.  No definite\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.  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. Patient is status post cholecystectomy.  There is increased fluid\ncollection around the porta hepatis surrounding the surgical clips, now\nmeasuring up to 7.5 cm.  New adjacent smaller pockets of fluid collections\nmeasuring up to 2.2 cm.  Findings are concerning for persistent bile leak.\n2. Previously seen discrete perihepatic fluid collection no has pigtail\ncatheter in has significantly decreased in size."
        },
        {
            "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. Minimal intrahepatic biliary\ndilatation, less conspicuous than the prior study.  Trace pneumobilia.  The\ngallbladder surgically absent.  There has been interval placement of a\ninternal external biliary drainage catheter, with the tip terminating within\nthe duodenum.  There has also been interval placement of a pigtail catheter,\nwith the tip within the cholecystectomy bed.  Previously seen fluid\ncollections within the cholecystectomy bed have substantially decreased in\nsize, no longer clearly evident.  A peripherally enhancing fluid collection\nanterior to the liver measures approximately 2.0 x 1.0 cm (2:34), decreased in\nsize from 7.4 x 1.9 cm previously.  Fat stranding surrounding the collection\nhas decreased.  No new fluid collections 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass.  There\nis a short segment small bowel to small bowel intussusception around\nanastomotic sutures located within the left upper abdomen.  No evidence of\nbowel obstruction.  Remaining small bowel loops appear unremarkable.  The\ncolon and rectum are within normal limits. Mild haziness of the mesenteric fat\nmay be sequela of prior process.\n\nPELVIS: The bladder appears unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  No adnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  An\nenlarged left external iliac chain node measures 1.4 cm, unchanged.  There is\nno 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 within the anterior abdominal wall.",
            "output": "1. Interval placement of an internal external biliary drainage catheter and a\npigtail catheter, both appropriately positioned, with interval near resolution\nof fluid collections within the gallbladder fossa, likely reflecting biliary\nleak.\n2. Interval decrease in size of a peripherally enhancing, right perihepatic\nfluid collection, now measuring 2.0 cm, previously 7.4 cm.  No new fluid\ncollections identified.\n3. Short segment, small bowel to small bowel intussusception around\nanastomotic sutures within the left upper abdomen, likely transient.  No\nevidence of bowel obstruction."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis, left greater than right.  No\npericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A left lobe PTBD terminates appropriately in the duodenum.  The\nliver demonstrates homogenous attenuation throughout.  There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Scarring appears similar over multiple prior exams.  The\ngallbladder is surgically absent.  There is near complete interval resolution\nof a right-sided perihepatic fluid collection, now measuring 0.7 x 0.4 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.  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass. No\nevidence of obstruction.  Remaining small bowel loops are normal caliber, wall\nthickness, and enhancement throughout.  There is a large stool burden in the\ncolon.  The colon and rectum are within normal limits.  Contrast is visualized\nin the colon, likely secondary to recent PTBD intervention.  The appendix is\nnormal and contains 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.  The left ovary is\nnormal.\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: Multiple surgical clips within the anterior abdominal wall.",
            "output": "1. Large stool burden in the colon.  Otherwise, no acute findings in the\nabdomen or pelvis to account for patient's pain.\n2. Appropriate positioning of left lobe PTBD without complication evident.\n3. Near complete interval resolution of right perihepatic fluid 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.  A stable 10 mm simple cyst abuts the\nvena cava between the insertions of the right and middle hepatic veins.  A low\nattenuation lesion is again seen in segment 6 of the liver measuring 7.2 mm in\nsize.  This is stable.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder polyp remains unchanged in size and\nappearance..\n\nPANCREAS: The pancreas has normal attenuation throughout.  In the head of the\npancreas anteriorly is a 4.5 x 6 mm low-attenuation lesion which was not seen\non the prior study 15 months previously.  This has a lower attenuation than\nthe adjacent parenchyma of the pancreas and cannot be further characterized on\nthis single phase CT scan.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Again seen are\nbilateral renal cysts the largest in the medial left kidney measuring 2.5 x\n2.1 cm in size.  No concerning cysts are identified.  No renal stones are\npresent.  No hydronephrosis is present.  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. Again seen is extensive sigmoid\ndiverticulosis with no CT evidence for diverticulitis or inflammation of the\nsigmoid colon wall.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No focal\nbladder wall thickening or intraluminal soft tissue is identified.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.  In\nparticular, the prostate gland is stable in size and appearance with no\nintra-prostatic fluid collections.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 changes are present in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New 4.5 x 6 mm low-attenuation lesion in anterior head of pancreas.  A\ndedicated pancreatic MRI is recommended for further characterization.\n2. Extensive sigmoid diverticulosis with no evidence for diverticulitis.\n3. No evidence for any inflammation in the prostate or bladder.\n\nRECOMMENDATION(S):  MRI of the pancreas to further characterize new\nlow-attenuation lesion in pancreatic head.\n\nNOTIFICATION:  The presence of a new lesion in the anterior head of the\npancreas was placed on the import result notification base dashboard for\ndirect communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: Except for mild dependent bibasilar atelectasis, lungs are clear\nwithout 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. \nA 6 mm hypodensity in the lower pole of the right kidney is too small to\ncharacterize, but statistically likely a cyst.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is\ncircumferential wall thickening and adjacent fat stranding of the descending\nand sigmoid colon (601B:39, 30, 2:66), without free intraperitoneal fluid or\nfree intraperitoneal air.  The appendix is not directly visualized, liver\nthere are no secondary inflammatory changes 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 reproductive organs are unremarkable, besides a\nfibroid 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: Multilevel severe degenerative changes of the visualized thoracolumbar\nspine are identified, most pronounced at L3-L4 and L5-S1, with endplate\nsclerosis, osteophytosis, and vacuum disc phenomenon.  There is grade 1\nanterolisthesis of L5 on S1.  Compression deformity of the T12 vertebral body\nis unchanged since the MRI lumbar spine from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Acute, uncomplicated colitis, involving the descending and sigmoid colon.  No\nfree intraperitoneal air or free fluid identified.\n\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 23:00 on ___, immediately after\ndiscovery."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries. The celiac artery, SMA,\nbilateral renal arteries and ___ are normal in caliber and patent.  There is\nno wall thickening, irregularity, aneurysm, or dissection of the arterial\nvasculature to indicate vasculitis.\n\nThere is a circumaortic left renal vein, an anatomic variant.\n\nLOWER CHEST: There is minimal subsegmental atelectasis of the bilateral lung\nbases.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  The gallbladder is surgically absent with\nminimal prominence of the intrahepatic bile ducts as well as extrahepatic bile\nduct, within expected limits of 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 nephrograms.\nA left upper renal pole 3 cm simple cyst and right interpolar 1.5 cm cyst are\nunchanged. No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber.  Intramural fat\ndeposition within the stomach segments of the jejunum and ileum, including the\nterminal ileum, is nonspecific but may be seen with chronic inflammation and\nwas noted on the prior exam (301:58, 100, 154).  No evidence to suggest active\ninflammation such as bowel wall thickening, mucosal hyperenhancement, or\nsurrounding fat stranding.  The colon and rectum are within normal limits. \nThe appendix is not visualized.\n\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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable..\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are predominantly of lower lumbar level where mild\nloss of disc space height is demonstrated.  There is no evidence of\nsacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "-No findings of vasculitis.  No acute process in the abdomen or pelvis.\n-Intramural fat deposition within the stomach segments of the jejunum and\nileum, including the terminal ileum, nonspecific but may be seen with chronic\ninflammation.  No evidence of active inflammation."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions with adjacent bibasilar\natelectasis.  Trace pericardial effusion is likely physiologic.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nsubcentimeter hypodensity in the right hepatic lobe is too small to\ncharacterize (02:13).  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder contains multiple 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 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 contains a 7 mm hypodensity measuring -23 Hounsfield units.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis.  There are cysts in both kidneys, the\nmajority of which are simple although a 1.9 cm cyst in the upper pole the\nright kidney measures 40 Hounsfield units.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach which is\ndecompressed.  The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Severe\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are present in the spine.  Mild superior endplate\ndeformities of the L2 and L4 vertebral bodies are new from ___ but without\nsurrounding soft tissue changes or fracture lucency to suggestive acuity.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of bowel obstruction or acute abnormality.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Right hyperdense renal cyst may be proteinaceous/hemorrhagic and can be\nfurther assessed with nonemergent renal ultrasound.\n4. 7 mm left adrenal adenoma.\n5. Mild compression deformities of the L2 and L4 vertebral bodies are new from\n___ but appear chronic.\n6. Diverticulosis."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Small bilateral pleural effusions and minimal atelectasis the lung\nbases is stable. Moderate cardiomegaly is stable. No large pneumothorax.\n\nABDOMEN:\n\nThe liver is homogeneous and grossly unremarkable. The gallbladder is normal\nwithout calcified gallstones.\n\nThe spleen is normal. The pancreas is atrophic.. The adrenal glands are\nunremarkable.\n\nPatient is status post left nephrectomy. The right kidney is grossly\nunremarkable. A stable 1.3 cm hypodensity within the interpolar region of the\nright kidney is most consistent with a simple cyst. No focal renal lesions.No\nhydronephrosis or hydroureter identified. No renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion.  No pneumatosis. Colonic diverticulosis is\npresent without evidence of acute diverticulitis. The appendix is not\nvisualized however no evidence of acute appendicitis.  Moderate fecal load is\npresent.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. \nModerate amount of atherosclerotic calcification noted. The iliac arteries are\nnormal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo abdominal wall hernia or pneumoperitoneum. Moderate volume ascites is\nunchanged in appearance. Diffuse anasarca is noted.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria. Small amount of free\npelvic fluid seen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. No CT evidence to explain patient's symptoms.  Moderate fecal load.  No\nobstruction.\n\n2. Moderate ascites and anasarca, unchanged since ___.\n\n3. Small bilateral pleural effusions."
        },
        {
            "input": "LOWER CHEST: A 1 mm calcified granuloma is noted in the lower lobe of the\nright lung (series 3, image 21).\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\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 show no evidence of hydronephrosis, stones or focal\nlesions.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix has\nnormal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries. There is no evidence of clot\nwithin the main portal vein, splenic vein and SMV.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable oter than a\nfocus of unchnged calcification with or adjacent to the anterior bladder wall.\nThere is no evidence of pelvic or inguinal lymphadenopathy. An IUD is noted\nwithin the uterus.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "No renal or ureteral or bladder calculi are noted."
        },
        {
            "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: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a small hypodensity in segment 6, which is too small\nto characterize, but likely represents a cyst.  Otherwise, the liver\ndemonstrates homogenous attenuation throughout.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  At the inferior aspect of\nthe gallbladder wall, there are 2 small cystic foci with rim enhancement that\nrepresent focal adenomyomatosis of no clinical significance.  The gallbladder\nis otherwise within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: There is a common bile duct stent, which appears in appropriate\npositioning.  The pancreatic duct appears prominent, unchanged in comparison\nto the prior examination.  Again visualized is the pancreatic mass at the\nuncinate process, which measures 2.1 x 2.2 x 1.5 cm.  The size and appearance\nis largely unchanged in comparison to the prior examination.  There is some\nfat stranding directly adjacent to the superior mesenteric artery, but no\nevidence of vascular invasion.  The previously visualized celiac axis lymph\nnode measures 1.5 x 1.5 cm, which may be reactive in nature, and is unchanged\nin size and appearance in comparison to 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.\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.  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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are 2 lucent lesions with sclerotic rims within the left greater\ntrochanter and a punctate sclerotic lesion in the right iliac bone, all of\nwhich likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable appearance of mass in the uncinate process of the pancreas and\nceliac axis lymph node without interval enlargement or vascular invasion.\n2. Small liver hypodensity that is too small to characterize, but likely\nrepresents a cyst.\n3. Atherosclerosis."
        },
        {
            "input": "LOWER CHEST: Subsegmental atelectasis in both lower lobes.  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 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.\n\nADRENALS: The left adrenal gland is normal in size and shape.  Overall stable\n3 cm right adrenal adenoma, previously characterized on MRI.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Treatment injection sites noted in the anterior abdominal wall. \nNo fluid collections or soft tissue mass.",
            "output": "1. No acute intra-abdominal process.\n2. No CT evidence of acute pancreatitis or sequella of chronic pancreatitis."
        },
        {
            "input": "LOWER 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 orthotopic liver transplant in ___. \nThe transplant liver demonstrates homogenous attenuation throughout.  There is\nno evidence of suspicious focal lesions.  Irregular linear hypodensities along\nthe medial margin of the left hepatic lobe and at the inferior most margin of\nthe right hepatic lobe favored to represent postsurgical change (601:24). \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is mild periportal edema.  Posttransplant fibrotic changes are noted\nwithin the porta hepatis.  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: Spleen is normal in size.  Hypodense nodules in the splenic parenchyma\nhave increased in size in comparison to ___.  A representative\nexophytic nodule the superior aspect of the spleen measures 4.9 cm, previously\n3.5 cm (3:61).\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are of normal symmetric size within normal nephrogram. \nThere is no hydronephrosis.  There are left peripelvic cysts.  No suspicious\nrenal lesions.  No perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable.  There is no small bowel\nobstruction.  The colon and rectum are unremarkable.  The appendix is normal. \nThere is trace mesenteric edema and fluid tracking along the prerenal and\nlateral conal fascia.\n\nPELVIS: The urinary bladder is decompressed and not well evaluated.  Distal\nureters are normal.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications are noted within the prostate.  Seminal\nvesicles are normal.\n\nLYMPH NODES: There is extensive conglomerate lymphadenopathy throughout the\nupper abdomen involving the periportal, gastrohepatic and gastrosplenic nodal\nstations as well as within aortocaval retroperitoneal nodal stations. The\nlargest conglomerate is located just posteriorly to the origin of the main\nportal vein and extends from the porta hepatis to the duodenal sweep measuring\n6.1 x 4.2 x 9.0 cm (3:75, 601:30).  The most inferiorly located nodal\nconglomerate is at the aortocaval nodal station measuring 4.5 x 3.0 x 5.0 cm\n(3:82, 601:34).  The most anterior nodal station is located just anterior to\nthe gastric antrum measuring 3.4 x 2.6 x 3.6 cm (3:82:, 601:20).  A\nconglomerate of left para-aortic retroperitoneal nodes measures 2.7 x 4.1 x\n5.3 cm (3:80, 602:60).\n\nVASCULAR: The main portal vein is patent.  Splenic vein is markedly attenuated\nby lymphadenopathy.  There are extensive portosystemic varices including\nuphill esophageal varices, gastric varices and a small splenorenal shunt. \nThere is no abdominal aortic aneurysm.  Moderate calcified atherosclerotic\ndisease is noted.\n\nBONES: No worrisome osseous lesions or acute fractures.\n\nSOFT TISSUES: There is a left-sided varicocele.  There is bilateral\ngynecomastia.",
            "output": "1. Extensive conglomerate lymphadenopathy throughout the upper abdomen and\nretroperitoneum is highly suspicious for a posttransplant lymphoproliferative\ndisorder (PTLD).  Several of these lymph node conglomerates would be amenable\nto CT-guided biopsy for example in the left periaortic retroperitoneal lymph\nnode station or within a upper abdominal conglomerate anterior to the gastric\nantrum.\n2. Significant interval growth of previously slow growing splenic nodules is\nsuspicious for an additional site of PTLD involvement.\n3. Sequelae of elevated portosystemic pressures including esophageal and\ngastric varices.\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 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 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. 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. No acute findings in the abdomen or pelvis to explain patient's symptoms. \nThe appendix is normal."
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion with adjacent\natelectasis..  Mild pericardial thickening versus a small 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 high attenuation material, likely PICC\nareas extrusion of contrast from prior contrast enhanced studies as it was not\npresent on the initial CTA chest.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 a nasogastric tube\nterminating in the gastric body.  Small bowel loops demonstrate normal caliber\nand wall thickness 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 a\nFoley catheter in-situ with air in the bladder.  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.  There is a small amount of free\nfluid in the pelvis adjacent to the rectum (2:119)..\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 fat stranding around the left inguinal soft tissue in\nkeeping with recent arterial catheterization.  No collection.",
            "output": "1. No acute intra-abdominal process.\n2. Please refer to separate chest CT done the same day for thoracic findings."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The dome of the liver was excluded from the field of view.  A\nhypoattenuating lesion in segment too small too small to completely\ncharacterize, but probably reflects a cyst or biliary hamartoma.  The\nremaining imaged hepatic parenchyma enhances homogeneously.    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 is diffuse\ndescending colon wall thickening with adjacent fat stranding and prominent\nvasculature.  No pneumatosis or pneumoperitoneum.  The appendix is normal.\n\nPELVIS: The urinary bladder is mildly distended and grossly unremarkable. \nThere 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.  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": "Descending colitis, probably infectious or inflammatory."
        },
        {
            "input": "Evaluation of the intra-abdominal and pelvic organs is somewhat limited on\nthis noncontrast exam.\n\nABDOMEN: Limited views of the liver, spleen, kidneys, and pancreas are\nunremarkable. A calcified gallstone is noted in the gallbladder.\n\nPELVIS:\n\nThe sigmoid colon and rectum are normal in appearance. The bladder is normal\nin appearance. The uterus appears to be surgically absent there. There is no\npelvic or inguinal lymphadenopathy. There is no free fluid in the pelvis.  Fat\nstranding and a probable small fluid collection are seen in the area of the\njunction of the inner right thigh with the right labia, best seen on coronal\nview (601b:53).\n\nBONES AND SOFT TISSUES:\n\nNo focal lytic or sclerotic osseous lesions suspicious for infection or\nmalignancy are seen.",
            "output": "Fat stranding and a probable small fluid collection are seen in the area of\nthe junction of the inner right thigh with the right labia, best seen on\ncoronal view (601b:53)."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Limited assessment of the lung bases demonstrates small bilateral,\nleft greater than right, pleural effusions and compressive atelectasis however\nclinical correlation is recommended to assess for superimposed infection. No\nlarge pneumothorax. The visualized heart is normal in size without pericardial\neffusion.\n\nABDOMEN:\n\nThe liver is homogeneous and grossly unremarkable.  Small amount of\nperihepatic fluid is stable. The gallbladder is moderately distended,\nincreased from ___, without additional specific signs for acute\ncholecystitis. No calcified gallstones. Trace amount of pericholecystic free\nfluid. No gallbladder wall thickening.\n\nThe spleen is normal.  Trace amount of perisplenic free fluid is stable. The\npancreas is homogeneous without peripancreatic fat stranding or focal fluid\ncollection. The adrenal glands are unremarkable.\n\nThe kidneys are symmetric in size. Multiple renal hypodensities are stable.\nRepresentative lesions measure 3.0 x 2.9 cm (02:18) within the upper pole of\nthe right kidney and demonstrate a fluid/fluid level, most consistent with a\nhemorrhagic/proteinaceous cyst. Additional 4.4 x 4.8 cm left lower pole simple\ncyst is stable. No hydronephrosis or hydroureter identified. No renal or\nproximal ureter calculi.\n\nAn enteric feeding tube tip is just distal to the gastroesophageal junction. \nSmall amount of oral contrast is seen within the distal esophagus. The stomach\nis moderately distended and filled oral contrast. Oral contrast is seen\nextending throughout the jejunum. A left lower quadrant colostomy is\npresent.Multiple dilated loops of small bowel measuring up to 3 cm are seen\npredominantly within the left upper quadrant with oral contrast extending up\nto the parastomal hernia. Within the parastomal hernia there is at least 1\nlarge dilated loop of small bowel measuring 3.3 cm with adjacent free fluid\nand fat stranding worrisome for strangulation.  Upstream colonic bowel\nentering into the colostomy demonstrates diffuse wall thickening and fat\nstranding. The cecum is dilated measuring up to 6.5 cm. The descending colon\nis featureless. The sigmoid colon and rectum is decompressed. The appendix is\nnot visualized however no evidence of acute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. \nAortobi-iliac stent grafts are noted. Moderate amount of atherosclerotic\ncalcification noted. The iliac arteries are normal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nModerate amount of free abdominal fluid.  No additional abdominal wall hernia.\nNo pneumoperitoneum. No pneumatosis.\n\nPELVIS: The bladder is mildly distended with a Foley catheter. No pelvic\nside-wall or inguinal lymph node enlargement by CT size criteria. Small volume\nof free pelvic fluid seen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Small bowel obstruction with transition point at neck of parastomal hernia\nwith findings worrisome for strangulation.  No pneumatosis. No free air.\n2.  Diffuse colonic wall thickening up to the colostomy with associated fat\nstranding, colonic dilatation, and adjacent free fluid is concerning for large\nbowel obstruction with transition point at the parastomal hernia, given\nabsence of IV contrast evaluation is limited. Differential includes acute\ncolitis in the appropriate setting.\n3.  Moderately distended gallbladder with trace amount of pericholecystic free\nfluid is most likely related to NPO status. No gallbladder wall thickening. No\nfat stranding or cholelithiasis.\n4.  NG tube tip just distal to the gastroesophageal junction. Consider\nadvancing 10 cm for better positioning.\n5. Small bilateral, left greater than right, pleural effusions and compressive\natelectasis.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 9:34 AM, 20 minutes after discovery\nof the findings."
        },
        {
            "input": "VASCULAR:\n\nEndograft noted in the lower thoracic and upper abdominal aorta without\nevidence of endoleak.  A 3 cm segment of focal dissection is seen in the lower\nthoracic aorta starting at the level of T10 vertebral bodies through inferior\nendplate of T11.  The dissection does not involve the celiac axis nor the SMA.\nAneurysmal fusiform dilation up to 4 cm in the suprarenal abdominal aorta is\nunchanged from ___.\n\nLOWER CHEST: Fat herniation into through the lateral left chest wall,\nunchanged from priors.   Minimal atelectasis is noted in the lung bases. There\nis no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. A 9\nmm homogeneously enhancing lesion in the right hepatic lobe, segment VI, could\nbe a hemangioma or transient hepatic difference attenuation.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  A 3 mm gallstone\nis seen, with a normal appearing 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 top-normal in size and normal in 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. \nMild scarring in the interpolar region of the left kidney.  A 2 cm simple cyst\nis seen in the upper pole of the right kidney.  No 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. Colon and rectum are within normal limits. There\nis no evidence of mesenteric 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: Patient appears to be status post hysterectomy.\n\nBONES: There 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. Lower thoracic and upper abdominal aorta endograft without evidence of\nendoleak.  Stable fusiform aneurysm of the suprarenal abdominal aorta\nmeasuring up to 4 cm and focal dissection in the suprarenal abdominal aorta\nare unchanged since ___.\n3. Cholelithiasis without evidence of 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 suspicious focal lesion.  There is no evidence of intrahepatic\nbiliary dilatation.  Dilatation of the CBD up to 1.1 cm is unchanged and\nlikely related to prior cholecystectomy.\n\nPANCREAS: The pancreas  proximal body is atrophied.  There are numerous coarse\ncalcifications throughout the pancreas, compatible with chronic pancreatitis. \nDilatation of the main pancreatic duct up to 6 mm is unchanged.  A 1.1 cm\ncystic lesion in the pancreas tail is unchanged in size and may represent a\ndilated side branch or chronic pseudocyst.  No focal mass lesions are seen. \nThere are no new peripancreatic fluid collections or acute inflammatory\nchanges.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 cysts are again seen.  There is no evidence of solid\nrenal lesions.   There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding. The\nappendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic 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 findings in the abdomen or pelvis.\n2. Unchanged findings related to chronic pancreatitis."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases demonstrates bilateral lower\nlobe, left greater than right, atelectasis. Tiny bilateral pleural effusions\nare noted. The visualized heart is normal in size without pericardial\neffusion.\n\nABDOMEN:\n\nThe liver is diffusely hypodense consistent with hepatic steatosis. No focal\nlesion identified.No intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is mildly thick-walled and otherwise unremarkable. No calcified\ngallstones.\n\nThe spleen is normal. Diffuse fatty infiltration of the pancreas is noted. \nSmall amount of free fluid is seen around the pancreatic tail. No significant\nfat stranding. No pancreatic duct dilatation. No calcifications. No focal\nfluid collection. The adrenal glands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. No focal\nrenal lesions. No hydronephrosis or hydroureter identified. No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. Mild diffuse bowel wall thickening involving the sigmoid colon and\ndescending colon as well as cecum is noted. Small amount of free fluid is seen\nalong inferior aspect of the liver and along the ascending colon. The large\nbowel is normal in caliber without wall thickening, fat stranding, or focal\nmass lesion. Colonic diverticulosis is present without evidence of acute\ndiverticulitis.The appendix is normal without evidence of acute appendicitis.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo pneumoperitoneum.\n\nPELVIS: The bladder is mildly thick-walled and decompressed with a Foley\ncatheter. No pelvic side-wall or inguinal lymph node enlargement by CT size\ncriteria. Small amount of free pelvic fluid seen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.\n\nCTA: The portal vein, SMV, and splenic vein are patent. The abdominal aorta is\nnormal in caliber without aneurysmal dilatation. Moderate amount of\natherosclerotic calcification noted. The celiac axis, SMA, and ___ are patent.\nThe common iliac, external, and internal iliac arteries are normal in course\nand caliber. Bilateral single renal arteries are patent. An accessory\nretroaortic left renal vein is noted.",
            "output": "1.  Severe hepatic steatosis. Clinical correlation is recommended to assess\nfor steatohepatitis. Small volume ascites.\n2. Diffuse colonic wall thickening with small amount of free fluid adjacent to\nthe ascending colon can be seen with colitis, infectious, inflammatory or\nischemic as well as portal colopathy secondary to severe hepatic disease.\nClinical correlation is recommended.\n3.  Diffuse bladder wall thickening may be related to underdistention however\ncan be seen in the setting of acute cystitis.\n4.  No CT evidence of pancreatitis."
        },
        {
            "input": "LOWER CHEST: A micronodule at the left lung base is stable.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\n2.4 cm hypodense lesion in the posterior right hepatic lobe with some\nperipheral nodular enhancement is unchanged and consistent with hemangioma. \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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Again seen are multiple\nbowel anastomoses compatible with history prior ileocecectomy and multiple\nsmall bowel resections.  Compared with MR enterography ___, the\noverall appearance of the bowel is not significantly changed.  Bowel loop in\nthe left pelvis appears more dilated as compared to ___, but similar\ncompared to MRI from ___ again seen are 2 areas of\nshort segment strictures measure up to 2 cm in the mid abdomen and 3 cm in the\nright mid abdomen.  A patulous loop of bowel in the right lower quadrant\nmeasuring up to approximately 15 cm is not significantly changed.  Under\nstricture seen.  There is equivocal mild wall thickening/mild hyperemia of\ndilated loop of bowel in the left pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: Prominent mesenteric lymph nodes are again seen.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post right total hip arthroplasty.  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. Equivocal mild wall thickening/mild hyperemia of dilated loop of bowel in\nthe left pelvis, could relate to subtly acute on chronic Crohn's disease.\n2. No significant change in postsurgical configuration of the bowel and 2\nshort segment strictures with associated pre stenotic dilatation.\n3. Cholelithiasis with no evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions, left greater than right with\nassociated atelectasis.  No pericardial effusion.\n\nABDOMEN:\nSmall volume pneumoperitoneum throughout the abdomen and pelvis is likely due\nto recent surgery.\n\nHEPATOBILIARY: 2.4 cm right hepatic hemangioma is unchanged.  Otherwise, the\nliver demonstrates homogenous attenuation throughout.  There is no evidence of\nnew focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Cholelithiasis.  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: The spleen shows normal size 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 hypodensities within kidneys bilaterally, too small to\ncharacterize, but likely represent cysts.  There are multiple punctate\nnonobstructing stones within the kidneys bilaterally measuring up to 3-4 mm\nwithin the lower pole of the left kidney (series 4, image 34).  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: The patient is status post multiple small bowel resections\nwith a right lower quadrant ileostomy.  There is no evidence of bowel\nobstruction.  However, multiple small bowel loops within the right and left\nhemiabdomen demonstrate circumferential wall thickening, which may be in part\ndue to underdistention, but raises suspicion for active bowel inflammation. \nContrast was given through the NG tube is seen throughout multiple jejunal\nbowel loops without evidence of extravasation.  Contrast was also given via a\nrectal tube and seen throughout the remaining colon, also without evidence of\nextravasation.  NG tube is seen terminating in the stomach.  There is a small\nhiatal hernia.\n\nPELVIS: Within the right hemipelvis, there is an air and fluid collection with\na thin enhancing rim measuring approximately 6.6 x 8.6 x 11.9 cm (series 4,\nimage 70 and series 6, image 12), however the bladder is not definitively\nvisualized, and this may represent a distended bladder.  There is also a\nmoderate amount of free fluid interspersed between bowel loops within the\nmidline pelvis (series 4, image 61).  No other focal fluid collections are\nvisualized.\n\nREPRODUCTIVE ORGANS: Uterus is not definitively visualized.  There is a 2.3 cm\ncystic structure within the right adnexa (series 4, image 68).\n\nLYMPH NODES: There is no retroperitoneal or 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 total right hip arthroplasty with streak\nartifact that limits evaluation over the pelvis.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse subcutaneous edema.  Scattered foci of subcutaneous air\nit is likely due to recent surgery.",
            "output": "1. Status post multiple small bowel resections with a right lower quadrant\nileostomy.  Status post partial colectomy with a blind-ending colonic loop in\nthe right hemiabdomen.  Contrast was given the NG and rectal tube without\nevidence of anastomotic leak.\n2. Air and fluid collection within the right hemipelvis measuring up to 11.9\ncm, however the bladder is not definitively visualized.  This may represent a\ndistended bladder or a rim enhancing fluid collection.  Once the rectal\ncontrast has passed, a repeat pelvic CT can be obtained after instillation of\ncontrast into the bladder via a Foley catheter for further evaluation.\n3. Diffuse small-bowel wall thickening, which may be partially due to\nunderdistention, but raises suspicion for active bowel inflammation.\n4. Other incidental findings include cholelithiasis, nonobstructing renal\nstones, and small bilateral pleural effusions."
        },
        {
            "input": "Limited views of the upper abdomen demonstrate cholelithiasis and a multiple\nsmall bilateral renal stones\n\nPELVIS:  The patient is status post multiple small bowel resections and\nileocecectomy with right lower quadrant\nIleostomy.  There is a small amount of residual contrast within the rectum and\nmultiple loops of bowel.  The previously seen fluid collection in the right\npelvis is filled with mildly hyperdense fluid and a small amount of air on\ninitial images.  Following injection air and contrast through the Foley\ncatheter, the structure distends with increase in air and contrast, confirming\nthe structure is the urinary bladder.  There is a moderate amount of free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight hip prosthesis is partially visualized.\n\nSOFT TISSUES: Right lower quadrant ileostomy is noted, as well as anterior\nmidline cutaneous staples.  There is mild diffuse subcutaneous edema.",
            "output": "1. CT cystogram confirms the previously seen fluid and air-filled structure in\nthe right pelvis represents the urinary bladder.\n2. Additional findings are better delineated on dedicated CT abdomen and\npelvis performed 1 day prior, and appear grossly 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:\nHEPATOBILIARY: There is unchanged appearance of a 1.8 x 2.4 cm hemangioma\nright hepatic lobes (04:53).  A focal region of hypodensity along the\nfalciform ligament likely represents focal fat, unchanged compared to exams\ndating to ___.  There is 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.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 nonobstructing renal stones in the lower calices, measuring up\nto 3 mm on the right and 4 mm on the left.  There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Patient is status post\nmultiple small bowel resections, right lower quadrant end ileostomy, and\nileocecectomy.  The remaining small bowel loops are diffusely thickened and\nedematous.  For example, the previously distended and thickened loops of bowel\nin the right mid abdomen from CTs dating back to ___ are\ndecompressed on today's study but have persistent circumferential wall\nthickening (4:85).  More proximal loops of small bowel, probably jejunal\nloops, now appear edematous, slightly increased since the prior exam in ___.   The remaining colon is mostly collapsed but appear to also have mild\nwall thickening, likely related to third spacing from recent postoperative\nstate.  Contrast seen layering in the right remaining colon is likely residual\nfrom prior rectal contrast on ___ CT exam.  There is persistence of\nmild intra-abdominal ascites and extraluminal gas, compatible with recent\npostoperative state (4:101).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  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.  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 following right lower quadrant\nileostomy and exploratory laparotomy with surgical staples along the midline.",
            "output": "1. Postoperative changes from multiple small bowel resections, right lower\nquadrant end ileostomy, and ileocecectomy. Diffuse wall thickening of almost\nthe entirety of remaining small bowel is probably related to third spacing and\nrecent surgery rather than a primary bowel inflammatory process.\n2. There is persistence of mild intra-abdominal ascites and extraluminal gas,\nminimally decreased since ___.\n3. Cholelithiasis is seen without acute cholecystitis.\n4. Stable appearance of multiple millimetric nonobstructive renal stones\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Linear opacity at the left lung base is likely due to\natelectasis.  Prior pleural effusions have resolved in the interim.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable appearance of 1.8 cm right lobe hemangioma.  There is no evidence of\nnew focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Small volume ascites.  The gallbladder contains calcified\ngallstone is somewhat distended though without evidence of 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. \nMultiple nonobstructing renal stones are seen the bilateral kidneys, not\nsignificant changed from prior.  There is no evidence of solid renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post multiple small and large bowel\nresections.  Interval reversal of right lower quadrant ileostomy since prior. \nLocules of air noted within the superficial abdominal soft tissues and\nintra-abdominally, likely postsurgical.  There is a small hiatal hernia. Again\nseen are multiple loops of small bowel that are diffusely thickened and\nedematous, overall appears mildly improved compared to prior.  Loops of\nduodenum appear to have normal wall thickness.  Loops of jejunum and ileum\nmeasuring up to 3.0 cm without evidence of acute transition point.\n\nThere is a an irregular shaped pocket of fluid with air in the right lower\nquadrant with air measuring approximately 8.3 cm TRV x 4.2 cm AP (02:49) x\napproximately 8.9 cm cc (602:25).  This is seen the level of the mid abdomen\nadjacent to a anastomotic site.  There are also likely small extensions\nsuperiorly just deep to the anterior abdominal wall.\n\nIn addition, there is a heterogeneous density in the right upper abdomen just\nbelow the liver (02:37).  Some of this is likely due to fluid though the more\nhyperdense components are identified could be related to blood products though\ndecompressed bowel loops are possible, this is less likely.\n\nThe colon is collapsed and rectum are within normal limits. The appendix is\nnot visualized.\n\nPELVIS: Detailed evaluation of the pelvis is limited secondary to right hip\narthroplasty.  Urinary bladder is somewhat distended with anti dependent air,\npresumably from recent instrumentation.  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: The abdominal and pelvic wall is within normal limits. \nSuperficial stranding edema is noted within the soft tissues of the abdominal.",
            "output": "1. Postsurgical changes from recent ileostomy reversal and right colectomy\nwith changes along the anterior abdominal wall.\n2. An approximate 8 x 9 x 4 mm pocket of fluid and air adjacent to the\nanastomotic site in the right mid to lower abdomen. Cannot exclude possibility\nof leak or infection.\n3. Additional superior more heterogeneous area in the right upper quadrant\njust below the edge of the liver in the postop bed.  Lower density regions of\nfluid mixed with higher density areas potentially due to the blood products.\nDecompressed bowel in this region could contribute to the higher density areas\nbut this is considered less likely. Consider repeat exam with enteric/rectal\ncontrast to further characterize these findings.\n4. No evidence of small-bowel obstruction.\n5. Similar appearance of multiple bilateral nonobstructing renal calculi.\n6. Cholelithiasis without evidence of cholecystitis.\n7. Small volume ascites."
        },
        {
            "input": "LOWER CHEST: Left lower lobe air space disease has improved since prior CT ___, but for a full description of chest findings reference is made to\nCT chest report of the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple hemangiomas unchanged in size since prior CT scan ___, as well as multiple small hypodense lesions too small to characterize\nand likely consistent with either biliary hamartomas or simple hepatic cysts. \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. \nThere is no evidence of solid renal lesions or hydronephrosis.  There are\nbilateral non-obstructing 2-3 mm renal calculi. There are bilateral, small,\nhypodense lesions consistent with cortical renal cysts measuring up to 6 mm. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatus hernia.  The patient is status post\nsmall and large bowel resection, reversal of right lower quadrant ileostomy\nand ileocolonic anastomosis.  The fluid collection which previously measured\n8.3 x 4.2 x 8.9 cm adjacent to the anastomotic site has improved, however\nthere are several residual smaller loculated collections measuring up to 3.6 x\n3.1 cm inferior to hepatic segment ___ (series 7, image 40). Additional\ncollections measuring up to 3.8 x 1.1 cm (series 7, image 39) have multiple\nramifications projecting superiorly and medially.  The majority of these\ncollections are likely communicating.  There is a single hyperdense foci in 1\nof the collections abutting the right anterior abdominal wall (series 7, image\n47) which is indeterminate but this may represent extravasated oral contrast\nor pre-existing density (to differentiate between these 2 a pre oral contrast\nstudy would of been needed).  No other areas of definite extravasation of oral\ncontrast.  There is a small pocket of extraluminal air associated with one of\nthese loculations (series 7, image 30).  There is surrounding presumably\nreactive bowel wall thickening similar to minimally improved since prior CT.\n\nPELVIS: Evaluation of the pelvis is limited secondary to the right hip\narthroplasty.  The visualized urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: There is a left ovarian simple cyst measuring 2.4 cm\n(series 7, image 62).  Otherwise, the visualized reproductive organs are\nunremarkable.\n\nLYMPH NODES: There are prominent retroperitoneal, mesenteric and inguinal\nlymph nodes which do not meet size criteria for lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is focal atherosclerotic calcification at the origin of the\nceliac 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. The previously described abdominal fluid collection has decreased in size\nand is now represented by multiple residual smaller loculated, rim enhancing\ncollections measuring up to 3.6 x 3.1 cm inferior to the right lobe of liver\nabout the ileocolic anastomosis.  Many of these collections appear to be\ncommunicating, and a small amount of extraluminal air is seen within 1 of the\nloculated collections.  .\n2. There is a single hyperdense foci in 1 of the collections abutting the\nright anterior abdominal wall which is indeterminate, but this may represent\nextravasated oral contrast or pre-existing density.  A pre oral contrast study\nwould have been needed to differentiate between the aforementioned.  Thus, no\ndefinite extravasated oral contrast.\n3. Bowel wall thickening about the ileocolic anastomosis is similar to\nminimally improved compared to prior study, most likely secondary to adjacent\nfluid collections/abscesses.\n4. Bilateral nonobstructing renal calculi are again noted and measure up to\n2-3 mm.  No hydronephrosis.\n\nNOTIFICATION:  The findings were discussed with ___ from Dr.\n___, by ___, M.D. on the telephone on ___ at\n5:28 pm, 5 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Nodular opacities are again identified in the left lower lobe\nsuch as on series 5, ___ 5.  These are stable and have represented airspace\ndisease.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 2.2 cm hypodense lesion in the posterior right lobe on series 5 ___\n15.  This was previously identified and demonstrates peripheral puddling\nconsistent with a hemangioma.  There is a vague heterogeneous area in segment\n4 B on series 5 ___ 22.  Not as well identified as previously but this also\nrepresented a hemangioma.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains a stone on series\n5, ___ 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 solid renal lesions or hydronephrosis.  Small\nnonobstructing stones are seen in the lower pole of the right kidney on series\n5 ___ 31 and of the left kidney on series 5 ___ 27.  There are tiny hypodense\nlesions in the kidneys bilaterally such as in the left kidney on series 5 ___\n20.  These are too small to characterize but cysts.  They are stable in size. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\nsmall and large bowel resection, reversal of a right lower quadrant ileostomy\nand ileocolic anastomosis.  Best seen on series 5 ___ 36..  A drainage\ncatheter is identified in a collection posterior to the anastomosis.  There is\nno residual fluid surrounding the catheter.  The previously identified\nanterior and medial collections have significantly improved.  A tiny residual\ncollection remains measuring 1.1 x 0.8 cm, previously 3.5 x 1.2 cm best seen\non sagittal images series 3 ___ 24.  This is identified on axial images on\nseries 5 ___ 37..  There is persistent bowel wall thickening about the\nileocolic anastomosis such as on series 5 ___ 43.  This is stable.  The colon\nand rectum are within normal limits.\n\nPELVIS: The pelvis is difficult to evaluate due to artifact from a right hip\nprosthesis.  The urinary bladder and distal ureters are unremarkable.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 2.3 cm cyst in the right ovary on series 5 ___\n60 measuring at 2 ___.  This is unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 improvement in right lower quadrant abscesses with a tiny 1.2\ncm collection remaining medially.  No fluid identified surrounding a drainage\ncatheter in the right lower quadrant.\n2. Persistent bowel wall thickening at the ileocolonic anastomosis\n3. Bilateral nonobstructing renal stones\n4. Liver hemangiomas\n5. Cholelithiasis without evidence for cholecystitis"
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  There is a simple\ncyst in the right lobe of the liver, unchanged from prior.  There are no new\nfocal parenchymal lesions.  Portal and hepatic veins patent.  There is mild\nhyperenhancement of the fundal gallbladder wall, but no evidence of\ngallbladder luminal distention or pericholecystic fluid.  There is no\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (10 cm).  There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: There are multiple tiny bilateral non-obstructing renal calculi. \nThere is a simple cyst at the lower pole of the left kidney.  Kidneys\notherwise unremarkable.  No hydronephrosis.\n\nGASTROINTESTINAL: Direct comparison is made to the CT performed ___ and the rectal MRI performed ___.  Known mid rectal tumor is\nredemonstrated.  The apple-core component is somewhat less perceptible on\ntoday's study.  There is however a large exophytic component which fills the\nmesorectal fat and extends towards the right presacral space (series 2, image\n102).  This component appears overall more hypoattenuating when compared to\nthe study performed in ___.  How much of this reflects residual\ntumor will be best described on the MRI of the rectum performed concurrently. \nThere remains significant upstream distension of the large bowel proximal to\nthe mass, with a large volume of stool.  This dilated segment of bowel\ndemonstrates diffuse wall thickening (up to 7 mm).  The dilatation is\nsegmental, in the caliber of the large bowel normalizes towards mid to\nproximal sigmoid and descending colon.  The remainder of the large bowel is\nunremarkable.  Small bowel loops demonstrate normal caliber, without mural\nthickening or luminal distention.  Stomach is grossly unremarkable.\n\nPERITONEUM: There is no evidence of free air.  There may be some free fluid in\nthe right presacral space.  No large volume free intra-abdominal or pelvic\nfluid.  No gross peritoneal or omental nodularity.\n\nPELVIS: Urinary bladder is largely collapsed.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are noted within the uterus, which is\ntilted towards the left hemipelvis.  There is no gross adnexal abnormality.\n\nLYMPH NODES: Large mesorectal lymph nodes are redemonstrated on the left,\nmeasuring up to 13 mm in diameter, unchanged from the study performed in\n___ (series 2, image 104).  There remains a prominent right internal\niliac lymph node which measures 10 mm in short axis, unchanged from prior\n(series 2, image 99). There is a left common iliac lymph node which measures 8\nmm in short axis, previously 5 mm in short axis.  Despite being slightly\nlarger, it remains normal by CT measurement criteria.  No additional\nlymphadenopathy noted on today's study.\n\nVASCULAR: Moderate aortoiliac atherosclerosis.  No aneurysmal dilatation.  IVC\nfilter in situ.\n\nBONES: No acute or focal destructive osseous lesions.  Degenerative facet\narthropathy and degenerative disease lumbar spine.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.  Small volume of\nsubcutaneous emphysema along the anterior abdominal wall, likely reflecting\nsubcutaneous injections.",
            "output": "1.  Direct comparison is made to the CT torso performed ___ and\nthe rectal MRI performed ___.  Known mid rectal tumor is\nredemonstrated.  The apple-core component appears less perceptible on today's\nstudy, but the large exophytic component which fills the mesorectal fat and\nextends towards the right presacral splays is redemonstrated, and appears\noverall more hypoattenuating when compared to the prior study, potentially\nreflecting necrosis.  Residual tumor analysis is better performed with MRI. \nPlease refer to the report from the rectal MRI performed concurrently.  The\nrectal tumor and potentially the associated inflammatory post-treatment\nchanges continue to cause some element of obstruction, with distension of the\nlarge bowel proximal to the tumor, and wall thickening of the distended\nportion of bowel.  Caliber normalizes more proximally.\n\n2.  Large left mesorectal lymph nodes remain, measuring up to 13 mm in short\naxis.  There is a prominent right internal iliac lymph node which measures 10\nmm in short axis, unchanged from prior.  There is a left common iliac lymph\nnode which measures 8 mm in short axis, previously 5 mm in short axis. \nDespite being slightly larger, it remains normal by CT measurement criteria.\n\n3.  There is no evidence of metastatic disease to the liver or metastatic\ndisease to the abdomen or pelvis otherwise.  No gross peritoneal/omental\ndisease.\n\n4.  Note that findings pertaining to 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 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 1.1 cm rounded hypodensity in the right lower renal pole is unchanged since\n___.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is again seen.  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: 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.  Note is again made of a left-sided IVC.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nMild lumbar degenerative changes are again seen.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "No acute intra-abdominal or intrapelvic process.  Normal appendix."
        },
        {
            "input": "PANCREAS:\nAn ill-defined hypoattenuating mass in the pancreatic head measures 3.0 cm x\n2.3 cm, causing upstream ductal dilation of the pancreatic and common bile\nducts as well as inferiorly-approaching ducts from the uncinate process\n(4:105, 4:99, 7:37,38).  The mass appears to invade the duodenum (4:104),\ncontacts the MPV (8:59) and SMV (4:105) less than 180 degrees and encases the\ndistal GDA (4:105), with the proximal 1 cm spared (07:37).  The SMA and celiac\ntrunk are spared. Conventional vascular anatomy is present. See pancreatic\nstaging above for further vascular details. There is no peripancreatic\nstranding.\n\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase):  Hypoattenuating, though\ndifficult to evaluate given extensive upstream atrophy.\nSize (maximal axial dimension in cm): 3.0 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\n\nArterial evaluation\n\n___ involvement: absent\nSolid soft-tissue contact:  Less than 180\u00b0\nIncreased hazy attenuation/stranding contact:  Less than 180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact:  Less than 180\u00b0\nIncreased hazy attenuation/stranding contact:  Less than 180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\nSolid soft-tissue contact:  Less than 180\u00b0\nIncreased hazy attenuation/stranding contact:  Less than 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:  Less than 180\u00b0\nDegree of increased hazy attenuation/stranding contact:  Less than 180\u00b0\nFocal vessel narrowing or contour irregularity:  Absent\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact:  Less than 180\u00b0\nDegree of increased hazy attenuation/stranding contact:  Less than 180\u00b0\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: present\nDegree of solid soft-tissue contact:  Less than 180\u00b0\nDegree of increased hazy attenuation/stranding contact:  Less than 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: Present.  Equivocal 15 mm perigastric lymph node along\nthe lesser curvature, though not conspicuous on the recent CTA from ___\n(series 7, image 24).  A 9 mm portacaval node is less specific, possibly\nreactive.\nOther extrapancreatic disease (invasion of adjacent structures): duodenum.\n\n\nVASCULAR:\n\nFusiform infrarenal abdominal aortic aneurysm is present measuring 6.0 x 5.7\ncm, unchanged in appearance from previous examination.  More complete\nevaluation including pre EVAR measurements can be found in separate report on\nCT of the abdomen pelvis from ___.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  Please see\npancreatic staging for details regarding pancreatic vascular anatomy.\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\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 and has normal caliber without evidence of fat\nstranding.\n\nLYMPHADENOPATHY: A 9 mm portacaval node is present.  There is no mesenteric,\ninguinal, or pelvic 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\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Ill-defined 3.0 cm pancreatic head mass causing upstream ductal dilation\nwhich invades the duodenum and contacts the MPV and SMV with less than 180\ndegree involvement.  Encasement of the distal GDA occurs 1 cm after takeoff. \nThe SMA and celiac trunk are not involved.\n2. 15 mm perigastric node along the lesser curvature of the stomach.\n3. Conventional hepatic vascular anatomy.\n4. Unchanged fusiform infrarenal abdominal aortic aneurysm, described on the\ndedicated CTA from ___."
        },
        {
            "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: A small foci of calcification is seen in segment 6 of the liver\n(4:108).  Subtle wedge shaped peripheral areas of hypoenhancement are noted in\nthe right lobe (4: 113 and 123), which may have been present in ___\nbut appears more prominent on today's study.  There is re- demonstration of\nperiportal edema, slightly increased compared to previous.  Pneumobilia is\nagain seen status post hepaticojejunostomy.  The gallbladder is surgically\nabsent.\n\nPANCREAS: The patient is post Whipple's procedure.  There is mild stranding in\nthe surgical bed, stable compared to previous.  Several fiducial markers are\nagain noted in this region.  The remainder of the pancreas appears\nunremarkable without evidence of ductal dilation or focal masses.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 re- demonstration of a fusiform infrarenal abdominal\naortic aneurysm with an aorto bi-iliac stent.  The aneurysm sac measures 6.0\ncm in maximal diameter, unchanged compared to previous.  An endoleak is again\nnoted, likely type 2.  Extensive atherosclerotic disease is again noted.  The\npatient is status post portal venous reconstruction.  There is narrowing at\nthe site of the splenic anastomosis to the main portal vein, similar compared\nto previous.\n\nPELVIS: There is thickening of the bladder wall which may be secondary to\nunderdistention.  There is no evidence of pelvic or inguinal lymphadenopathy. \nSmall amount of free fluid is seen pelvis.\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. \nDegenerative changes are seen in the lower lumbar spine.\n\nSOFT TISSUES:  There is mild diffuse anasarca.",
            "output": "1. No evidence of local recurrence or new metastatic disease within the\nabdomen and pelvis.\n2. Peripheral wedge-shaped areas of hypoenhancement in the right lobe of the\nliver, may represent areas of abnormal perfusion /infarcts.\n3. Status post aorto bi-iliac stent graft repair of an abdominal aortic\naneurysm with persistent endoleak.  The aneurysm sac is unchanged in size.\n4. There is mild anasarca and a small amount of free fluid in the abdomen and\npelvis."
        },
        {
            "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. \nThere is a small calcification seen in segment 6 stable from prior exam. \nRelative ___ in geographic distribution in peripheral segment ___\nand 4A are likely related to transient perfusional differences.  These appear\nto correspond to areas of relative ___ on prior exam.  Periportal\nedema is grossly stable from prior exam.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is is surgically absent.\n\nPANCREAS:  Status post Whipple procedure.  The remaining tail and body of the\npancreas has normal attenuation throughout without evidence of focal lesions\nor 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 left adrenal gland is normal in size and shape.  There is a 1.2\nx 0.9 cm nodule in the medial limb of the right adrenal gland.  There is no\nsignificant change in this nodule when compared to the oldest prior exam in\n___ on axial images, but it is equivocally larger on coronal\nreconstructions.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2 mm nonobstructive calculus in the right kidney.  There is no\nevidence of focal renal lesions, or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post Whipple procedure.  The stomach is unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are within normal limits.  Appendix contains air,\nhas normal caliber without evidence of fat stranding.  There is no evidence of\nmesenteric lymphadenopathy.\n\nVASCULAR:\n\nA fusiform infrarenal abdominal aorta measures up to 6 cm in maximal\ndimension, stable from prior exam.  Aortic bi-iliac stent is in stable\nposition.  Extraluminal contrast around the left iliac graft is again noted\nand compatible with endoleak as seen on prior exam.  There is severe calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nThe hepatic veins are patent.  The portal vein and its major branches are\npatent.  The splenic vein and SMV are patent.  There is unchanged appearance\nof mild stenosis at the anastomosis of the SMV to the main portal vein and\nsevere stenosis at the anastomosis of the splenic vein to the main portal\nvein.\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 free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged the seminal vesicles are grossly\nwithin normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of local recurrence or metastatic disease in the abdomen or\npelvis.\n2. Unchanged appearance of infrarenal abdominal aortic aneurysm measuring up\nto 6 cm status post aorta bi-iliac stent graft repair with persistent\nendoleak.\n3. 1.2 cm nodule of the right adrenal gland equivocally larger compared to\noldest prior exam in ___.  Recommend attention on follow-up.\n4. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nRe-demonstration of a 6.2 x 5.8 cm fusiform infrarenal abdominal aortic\naneurysm appears stable from prior exam (3:161).  Aorto-bi-iliac stent is in\nstable position.  Extraluminal contrast around the left iliac graft is again\nnoted and compatible with a likely type II endoleak as seen on multiple prior\nexams (3: 161-162). There is severe calcium burden in the abdominal aorta and\ngreat abdominal arteries.\n\nThe hepatic veins are patent.  The portal vein and major branches are patent. \nThe splenic vein and SMV are patent.  There is stable severe stenosis of the\nanastomosis of the splenic vein and main portal 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:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is re-demonstration of a punctate calcification in segment VI is stable\nfrom prior exam performed ___ (3:109).  A subtle 1.2 cm\nhypodensity in segment V is not fully characterized but is new from prior MR\nexam (3:115).  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is is resected.\n\nPANCREAS: Patient is status post Whipple procedure.  The remaining tail and\nbody of the pancreas is 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: Right adrenal gland is normal in size and shape.  A 1.2 x 0.9 cm\nnodule in the medial limb of the right adrenal gland appears grossly stable\ncompared to prior exam performed ___ (3:115).\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 Whipple procedure with associated\nsurgical changes.  Small bowel loops are fluid-filled without significant wall\nthickening or dilation. Colon and rectum are within normal limits.  Appendix\nis not visualized. There is no evidence of mesenteric lymphadenopathy.\nModerate ascites surrounding the liver, spleen, and bilateral paracolic\ngutters is stable compared to prior MR exam performed ___.\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 free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged up to 4.6 x 5.1 cm (3:231),\nwhich is stable compared to prior exam and the seminal vesicles are\nunremarkable.\n\nBONES: Mild degenerative changes of the thoracolumbar spine.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small left ventral hernia containing small bowel without\nevidence of obstruction.",
            "output": "1. Subtle new 1.2 cm hypodensity in liver segment V is not fully characterized\non current exam but is new compared to prior study.  Recommend MR for further\nevaluation.\n2. Re-demonstration of moderate ascites surrounding the liver, spleen, and\nbilateral pericolic gutters that appear stable compared to prior MR exam\nperformed ___.\n3. Otherwise no evidence of local tumor recurrence.\n4. Re-demonstration of a stable 6.2 x 5.8 cm fusiform infrarenal abdominal\naortic aneurysm status post aorto bi-iliac graft stent as well as endoleak,\nwhich appears grossly unchanged compared to prior CT scan performed ___.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "VASCULAR:  A previously seen fusiform infrarenal abdominal aortic aneurysm\nmeasures 6.2 x 5.8 cm, which is unchanged from prior exams (4:132).  The aorto\nbi-iliac stent is unchanged in position.  A likely type II endoleak is\nre-demonstrated, which appears unchanged over multiple prior exams.  Moderate\nto severe atherosclerotic calcification is again noted.\n\nThe hepatic veins are patent.  The portal, splenic and superior mesenteric\nveins are patent.  Stable stenosis at the splenic and main portal vein\nanastomosis.\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 previously seen mild perihepatic ascites is largely\nunchanged from prior.  No significant change in mild intra hepatic biliary\nductal dilatation.  A punctate calcification within hepatic segment VI is\nunchanged from prior.  There is a vague and subtle region of hypodensity\nwithin hepatic segment V measuring approximately 2.4 cm (4:91), with a\ntransient correlate on recent MR from ___, but no concerning features at\nthat time.  The liver demonstrates homogenous attenuation throughout. There is\nno evidence of focal lesions.  The gallbladder is resected.\n\nPANCREAS: Patient is status post proximal pancreatic resection and\npancreaticojejunostomy.  The remnant 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: A previously seen 1.0 x 0.9 cm right adrenal nodule is unchanged\n(4:94).\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 colonic wall thickening, which may be\nrelated to history of radiation therapy.  Appendix is not visualized.  There\nis no evidence of mesenteric lymphadenopathy.  Mild ascites noted over both\npericolic gutters.\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.  Mild pelvic ascites.\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: The abdominal and pelvic wall is within normal limits.  There is\na 6.4 by 6.0 cm ventral fascial defect to the left of the midline containing\nloops of small bowel just distal to the jejuno-jejunostomy.  There is a small,\nfat containing umbilical hernia.",
            "output": "1. No evidence for disease recurrence or metastases within the abdomen or\npelvis.\n2. No change in mild intra-abdominal ascites.\n3. Stable 6.2 x 5.8 cm fusiform infrarenal abdominal aortic aneurysm status\npost aorto bi-iliac grafting stents, which are patent.  Stable likely type II\nendoleak.\n4. Subtle hypodensity within hepatic segment V, of uncertain significance but\nstable since ___.  Attention on follow-up.\n5. 6.4 x 6.0 cm ventral fascial defect containing multiple loops of small\nbowel just distal to the jejunojejunostomy.  Small fat containing umbilical\nhernia.\n6. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  Calcified plaque is\nidentified in left renal artery ostium.\n\nLOWER CHEST: Dense and ground-glass airspace opacities are noted in bilateral\nposterior lung bases, right worse than left.  Trace bilateral pleural\neffusions are noted.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple cystic lesions are identified in bilateral kidneys,\nmeasuring up to 4.0 cm.  Larger ones are consistent with renal cysts, however\nmany of cysts are too small to be fully characterized.  There is no\nhydronephrosis.  Bilateral nephrograms are symmetric.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is unremarkable.  there 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.  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: Prosthetic right hip is noted.  No concerning bone lesion is\nidentified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right lower lobe pulmonary opacities may reflect atelectasis or pneumonia.\n2. No notable incidental findings identified in the abdomen.  Please see\nseparate report for torso CTA for vascular findings."
        },
        {
            "input": "VASCULAR:\n\nThe abdominal aorta is normal in caliber and mildly calcified.  Major proximal\ntributaries are patent.  Specifically, the celiac axis and major branches\nincluding the left gastric artery, the splenic artery, and the common hepatic\nartery, are patent.  Hepatic artery anatomy is conventional.  The SMA is\npatent throughout its visualized course.  Moderate calcification at the\norigins of the renal arteries may cause mild luminal narrowing, however\notherwise the paired bilateral renal arteries are patent.  The left renal\nartery demonstrates early branching. The bilateral iliac arteries are patent. \nThere is a short segment focal dissection within the right external iliac\nartery extending from its proximal portion (see series 7, image 224) distally\n4 mm proximal length of 2.5 cm (see series 9b, image 72).  Otherwise, the\nbilateral common, left external, and bilateral internal iliac arteries are\npatent and only mildly calcified.  The imaged proximal femoral arterial\nvasculature is mild to moderately calcified but widely patent.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: Non-masslike hyper enhancement in the inferior right hepatic\nlobe segment V/VI (7, 183) is probably perfusional in nature.  Otherwise, the\nliver enhances homogeneously without evidence of concerning focal lesion.\nThere is no intrahepatic biliary ductal dilation. The portal vein is patent. \nThe gallbladder is unremarkable without evidence of wall thickening or\ninflammation.\n\nPANCREAS: The pancreas enhances homogeneously. There is no peripancreatic\nstranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The right kidney is malrotated.  The kidneys enhance normally and\nsymmetrically.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach and duodenum are unremarkable.  Non-dilated\nsmall bowel loops are normal in course and caliber without evidence of wall\nthickening or obstruction.  The colon is decompressed, and suboptimally\nevaluated.\n\nRETROPERITONEUM AND LYMPH NODES: Scattered retroperitoneal and mesenteric\nlymph nodes are not pathologically enlarged.  There is no free intraperitoneal\nair or fluid.\n\nCT PELVIS:\nThe bladder is decompressed and suboptimally evaluated, but grossly within\nnormal limits.  There is no worrisome focal uterine or adnexal abnormality. \nEnlarged pelvic lymph nodes are noted; for instance, there is a 12 mm right\npelvic sidewall lymph node (7, 248), as well as bilateral external iliac lymph\nnodes which are enlarged (see series 7 images 249 and 251), measuring 7 mm on\nthe right and 10 mm on the left.  There is no inguinal lymphadenopathy.  There\nis no free pelvic fluid.\n\nMUSCULOSKELETAL: There is a midline upper abdominal wall fat containing hernia\nmeasuring 4.9 x 3.5 cm at the neck ; the inferior aspect of the left hepatic\nlobe protrudes slightly through the hernia (see series 10b, image 104 as well\nas series 7, image 156).  Otherwise, there is no concerning focal subcutaneous\nor musculoskeletal soft tissue abnormality.  The imaged thoracolumbar\nvertebral bodies are normally aligned. There is mild multilevel degenerative\nchange. Vertebral body heights are preserved. No concerning focal lytic or\nsclerotic osseous lesions are seen.",
            "output": "1. Short (approximately 2.5 cm) focal dissection within the midportion of the\nright external iliac artery.\n2. Otherwise, patent and unremarkable abdominal aortic and iliac arterial\nvasculature.  Conventional hepatic arterial anatomy.  For details of arterial\nvascular measurements, please see separate report from same-day cardiac CTA.\n3. Bilateral pelvic lymphadenopathy.  These could be re-evaluated at the time\nof TAVR followup; however, in the absence of this, recommend followup CT\nabdomen/pelvis in 6 months.\n4. Please see separate report for intrathoracic findings from same-day CT\nchest.\n\nRECOMMENDATION(S):  In the absence of imaging performed prior to this time,\nrecommend six-month followup abdomen and pelvis CT to re-evaluate enlarged\npelvic lymph nodes."
        },
        {
            "input": "VASCULAR:\nModerate atherosclerotic calcifications involve the abdominal aorta which is\nnon aneurysmal.  A pseudo aneurysm at the level of left common femoral artery\nbifurcation measures 1.3 x 1.0 cm (4B: 329).  There is no evidence of active\nextravasation.  There is extensive soft tissue stranding within bilateral\ninguinal regions with foci of air noted in the subcutaneous fatty tissues on\nthe right (2:82) in close proximity to overlying cutaneous staples.  Celiac\naxis vessels, superior and inferior mesenteric arteries and renal arteries are\npatent.\n\nLOWER CHEST:  Secretions fill her airways supplying her right lower lobe. \nAortic valve replacement is partially imaged.  Median sternotomy wires appear\nintact.  Bibasilar atelectasis is symmetric and 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,\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: Wedge-shaped hypodensities within the spleen are new (4B: 204),\ntypical in appearance for splenic infarctions.  The spleen is otherwise normal\nin 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.  Wedge shaped\nhypodensity within the posterior interpolar region of the right kidney to\nsuggestive of an infarct. There is no evidence of stones, focal renal lesions,\nor hydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates within the gastric lumen.  A\nlarge ventral abdominal wall hernia contains a portion of the distal stomach\nand first portion of the duodenum, the vaginal defect measuring 4.7 cm (4B:\n238).  The hernia which contains omentum measures approximately 3.5 x 8.  8 x\n7.2 cm (AP x TV x CC).  Loops of small bowel are normal in caliber.  The\nappendix is not definitely visualized.  The colon is unremarkable.  There is\nno mesenteric adenopathy.\n\nRETROPERITONEUM: There is no retroperitoneal hematoma.  There is no\nretroperitoneal adenopathy.\n\nPELVIS: A Foley catheter is present within the bladder lumen, a locule of air\nnoted anteriorly within the bladder lumen.  Distal opacified ureters are\nwithout a filling defect.  Scattered pelvic sidewall nodes measure up to 9 mm\non the right (7:67), may be reactive.  There is no free fluid in the pelvis. \nProminent bilateral inguinal nodes are present, the largest which measures 1.3\nx 2.4 cm (4A: 130) along the left external iliac artery.\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: Ventral wall hernia containing portion of stomach and duodenum\nas previously described.  Diffuse anasarca is mild.",
            "output": "1.  Post procedural changes within bilateral groin regions correlates to\nrecent vascular access with left common femoral artery pseudoaneurysm\nmeasuring 1.3 x 1.0 cm.  No retroperitoneal hematoma.\n\n2.  Large ventral abdominal wall hernia contains a portion of the distal\nstomach and first portion of duodenum.  No evidence of obstruction or\nincarceration.\n\n3.  New wedge shaped hypodensities within the spleen and focal hypodensity\nwithin the right posterior kidney are worrisome for infarctions."
        },
        {
            "input": "LOWER CHEST: A consolidation at the right lung base likely represents\natelectasis.  There is no evidence of pleural or pericardial effusion.\nElevation of the right hemidiaphragm is likely related to paralysis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is air seen within the\ngallbladder as well as the bile ducts predominately in the left hepatic lobe\nas well as air within the common bile duct a 2 mm punctate hyperdensity near\nthe ampulla is concerning for a ductal stone.  Intrahepatic bile ducts are not\ndilated, however and the common bile duct is decreased in size compared to the\nprior study from ___. the gallbladder is within normal limits.\n\nPANCREAS: The pancreas appears atrophic, but without peripancreatic stranding\nor fluid collection.  Compared to the prior study from ___, the 12 mm\nnonobstructing calculus in the proximal main pancreatic duct is no longer\nvisualized, however a 2 mm calcification may represent residual stone.\n\nSPLEEN: The spleen shows normal size and attenuation 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, unchanged.  Scattered cortical\nhypodensities are again noted, too small to characterize by CT but likely\nrepresenting cysts.  No solid renal lesions.  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. Colonic\ndiverticulosis, without wall thickening or fat stranding.\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 process within the abdomen or pelvis.\n2.  Chronic elevation of the right hemidiaphragm to the level of the right\nhilum, likely related to paralysis. This compromises the normal lung volume.\n3. Pneumobilia likely related to prior sphincterotomy given improved\nappearance of the previous 12 mm main pancreatic ductal stone. There is only\nresidual 2 mm stone near the ampulla. No intrahepatic or extrahepatic biliary\ndilatation.\n4. Colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "LUNG BASES:  Minimal streaky opacities in the dependent portions of the lung\nbases is compatible with subsegmental atelectasis.  Otherwise, the imaged lung\nbases are clear.  There is no pleural or pericardial effusion.  There is a\nsmall hiatus hernia.\n\nCT ABDOMEN:\nThe liver demonstrates normal homogeneous enhancement without evidence of\nfocal lesion.  There is moderate amount of periportal edema, often seen in the\nsetting of volume resuscitation.  The gallbladder does not demonstrate\nevidence of stones; there is a small amount of gallbladder wall edema, also\ncompatible with volume resuscitation.  There is no evidence of adjacent\nstranding to suggest gallbladder inflammation.  There is normal homogeneous\nenhancement of the pancreas.  There is no peripancreatic stranding or ductal\ndilation.  There is no splenomegaly or focal splenic lesion.  The adrenal\nglands are normal bilaterally.\n\nThere is diffuse, multifocal, patchy hypoenhancement of the bilateral renal\ncortices, extending to the capsular rim, concerning for severe bilateral\npyelonephritis.  Some of the areas of hypoenhancement demonstrate a masslike\nappearance (for example see series 2, image 38), possibly representative of\nlobar nephronia/early phlegmonous change, for example involving the posterior\nright interpolar region (series 2, image 30), as well as the left lower pole\n(series 2, image 30).  In one of the mildly expansile areas on the right\n(2:30) a tiny suspected early fluid pocket measures 5-6 mm in diameter.  There\nis no hydronephrosis.\n\nThe stomach and duodenum are unremarkable.  Multiple fluid-filled small bowel\nloops are nondilated, without evidence of wall thickening or obstruction.  The\ncolon is unremarkable.  The appendix is not directly seen, however there are\nno obvious secondary signs of appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation.  Proximal tributaries appear patent.\n\nThere is no evidence of retroperitoneal or mesenteric lymphadenopathy by CT\nsize criteria.  There is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs including the bladder and terminal ureters are\nunremarkable.  There is no pelvic sidewall or inguinal lymphadenopathy.  There\nis no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is a small fat containing umbilical hernia. There is mild degenerative\nchange of the imaged thoracolumbar spine.  Alignment is normal.  There is no\nevidence of concerning focal lytic or sclerotic osseous lesion.",
            "output": "1. Severe bilateral diffuse pyelonephritis.  Possible small areas of early\nphlegmonous change in the posterior right upper pole and in the left anterior\nlower pole with suspicion for tiny early developing fluid pocket in one of\nthese areas.  No evidence of bladder involvement.  It may be appropriate to\nconsider ultrasound for follow-up if future development of abscess is a\nclinical concern.\n2. No hydronephrosis.  No evidence of bladder involvement.\n3. Sequela of volume resuscitation, including periportal and gallbladder wall\nedema."
        },
        {
            "input": "Lungs: Please see the report of the CT chest performed on the same day for\ndetails on the chest.\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: A 5 mm cystic hypodensity seen in the head of pancreas on series 2,\nimage 120, likely a side-branch IPMN. No focal mass is seen.\n\nThere is subtle increased enhancement of the body of the pancreas with\nthickening, series 2 image 102, raising the possibility of autoimmune\npancreatitis. Lymphoma cannot be excluded.\n\nThere is pancreas divisum.  There is no pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Small hypodensities in both cases, too small to characterize but\nlikely cortical cysts.  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\nMild prostatomegaly.\n\nGastrointestinal: The bowel is within normal limits, except for a few\ndiverticula. Fecal loading is seen throughout the colon. The appendix\nunremarkable. A small hiatal hernia is seen.  There is no evidence of bowel\ndilatation 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. Subcutaneous\nemphysema is seen in the anterior abdominal wall on the left, likely related\nto subcutaneous injections.",
            "output": "1. There is subtle increased enhancement of the body of the pancreas with\nthickening, raising the possibility of autoimmune pancreatitis. Lymphoma\ncannot be excluded. Recommend further evaluation with MRCP.\n\n2. 5 mm cystic hypodensity in the head of pancreas, likely a side-branch IPMN.\n\n3. Please see the report of the CT chest performed on the same day for details\non the chest.\n\nRECOMMENDATION(S):  Recommend further evaluation of the pancreas with MRCP.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:09 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear aside from clinical in atelectasis/\nscarring at the left lung base. The heart is moderately enlarged and there is\nno pleural or pericardial effusion. Densities along the right coronary artery\nmay represent stents.\n\nABDOMEN:\nThe liver demonstrates numerous small hypodensities likely representing cysts.\nThe portal vein is patent and the liver is normal in attenuation. The\ngallbladder surgically absent. The pancreas is normal with no peripancreatic\nfat stranding or fluid collections. The spleen is mildly enlarged, with no\nfocal lesions. The adrenal glands are normal in size and morphology. The\nkidneys are atrophic and demonstrate a multicystic appearance, with punctate\ncalcifications at the upper and lower poles of the right kidney. The\nappearance of the kidneys is likely explained by dialysis acquired cystic\ndisease.\n\nThere is stomach demonstrates a hyperdense focus which corresponds to the area\nof endoscopic therapy. The small bowel is normal in caliber. There are\nnumerous ascending and descending as well as sigmoid colonic diverticula,\nwithout evidence of diverticulitis. The appendix isnot clearly visualized.\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nThere is no intraabdominal free air or free fluid.\n\nPELVIS: The prostate contains brachytherapy seeds. The bladder is uniformly\nthick walled with a thin layer of fat at the inner wall, consistent with\nradiation cystitis. There is no pelvic side-wall or inguinal lymphadenopathy\nby CT size criteria. No free pelvic fluid is identified.  Fat stranding around\nthe left femoral vessels is secondary to recent intervention.\n\nCTA ABDOMEN PELVIS:  There is a moderate atherosclerotic calcification of the\nabdominal aorta without aneurysmal dilatation. Focal atherosclerotic plaque is\nseen at the origin of the SMA, with moderate stenosis. Two left renal arteries\nare noted. The celiac axis demonstrates conventional anatomy.\n\nIn the distal jejunum (3a:93) there is a focus of high density material within\nthe lumen of the small bowel, which is not present on the precontrast or\nportal venous phase, concerning for a brisk arterial bleed. Additionally, in\nthe proximal ileum (3b:291) there is a high-density focus within a loop of\nbowel, concerning for another focus of hemorrhage, which is not seen on the\narterial phase, possibly because it is a slower bleed. The ileum and entire\ncolon are filled with high-density material on the noncontrast phase,\ncompatible with intraluminal blood.\n\nOSSEOUS STRUCTURES: The upper lumbar spine, particularly at L1-2, demonstrates\nexuberant marginal osteophyte formation. No blastic or lytic lesions\nconcerning for malignancy or infection..",
            "output": "1.  Intraluminal high density material in the distal jejunum and in the\nproximal ileum concerning for foci of arterial hemorrhage. High-density\nmaterial filling the ileum and colon on the noncontrast study and is\nconcerning for intraluminal blood.\n2. Multiple hepatic hypodensities likely represent cysts.\n3. Dialysis acquired renal cystic disease\n4. Colonic diverticulosis without diverticulitis.\n\nNOTIFICATION:  These findings were relayed to Dr. ___ by Dr. ___\ntelephone at 13:56, 2 min after discovery."
        },
        {
            "input": "CT ABDOMEN: Bilateral nonhemorrhagic pleural effusions are larger than on ___, moderately large on the right and moderate on the left, with\nadjacent compressive atelectasis.  Trace pericardial fluid is similar.\n\nThe liver has a slightly nodular appearance. Multiple tiny hypodensities\nthroughout the liver are too small to characterize, most likely cysts or\nbiliary hamartomas, unchanged from ___. No enhancing liver lesion is\nidentified. A calcification at the inferior liver tip suggests prior exposure\nto granulomatous disease. There is no intra or extrahepatic bile duct\ndilation. The gallbladder surgically absent. The spleen is enlarged to 13.7 cm\ncraniocaudally. The pancreas enhances homogeneously without focal lesion\nidentified. Pancreatic duct is normal in caliber. The right adrenal gland is\nnormal. A 1 cm left adrenal nodule has ___ -8.8 on non contrast images,\ncompatible with an adenoma.\n\nThe kidneys are atrophic but enhance symmetrically without hydronephrosis.\nMultiple cysts bilaterally are likely related to dialysis acquired renal\ncystic disease. A punctate nonobstructing stone is seen in the right kidney\n(02:31).\n\nThe small and large bowel are normal in course and caliber without\nobstruction. Diverticula are seen throughout the colon without inflammatory\nchanges. A 0.9 cm enhancing lesion in the cecum adjacent to the ileocecal\nvalve (3b:284) is unchanged from ___. A clip in the stomach is likely\nrelated to clipped gastric AVM (3b: 215). There is no evidence of arterial\ncontrast extravasation to suggest active bleeding.\n\nThe abdominal aorta is normal caliber throughout with mild atherosclerotic\ncalcifications along its course. Atherosclerotic calcifications are seen at\nthe origin of the celiac axis and SMA, which remain patent. There are patent\nsingle renal arteries bilaterally. The ___ is patent. Hepatic arterial anatomy\nis conventional. The main portal vein, splenic vein and SMV are patent with\nnumerous perisplenic varices.\n\nThere is no free fluid and no free air. No pathologically enlarged\nretroperitoneal lymph nodes are identified. Prominent porta hepatic lymph\nnodes measuring up to 11 mm are unchanged, likely related to underlying liver\ndisease.\n\nCT PELVIS: The rectum is normal.  Diverticula are seen in the sigmoid colon\nwithout inflammatory changes. Brachytherapy seeds are noted in the prostate.\nThe bladder is partially distended, but circumferential bladder wall\nthickening may be related to chronic outflow obstruction.  There is no free\nfluid and no pelvic or inguinal lymphadenopathy.\n\nBONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.",
            "output": "1.  No evidence of active extravasation.\n\n2.  1.2 cm enhancing lesion in the cecum is unchanged from ___.\nCorrelate with recent colonoscopy findings.\n\n3.  Findings suggest cirrhosis with splenomegaly, porta hepatic\nlymphadenopathy and varices. No ascites.\n\n4. Bilateral pleural effusions are larger than on ___, moderately\nlarge on the left and moderate on the right, with adjacent compressive\natelectasis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Mild atelectasis is noted in the lung bases. There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense structures are seen scattered throughout the liver, with\nthe largest measuring up to 1.1 cm in the left hepatic lobe, likely hepatic\ncysts or biliary hamartomas.  There is no evidence of focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is is 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 appear atrophic and cystic, compatible with known history\nof end-stage renal disease.  There is no evidence of stones or hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is no obvious arterial extravasation noted\nwithin the visualized small bowel on the available sequences.  Sigmoid\ndiverticulosis is noted without evidence of acute diverticulitis.  Note, there\nis dense barium noted within the length of the colon and portion of the\nterminal ileum, and as such, active arterial extravasation cannot be assessed.\nThe visualized rectum is within normal limits.  Appendix is not visualized. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder wall has mild interdigitating submucosal fat,\npossibly reflecting sequela of prior cystitis likely from brachytherapy\nradiation treatment.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS:  Brachytherapy seeds are noted in the prostate.\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. Of note, the study severely limited for assessment of arterial\nextravasation in the colon due to dense barium seen within the colon and\nportion of terminal ileum.  No obvious extravasation is noted within the\nvisualized small bowel.\n2. Cholecystectomy.\n3. Hepatic cysts"
        },
        {
            "input": "LOWER CHEST: Atelectasis noted at the lung bases.  Subtle centrilobular\nnodules at the left lung base could represent a small area of aspiration. \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 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 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. \nDegenerative changes noted in the 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 symptoms.  No\nobstruction.\n2. Subtle, mild centrilobular nodules at the left lung base which could\nrepresent a small area of aspiration or small airway inflammation."
        },
        {
            "input": "LOWER CHEST:  There is bibasilar dependent atelectasis.  Remainder of the lung\nbases are otherwise clear, without pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is diffusely hypoattenuating, measuring 39\nHo___ units on this noncontrast study, suggestive of hepatic 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 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.  There is diffuse thickening of\nthe colon, suggestive of colitis.  The rectum is unremarkable.  The appendix\nis not visualized, but there are no secondary signs of appendicitis.  No free\nfluid in the abdomen.  No pneumoperitoneum.\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 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.  Mild diffuse thickening of the entire colon is suspicious for acute\ncolitis.\n2.  Hepatic steatosis.\n\nNOTIFICATION:  Updated findings telephoned to Dr. ___ by ___\non ___ at 12:56PM."
        },
        {
            "input": "LOWER CHEST:\nThere is bilateral lung base atelectasis. There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver is unremarkable.  Common bile duct is mildly dilated\nupto 0.9 cm.\nPigtail drain is noted at the edge of the gallbladder.  Gallbladder contains\nlarge gallstone.  There is no evidence of cholecystitis.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY:  0.7 cm hypodensity in the left kidney is too small to be\ncharacterized.  There is no hydronephrosis.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.  Appendix is\nunremarkable. There is colonic diverticulosis without evidence of\ndiverticulitis.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder and uterus are unremarkable.\n\nBONES AND SOFT TISSUES:\nOld healing fractures at the left superior and inferior pubic rami are similar\nto prior.  Multilevel degenerative changes are noted at the lumbar spine.",
            "output": "1.  No evidence of diverticulitis.\n\n2.  Pigtail catheter is noted at the edge of the gallbladder. Gallbladder\ncontains large gallstone without evidence of cholecystitis.\n\n3.  Common bile duct is mildly dilated up to 0.9 cm.  Correlate with LFTs and\nneed for additional imaging."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases demonstrate bibasilar atelectasis.  There\nis 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 surgically absent.  A\n5.6 x 3.6 cm fluid collection within the gallbladder fossa without a thick\nrind but with foci of air is concerning for an abscess.  A second fluid\ncollection measuring 2.5 x 2.4 cm in the right flank inferior to the liver tip\nwith adjacent fluid and significant stranding is also noted (02:47).\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nPANCREAS: The pancreas is atrophic, but has normal attenuation throughout,\nwithout evidence of focal 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.  An 8 mm hypodensity in the left renal interpolar\nregion is too small to characterize, most likely a cyst.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Diverticula are seen throughout the colon without\nevidence of diverticulitis..\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is heavy calcium\nburden in the abdominal aorta and great abdominal arteries.  The main portal\nvein, splenic vein and SMV are patent.  An 8 mm old thrombosed tiny splenic\nartery aneurysm is unchanged since ___ ( 02:31).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  A 6.4 x 3.7 cm fluid\ncollection is seen in the right hemipelvis posterior to the uterus with\nadjacent stranding.  Additionally, an approximately 4.3 x 9.6 cm fluid\ncollection is seen in the left hemipelvis anterior to the uterus.  The pelvic\nfluid collections are likely connected.  They both surround the bilateral\nfallopian tubes.  Fluid within the cervical canal (602b:51) is new from ___ with a small focus of air in the vaginal vault.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  There is multilevel degenerative change in the thoracolumbar spine\nwith levoconvex scoliosis centered at L1-L2.  Healed fractures of the left\nsuperior and inferior pubic rami are noted.  Postsurgical changes are seen in\nthe anterior abdominal wall, likely the site of laparoscopic ports.",
            "output": "1.  Fluid collection with air in the gallbladder fossa is concerning for an\nabscess.\n2.  Fluid collection in the right flank inferior to the liver may represent a\npost surgical fluid collection but superinfection cannot be excluded given the\nsignificant adjacent inflammation.\n3.  Fluid collection in the pelvis may be post surgical. Superinfection cannot\nbe excluded.\n4.  Additional findings of bibasilar atelectasis, diverticulosis without\ndiverticulitis, and heavy atherosclerotic calcifications in the aorta."
        },
        {
            "input": "LOWER CHEST: Scattered streaky opacities at the lung bases are compatible with\nsubsegmental atelectasis; otherwise, the partially imaged lung bases are\nclear. There is no pleural or pericardial effusion. There is a small hiatus\nhernia.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously without evidence of concerning\nfocal lesion. There is no intrahepatic biliary ductal dilation. The portal\nvein is patent.  Again seen in the gallbladder fossa is a 3.1 x 2.5 cm\nhypodense fluid collection with a mildly thickened enhancing rim (series 2,\nimage 27).  This is a persistent residual fluid collection in the gallbladder\nfossa, smaller comparison to prior CT from ___ (at that time 4.8 x 3.2\ncm).  Mild haziness/ stranding of the adjacent mesenteric fat is compatible\nwith mild residual/ongoing inflammation (for example see series 601b, image\n25).\n\nPANCREAS: The pancreas enhances homogeneously. There is no peripancreatic\nstranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: A 6 mm left renal cortical hypodensity is too small to characterize\nactivity by CT, but is unchanged from prior exam.  Otherwise, the kidneys\nenhance normally and symmetrically.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach and duodenum are unremarkable.  Non-dilated\nsmall bowel loops are normal in course and caliber without evidence of wall\nthickening or obstruction.  The colon is unremarkable.  The appendix is\nnormal.\n\nVASCULAR AND LYMPH NODES: Moderate to severe atherosclerotic disease is most\nprominent in the infrarenal abdominal aorta.  The abdominal aorta is normal in\ncaliber without evidence of aneurysm or dilation.  Major proximal tributaries\nare patent.\n\n There is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriteria.  There is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs, including the bladder and terminal ureters, are\nunremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL: Irregularity of the left inferior pubic ramus is consistent\nwith old/prior fracture (series 2, image 80).  Linear lucency through the\nanterior left acetabulum (series 2, image 71) is unchanged since at least ___, suggestive of prior fracture.  There is moderate degenerative change of\nthe imaged thoracolumbar spine, worst at the thoracolumbar junction. \nAlignment is normal.  No concerning focal lytic or sclerotic osseous lesions\nare identified.",
            "output": "1. Persistent 3.1 x 2.5 cm thick-walled gallbladder fossa fluid collection\nwith mild surrounding residual inflammation.  Fluid collection is smaller\nsince ___.\n2. No evidence of additional acute intra-abdominal or intrapelvic process to\nexplain patient's pain.  Normal appendix.\n3. Moderate to severe abdominal aortic atherosclerotic disease.\n4. Chronic fractures of the left anterior acetabulum and the left inferior\npubic ramus."
        },
        {
            "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 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: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is colonic diverticulosis; 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 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 fracture of the left inferior pubic ramus (2:77). \nThere is an unchanged linear lucency through the anterior left acetabulum\n(2:69) unchanged since CT ___. There are severe multilevel\ndegenerative changes, most prominently at the thoracolumbar junction,\nincluding osteophytosis, loss of intervertebral disc space height, and facet\nhypertrophy.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.",
            "output": "No acute intra-abdominal process."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  Otherwise, 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. 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 a subcentimeter hypodense lesion in the midpole of the left kidney,\nunchanged from prior study and too small to characterize (02:32).  Otherwise,\nthere is no evidence of focal renal lesions 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.  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\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 redemonstration of a chronic fracture of the left inferior\npubic ramus (2:82), unchanged from prior study.  There are severe multilevel\ndegenerative changes of the thoracolumbar spine, most prominent at T12-L1. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "No acute intra-abdominal process."
        },
        {
            "input": "Minor atelectasis is found at each lung base.  Heart is normal in size.\n\nPatient is status post cholecystectomy.  No significant biliary dilatation. \nNo focal liver lesions are identified.  Pancreas is unremarkable.  Spleen is\nnormal in size and appearance.  Adrenals also appear normal.  Kidneys\ndemonstrate no stones solid masses or hydronephrosis.  Small simple cyst in\nthe left inter polar region measuring up to 9 mm is unchanged.\n\nThe stomach is nondistended.  Small bowel is unremarkable.  Diverticulosis of\nthe sigmoid colon is moderately severe.  There are also a few diverticula\nalong the cecum.  There is a small fat containing paraumbilical hernia shortly\nto the left of midline.\n\na 4.8 x 2.3 x 5.3 cm (TR x AP x CC) soft tissue density in the omentum\nanterior to the transverse colon and mild surrounding stranding, which most\nlikely represents evolving postsurgical changes. A very small heavily rim\ncalcified splenic artery aneurysm measures 9 mm in diameter which is stable\n(2:20).  Atherosclerotic change along the aorta is moderately severe.  Major\nvascular structures appear patent.  There is no lymphadenopathy, free air, or\nfree fluid.\n\nBones appear demineralized.  There are no suspicious bone lesions.  Old healed\nfracture of the late involving the left inferior pubic ramus is unchanged. \nPrior fracture also involves the anterior column of the left acetabulum,\nunchanged, incompletely united as before.   Visualized thoracolumbar spine\nshows mild-to-moderate S-shaped curvature degenerative changes of the upper\nlumbar spine are also stable.  Moderate degenerative changes again affect\nlower lumbar facet joints. Vertebral body heights are essentially preserved. \nNo evidence of acute fracture.",
            "output": "1.  No evidence of acute process involving the abdomen or pelvis.\n\n2.   No acute fracture identified."
        },
        {
            "input": "LOWER CHEST: Small right pleural effusion is new compared to ___. \nThere is subjacent passive atelectasis at the right base.  Trace pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 appear mildly atrophic as before.  There is a simple left\nrenal cyst, unchanged.  There is no evidence of solid renal lesions.   There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe bladder is under distended, but grossly unremarkable.\n\nGASTROINTESTINAL: There is thickening of the distal esophagus with mucosal\nhyperenhancement, with a small hiatal hernia.  Probable mucosal\nhyperenhancement and possible edema at the pylorus/duodenal bulb could reflect\ninflammatory change.  There is trace adjacent stranding (2:32).  Large volume\nstool in the distal sigmoid colon and rectum has increased.  The stool ball in\nthe rectum measures up to 7 cm.  There is presacral stranding, which is new. \nNo free air.  The appendix is not visualized.\n\nPELVIS:  Presacral stranding, as described above.\n\nREPRODUCTIVE ORGANS: The uterus appears atrophic, with probable small\ncalcified fibroids.  No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease. There is no abdominal\naortic aneurysm.\n\nBONES: Right superior and inferior pubic rami fractures are noted.  The\nsuperior pubic ramus fracture appears similar, but the inferior pubic ramus\nfracture was not definitely seen on ___.  However, there is\nsurrounding periosteal reaction which may be related to early healing.  A\nright sacral alar fracture is unchanged.  A right iliac bone fracture is also\nseen, with early healing.\n\nSOFT TISSUES: Mild anasarca. There are tiny foci of gas in the right anterior\nabdominal wall.",
            "output": "1. New small right pleural effusion.\n2. Thickening and mucosal hyperenhancement of the distal esophagus, suggestive\nof esophagitis.  Correlate with endoscopy.\n3. Mucosal hyperenhancement and mural edema of the pylorus/duodenal bulb with\nadjacent stranding, suggestive of gastritis/duodenitis.\n4. Significant increase in the size of a stool ball with presacral stranding,\nsuspicious for stercoral colitis.  No free air.\n5. Right inferior pubic ramus fracture was not definitely seen on ___, and may have been nondisplaced at that time but now demonstrates\nincreased displacement with surrounding periosteal reaction.\n6. Redemonstrated right superior pubic ramus fracture, right sacral ala, and\nright iliac wing fracture.\n7. There are tiny foci of gas in the right anterior abdominal wall, correlate\nwith subcutaneous injection."
        },
        {
            "input": "A large ulcer is present involving the skin and subcutaneous tissues overlying\nthe distal sacrum and coccyx.  There is new discontinuity of the fifth sacral\nsegment with displacement of the distal sacrum and coccyx anteriorly.  There\nis periosteal reaction along the anterior aspect of the distal sacrum. There\nis enhancing inflammatory soft tissue thickening extending through the osseous\ndefect into the presacral space. There also complex enhancing tracks which\nextend into the right gluteal region, partly containing gas, and extending\ninto the right gluteus medius muscle.\n\nThere is a moderate left hip effusion, increased from prior study. Some\ncurvilinear areas of calcification are seen posterior to the left greater\ntrochanter and ischium, similar to prior study.  There is also a moderate\nright hip effusion, which appears increased from prior study, with irregular\njoint margin anteriorly. Some of the fluid appears to track towards the right\ngreater trochanter where there is an area of calcification anterior to the\ngreater trochanter which may reflect dystrophic calcification. Similar linear\ncalcification is seen along the right and anterior inferior iliac spine,\nslightly more pronounced than previous.\n\nThere is L5 spondylolysis bilaterally with grade 1 spondylolisthesis (anterior\npositioning of L5 with respect to S1). There is degenerative discogenic change\nwith severe disc space narrowing, sub-chondral sclerosis at L5-S1.\n\nThere is a catheter in the bladder. Bladder wall appears somewhat thickened\nalthough not distended. There is ascites, moderate in the pelvis.\n\nNon enlarged pelvic sidewall lymph nodes is seen.",
            "output": "1. Interval development of bony discontinuity of the sacrum at S5 level with\nenhancing soft tissue tracking through the osseous defect from the overlying\nskin ulcer and into the surrounding soft tissues including the right gluteal\nregion and presacral region, compatible with osteomyelitis with associated\ninflammatory/infected tracts.\n2. Bilateral moderate hip joint effusions increased from previous, recommend\nclinical correlation, superimposed infection not excluded.\n3. Ascites.\n4. Several unusual foci of abnormal linear calcification are seen at the\ngreater trochanters bilaterally, and at the right anterior inferior iliac\nspine.\n\nNOTIFICATION:  Discussed over telephone by Dr. ___ with ___ Dr\n___ at 4.15pm on ___, 15 min after discovery of findings."
        },
        {
            "input": "There are malleable plates and multiple screws transfixing a comminuted\nacetabular fracture with extensive surrounding heterotopic bone formation\n(02:52) mildly expanding the gluteus minimus and rectus femoris muscles\n(2:64).  Streak artifact from hardware mildly limits the evaluation.\n\nThere is severe collapse of the right femoral head involving greater than 50%\nof the femoral head articular surface (401b:62).  The femur is subluxed\nsuperiorly and impacted upon the superior rim of the acetabulum.  Remaining\nproximal portions of the femoral head are sclerotic.  There is periosteal\nreaction in the femoral neck and proximal femoral diaphysis (3:81).  Intra\ncortical tunneling in the proximal femoral shaft is likely due to progressive\nosteopenia. There is amorphous soft tissue anterior to the femoral head with a\nfew small scattered locules of gas (2:71) likely from recent aspiration. \nThere is extensive heterotopic ossification within the gluteus minimus\nconnected to the right ilium also extending inferiorly within the rectus\nfemoris muscle.\n\nThere is asymmetric atrophy of the musculature of the right thigh when\ncompared to the contralateral leg, most severe in the posterior compartment\nespecially affecting the semimembranosus muscle (2:178).  Scattered moderate\natherosclerotic calcifications are seen throughout the main arterial\nstructures of the thighs.  There is posttraumatic appearance of the partially\nimaged right knee with well corticated heterotopic bone along the lateral\nfemoral condyle and chronic deformity of the proximal tibia.\n\nIncluded loops of small and large bowel are normal in caliber without\nobstruction.  The appendix is along with hyperdense material distally which\nmay reflect a forming appendicolith versus retained ingested hyperdense\nmaterial.\n\nScattered lower retroperitoneal lymph nodes are prominent in number but not\npathologically enlarged by CT size criteria.  6 mm and lymph node adjacent to\nthe origin of the left common iliac artery (02:12) previously measured 4 mm in\n___.  There are additional prominent right external iliac lymph nodes\nmeasuring up to 8 mm (02:46), previously 4 mm.  There is no inguinal\nlymphadenopathy.  Small bilateral hydroceles are noted.",
            "output": "1. Collapse of the right femoral head which is subluxed superiorly and\nimpacted upon the superior acetabulum as detailed above.  This likely\nrepresents sequela of avascular necrosis.\n2. Extensive heterotopic ossification about the right hip within the gluteus\nminimus connected to the right ilium also extending inferiorly within the\nrectus femoris muscle.\n3. Disuse osteopenia throughout the right femur and asymmetric muscle atrophy\nin the right thigh most pronounced in the semimembranosus."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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. 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 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.\n\nSOFT TISSUES: There is a ventral hernia containing nonobstructed bowel.",
            "output": "No evidence of local or distant recurrence in the abdomen or pelvis."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The hepatic parenchyma enhances homogeneously with no focal\nliver lesions.  The hepatic veins are patent.  The portal vein and its\nbranches are patent.\nThe gallbladder is distended with no radiopaque calculi within it or\npericholecystic inflammation.\nPANCREAS: There is homogeneous enhancement of the pancreatic parenchyma\nwithout main duct dilation or focal lesions.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: The kidneys are unremarkable.\nGASTROINTESTINAL: No bowel obstruction.  A ventral abdominal wall\nhernia/rectus sheath diastasis containing nonobstructed loops of small and\nlarge bowel noted.  The craniocaudal extent of the abdominal wall defect\nmeasures 17.8 cm.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.  Mild calcified\natherosclerotic plaque is noted within the abdominal aorta and its branches.\n\nPELVIS:\nThe bladder is moderately distended and appears normal the uterus and both\novaries are surgically absent.  No suspicious masses identified in the pelvis.\nThere is no free fluid in the pelvis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1. No pelvic masses, free fluid or metastatic disease seen in the abdomen or\npelvis.\n2. Ventral abdominal wall hernia/rectus sheath diastasis containing\nnonobstructed loops of small and large bowel noted.  The craniocaudal extent\nof the ventral abdominal wall defect measures 17.8 cm.  Compared to the prior\nstudy dated ___, the hernia has progressed significantly in size."
        },
        {
            "input": "LOWER CHEST: Will be reported separately.  Note is made of a small right sided\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.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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, bilateral paracolic gutter,\nperihepatic as well as perisplenic.\n\nREPRODUCTIVE ORGANS: Heterogenously thickened endometrium.  Large\nwell-encapsulated predominantly cystic solid mass arising from the pelvis\ninvolving the ovaries bilateral measuring 24.7 x 18.1 x 24.8 cm and extending\ninto the lower abdomen\n\nLYMPH NODES: No pathologically in how large 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: There 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 complex cystic pelvic masses involving both adnexae measuring 24.7 x\n18.1 x 24.8 cm and extending into the lower abdomen with solid enhancing\ncomponents, highly suggestive for a primary gynecologic malignancy.\n2. Heterogenous thickened endometrium is also concerning for malignancy.\n3. No distal abdominopelvic lymphadenopathy or metastasis detected.\n4. Mild bilateral paracolic gutter, perisplenic, and perihepatic ascites.\n5. For chest findings reference is made to CT chest report of the same day,\nbut note is made of a small right-sided pleural effusion."
        },
        {
            "input": "VASCULAR:\n\n Notes:\n1. The diameter of the perforators is measured at the level of the fascia as\nthe perforators exit the rectus muscle.\n2. The number of perforators varies; you need to comment only on the ___\nlargest on each side.\n3. On the sagittal MIP that is part of each study, please place an arrow on\nthe largest perforator on each side and save as a significant image.\n\nThe inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are  perforators on the right\nand  perforators on the left.\n\nLEFT:\nBranching pattern: Type 1\nPerforators:\n2 mm, 50 mm to the left and 12 mm above the umbilicus, (601:16)\n\nRIGHT:\nBranching pattern: Type 1\nPerforators:\n1.8 mm, 53 mm to the right and 29 mm below the umbilicus, (601:15)\n\n\nThere is no abdominal aortic aneurysm.  There is no significant calcium burden\nin the abdominal aorta and great abdominal arteries.  The celiac axis, SMA,\nbilateral renal arteries, ___, bilateral common iliac arteries and their major\nbranches are patent.\n\nLOWER CHEST: There is minimal atelectasis in the imaged lung bases. No pleural\nor pericardial effusion is seen. Partially imaged bilateral breast implants\nare noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable.  The gallbladder is resected.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: A left subcortical hypodensity is too small to characterize (02:45),\nbut likely represents a cyst.  The kidneys are otherwise unremarkable.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable. Small and large bowel\nloops are normal in caliber.  The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are unremarkable.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is intermediate and measures 1.8 mm. The largest perforator on the\nleft is intermediate and measures 2 mm.\n2. No evidence of metastatic disease in the abdomen or pelvis."
        },
        {
            "input": "Minor atelectasis in the right middle lobe and lingula.  Very small right\nposterior Bochdalek's hernia containing only fat.\n\nWithin the limitations of a non-contrast examination, aside from two small\nunchanged cysts, no focal liver lesions are identified.  There is no biliary\ndilatation.  Gallbladder is mostly empty.  Spleen is normal in size and\nappearance.  Calcifications along the pancreas suggest chronic pancreatitis. \nThe right kidney again shows severe hydronephrosis with a cortical thinning,\nalready present before, and unchanged.  Point of transition is apparently the\nureteropelvic junction.  A few periphery round calcifications are again\nvisualized along the lower pole.  Few tiny nonobstructing stones are also\nfound in the left kidney.  Small simple appearing cyst is unchanged along the\nleft lower pole measuring 15 mm.  No hydronephrosis on the left.  Although the\ndegree of hydronephrosis on the right is stable, new asymmetric stranding\nabout the right kidney suggests superimposed congestion associated with acute\non chronic obstruction, superimposed pyelonephritis or both.  There is no\nstone at the ureteropelvic junction.  Ureters are not dilated.\n\nThe stomach is nondistended.  Small bowel appears normal.  Quantity of stool\nalong the whole colon is mildly prominent.  Sigmoid diverticulosis is moderate\nin severity.\n\nUterus is not well seen due to crowding of structures.  No adnexal mass is\nvisualized.  Bladder appears normal.  No enlarged lymph nodes are found. \nVascular calcification is moderate.  Dilatation of the infrarenal abdominal\naorta, whose maximum axial ___ now measure 32 x 28 mm in axial\n___, is stable.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Old\nfracture of the right posterolateral ninth rib.  Fractures of left pubic\nsymphysis, left iliac wing, appear old.  Patient is status post open reduction\nand internal fixation of the left femur.",
            "output": "Similar severe pre-existing hydronephrosis involving the right kidney probably\nassociated with ureteropelvic junction obstruction.  What is new is asymmetric\nfat stranding suggesting superimposed infection and/or acute on chronic\nobstruction involving the right kidney."
        },
        {
            "input": "Please refer to dedicated chest CT report of same date for evaluation of\nthoracic findings. Bilateral breast reconstructions are noted.\n\nThroughout the liver are scattered hypodense lesions, some of which contain\ninternal fluid density, consistent with cysts, with others too small to\ncharacterize but unchanged.  No new or suspicious hepatic lesions are\nidentified. There is no intra or extrahepatic biliary ductal dilation.\nGallbladder appears unremarkable. Pancreas, spleen, bilateral adrenal glands,\nappear within normal limits.  In the interpolar region of the right kidney, a\nsimple cyst measuring 4.2 cm, is unchanged. There is no hydronephrosis.  No\npathologically enlarged mesenteric or retroperitoneal lymph nodes.  Abdominal\nloops of bowel are normal in caliber and contour.\n\nCT of the pelvis with intravenous contrast:  Bladder, distal ureters, rectum\nand sigmoid colon, pelvic loops of small bowel appear unremarkable.  No\nadnexal masses are appreciated. The uterus is not visualized.\n\nBone windows:  Diffuse sclerotic lesions throughout the pelvis and visualized\nspine, consistent with known metastatic disease, are unchanged in size and\nconfiguration. No new lesions are identified.",
            "output": "1. No change in CT appearance of osseous metastases. No new lesions\nidentified.\n2. No new evidence for metastatic disease in the abdomen or pelvis.\n3. Hepatic and right renal cysts, unchanged."
        },
        {
            "input": "LOWER CHEST: For supradiaphragmatic findings, please refer to CT of the chest\nfrom same date.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nMultiple hypodense hepatic lesions are seen, corresponding to simple cysts and\nhepatic metastases noted on prior imaging.  These have remained grossly\nsimilar to the prior examination, with the largest lesion in segment 7\nmeasuring 2.4 x 1.7 cm, grossly unchanged since the prior examination.\nMultiple simple hepatic cysts are also seen, also unchanged.  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.\nA hypodense, simple cyst in the midpole of the right kidney and stable since\nthe prior examination.  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 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.  The\npreviously seen prominent lymph node adjacent to the pancreatic head and well\nvisualized.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Minimal atherosclerotic\ndisease is noted.\n\nBONES: Innumerable sclerotic metastases are seen throughout the visualized\nspine, pelvis, and bilateral hips. These are unchanged since the prior\nexamination. There is no evidence of pathologic fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of new metastasis in the abdomen or pelvis.\n2. Largely stable hepatic and osseous metastases."
        },
        {
            "input": "ABDOMEN:\n\nNo retroperitoneal hematoma or collections are identified. No intraperitoneal\ncollections are seen. The lung bases are clear. A tiny 1-2 mm subpleural\nnodule in right middle lobe (3:5) is unchanged. There is evidence of coronary\nartery calcification. A large hiatal hernia is again identified demonstrating\n2 hyperdense pills. The liver is normal in attenuation. With the limitations\nof an unenhanced CT, no focal hepatic lesions are identified. No intrahepatic\nor extrahepatic biliary ductal dilatation.  Subtle dependent sludge/calculi\nare suspected in the gallbladder (03:22). The pancreas and adrenal glands are\nunremarkable.  A tiny calcification adjacent to the pancreatic head (03:23),\nis likely vascular in etiology. The spleen is normal in size. Both kidneys are\nsymmetric in size, with no evidence of obstructing renal calculi or\nhydronephrosis. No ascites. Caliber of small and large bowel is within normal\nlimits. The appendix is unremarkable. The stomach is unremarkable. Moderate\natheromatous calcification of abdominal aorta and its branches is noted. \nInfrarenal abdominal aortic ectasia is noted measuring 2.6 x 2.2 cm (03:35).\nVascular structures are better assessed on the prior CTA. No aneurysmal\ndilatation is noted. No soft tissue abnormality is identified.\n\nPELVIS:\n\nA Foley catheter is identified within a partially distended urinary bladder.\nNondependent air is seen within the urinary bladder, likely related to the\ncatheterization. A left 3.9 x 2.2 cm bladder diverticulum is again identified.\nSmall punctate calcification of the anterior aspect of urinary bladder remains\nunchanged, nonspecific. Mild calcification of the prostate gland is\nidentified. The seminal vesicles and rectum are unremarkable. No bowel the\ninguinal or pelvic lymphadenopathy. No pelvic free fluid is identified.\nSubcutaneous fatty stranding is identified at the left groin, likely related\nto recent catheterization. A fat containing left inguinal hernia is noted.\nCalcification of the gonadal arteries is identified.  There is evidence of\ncalcification of vas deferens bilaterally. Moderate colonic diverticulosis is\nidentified. No evidence of diverticulitis.\n\nOSSEOUS STRUCTURES:\n\nMild multilevel degenerative changes of the lumbar spine are evident. No focal\nosteolytic or osteoblastic lesions are identified.",
            "output": "1. No retroperitoneal hematoma or fluid collections.\n2. Other incidental findings including large hiatal hernia, left bladder\ndiverticulum, fat containing left inguinal hernia and moderate colonic\ndiverticulosis again noted.\n3. Subcutaneous fatty stranding at the left groin likely related to recent\ncatheterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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 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 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.  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 nephrolithiasis, ureterolithiasis, or hydronephrosis."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is normal and without gallstones.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThere is a small hiatal hernia. The stomach is grossly unremarkable in\nappearance. Oral contrast is seen extending through the proximal ileum. The\nsmall bowel a is mildly prominent with fecalization of the terminal ileum. No\ntransition point is identified. A large amount of stool is noted within the\ncolon. There is no evidence of colonic dilation. The appendix is well\nvisualized and normal (series 601b, 40).\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches contain calcified and noncalcified plaque. Are normal in course and\ncaliber. There are scattered retroperitoneal and mesenteric lymph nodes but\nnone are pathologically enlarged.. There is no free abdominal fluid or\npneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Mild multilevel multifactorial degenerative changes are\nnoted within the thoracic lumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "No evidence of small bowel obstruction. Mildly dilated loops of small bowel\nwith fecalization of the terminal ileum and no transition point seen, findings\nare likely secondary to slow transit."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSeveral subcentimeter hypodensities are too small to characterize but in the\nabsence of known malignancy are likely benign, likely representing cysts or\nbiliary hamartomas (see series 2: 12, 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 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 subcentimeter accessory spleen is incidentally\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 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. There is colonic\ndiverticulosis, with an area pericolonic fat stranding near the junction of\nthe descending colon and sigmoid colon (series 2:58), consistent with acute\nsigmoid diverticulitis.  There is no surrounding fluid collection.  No\nevidence of free intraperitoneal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcifications are noted in the prostate, which 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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing right inguinal hernia, and a small fat\ncontaining umbilical hernia.",
            "output": "Findings consistent with acute uncomplicated sigmoid diverticulitis.  No\ndrainable fluid collection or evidence of perforation."
        },
        {
            "input": "The bases of the lungs are clear. There is no pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver enhances homogeneously without focal lesion or\nintrahepatic biliary duct dilatation.  The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas appears normal, without focal lesion or peripancreatic\nstranding or fluid collection. There is no pancreatic duct dilatation.\n\nSPLEEN:  The spleen is homogeneous and normal in size, without focal lesion.\n\nADRENALS:  The adrenals glands are unremarkable bilaterally.\n\nKIDNEYS: The kidneys are normal in size and demonstrate symmetric nephrograms\nand excrete contrast promptly. No stone, focal lesion or hydronephrosis is\nidentified. Punctate calcific densities near the renal hilum likely represent\nvascular calcifications.\n\nRETROPERITONEUM:  No retroperitoneal or mesenteric lymph node enlargement by\nCT size criteria.\n\nVASCULAR:  The abdominal aorta demonstrates moderate atherosclerosis,\nunchanged.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  Again seen is an\nenlarged prostate. No pelvic wall or inguinal lymph node enlargement by CT\nsize criteria seen. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo focal lytic or sclerotic lesion suspicious for malignancy is present.\nAnkylosing sacroiliitis and multilevel degenerative changes of the lumbar\nspine are unchanged.",
            "output": "1. Normal kidneys bilaterally without evidence of renal stone, mass, or\nhydronephrosis.\n2. Unchanged prostate hypertrophy, ankylosing sacroiliitis, and\natherosclerosis of the abdominal vessels."
        },
        {
            "input": "Chest is reported separately.\n\nPatient is status post liver transplant.  No suspicious focal liver lesions\nare identified.  There is no biliary dilatation.  The pancreas appears normal.\nNative spleen is absent.  Regenerative is spleens appear unchanged.  Adrenals\nare unremarkable.  No evidence for solid masses or hydronephrosis in either\nkidney. Non-obstructing stone in the lower pole of the right kidney left\nkidney measures 2 mm in diameter. In the mid-upper pole the larger of a pair\nof adjacent stones also measures 3 mm.\n\nHepatic artery is widely patent.  Mild narrowing is noted at the celiac origin\nassociated with atherosclerosis.  Hepatic and portal veins are widely patent.\nThere is some lumbar drainage of the left renal artery as before which is\nlikely associated with relative narrowing of the left renal vein as it passes\nposterior to a narrow aperture between the superior mesenteric artery and\naorta, a nutcracker like configuration.\n\nStomach and small bowel appear normal.  Sigmoid diverticulosis is mild.\n\nBladder appears normal.  A uterine fibroid along the left posterior uterine\nbody measures 19 mm in diameter.  No adnexal masses found.  There is no\nlymphadenopathy or ascites.\n\nThere are no suspicious bone lesions. Moderate degenerative changes affect the\nL4-L5 and L5-S1 facet joints. Degenerative changes are moderate at the left\nsacroiliac joint. Pubic symphysis is also moderately narrowed. Bones appear\nprobably demineralized.  Mild compression fracture of the T12 vertebral body\nshows interval healing response without increase loss in height.",
            "output": "Status post liver transplant with no evidence for complications or\nhepatocellular carcinoma.  Nonobstructing nephrolithiasis.\n\nChest is reported separately."
        },
        {
            "input": "LOWER CHEST: There is mild scattered subsegmental atelectasis in the imaged\nlung bases.  There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.\n\nThere is mild intrahepatic biliary dilatation.  There is moderate extrahepatic\nbiliary ductal dilatation, with the common bile duct measuring up to 1.3 cm. \nFindings have slightly progressed compared to CT of the abdomen/pelvis from ___ (at which time the CBD measured up to 1 cm), likely sequelae of\ncholecystectomy.  The gallbladder is surgically absent.\n\nPANCREAS: There is fatty infiltration of the pancreatic head, stable.  The\nremaining pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 calculus is seen in the mid left kidney.  There\nare no ureteral stones.  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. Mild\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.  There is mild perirectal fat stranding and\nvascular engorgement, with prominent perirectal nodes measuring up to 5 mm and\n___ chain nodes measuring up to 7 mm (3; 134), concerning for\nproctitis.  There is no rectal wall thickening or evidence of mass by CT.  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 does not appear enlarged.  The seminal\nvesicles 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.\n\nSOFT TISSUES: A small left fat containing Bochdalek hernia is seen.  There are\nsmall fat containing bilateral inguinal hernias.",
            "output": "1. Mild perirectal fat stranding and vascular engorgement, with prominent\nperirectal nodes and ___ chain nodes, concerning for proctitis.  No\nrectal wall thickening or evidence of mass by CT.  Recommend correlation with\nproctoscopy (if colonoscopy has not recently been performed for screening).\n2. 4 mm nonobstructing left renal stone.  No ureteral stones.  No\nhydronephrosis.\n3. Mild intrahepatic and moderate extrahepatic biliary ductal dilatation, with\nthe common bile duct measuring up to 1.3 cm, slightly progressed since ___,\nlikely sequelae of cholecystectomy.  Correlation with LFTs is recommended."
        },
        {
            "input": "CHEST:  There is bibasilar atelectasis. Visualized heart and pericardium are\nunremarkable\n\nABDOMEN: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary dilatation. The gallbladder is unremarkable and the portal vein is\npatent. The pancreas, spleen and adrenal glands are unremarkable. The kidneys\npresent symmetric nephrograms and excretion of contrast with no focal lesions,\nstones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  The appendix is not visualized though there are no secondary\nsigns of appendicitis.  There is no retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria. No ascites, free air or abdominal hernia.\n\nPELVIS: The urinary bladder is unremarkable.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  Trace free fluid in the pelvis is likely\nphysiologic. Uterus appears unremarkable. No adnexal masses are seen.\n\nBONES AND SOFT TISSUES: No lytic or sclerotic lesion suspicious for malignancy\nis present.",
            "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 homogeneous attenuation throughout. \nPatient is status post liver transplant.  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 bilateral kidneys are atrophic.  There is a transplanted kidney\nin the right lower quadrant.  There is a 3.1 x 3.3 cm hypodense lesion in the\nrenal transplant.  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.  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.  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 unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or 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 in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute intra-abdominal or pelvic pathology to explain\nsymptoms.\n2. Status post right lower quadrant renal transplant.  Correlate with UA if\nthere is concern for pyelonephritis.\n3. Diverticulosis without evidence of diverticulitis.\n\nNOTIFICATION:\n1. No evidence of acute intra-abdominal or pelvic pathology to explain\nsymptoms. No evidence of intra-abdominal Fluid collection.\n2. Status post right lower quadrant renal transplant.  Difficult to exclude\npyelonephritis. Recommend correlation with UA.\n3. 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 suspicious focal lesions.  Multiple focal\nsubcentimeter hypodensities are seen in the liver, too small to characterize,\nthough likely biliary hamartomas versus hepatic cysts (series 2, image 119). \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 solid focal renal lesions or hydronephrosis.  A\nsubcentimeter partially exophytic cystic structure within the upper pole of\nthe right kidney too small to characterize, though statistically likely a\nsimple cyst (series 2, image 50).  In the lower pole of the left kidney a 7 mm\nfat containing lesion is suggestive of an angiomyolipoma (series 2, image 65).\nThere 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 colon and rectum are\nwithin normal limits. The appendix measures 7 mm in transverse dimension and\nappears fluid-filled (series 2, image 106, 114).  While there is no\nsignificant inflammation surrounding the appendix, early appendicitis is not\nexcluded\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is grossly within normal limits.  Within left\nadnexa, there is a 2.0 x 1.8 cm simple cystic structure (series 2, image 124).\nIn the right adnexa, there is a similar 1.0 x 1.0 cm cystic structure with\nlikely thin septation (series 601, image 60, series 2, image 129).\n\nLYMPH NODES: There is no retroperitoneal or 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 multilevel degenerative changes in the spine and\npelvis.  There is osseous demineralization.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1.  No evidence of diverticulitis.\n2.  Bilateral adnexal cystic structures are noted, left greater than right and\nmeasuring up to 2.0 cm.  The right adnexal cyst is complex with internal thin\nseptation, for which pelvic ultrasound may be considered for further\nevaluation.\n3.  Prominent fluid-filled appendix measuring 7 mm is noted though without\nsurrounding inflammation, making acute appendicitis less likely.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 2:40 pm, 20 minu"
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases are clear.  No pleural effusion.\nThe visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones. The portal vein, SMV, and splenic vein are\npatent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. Large amount of stool throughout the colon.\nThe appendix is fluid-filled measuring 6 mm. No appendicolith.  No adjacent\nfat stranding. (601b: 24). No mucosal hyper enhancement.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  The iliac arteries are normal in\ncourse and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is largely distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. The uterus and ovaries are unremarkable.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Largely distended otherwise normal appearing bladder.\n2.  No definite evidence of appendicitis. No focal fluid collection.\n3.  Large fecal load.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ on the\ntelephone on ___ at 11:26 ___, 5 minutes after discovery of updated\nfindings."
        },
        {
            "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nPeritoneal Cavity: There is no free air or free fluid.  There is no\nsignificant fat stranding in the right lower quadrant. There is no focal fluid\ncollection 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 no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits with\nno evidence of bowel obstruction. The appendix is difficult to definitively\nvisualized, however, there is a serpiginous soft tissue density extending from\nthe cecum that measures no more than 5 mm with no surrounding fat stranding,\nfluid or inflammatory changes which likely represents a normal appendix (05:58\n).  There are no findings in the right lower quadrant to suggest appendicitis.\n\nPelvis: The urinary bladder is unremarkable. The uterus and ovaries are\nunremarkable with no adnexal mass.\n\nLymph Nodes: There is no size significant mesenteric, pelvic or\nretroperitoneal lymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "No evidence of acute appendicitis nor other radiological explanation for\npatient's right lower quadrant 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 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 1.1 cm cyst is seen in the upper pole of the left kidney.  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.  Moderate amount of stool seen throughout the\ncolon and rectum.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  There is streak artifact in the pelvis from a dense\nradiopaque structure in the right lower quadrant, likely intraluminal ingested\nmaterial in the ascending colon.\n\nREPRODUCTIVE ORGANS: The uterus contains partially calcified fibroids.  No\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.  No atherosclerotic disease\nis noted.\n\nBONES: Moderate levoconvex scoliosis 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": "No acute abnormality 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 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. \nNo hydronephrosis.  1 cm hypodense lesion at the upper pole of the left kidney\nis compatible with a renal cyst and unchanged compared to prior.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The rectum is\nlargely distended and contains a fecaloma.  Consequently, the wall of the\nrectum is thickened with mucosal hyperemia and there are significant\nsurrounding inflammatory changes.  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: Multiple calcifications within the uterus likely\nrepresent degenerating 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. \nLevoscoliosis of the lumbar ___ at L3 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Markedly distended rectum containing a large fecaloma with evidence of\nstercoral proctitis.  Recommend disimpaction."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. \n1 cm simple renal cyst at the left upper pole is unchanged.  There is no\nevidence of suspicious 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.  The previously\nnoted large fecaloma has resolved.  However, there continues to be a moderate\nstool burden within the ascending colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple uterine calcifications are suggestive of uterine\nfibroids.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 changes of the imaged spine.  Unchanged\nlevoscoliosis of the lumbar ___ at L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Moderate colonic stool burden with no evidence of obstruction, abscess,\nresidual stercoral 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 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 solid renal lesions or hydronephrosis.  Left upper\npole simple renal cyst measuring 1.2 cm is unchanged.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The rectum is\ndistended with air.  There is moderate fecal loading throughout the colon,\nsimilar to prior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Scoliotic 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": "When compared to the prior study from ___, there is no significant\ninterval change.  Absence of oral contrast somewhat limits evaluation of the\nbowel.  Moderate colonic stool burden is re-demonstrated without evidence of\nobstruction."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  Left upper\npole renal cyst is noted.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Moderate stool\nburden seen the colon.  The colon and rectum are within normal limits. The\nappendix is not identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is noted.  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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThrough echo lumbar S-shaped scoliosis is again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal process, no findings to explain symptoms."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nHEPATOBILIARY: There are multiple hepatic hypodense lesions, which are stable\nsince ___.  Some of these are indeterminate, for instance the 1.2 x 1.2 cm\nhypodensity in the right hepatic lobe (4:43); there is a stable 1.2 cm left\nhepatic lesion on series 4, image 41.  A few hypodense lesions are too small\nto characterize (04:41, 04:48) the stable.  There is no biliary dilatation. \nThe gallbladder is unremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable.\n\nGASTROINTESTINAL: No intestinal obstruction, free air or ascites.\n\nPELVIS: There is no free fluid in the pelvis.  The uterus and adnexa are \nunremarkable on CT for age.\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 lesionsd.  The left sacral\nTarlov cyst is unchanged.  Multilevel degenerative changes in the\nthoracolumbar spine are mild-to-moderate.\n\nSOFT TISSUES: A small umbilical hernia containing fat is unchanged.",
            "output": "1.  Stable examination.  No definite findings of metastatic disease.\n\n2.  Please refer to the dedicated CT chest report of the same date for the\nintrathoracic findings."
        },
        {
            "input": "ABDOMEN:\n\nMild bibasilar atelectasis is noted. The liver demonstrates normal\nattenuation. Within the limitations of an unenhanced CT, no focal hepatic\nlesions are identified. The decompressed gallbladder is unremarkable. To the\nextent assessed, the pancreas, adrenal glands and spleen are unremarkable.\nBoth kidneys are symmetric in size, with no evidence of hydronephrosis. 2 tiny\nnon-obstructing calculi are identified in the lower pole of the left kidney,\nmeasuring up to 3 mm (3:43, 5:27, 05:31). No ascites. A small to moderate\nparaesophageal hernia is identified. The caliber of small and large bowel is\nwithin normal limits. Few sub-centimeter periaortic retroperitoneal lymph\nnodes are identified (03:44, 48). No intraperitoneal lymphadenopathy. The\nappendix is unremarkable. No focal soft tissue abnormalities identified.\n\nPELVIS:\n\nThe moderately distended urinary bladder is unremarkable. Prostate gland,\nseminal vesicles and rectum are unremarkable. No pelvic free fluid. No\ninguinal or pelvic lymphadenopathy. Small bilateral fat containing inguinal\nhernias are noted. A few scattered sigmoid diverticula are identified, however\n\nOSSEOUS STRUCTURES:\n\nNo focal osteolytic or osteoblastic lesions are identified.",
            "output": "1. 2 tiny nonobstructing calculi in the lower pole of left kidney measuring up\nto 3 mm. No hydronephrosis.\n2. Small to moderate paraesophageal hernia."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases are clear.  No pleural effusion.\nThe visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.Mild\nperiportal edema. No intra or extrahepatic biliary duct dilatation. The\ngallbladder is normal without calcified gallstones. The portal vein, SMV, and\nsplenic vein are patent.\n\nThe spleen is mildly enlarged. The pancreas enhances homogenously and is\nwithout focal lesions, peripancreatic fat stranding, or focal fluid\ncollection. The adrenal glands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion.  Few sigmoid diverticula seen without\nevidence of acute diverticulitis. The appendix is normal without evidence of\nacute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent . The iliac arteries are normal in course\nand caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo pneumoperitoneum, abdominal wall hernia.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  Small amount of free\npelvic fluid identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  No CT evidence to explain patient's symptoms.\n2.  Normal appendix. No evidence of colitis.\n3.  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: Liver shows diffusely decreased attenuation, which may\nrepresent 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is mild\nprominence of the right ureter throughout its course without frank dilation. \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, although\nthere are no secondary signs of inflammation 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 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 definite etiology identified for patient's abdominal pain.\n2. Mild steatosis of the liver."
        },
        {
            "input": "The visualized lung bases are clear.  A right-sided Bochdalek hernia is\nincidentally noted. The heart is normal in size and there is no evidence of\npericardial effusion.\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\nair-filled and normal in appearance.  Several mesenteric adhesions are noted,\nlikely post-surgical in nature. There is no retroperitoneal lymphadenopathy by\nCT size criteria. There is no free abdominal fluid or pneumoperitoneum. The\naorta and iliac branches are normal in course and caliber. The celiac trunk\nand SMA are grossly patent.\n\nPELVIS:\n\nThe urinary bladder is grossly unremarkable.  Circumferential surgical sutures\nare noted surrounding the lower rectum (3:62), likely correlating with the\nhistory of partial colectomy. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  The patient is status post left\ntotal hip arthroplasty. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute intra-abdominal process is identified to explain the patient's\nsymptoms."
        },
        {
            "input": "Thorax: The chest/ intrathoracic portion of this exam will be dictated under\nanother clip number.\n\nLiver: The liver is normal in size and attenuation. No focal hepatic lesions\nare identified. A 7 mm porta hepatis lymph node is unchanged from prior\nexamination. The portal vein is patent. There is no intra or extrahepatic\nbiliary duct dilatation.\n\nGallbladder: There is minimal cholelithiasis with no evidence of\ncholecystitis.\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:  Unchanged appearance of the 1.1 cm left adrenal adenoma. The right\nadrenal gland is normal.\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. \nThere is diverticulosis of the sigmoid colon with no evidence of\ndiverticulitis.\n\nVessels: There is moderate calcified atherosclerosis of the abdominal aorta\nand bilateral iliac arteries. Additionally there is calcification of the\nsplenic artery which is unchanged in appearance from the prior study.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The patient is status post hysterectomy. There are no soft tissue\nmasses or lesions identified in the pelvis. There is no pelvic sidewall\nlymphadenopathy. The rectum is unremarkable.\n\nThere is minimal bladder wall thickening superiorly to the left. Additionally,\nthere is diverticulosis of the sigmoid colon as well as apparent tethering of\na single diverticulum to the left superior portion of the bladder. There is\nminimal stranding seen in fat adjacent to the sigmoid colon, which could be\nrelated to prior radiotherapy, inflammation (e.g.  prior diverticulitis) or\npost surgical changes.\nA 7 mm right common iliac lymph node is unchanged from the prior examination\n(series 5, image 79).\n\nOsseous Structures/ Soft Tissues: Ventral hernia which contains a loop of\nsmall bowel without evidence of strangulation. There are no suspicious lytic\nor blastic lesions seen in the visualized osseous structures.  There is\nextensive stranding of the subcutaneous soft tissue in the anterior abdominal\nwall. There is moderate degenerative change throughout the lumbar spine.",
            "output": "1. No evidence of recurrence or metastatic disease in the abdomen or pelvis.\n2. Tethering of a sigmoid diverticulum to the superior left portion of the\nbladder may be related to prior surgery, radiation or prior inflammation.\nAttention on followup CT is recommended."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Aortic valve calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY:  Innumerable hypodense lesions are seen throughout the liver as\nnoted on the prior MRI, new from ___, concerning for metastatic\ndisease, mesauring up to 4.0 x 4.3 cm in the right hepatic lobe (13:19).  A\n1.3 cm cyst in segment VII (06:59) is unchanged. There is no intra or\nextrahepatic bile duct dilation. Stones are seen within the gallbladder\nwithout wall edema or pericholecystic fluid.\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:  A 1.0 cm nodule in the right adrenal gland has attenuation -4 ___ on\nthe noncontrast images, compatible with an adenoma.  There is mild left\nadrenal thickening without a discrete nodule.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.  Tiny cortical hypodensities in left kidney are too\nsmall to characterize, most likely representing cysts. A 2.0 cm right\nperipelvic simple cyst is noted.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and 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 but has lost parallelism\ninfrarenally and there are dense atherosclerotic calcifications along its\ncourse. There is a partially thrombosed 1.6 cm aneurysm of the right common\niliac artery (6:85). The main portal vein, splenic vein and SMV are patent.\n\nPELVIS: The prostate is enlarged with circumferential bladder wall thickening,\nsuggesting chronic outflow obstruction. There is no free fluid in the pelvis.\nWithin the left anterior hemipelvis, a 6.2 x 2.1 cm soft tissue mass (6:105)\nis unchanged from PET-CT ___ at which time it was not FDG avid\nand is significantly smaller than in ___, likely representing treated\nlymphoma.  No newly enlarged lymph nodes are identified in the pelvic or\ninguinal regions.\n\nBONES AND SOFT TISSUES:  Spinal osseous metastatic disease is better evaluated\non the prior MRI.  Osseous metastases are also noted in the bony pelvis; for\nexample, a 14mm lytic lesion in the right iliac wing (6:90) and a lytic lesion\nin the right inferior pubic ramus (6:118) with associated 2.3cm soft tissue\nmass and possible non-displaced pathologic fracture are seen. Again noted is\ncompression deformity of thoracic vertebral bodies with retropulsion of T7\ninto the spinal canal.  A 9 mm non-aggressive appearing sclerotic focus in the\nright femoral neck is unchanged from ___, likely a bone island.",
            "output": "1.  Diffuse hepatic and osseous metastatic disease in the abdomen and pelvis.\nOsteolytic lesion with soft tissue and possible nondisplaced pathologic\nfracture in the right inferior pubic ramus. The left paraspinal soft tissue\nmass at the T5 vertebral body seen on the concurrent chest CT and prior MRI\nwill be targeted for CT-guided biopsy.\n2.  Additional findings of right adrenal adenoma, cholelithiasis,\ndiverticulosis, and partially thrombosed 1.6 cm right common iliac artery\naneurysm.\n3.  Soft tissue mass in the left anterior hemipelvis is unchanged from ___ and not FDG-avid on the prior PET CT, likely treated lymphoma.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 3:05 ___.  Finding of possible\nright inferior pubic ramus nondisplaced fracture discussed with Dr. ___ at\n5:04PM, 5 minutes after discovery of findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Linear consolidative opacities in the bilateral lung bases,\nslightly increased compared to the prior study from ___, likely\nrepresents atelectasis.  Mucous plugging in the distal airways are noted in\nthe right lower lobe (3:83).  There is mild peribronchial wall thickening in\nthe right lower lobe.  There is no pleural effusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Since the prior study from ___, there has been\ninterval development of numerous ill-defined heterogeneously hypodense lesions\nthroughout the liver, compatible with metastases.  The largest in the left\nhepatic lobe in segment III measures 3.7 x 3.1 cm (3:124).  The largest lesion\nin the right hepatic lobe in segment VI measures 2.0 x 1.9 cm (3:134).  There\nis mild dilation of the intrahepatic ducts, right greater than left, and\nmoderate dilatation of the common bile duct, measuring up to 12 mm (previously\n17 mm), significantly improved from prior.  A metallic stent reportedly placed\nduring ERCP performed on ___ is not visualized in the common bile\nduct or bowel.  The gallbladder is contains stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.\n\nSlightly heterogeneous enhancement of the main portal vein near the confluence\nlikely represents contrast mixing.  The main portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  Mild diffuse\nprominence of the main pancreatic duct, measuring up to 3 mm, is unchanged\nfrom prior exam.  Cystic lesions in the pancreatic tail measuring 5 mm 9 mm\n(601: 49 and 52) likely represent side-branch IPMNs.  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 bilateral renal cysts and subcentimeter cortical hypodensities too\nsmall to characterize.  A subcentimeter cyst in lower pole of the left kidney\ndemonstrates mural calcification (3:138).  There is no evidence renal stones\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Again seen is an enhancing soft tissue lesion in the\nampulla, measuring approximately 1.3 x 2.3 cm, likely corresponding with the\nknown ampullary carcinoma.  Otherwise, small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout.  There is a left lower\nquadrant colostomy with a small parastomal hernia containing fat and a\nnondilated loop of transverse colon.  There is no bowel obstruction.  Appendix\nis not visualized.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: Peripancreatic and porta hepatis lymphadenopathy has worsened\nfrom prior, measuring up to 10 mm short axis, previously 5 mm.\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 within normal\nlimits.\n\nBONES: The bones are demineralized.  There is no suspicious osseous lesion. \nMultilevel spinal degenerative changes and Grade 1, 4 mm anterolisthesis of L4\non L5 with endplate sclerosis is unchanged.\n\nSOFT TISSUES: A large fat containing right inguinal hernia containing fat is\nnoted.",
            "output": "1. Interval development of innumerable new ill-defined, hypodense lesions in\nthe liver, compatible with metastases.\n2. Peripancreatic and porta hepatis lymphadenopathy, worsened compared to\nprior CT of the abdomen/pelvis from ___.\n3. Mild dilation of the intrahepatic ducts, right greater than left, and\nmoderate dilatation of the common bile duct, measuring up to 12 mm,\nsignificantly improved from prior.  A metallic stent reportedly placed during\nERCP performed on ___ is not visualized in the common bile duct or\nbowel.\n4. Persistent soft tissue mass at the ampulla measuring 2.3 cm, likely\ncorresponding with the known ampullary carcinoma.\n5. Left lower quadrant colostomy and parastomal hernia containing fat and\nnondilated loop of transverse colon.  No bowel obstruction.\n\nNOTIFICATION:   The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 10:56 am, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "There is no acute fracture of the pelvis or proximal femurs bilaterally. \nThere are no suspicious osseous lesions.  The partially visualized small and\nlarge bowel are unremarkable. The urinary bladder and distal ureters are\nunremarkable. There is no free fluid in the pelvis. There is no pelvic or\ninguinal lymphadenopathy. Mild atherosclerotic disease is noted.  There is a\nsmall fat containing umbilical hernia.\n\nThere is a fat containing retroperitoneal lesion adjacent to the left psoas\nmuscle that measures approximately 7 x 2.0 cm in maximal ___ (series\n400b, image 63).  Although predominately fat in attenuation, at its inferior\nmargin there are linear soft tissue components as well.  There is extension\ninferiorly to the adductor compartment.",
            "output": "1. No evidence of acute pelvic or femoral neck fracture.\n2. Fat containing retroperitoneal lesion adjacent to the left psoas muscle\nmeasuring up to 5.7 cm.  The retroperitoneal location and the small amount of\nsoft tissue density within the lesion make it concerning for a low-grade\nliposarcoma.\n\nNOTIFICATION:  The findings were discussed with ___ by ___\n___, M.D. on the telephone on ___ at 3:27 ___, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Please see the dedicated CT chest report from the same date for the thoracic\nfindings.\n\nLIVER: There is a 1.4 x 1.1 cm rounded, hypodense cystic lesion demonstrating\ninternal attenuation of simple fluid, within hepatic segment VI (5:57). The\nliver otherwise enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The non-distended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. The upper pole of the left kidney contains a subcentimeter,\nhypodense, round lesion, too small to characterize on the current exam but\nlikely a cyst (5:65 and 8:26). There is no other focal lesion or\nhydronephrosis.\n\nGI:The patient is status post partial gastrectomy, denoted by multiple\nsutures. The stomach contains fluid and contrast, limiting its evaluation,\nhowever there is no obvious intraluminal mass.The small and large bowel are\nwithin normal limits, without wall thickening or evidence of obstruction.A\nnormal, air-filled appendix is visualized.\n\nRETROPERITONEUM: There is a fusiform abdominal aortic aneurysm measuring 3.3\ncm at greatest diameter (5:78). The wall of the aorta is thickened with\ncalcifications. The common iliac arteries contain moderate calcifications.\nThere is no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.The prostate is mildly enlarged.  The\nseminal vesicles are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. No evidence of recurrent malignancy or metastatic disease within the\nabdomen and pelvis.\n\n2.  3.3 cm fusiform abdominal aortic aneurysm.\n\n3.  Hepatic and left cysts, which per OMR had been seen previously on outside\nhospital images."
        },
        {
            "input": "Lower Thorax: Please see CT thorax from same day for further details.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\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 no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: There are parapelvic cysts in the left kidney with no\nhydronephrosis bilaterally.  There is symmetric enhancement with no suspicious\nmass lesion bilaterally\nThe adrenal glands are normal bilaterally.\n\nBowel: There is significant distal colonic diverticulosis with no evidence of\ndiverticulitis. There is no bowel obstruction or suspicious mass lesion.\n\nPelvis: There is a Foley catheter within the urinary bladder with air seen\nwithin the lumen anteriorly likely related to Foley insertion.The prostate\ngland is within normal limits.\n\nLymph Nodes: There is no significant mesenteric, pelvic or retroperitoneal\nlymphadenopathy.\n\nVessels: There is a retroaortic left renal vein (3:75). The abdominal\nvasculature is otherwise normal and widely patent.\n\nBones: There are degenerative changes at L5/S1. There is no suspicious bone\nlesion.",
            "output": "No evidence of neoplastic or metastatic disease to 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 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. \nRedemonstration of a rounded 1.5 cm left renal hypoenhancing cystic-appearing\nwith Hounsfield unit of ___, not significantly changed in size since ___ CT measurements of 1.4 cm, but is slightly enlarged compared to ___ measurements of 1.0 cm.  This lesion is minimally complex, as it contains\nseveral thin internal septations.  There is no evidence of focal renal lesions\nor hydronephrosis.  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. 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 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. \nDegenerative changes are seen within the lumbar spine, especially notable at\nthe L5-S1 level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 1.5 cm minimally complex cystic appearing lesion within left kidney,\nslightly enlarged since ___ CT.  Consider further evaluation with\nMR.\n2. No findings concerning for metastatic disease within the imaged abdomen and\npelvis.\n\nRECOMMENDATION(S):  Consider further characterization of left renal lesion\nwith MRI.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:48 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "There is bilateral pulmonary edema and pulmonary effusions with septal\nfissuring at what appears to be atelectasis, though pneumonia cannot be\nexcluded.\n\nLIVER: The liver is homogeneous without focal lesion or intrahepatic biliary\nduct dilation.  The non-distended gallbladder is within normal limits, without\nwall thickening or pericholecystic fluid. Several small dependent gallstones\nare noted.\n\nSPLEEN: The spleen is homogeneous and normal in size.  The splenic artery is\nmoderately calcified, unchanged from the prior study.\n\nPANCREAS: Evaluation of the transplanted pancreas is very limited without the\nadministration of IV contrast\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The bilateral native kidneys are atrophic, and the native renal\narteries are calcified. The transplanted kidney is in the left iliac fossa,\nwith a small amount of fluid tracking in the posterior perirenal space. There\nis no evidence of hematoma. A double-J ureteral stent is noted within the\ntransplanted kidney, extending appropriately into the bladder.\n\nGI:The stomach has no obvious intraluminal mass or wall thickening.The small\nand large bowel are within normal limits, without wall thickening or evidence\nof obstruction.A normal, air-filled appendix is visualized.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith significant atherosclerotic calcifications.  A left external iliac stent\nis noted. There is no retroperitoneal or mesenteric lymph node enlargement by\nCT size criteria.\n\nCT PELVIS: A Foley catheter and the distal portion of the double-J ureteral\nstent are seen within the bladder.No pelvic wall or inguinal lymph node\nenlargement by CT size criteria is seen.There is a small amount of pelvic free\nfluid.The uterus is unremarkable in appearance.\n\nBONES & SOFT TISSUES:  Extending approximately 10 staples superiorly from the\nmost inferior staple is a subcutaneous fluid collection, demonstrating simple\nfluid attenuation and measuring approximately 5.4 cm in craniocaudal height\n(2:73 and 601b:15). There is a small gas bubble at the superior aspect of this\ncollection. This is most likely a seroma, though infection cannot be excluded.\nThere is no evidence of wound dehiscence. No focal osseous lesion suspicious\nfor malignancy present.",
            "output": "1.  5.4 cm subcutaneous, simple fluid collection at the incisional site\ninferiorly, likely a seroma, though infection cannot be excluded.\n\n2. Unremarkable non-contrast appearance of the transplanted kidney in the left\niliac fossa, with an appropriately placed double-J ureteral stent.\n\n3.  Bilateral pulmonary edema at the lung bases with effusions and what\nappears to be atelectasis, though pneumonia cannot be excluded.\n\nNOTIFICATION:  The above findings were discussed in person with Dr. ___\n___ at approximately 11:40 on ___, 5 min 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 8 mm enhancing nodule in segment 7.  There is no evidence of\nintrahepatic biliary dilatation.  The common bile duct measures 0.9 cm without\nclear etiology.  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: Small hiatal hernia.  Small bowel loops are mildly fluid\ndistended without frank dilation, wall thickening or abnormal enhancement. \nThe appendix is normal.  The colon contains a mild fecal load.  Sigmoid\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: The uterus and bilateral adnexae are grossly 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Given mild fluid distension of small bowel loops, please correlate for mild\ngastroenteritis.\n2. Sigmoid diverticulosis without evidence of diverticulitis.\n3. 8 mm enhancing hepatic nodule in segment 7."
        },
        {
            "input": "LOWER 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 hydronephrosis.  There are no concerning renal lesions.  There are\nmultiple, cortically based renal hypodensities, which measure simple density,\nthe largest of which is an exophytic lesion off the upper pole of the\nposterior left kidney, measuring 3.2 cm.  These lesions are consistent with\nsimple 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. Appendix is not visualized.\n\nPatient shows right lower quadrant ileal conduit, which is within normal\nlimits.\n\nPELVIS: Patient is status post cystectomy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are not visualized,\npresumably due to prior section.\n\nLYMPH NODES: Patient is status post retroperitoneal and bilateral iliac lymph\nnode dissections without evidence of local recurrence.  There is no mesenteric\nor 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 or acute fracture.\nSmall benign-appearing sclerotic focus is seen in the left iliac bone.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patient is status post cystectomy with right lower quadrant ileal conduit\nwithout evidence of local recurrence.  No metastatic disease identified within\nthe 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 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 stable bilateral renal cortical hypodensities that are incompletely\ncharacterized based on density but are most likely cysts.  There is an ileal\nconduit with an ostomy in the right mid abdomen.  There is no hydronephrosis\nor hydroureter.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is an\nanastomotic loop in the right upper quadrant.  The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: The patient is status post radical cystoprostatectomy with bilateral\npelvic lymph node dissection.  There is no free fluid or mass 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 metastatic disease in the abdomen or pelvis.\n2. Please refer to the separate report for the CT chest."
        },
        {
            "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.\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: A 1.5 cm hypodensity seen in the lower pole of the right kidney,\nlikely cortical cyst. Interval collapse of the previously described exophytic\ncyst in the upper pole of the left kidney, with mild residual fat stranding.\nAn ileal conduit is present.  There is no hydronephrosis.\n\nPelvis: The urinary bladder has been surgically removed. There is no free\nfluid in the pelvis.\n\nGastrointestinal: A small hiatal hernia seen. The colon is fecal loaded. \nThere is no evidence of bowel 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 are no size significant lymph nodes. There has been\nprevious extensive bilateral pelvic lymph node dissection.\n\nBone and soft tissues: There is no suspicious bone lesion. Unchanged sclerotic\nfocus in the left iliac bone.",
            "output": "1. No evidence of recurrence or metastasis in the abdomen or pelvis.\n\n2. Please see the report of the CT chest performed on the same day for more\ndetails."
        },
        {
            "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 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 ileal conduit.  There has been interval development of\nsoft tissue stranding adjacent to the ileal conduit.  The ileal conduit\nappears distended intra-abdominally and within the subcutaneous tissues of the\nanterior abdominal wall superficial to the abdominal musculature. \nAdditionally, there is moderate bilateral hydroutereteronephrosis, perinephric\nstranding, and urothelial enhancement with adjacent stranding.  The kidneys\nare of normal and symmetric size with normal nephrogram.  There is a 2.1 cm\nsimple cyst in the lower pole of the right kidney.  There are additional\nsubcentimeter hypodensities in the right kidney, too small to characterize but\nlikely representing cysts.  There is a 3.5 cm exophytic cyst arising from the\nupper pole the left 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. The appendix is normal.\n\nPELVIS: Status post radical cystectomy and prostatectomy.  There is no free\nfluid in the pelvis.\n\nLYMPH NODES:Extensive surgical clips are noted noted along the pelvic\nsidewalls.  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. Interval development of ileal conduit distension and moderate bilateral\nhydroureteronephrosis raises the possibility of ileal conduit obstruction,\nhowever, no obvious cause for obstruction is identified.\n2. Stranding along the course of the ileal conduit, bilateral ureters, and\nbilateral perinephric spaces raises the possibility superimposed infection. \nCorrelation with urinalysis is recommended.\n3. No discrete mass seen in the region of the stoma though the ileal conduit\nis fluid filled and relatively distended in the subcutaneous fat which could\nmimic focal lesion on physical 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 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. \nStable 1.5 cm simple cyst at the right lower renal pole.  An ileal conduit is\nagain demonstrated, with a small parastomal hernia (601:13), unchanged.  There\nis no evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: The urinary bladder is surgically absent.  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.  Extensive bilateral pelvic lymph\nnode dissection is again noted.\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. \nUnchanged small sclerotic focus in the left iliac bone, consistent with benign\nbone island.\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. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day."
        },
        {
            "input": "LOWER CHEST: Please refer to the dedicated CT chest report performed on the\nsame day for intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of focal lesions. No evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is non-distended and appears normal.\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.  Small splenule at the inferior aspect of the\nsplenic 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.  There are several\nhypodensities of fluid attenuation scattered throughout the right kidney with\nthe largest measuring 1.7 cm at the inferior renal pole consistent with a\nrenal cyst, unchanged.  Left kidney appears normal. No evidence of solid renal\nlesions or hydronephrosis.  The distal ureters can be seen connecting to the\nileal conduit within the right lower quadrant which contains an unchanged\nsmall peristomal hernia..\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix is normal.  Staple lines within\nsmall bowel in the right lower quadrant consistent with history ileal conduit\ncreation.\n\nPELVIS: There are multiple surgical clips within the pelvis.  The urinary\nbladder surgically absent in keeping with history of cystectomy.  No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is surgically absent.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.  No inguinal\nlymphadenopathy.  Status post extensive pelvic lymph node dissection.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Unchanged sclerotic focus of the left iliac bone. No evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Ileal conduit within the right lower quadrant with small\nunchanged peristomal hernia as detailed above.",
            "output": "1. No evidence of locally recurrent or metastatic disease within the abdomen\nor pelvis.\n2. Status post cysto prostatectomy with ileal conduit creation. Unchanged\nsmall peristomal hernia of the ileal conduit.\n3. Please refer to the dedicated CT chest report performed the same day for\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. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There is a small focus of hyperenhancement\nof the gallbladder neck, suggestive of adenomyomatosis (10:28).  Otherwise,\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.  There 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. \nA 1.8 cm simple cyst in the right upper pole is unchanged.  Additional\nsubcentimeter hypodensities in the right kidney are too small to characterize,\nbut statistically likely represent simple cysts.  There is no evidence of\nsolid 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.  Surgical sutures\nare noted in the right lower quadrant.  There is moderate stool burden in the\ncolon.  The appendix is normal.\n\nPELVIS: As before, the distal ureters communicate with a right lower quadrant\nileal conduit.  The bladder is surgically absent.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is surgically absent\n\nLYMPH NODES: Multiple retroperitoneal and pelvic sidewall surgical clips\ndenote previous lymph node dissection.  There is no retroperitoneal or\nmesenteric lymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: A 1.1 cm sclerotic focus left iliac bone is stable.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are small bilateral inguinal hernias as well as the\npreviously mentioned right lower quadrant ileal conduit.",
            "output": "1. Status post cysto prostatectomy with right lower quadrant ileal conduit. \nNo evidence of locally recurrent or metastatic disease in the abdomen or\npelvis.\n2. Please refer to dedicated chest CT performed on same day for description of\nthe intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Partial visualization of moderate to severe centrilobular\nemphysema in the lung bases.  Dependent atelectasis.  No focal opacification. \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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is loss of the fat plane between the pancreatic head and\nadjacent duodenum with slight enlargement and indistinct contours of the\npancreatic head and uncinate process with mild surrounding fat stranding.  No\nevidence of necrosis.  No acute fluid collection.  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.  A 1.3 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 solid renal lesions or hydronephrosis.  A 1.8 cm\nsimple cyst in the right upper pole is unchanged.  Additional subcentimeter\nhypodensities in the right kidney are too small to characterize, but likely\nrepresent simple cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Surgical sutures\nare noted in the right lower quadrant.  The colon and rectum are within normal\nlimits.  Moderate stool burden in the colon.  The appendix is normal.\n\nPELVIS: The distal ureters are visualized communicating with a right lower\nquadrant ileal conduit.  The bladder is surgically absent.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is surgically absent.\n\nLYMPH NODES: Multiple retroperitoneal and pelvic sidewall surgical clips\nconsistent with prior lymph node dissection.  No retroperitoneal or mesenteric\nlymphadenopathy.  No pelvic or inguinal lymphadenopathy.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: A 1.1 cm sclerotic focus in the left iliac bone is stable (series 2:\nImage 57).  No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small bilateral inguinal hernias.  Small parastomal hernia in\nthe right lower quadrant ileal conduit is unchanged.",
            "output": "1. Mild interstitial edematous pancreatitis involving the pancreatic head and\nuncinate process.  No dilatation of the main pancreatic duct, necrosis, or\nperipancreatic fluid collection.\n2. Status post cystoprostatectomy with right lower quadrant ileal conduit.  No\nevidence of locally recurrent or metastatic disease in the abdomen or pelvis."
        },
        {
            "input": "CHEST:\nThe visualized portion of the thyroid gland appears normal.\nThere are no enlarged lymph nodes in the mediastinum or axillae on both sides.\nNo hilar lymphadenopathy noted.\nNo pleural or pericardial effusions identified.\nThere is no cardiomegaly.\nThe trachea and central airways are widely patent.\nThere are no pulmonary nodules.\n\nABDOMEN:\n\nNOTE: THIS EXAM IS LIMITED BY LACK OF A PORTAL VENOUS AND DELAYED 3 MINUTES\nPHASE.\n\nGENERAL: There is no ascites or free intraperitoneal air.\nHEPATOBILIARY:  The liver demonstrates a cirrhotic morphology with a nodular\ncontour.  Lack of a triple phase exam limits optimal evaluation of the\nnumerous liver lesions described on the MRI dated ___.  Within this\nlimitation, a conglomerated area of arterial enhancement is seen at the\nhepatic dome, at the junction of segment ___ measuring 3.5 x 3 cm in size\n(series 5, image 220).\nAnother rounded subcapsular arterial enhancing lesion at the dome, in segment\n8 (series 5, image 221) measures 1 cm.\nA third rim enhancing lesion in segment 7 (series 5, image 238) measures 1.9\ncm in size.\nThe gallbladder is the hepatic veins are patent.\nThe portal vein appears diminutive, without thrombosis.\nPANCREAS: The visualized portion of the pancreas enhances homogeneously\nwithout main duct dilation.\nSPLEEN:  No splenomegaly.\nADRENALS:  There are no adrenal nodules..\nURINARY: Bilateral nonobstructing calculi with the largest measuring 8 mm,\nlocated in the lower pole of the left kidney (2:84) noted.\nGASTROINTESTINAL: There is no bowel obstruction.  Normal appendix.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.  Mild calcified\natherosclerotic plaque is noted throughout the abdominal aorta and its\nbranches.\nA large vascular shunt from the splenic vein to the SMV is identified. \nAnother splenorenal shunt also noted.\nPELVIS:\nThe bladder is moderately distended and appears normal.  No prostatomegaly..\n\nBONES AND SOFT TISSUES:\nThere are old healed right lateral lower rib fractures.  No worrisome osseous\nlesions identified.",
            "output": "This exam is limited by lack of portal venous and 3 minutes delayed phases.\n\n1. No suspicious pulmonary nodules.\n2. Cirrhotic morphology of the liver.  Due to suboptimal contrast phases,\noptimal evaluation for HCC is not possible on this exam; however the lesions\ndemonstrated on the recent MRI from ___ are visualized in the\narterial phase with no significant increase in size.  These are measured\ndifferently on the CT and appear comparable.\n3. The main portal vein is diminutive.  A large splenorenal shunt and a shunt\nfrom the splenic vein to the SMV are visualized.  There is no ascites.\n4. No suspicious osseous 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: Cirrhotic liver morphology again seen.  There is an\nill-defined, apparently expansile mass of heterogeneous attenuation,\npredominantly slightly hypoattenuating with few areas of more pronounced\nhypoattenuation throughout the right hepatic lobe measuring approximately 10.6\nx 9.3 x 9.1 cm (2:13, 601:33).  This region abuts the right hepatic vein which\nis attenuated along its periphery (2:12).  There is no definite 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.  Mild peripancreatic stranding\nmay be reactive or could suggest acute pancreatitis.\n\nSPLEEN: The spleen is enlarged measuring 13.8 cm, previously 11.7 cm.  There\nis 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 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.  There is\ninterposition of the colon between the liver and peritoneal lining.  There is\nmild diverticulosis without 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 essentially completely occlusive thrombus within the\nexpanded main portal vein just downstream from portal vein/SMV confluence. \nThe right portal veins are completely attenuated.  The left portal vein is at\nleast partially occluded but appears patent distally.  The hepatic mass above\nappears to extend through the porta hepatis (2:21) into the main portal vein\nwhere the thrombus is hyperattenuating, suggestive of tumor thrombus.\n\nMultiple large varices are seen about the left upper abdomen, likely\nsplenorenal.  There is no abdominal aortic aneurysm.  Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild retrolisthesis of L4 on L5 and mild anterolisthesis of L5 on S1 are\nunchanged.  Chronic bilateral L5-S1 pars defects are again seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Cirrhosis with large hepatic mass measuring 10.6 x 9.3 x 9.1 cm.  Although\nindeterminate, there is evidence of likely intravascular tumor extension,\ncommonly seen with hepatocellular carcinoma.  Nonurgent MRI is recommended for\nfurther evaluation.\n2. Expansion and essentially complete occlusive thrombus within the main\nhepatic vein just downstream from the portal vein/SMV confluence with complete\nocclusion of the right portal veins and partial occlusion of the left portal\nvein.  Given probable thrombus enhancement and venous expansion, this likely\nrepresents tumor thrombus.\n3. Portal hypertensive sequelae including multiple upper abdominal varices and\nincreased moderate splenomegaly.  No ascites.\n4. Mild peripancreatic stranding is likely reactive, although acute\npancreatitis cannot be excluded in the appropriate clinical setting. \nCorrelation with lipase level recommended.\n5. Cholelithiasis without acute cholecystitis.\n6. Diverticulosis without acute diverticulitis."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nThe liver enhances homogeneously without focal lesion. The portal vein is\npatent. There is sludge and stone within the gallbladder body, associated with\nintra- and extra-hepatic ductal dilatation, measuring up to 10-11 mm. There is\nno gallbladder wall thickening or pericholecystic fluid.\n\nThe spleen, pancreas, and bilateral adrenal glands are normal.\n\nThere are no calcified stones in bilateral kidneys, ureters, or bladder.  In\nbilateral mid renal poles, there are hyperdense cortical lesions, which\nappears hypointense after contrast, that are likely cysts with\nproteinaceous/blood contents. There is no hydronephrosis.\n\nNo bowel obstruction is seen. . The appendix is not visualized, however there\nare no secondary signs of appendicitis. There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nThe aorta is normal in caliber, with scattered atherosclerotic calcifications.\n\nThere is no mesenteric, retroperitoneal, or pelvic sidewall lymphadenopathy.\n\nThere are prominent pelvic veins, suggestive of chronic venous congestion. The\novaries are not visualized.\n\nThere are bilateral sacral fractures, likely insufficiency fractures. The\nleft-sided sacral fracture involves the first sacral foramen and extends to\nthe midline. There is anterolisthesis of L4 on L5 and L5 on S1, likely\ndegenerative in origin.",
            "output": "1.  Stones and biliary sludge in the gallbladder, associated with mild intra-\nand extra-hepatic ductal dilatation.  Please correlate with LFTs and consider\nMRCP if clinically warranted.\n2. Bilateral sacral fractures, likely insufficiency fractures.  The left-sided\nsacral fracture extends to the midline of the sacrum involving the left sacral\nforamen.\n3. Hyperdense cortical lesions in bilateral mid renal poles, likely cysts with\nproteinaceous/blood contents. Non-emergent renal ultrasound study is\nrecommended.\n4. Prominent pelvic veins, likely chronic venous congestion."
        },
        {
            "input": "LOWER 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 measuring up to 1.2 cm are\nstable compared to prior and correspond with a combination of biliary\nhamartomas and cysts as seen on the MRI of ___.  A nonspecific,\nill-defined 1.7 cm area of heterogeneous hypoattenuation in segment IV B\n(2:60) is less conspicuous than prior and did not exhibit DOTATATE uptake on\n___, possibly focal steatosis.  There are no new focal liver\nlesions.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is surgically absent.\n\nPANCREAS: A mixed cystic and solid enhancing mass in the pancreatic head\nmeasures 2.1 x 2.0 cm in the axial plane (2:64), is stable since the CT of ___ when both the cystic and solid components measured the same.  A\n1.4 cm cystic lesion with hyperattenuating rim in the pancreatic body (02:49)\nis also unchanged.  The previously identified cystic lesion in the pancreatic\nbody seen on prior MRI and characterized as a likely side-branch IPMN is not\nwell seen on the current study.  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: A 2.0 cm right adrenal nodule is unchanged in size since ___ and is consistent with an adenoma.  The left adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 2.2 cm left renal angiomyolipoma (02:52) is stable since ___ and\nslightly increased in size since ___ when it measured 1.7 cm.  A few\nadditional subcentimeter hypodensities are too small to characterize but are\nconsistent with cysts in correlation with the previous MRI.  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 distal\nto the splenic flexure is decompressed.  Otherwise, 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.  No adnexal abnormality is\nseen.\n\nLYMPH NODES: A 2.6 x 1.6 cm left para-aortic nodal mass (2:64) which was\npreviously DOTATATE avid is stable, previously measuring 2.7 x 1.7 cm.  Other\nprominent subcentimeter retroperitoneal lymph nodes are stable.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are multiple subacute rib fractures involving the posterolateral\nseventh as well as posterior and posterolateral ninth ribs.  The fracture\ninvolving the posterior ninth rib is minimally displaced.  No definite\nassociated lytic or sclerotic osseous lesion or soft tissue.  Allowing for\ndifferences in technique, multiple lytic lesions involving the lower thoracic,\nlumbar, and pelvic bones are similar in size.  For example, a 0.8 cm lytic\nlesion involving the left inferior L3 vertebra (2:71) previously measured 0.7\ncm.  A 1.3 cm lytic lesion involving the left iliac bone (2:86) previously\nmeasured 1.2 cm.  Mild anterolisthesis of L4 on L5, likely degenerative in\netiology, is stable.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable intra-abdominal disease, including pancreatic masses of the\npancreatic head and body as well as left para-aortic nodal mass.  No new\nlesions within the abdomen or pelvis identified.\n2. Allowing for differences in technique, osseous metastatic disease involving\nthe lower spine and pelvis is stable.\n3. Stable renal AML.\n4. Multiple subacute fractures involving the seventh and ninth ribs as\ndescribed above.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION:  Wet read findings discussed with ___, MD by ___\n___, MD via telephone at 16:25 on ___."
        },
        {
            "input": "LOWER CHEST: There are multiple subcentimeter pulmonary nodules at bilateral\nlower lungs, unchanged in size.  For example in the left lower lobe is a 6 mm\nsubpleural pulmonary nodule, unchanged, (series 2, image 4).  Additionally\nthere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic hypodensities measuring up to 1.2 cm are\nstable when compared to prior and may represent a combination of biliary\nhamartomas and cysts which are seen on MRI dated ___.  A\nnonspecific ill-defined 1.7 cm area of heterogenous attenuation at segment IV\nB is unchanged and may represent focal steatosis.  No new focal hepatic\nlesions.  The liver demonstrates homogenous attenuation throughout.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: A mixed cystic and solid mass at the pancreatic head 2.1 x 1.9 in\nthe axial plane, (series 2, image 33), unchanged when compared to most recent\nCT.  Within the pancreatic midbody, a cystic lesion is unchanged measuring 1.1\nx 0.9 cm, (series 2, image 18.  Otherwise pancreas is unremarkable.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 2.0 right adrenal nodule is unchanged in size when compared to CT\nabdomen and pelvis dated ___ and consistent with an adenoma. \nLeft adrenal gland is thickened without evidence of discrete mass\n\nURINARY: A fat containing lesion arising from the upper pole of the left\nkidney measuring 2.2 cm is consistent with angiomyolipoma, unchanged.  There\nare multiple subcentimeter hypodensities throughout the bilateral kidneys too\nsmall to fully characterize on CT but are likely renal cysts, better\ncharacterized on previous MRI.  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 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 grossly within\nnormal limits.\n\nLYMPH NODES: At the left periaortic station is a 2.8 x 1.7 cm nodal mass,\nunchanged.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are multiple lytic osseous metastatic lesions involving the right\nhead of the femur, pelvis iliac bones and vertebral bodies of L3 and T10 that\nare unchanged.  No evidence of acute pathologic fracture.  Multiple healing\nright-sided rib fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic process.\n2. Stable intra-abdominal disease including cystic and solid pancreatic mass\nat the pancreatic head and cystic lesion within the mid body of the pancreas. \nSimilar appearance of a retroperitoneal periaortic nodal mass.\n3. Stable osseous metastatic disease involving the lower spine and pelvis.\n4. Stable left renal AML.\n5. Multiple healing right rib fractures.\n6. Long-term stability of a right adrenal nodule measuring 2 cm."
        },
        {
            "input": "Lungs: A stable 1.0 cm cyst is seen in the lingula. There is a stable\nnonspecific 2 mm nodule in the right lower lobe, series 4, image 15.\n\nLiver: The liver is homogeneous with a smooth contour. Stable hypodensities in\nsegment 2 and 5 of the liver, too small to characterize, but likely cysts. No\nsuspicious liver lesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nhas been removed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Redemonstration of the round cystic lesion within the body/tail,\nmeasuring 1.5 cm in diameter, characterized as a side branch intraductal\npapillary mucinous neoplasm (IPMN). Redemonstration of the uncinate process\ncystic lesion with a mural nodule, previously characterized as a possible\ncystic pancreatic neuroendocrine tumor. This also unchanged in size and\nappearance. No pancreatic duct dilatation.\n\nAdrenal glands: There is a stable mass within the right adrenal gland,\nmeasuring 2.4 cm in maximal length. The left adrenal gland is unremarkable.\n\nUrinary: Tiny hypodensities are seen bilaterally, too small to characterize,\nbut likely cortical cysts. There is an unchanged fat containing lesion in the\nupper pole of the left kidney, consistent with angiomyolipoma. No\nhydronephrosis.\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 except for a few\ndiverticula.  No evidence of bowel dilatation or obstruction.\n\nVascular: Mild to moderate atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: Mild interval increase in the left para-aortic lymph node\nmeasuring 2.8 cm x 1.7 cm, previously 2.3 cm x 1.5 cm. There is a stable porta\nhepatis lymph node.\n\nBone and soft tissues: No suspicious bone lesion. Grade 1 anterolisthesis of\nL4 over L5.",
            "output": "1. Stable uncinate process cystic lesion with a mural nodule, previously\ncharacterized as a cystic pancreatic neuroendocrine tumor.\n\n2. Mild interval increase in the left para-aortic lymph node measuring 2.8 cm\nx 1.7 cm, previously 2.3 cm x 1.5 cm.\n\n3. Stable right adrenal gland mass.\n\n4. Stable round cystic lesion within the body/tail, measuring 1.5 cm in\ndiameter, characterized as a side branch intraductal papillary mucinous\nneoplasm (IPMN)."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Partially imaged concentric left\nventricular hypertrophy.\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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is patulous with wall thickening and\nsubmucosal edema,  similar in appearance to ___.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is not definitively visualized, however there are no secondary signs\nof 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 at the upper limit normal.  There is\ncalcification of the vas deferens and penile soft tissues, in keeping with\nhistory of poorly-controlled diabetes mellitus.\n\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, in keeping with history of poorly controlled diabetes\nmellitus and hypertension.\n\nBONES: There 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 finding in the abdomen or pelvis\n2. Distal esophageal wall thickening and submucosal edema, similar to study\nfrom ___, possibly related to recent vomiting.  Clinical correlation\nrecommended\n3. Partially visualized concentric left ventricular hypertrophy."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSegment 2 focal fat along the falciform ligament is similar to prior.  There\nis no evidence of focal lesions. Mild central intrahepatic biliary ductal\nprominence is unchanged.  There is no evidence of 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: When compared to the most recent ___ CT abdomen\npelvis, the degree of severe distal esophageal circumferential mural\nthickening and submucosal edema has slightly worsened, which may be sequela of\nongoing emesis.  The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Hyperdense\nmaterial mixed with stool is noted within the distal sigmoid colon and rectum.\nIn particular the rectum is markedly distended with stool and there is new\nmild circumferential thickening of the rectal wall with mild stranding of the\nperirectal fat, concerning for stercoral proctitis.  The appendix is not\ndefinitively seen however there are no secondary CT signs of acute\nappendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly is similar to prior.  Calcification\nof the vas deferens and penile soft tissue is also similar to prior, in\nkeeping with history of diabetes.\n\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. Markedly distended rectum filled with stool with new mild circumferential\nrectal wall thickening and perirectal fat stranding worrisome with stercoral\nproctitis.  Disimpaction is recommended.\n2. Slightly worse, severe distal esophageal wall thickening and submucosal\nedema since ___ CT, likely esophagitis from ongoing emesis.\n3. No small bowel obstruction or evidence of infection."
        },
        {
            "input": "LOWER 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. Mildly prominent central intrahepatic\nducts, unchanged compared to CT from ___. the gallbladder is within\nnormal limits.\n\nPANCREAS: Limited visualization of the pancreas demonstrates no ductal\ndilatation.\n\nSPLEEN: No splenomegaly or focal splenic lesions within the limitations of\nthis exam.\n\nADRENALS: Bilateral adrenal glands are unchanged compared to prior.\n\nURINARY: The kidneys are of symmetric size.  There is no evidence of solid\nrenal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Diffuse mesenteric edema.  Debris-filled, moderately\ndistended stomach, with Dobbhoff catheter tip projecting along the antrum.  No\nabnormally dilated loops of bowel.  New metallic object projecting over the\nfirst part of the duodenum, along the hepatic hilum, new compared to prior,\nmay reflect a postsurgical clip, correlation with recent procedures.  Moderate\nstool burden throughout the colon.  Suboptimal opacification of the abdomen\nand pelvis with contrast, limiting evaluation for active extravasation.  No\nascites or drainable fluid collections.\n\nPELVIS: Partially distended urinary bladder, limiting evaluation.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Redemonstrated scattered mildly prominent retroperitoneal lymph\nlymph nodes, similar to prior compared to CT from ___. scattered\nmildly prominent bilateral inguinal lymph nodes, likely reactive.  No pelvic\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: No destructive osseous lesions.\n\nSOFT TISSUES: Diffuse anasarca.",
            "output": "1. Suboptimal contrast opacification of the abdomen and pelvis, limiting\nevaluation for active extravasation.  There is no ascites or drainable fluid\ncollections.  No evident hematoma.\n2. Diffuse anasarca.  Nonspecific mesenteric edema.\n3. Moderate stool burden.\n4. Please refer to separate report for 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 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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are retroperitoneal lymph nodes enlarged when compared with\nprevious, in the aortocaval region, adenopathy measuring up to 16 mm, in the\nleft para-aortic region, adenopathy measuring up to 13 mm.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 is diffuse fat stranding of subcutaneous fat as well\nas diffuse fat stranding of the mesenteric fat, which could be relationship\nwith third spacing.",
            "output": "No definite evidence of focal infection source within the abdomen or pelvis. \nThere are reactive adenopathies and diffuse abdominopelvic fat stranding most\nlikely due to third spacing."
        },
        {
            "input": "LOWER CHEST: Partially visualized lung bases are notable for diffuse\nparenchymal opacities, findings concerning for multifocal infection or sequela\nof aspiration.  There is no evidence of pleural effusion.  Trace pericardial\neffusion 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 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, however no secondary signs of\ninflammation 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: Few mildly prominent retroperitoneal lymph nodes are again noted,\nwith the largest measuring up to 1.4 cm in the aortocaval region (02:35), and\nup to 1.0 cm in the left periaortic region.  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.  A right lower extremity 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.  Diffuse\nstranding is again seen within the subcutaneous soft tissues as well as within\nthe mesenteric soft tissues, likely related to fluid overload.",
            "output": "1. Diffuse parenchymal opacities partially visualized at the bilateral lung\nbases, findings concerning for multifocal infection or sequela of aspiration.\n2. No evidence of acute process within the abdomen or pelvis, within the\nlimitations of an unenhanced study.\n3. Diffuse anasarca and mesenteric fluid and fat stranding, similar in\nappearance to prior CT abdomen/pelvis from ___ and likely related\nto third spacing of fluids.\n4. Stable appearance of few mildly prominent retroperitoneal 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\n LIVER TRANSPLANT - PREOPERATIVE EVALUATION\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken and nodular, consistent with cirrhotic\nmorphology.  Enhancement is heterogeneous, but no focal, arterially enhancing\nlesions are identified.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.  There is large\nvolume, nonhemorrhagic ascites.  Large, recanalized paraumbilical vein is\nnoted.\n\nARTERIAL VASCULATURE:\nCeliac trunk normal\nCommon hepatic artery normal, accessory left hepatic artery off the left\ngastric to the lateral segment of the left lobe.\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): No\n\nLiver masses concerning for ___: No\n\nLiver volume: 1808.7 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: There is massive splenomegaly, measuring up to 19.2 cm in the axial\nplane.  Along the inferior margin of the spleen, there is wedge-shaped\nhypodensity, consistent with splenic infarct.\n\nIn the region of the splenic hilum, there are multiple small locules of gas,\nwhich are consistent with sinus tract, likely due to prior diverticulitis.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is loss of normal corticomedullary differentiation within both\nkidneys, likely due to hepato renal syndrome.  Of note, there is an accessory\nright renal artery of the inferior pole.  There is a single left renal artery\nas well as single bilateral renal veins.  There is no evidence of focal renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are multiple periesophageal varices, consistent with\nportal hypertension.  The stomach is unremarkable.  Multiple pancolonic\ndiverticula are noted.  In the proximal sigmoid colon, there is a gas and\nfluid-filled collection, which measures 1.0 x 1.3 x 2.5 cm (series 303; image\n210, series 604; image 78), which sits atop the dome of the bladder.  This\ncollection is concerning for a possible colovesicular fistula from prior\nepisode of diverticulitis.  Minimal acute inflammation is identified in this\narea.  Additionally, there is a small area of tethered small bowel to this\ncollection (series 604; image 75).  While ___ fistula is not\nvisualize, it certainly cannot be excluded on this exam.  There is no small\nbowel obstruction.\n\nPELVIS: See above description for description of possible colovesicular\nfistula.  Overall, no bladder masses are identified.\n\nREPRODUCTIVE ORGANS: Prostate is normal in size.  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": "1. Cirrhotic liver morphology with sequela of portal hypertension, including\nrecanalized paraumbilical vein, multiple esophageal varices, massive\nsplenomegaly, and large volume, nonhemorrhagic ascites.  Portal venous system\nis patent.  No concerning hepatic lesions.\n2. Accessory left hepatic artery is noted off the left gastric to the lateral\nsegment of the left lobe.  No accessory hepatic veins are noted.  Liver volume\nis 1808.7 cc.\n3. Loss of corticomedullary differentiation in both kidneys, likely due to\nhepatorenal syndrome. Note is made of an accessory right renal artery of the\ninferior pole.\n4. Multiple small locules of gas in the splenic hilum, consistent with sinus\ntract, likely due to prior diverticulitis.\n5. Pancolonic diverticula are noted.  In the proximal sigmoid colon, gas and\nfluid-filled collection measures 1.0 x 1.3 x 2.5 cm, which sits atop the\nbladder dome and appears to invade the level of the mucosa without definite\ncolovesicular fistula.  Additionally, there is a loop of small bowel, which\nappears tethered to this region of presumed prior diverticular inflammation,\nalthough no definite ___ fistula is visualized."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nborder is irregular, consistent with cirrhosis.  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 extensive\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: Splenomegaly, without evidence of focal lesions.  Redemonstration of\nsplenic infarct, involving the lower pole.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 or fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nair in the bladder.  There is no rectal contrast visible in the bladder. \nThere is a loop of small bowel lying on top of the bladder, as noted on scan\nfrom ___.  There is ascitic fluid 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.  Recanalization of 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. No air in the bladder or rectal contrast in the bladder to suggest\ncolovesicular fistula.  Redemonstration of loop of small bowel lying on top of\nthe bladder.\n2. Cirrhotic liver morphology with sequela of portal hypertension, including\nrecanalized paraumbilical vein, splenomegaly, and large volume nonhemorrhagic\nascites.\n3. And colonic diverticula."
        },
        {
            "input": "PELVIS:  The bladder has an indwelling Foley catheter with small luminal gas\nfoci related to this instrumentation.  After contrast injection, there is no\nextravasation seen into the mesentery, retroperitoneum or any adjacent bowel\nloops.  The bladder appears overall unremarkable.  Large amount of ascites\npersists.  The visualized segments of small bowel are unremarkable in the\ndistended.  Numerous colonic diverticula are again noted with no associated\ninflammatory/infectious signs.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small umbilical hernia through a 1.0 cm gap with insinuation of\nascitic fluid.",
            "output": "1. No evidence of contrast extravasation from the bladder into the ascitic\nfluid or any bowel loop.\n2. Redemonstration of colonic diverticulosis without evidence of\ndiverticulitis."
        },
        {
            "input": "Lungs: Right pleural effusion is decreased in the interval.  The left pleural\neffusion is now substantially larger with associated relaxation atelectasis..\n\nLiver: The liver borders are irregular consistent with cirrhotic morphology.  \nNo suspicious liver lesion. Small amount of perihepatic fluid is seen.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder is unremarkable.\n\nSpleen: Splenomegaly is noted again, with multiple areas of scarring.\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. The prostate is unremarkable.\n\nGastrointestinal: Large 18.5 x 22.4 x 7.6 cm irregular fluid collection with\ninternal gas bubbles centered at the lower abdomen and extending inferiorly to\nthe pelvis, superiorly up to the lower pole of the spleen, and anteriorly\ndraining to the ostomy (5:120).  There is increased density in the fluid\nconsistent with hemorrhage with particularly high density in the pelvis,\nindicating clotted blood.  The way the gas is scattered in the collection\nindicates that it is extensively compartmentalized within the larger\ncollection.  Excluding the proximal colon which contains radiopaque contrast\nfrom prior fluoroscopic examination and cannot be assessed, there is no\nevidence of active contrast extravasation in the remaining GI tract.  Diffuse\nmesenteric edema is noted among the bowel loops and is most likely secondary\nto the known hepatic dysfunction. Left anterior abdominal wall ostomy is as\nexpected with no evidence of adjacent parastomal varices.\n\nOmentum: Increased density in the omentum is probably reflecting edema.\n\nVascular: No atherosclerotic calcifications of the abdominal aorta.  The\nportal vein and hepatic veins are patent.  There are anterior abdominal wall\nvarices and collateral veins.\n\nLymph nodes: There are no size significant lymph nodes.\n\nBone and soft tissues: There is no suspicious bone lesion.",
            "output": "Large high density collection in the pelvis and lower abdomen with gas is\nlikely a complex hematoma, possibly with superinfection.  No extravasation or\ncause of bleeding. No evidence of parastomal varices.\n\nBilateral left greater than right pleural effusions.\n\nRedemonstrated hepatic cirrhosis and splenomegaly with abdominal wall varices\nand small amount of perihepatic ascites."
        },
        {
            "input": "LOWER CHEST: Moderate left and smaller right pleural effusions with subjacent\npassive atelectasis are similar.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a cirrhotic morphology.  There are no\nfocal hepatic lesions given limitations of an unenhanced scan.  There is a\nsmall amount of high-density material within the gallbladder lumen, which\ncould reflect vicarious excretion of contrast versus sludge.  No biliary\ndilation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 remains enlarged, measuring up to 18 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Residual intravenous contrast remains in the kidneys, compatible with\ndelayed renal clearance.  No hydronephrosis.\n\nGASTROINTESTINAL: Large fluid collection with layering hyperdense material and\nnumerous locules of gas centered in the mid abdomen and extending into the\npelvis now contains a pigtail catheter, which is coiled in the right inferior\nportion of the collection.  The collection now measures 23 x 10 x 7 cm,\npreviously 24 x 11 x 7 cm.  An enteric tube terminates at the duodenal jejunal\njunction.\n\nDiffuse thickening of the bowel is most consistent with portal\nenterocolopathy. A left lower quadrant colostomy is re-demonstrated.  Surgical\nsutures are seen in the pelvis there is small volume ascites.\n\nPELVIS: The urinary bladder is underdistended, and contains excreted\nintravenous contrast.  High-density material remains in the pelvis, as a part\nof the collection described above.\n\nREPRODUCTIVE ORGANS: The prostate gland 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.  Trace atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: As described above, there is a left lower quadrant colostomy. \nMild subcutaneous body wall edema is present.",
            "output": "1. Minimal decrease in the size of the large pelvic collection that now\ncontains a drainage catheter.\n2. Cirrhotic liver and splenomegaly.\n3. Unchanged moderate left and small right pleural effusions."
        },
        {
            "input": "LOWER CHEST: There are small pleural effusions bilaterally, left greater than\nright, decreased on the left and unchanged on the right compared to CT of the\nabdomen/pelvis from ___.  There is mild bandlike atelectasis in\nthe bilateral lower lobes.  Heart size is normal.  There are mild coronary\ncalcifications.  There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is mildly nodular in contour, in keeping with known\ncirrhosis.  There are no overt lesions within limitations of a noncontrast\nstudy.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is normal in bulk and homogeneous in attenuation. \nThere is no main ductal dilatation.\n\nSPLEEN: There is unchanged marked splenomegaly, measuring 18.4 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 no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There are a few punctate calcifications within right lower\npole calices (series 4, images ___.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber.  The patient is\nstatus post sigmoidectomy with a left lower quadrant end colostomy.  There is\npancolonic diverticulosis.\n\nPERITONEUM: There has been interval up-size of a left-sided percutaneous\ndrain, which is appropriately positioned within an irregular fluid collection\nin the lower abdomen and pelvis.  The collection has markedly decreased in\nsize, now measuring approximately 5.0 x 17.0 x 17.0 cm, decreased from 7.5 x\n22.8 x 17.2 cm. Again seen is hyperdensity of the fluid in the pelvis,\nconsistent with blood products.  There is diffuse mesenteric edema trace\nscattered intra-abdominal ascites.\n\nPELVIS: The urinary bladder is nondistended and displaced anteriorly by the\npelvic fluid collection.  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: The abdominal aorta is normal in caliber.  There are minimal\natherosclerotic calcifications of the right common iliac and bilateral common\nfemoral arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild edema about the umbilicus.",
            "output": "1. Interval up-size of a left-sided percutaneous drain which is appropriately\npositioned within an irregular fluid collection in the lower abdomen and\npelvis. The collection has markedly decreased in size, now measuring\napproximately 5.0 x 17.0 x 17.0 cm, previously 7.5 x 22.8 x 17.2 cm on CT of\nthe abdomen/pelvis from ___.  Redemonstration of hyperdensity of\nthe fluid in the pelvis, consistent with blood products.\n2. Small pleural effusions bilaterally, left greater than right, decreased on\nthe left and unchanged on the right."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions, similar to slightly\nincreased on the right and mildly decreased on the left.  There is associated\nmild compressive atelectasis.  A moderate pericardial effusion is present, new\nsince the previous examination, and demonstrating complex density.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver shows mild nodular contour is and prominent fissures.\nNo discrete lesion is identified within the limitations of a noncontrast\nexamination.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Within limitations of a noncontrast examination, no definite focal\nlesion or main pancreatic ductal dilatation is identified.\n\nSPLEEN: The spleen is enlarged, 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 without evidence of\nhydronephrosis.  Nonobstructing mm calculi are noted in right lower pole.  The\nurinary bladder is mildly distended and unremarkable.\n\nGASTROINTESTINAL: An enteric tube is present terminating at the junction of\nthe second and third portions of the duodenum.  No focally thickened or\ndistended loop of small bowel is identified.  The colon is largely\ndecompressed.  There is redemonstration of a left lower quadrant end\ncolostomy.  Contrast within the rectal vault likely to relate to a prior oral\ncontrast enhanced examination.  The appendix is not visualized.\n\nPERITONEUM AND PELVIS: There is redemonstration of an irregular fluid\ncollection within the rectovesical space extending superiorly and laterally\ninto the left paracolic gutter.  A left lateral wall large bore pigtail\ndrainage catheter is present within the fluid collection, in appropriate\nposition.  The fluid collection shows overall decreased in size, measuring up\nto 12.2 cm in maximum transverse dimension where it previously measured 13.5\ncm.  The larger pocket within the pelvic cavity that previously measured up to\n6.8 cm now measures up to 4.9 cm.  Mild hyperdensity of intraluminal products\nand locules of gas are again noted.\n\nThere is redemonstration of extensive mesenteric fat stranding and edema\nthroughout the abdomen and pelvis, predominantly concentrated in the region of\nthe known hematoma, and extension into the right paracolic gutter.  No\nadditional drainable fluid collection is identified at this time.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Innumerable pelvic, mesenteric and upper abdominal prominent\nlymph nodes are identified, most likely reactive.\n\nVASCULAR: Moderate atherosclerotic calcifications are noted in the proximal\nfemoral vessels.  There is no abdominal aortic aneurysm.  There is stable\nprominence of the splenic vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left abdominal wall and colostomy and left lateral wall drain,\nas described above.",
            "output": "1. Interval development of moderate pericardial effusion demonstrating non\nsimple density, suggestive of hemorrhagic contents.\n2. Overall decrease in size of irregular pelvic fluid collection in the\npelvis, with extension into the left paracolic region.  The left lateral wall\na drainage catheter remains in appropriate position.  Stable fat\nstranding/edema throughout the mesentery.\n3. Marked splenomegaly, likely sequela of portal hypertension.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:10 pm, 20 minutes after\ndiscovery of the findings."
        },
        {
            "input": "PELVIS: The pelvic component of the collection that was partially imaged on\nthe CT dated ___ is redemonstrated.  A pigtail catheter terminates\nwithin the collection which is predominantly sited in the rectovesical pouch. \nThe collection currently measures 6.5 x 2.7 x 7.1 cm (TV x AP x  SI) (\nmeasured on series 602 image 32 and series 2, image 18) compared with 6.1 x 4\nx  10.1 cm on the scan dated ___.\nLeft colostomy is noted.  The remainder of the partially visualized small and\nlarge bowel are unremarkable. The urinary bladder and distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.  A 9 mm left\nexternal iliac node is unchanged from previous and is likely to be reactive.\n\nVASCULAR: 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.  Left\ncolostomy noted.",
            "output": "A pelvic drain terminates in a fluid collection in the rectovesical pouch\nwhich is contiguous with a partially imaged left paracolic gutter collection\ndemonstrated on the study dated ___.\nThis pelvic component of the known collection is slightly smaller in size when\ncompared with the study dated ___ now measuring 6.5 x 2 x 7.1 cm\ncompared with 12.2 x 4 x 10.1 cm on the prior study."
        },
        {
            "input": "LOWER CHEST: Interval improvement from moderate-sized pericardial effusion and\nof small bilateral pleural effusions.  There is persistent dependent\natelectasis at the right lung base.  Hemodialysis catheter is seen projecting\ninto 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 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: 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There are\nmultiple bilateral small hypodense lesions, too small to further characterize,\nbut likely simple cortical cysts.  There is redemonstration of multiple\nnonobstructive 1-2 mm stones in the lower pole of the right kidney.  There is\nno hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is interval removal of\nenteric tube.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. Status post sigmoid colectomy and end colostomy in the left lower\nquadrant, with a draining tube seen terminating in the area of prior\ncolovesicular fistula.  The fluid collection previously seen in the left\nparacolic gutter that goes along the pigtail catheter up to the midline\npelvis, has decreased in size compared to most recent CT, without air\nevidenced.  There is persistent small amount of ascites and mesenteric edema\nwith fat stranding.  The appendix is normal (3:56).\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 fluid collection in the left lower quadrant\nwith pigtail catheter in place.  No evidence of other fluid collections.\n2. Persistent mesenteric edema with ascites and fat stranding.\n3. Interval resolution of pericardial effusion.\n4. Interval decrease in bilateral pleural effusion now with minimal fluid and\npersistent right lung base atelectasis.\n5. Nonobstructive right renal nephrolithiasis.\n6. Stable splenomegaly."
        },
        {
            "input": "LOWER CHEST: Partial visualization of a central venous catheter.  Small right\npleural effusion with adjacent atelectasis.  Scarring is visualized in the\nright lung base.  Trace left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic liver morphology.  No focal lesions.  The portal\nveins are diminutive in appearance.  There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is a mild amount of abdominopelvic ascites.  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: Splenomegaly measuring up to 19.5 cm, 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post sigmoid\ncolectomy and colostomy in the left lower quadrant.  Parastomal varices are\nnoted without evidence of active bleed.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\ndescending colon without evidence of diverticulitis.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Mild ascites\nin the pelvis.  No abscess formation.\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.  Esophageal varices are noted.  A prominent recanalized umbilical\nvein drains into the right liac vein.  Anterior abdominal wall varices and\ncollateral veins are again 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": "1. Cirrhotic liver morphology with sequela of portal hypertension including\nsplenomegaly, abdominopelvic ascites, varices and a prominent recanalized\numbilical vein.  Peristomal varices are noted without evidence of active\nbleed.  ___ consultation can be considered for variceal embolization.\n2. No focal liver lesions identified."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day\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,.  There is a cystic\nlesion in the uncinate process measuring 1.7 x 1.1 cm, previously 1.0 x 0.5\ncm.  Best seen on series 2, ___ 68. there is no peripancreatic stranding.\n\nSPLEEN: The spleen measures 18.6 cm in craniocaudal dimension, previously 13.2\ncm.\n\nADRENALS: The right 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 cysts in both kidneys.  The largest cyst on the left\nmeasures 5.4 x 5.0 cm increased in size, previously 3.4 x 2.9 cm.  There are 2\ncysts in the right kidney including subcentimeter hypodense lesions\nbilaterally that are too small to characterize but also likely represent\ncysts.  These are increased in number compared to prior study..  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. New splenomegaly of 18.6 cm\n2. No evidence for lymphadenopathy\n3. Bilateral renal cysts"
        },
        {
            "input": "LOWER CHEST: There is left basilar atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities in the liver measuring up to 2.4 cm in segment 6\n(02:31) are unchanged in size compared to the prior study, likely cyst/biliary\nhamartoma.  There is mild intrahepatic biliary dilatation.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas is diffusely atrophic.  A cystic lesion at the uncinate\nprocess again is again noted measuring approximately 2.4 x 1.1 cm (02:34),\npreviously 1.7 x 1.1 cm.  The pancreatic duct is mildly dilated measuring 6\nmm, previously 4 mm.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 20.9 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 with normal nephrogram. \nMultiple bilateral cysts are seen measuring up to 6.0 cm in the left kidney. \nSubcentimeter hypodensities in bilateral kidneys are too small to\ncharacterize.  There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is diffusely distended with enteric contrast. \nThe mid to distal loops of small bowel are diffusely dilated and fluid-filled\nmeasuring up to 4.0 cm.  There appears to be a transition point in the right\nlower abdomen (02:53) adjacent to a fecalized loop of bowel.  There is trace\nfree fluid in this region as well (601:28).  The colon and rectum are within\nnormal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is distended.  There is mild free fluid in the\npelvis.  The prostate is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The left common iliac artery is aneurysmally dilated measuring 1.8\ncm.  There is no abdominal aortic aneurysm.  Mild atherosclerotic disease is\nnoted.\n\nBONES: Right total hip arthroplasty noted.  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. Small-bowel obstruction with a fecalized loop of bowel and trace fluid in\nthe right lower abdomen.\n2. Splenomegaly.\n3. Aneurysmal dilation of the left common iliac artery measuring 1.8 cm.\n4. 2.4 cm pancreatic cystic lesion in the uncinate process.\n For pancreatic cysts measuring more than 1.5cm, patients should be referred\nto the pancreas cyst clinic for consultation. These referrals can be made by\nemailing ___ or by calling\n___."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  Interval resolution of pleural\neffusion.  Mild cardiomegaly with multivessel coronary artery calcification. \nNo pericardial effusion.  Distal tip of the PICC line terminates in the right\natrium..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is small with a slightly nodular surface suggesting\ncirrhosis.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  There is a large volume of nonhemorrhagic ascites with more in\nthe right abdomen than left.  No pneumoperitoneum.\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: There is a stable hyperdense lesion in the lower pole of the left\nkidney measuring approximately 1 cm with a second subcentimeter high-density\nlesion adjacent to the.  These most likely represent hemorrhagic cysts.  No\nhydronephrosis.  Stable nonobstructing 2 mm renal calculus in the lower pole\nof the right kidney.    There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Since the prior\nstudy there has been increased dilatation of the large bowel.  Colonic\ndiverticulosis is present without evidence of diverticulitis.  The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder contains a balloon catheter.  Free fluid tracks\ndown the pericolic gutters into 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 findings identified within the abdomen or pelvis.\n2. Hepatic apparent consistent with cirrhosis.\n3. Large volume of nonhemorrhagic ascites without evidence of\npneumoperitoneum."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 4.6 x 4.3 cm\nLocation (head right of SMV, body left of SMV): 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\nVariant anatomy: none\n\nVenous evaluation:\nMPV involvement: absent\nSMV involvement: absent\nSplenic vein involvement: Occlusion of splenic vein.\n\n\nExtrapancreatic evaluation\nLiver lesions: Present as described above.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: paraaortic\nOther extrapancreatic disease (invasion of adjacent structures): Osseous\nmetastases as described below.\n\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: Again demonstrated are innumerable hypoattenuating lesions\nthroughout the liver consistent with known metastasis.  Some of these lesions\nappear smaller.  For example the dominant lesion in the hepatic dome (Series\n4, image 55) measures 4.5 x 5.7 cm, previously 5.2 x 6.5 cm.  Right\nsubcapsular lesion (series 4, image 77) measures 1.6 x 4.4 cm, previously 2.1\nx 5.1 cm.  The gallbladder is contracted.\n\nPANCREAS: Again seen is a 4.6 x 4.3 cm heterogeneously enhancing lesion\n(series 4, image 23) in the pancreatic tail, previously 5.5 x 3.3 cm.  The\nmass is inseparable from the in as on prior.  Obliteration of the splenic vein\nis also unchanged. The remaining pancreas demonstrates normal enhancement\nwithout focal lesions.  The celiac trunk and its branches are patent.  The SMA\nis patent.  The SMV  and main portal vein are patent.\n\nSPLEEN: Spleen shows normal size with heterogeneous enhancement unchanged\ncompared 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 stones or hydronephrosis.  Multiple hypoattenuating\nlesions in the bilateral kidneys consistent with cysts, largest measuring 4.9\nx 4.4 cm are unchanged.  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.\n\nRETROPERITONEUM: The necrotic lymph node conglomerate measuring 2.5 x 1.9 cm\n(series 4, image 105) at the level of left kidney partially encasing the left\nrenal vein, is stable, previously 2.4 x 1.7 cm.  No new retroperitoneal\nlymphadenopathy.  There is no mesenteric lymphadenopathy.  No pelvic or\ninguinal 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: A retroverted uterus is noted.\n\nBONES: Again seen are multiple sclerotic lesions in the bilateral iliac bones,\nsacrum, and L2 vertebral body without significant interval changes.  A new 1\ncm sclerotic lesion in the left date of L2 vertebral body is noted.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.",
            "output": "1. Overall stable metastatic pancreatic cancer.  Stable to slightly decrease\nin size of the pancreatic tail mass with occlusion of the splenic vein and\nretroperitoneal adenopathy.  Innumerable hepatic metastases, some of which are\nslightly smaller.  Multiple osseous metastases in the bilateral iliac bones,\nsacrum, and L2 vertebral body.  A new focus of sclerotic lesion in the left\nsuperior endplate of L2 vertebral body.  Please see above for detailed\ndescription.\n2. Please see separate report performed on the same day for detailed\nevaluation of the chest."
        },
        {
            "input": "PELVIS: The right hepatic lobe and the right kidney are partially imaged,\nunremarkable.  The partially visualized small and large bowel are\nunremarkable. The urinary bladder and distal ureters are unremarkable. A small\namount of free fluid in the pelvis is more than expected for this age group,\nhowever is unchanged from prior, possibly secondary to third spacing.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There are degenerative changes in the bilateral hips with subchondral\ncysts and sclerosis, and spurring.  There are degenerative changes of the\npubic symphysis, as well as in the visualized lumbar spine.  There is no acute\nfracture.\n\nSOFT TISSUES: There is bilateral subcutaneous edema, unchanged.  No soft\ntissue hematoma visualized.",
            "output": "No acute fracture or dislocation."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar atelectasis, the lung bases are\nclear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhemangioma in segment 2 is unchanged.  There is no evidence of focal lesions.\nThe common bile duct measures up to 14 mm, and there is mild diffuse\nintrahepatic biliary dilation.  There is no clear obstructing point seen in\nthe common bile duct.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is a punctate\ncalcification in the head of the pancreas, which is nonspecific, but could\nreflect parenchymal calcification, or a tiny duct stone, unchanged from prior\n(2:28, 601:23).  There is mild peripancreatic haziness, but no adjacent fluid\nor fluid 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. \nSubcentimeter cortical hypodensities are too small to characterize, but most\nlikely reflect simple cysts.  There is no evidence of suspicious renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass surgery with\nthe expected postsurgical configuration.  Enteric contrast seen in the\nexcluded portion of the stomach may reflect a gastrogastric fistula.  No\nevidence of bowel obstruction.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. 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 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.  No 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.",
            "output": "1. Mild peripancreatic haziness may be related to early acute interstitial\npancreatitis, given known elevated lipase.  No fluid collectio.  No evidence\nof necrosis.  Please note that imaging findings can lag behind laboratory and\nclinical findings of early acute pancreatitis.\n2. Common bile duct measuring up to 14 mm with intrahepatic biliary dilation\nis commonly seen post cholecystectomy.  However, if there is concern for\nbiliary obstruction, correlate with laboratories and if appropriate an MRCP\ncould be considered.\n3. Post Roux-en-Y gastric bypass.  A small amount of contrast witin excluded\nstomach is compatible is indicative of a gastrogastric fistula.\n4. No 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. \nAgain seen are few subcentimeter hypodensities scattered throughout the liver\nwhich are too small to characterize but unchanged, likely cysts or biliary\nhamartomas.  No new 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 heterogeneous enhancing mass arising from the interpolar region of the left\nkidney measures 2.7 x 2.6 x 2.7 cm (4:70, 09:28), previously 3.3 x 3.0 x 3.1\ncm.  No new renal lesions.  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 or fat\nstranding. The appendix is not visualized, although 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: 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.\n\nSOFT TISSUES: The large heterogeneous anterior compartment right thigh mass,\nbiopsy proven liposarcoma, is partially visualized in the axial dimension. \nAllowing for this, this mass appears similar the slightly increased in size\nmeasuring 29.4 x 15.8 x 16.0 cm, previously 29.4 x 15.1 x 16.0 cm.  No osseous\nerosion of the adjacent femur.  Discontinuity of the overlying skin anteriorly\nwith exophytic protruding component is also partially again seen (4:166).  A\nsmall right knee effusion is again seen.",
            "output": "1. Slight interval decrease in size of biopsy-proven left renal cell carcinoma\nmeasuring up to 2.7 cm, previously up to 3.3 cm.\n2. No substantial change in size of biopsy-proven liposarcoma involving the\nanterior compartment of the right thigh measuring 29.4 x 15.8 x 16.0 cm. \nDiscontinuity of the overlying skin and exophytic protrusion of an exophytic\ncomponent of the mass consistent with wound dehiscence from open biopsy is\nagain seen but partially visualized."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 hypodense cystic structures scattered throughout the\nliver, unchanged, too small to characterize however likely cysts/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 adrenal gland is normal in size and shape.  Stable\nappearance of a 1.0 cm nodule in the left adrenal gland (7:37), indeterminate.\n\nURINARY: Redemonstration of mild arterially enhancing nodule in the interpolar\nregion of the left kidney (7:60), now measuring 3.0 x 2.8 cm, previously 2.7 x\n2.6 cm.  No new solid lesions are identified.  The kidneys are of normal and\nsymmetric size with normal nephrogram.  There is no nephrolithiasis or\nureterolithiasis.  There is no hydronephrosis.  There is no perinephric\nabnormality.  There is no evidence of urothelial lesions.  The distal ureters\nand 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 prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nDemonstration of small arterially enhancing lymph nodes in the right inguinal\nstation (7:152, 149).\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.\nStable mild sclerosis in the left iliac bone (7:103).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild interval increase in size of a hyperenhancing left renal nodule now\nmeasuring 3.0 cm, suggestive of a slowly growing renal cell carcinoma.  No new\nsolid lesions.  No evidence of abdominopelvic metastatic disease.\n2. Stable indeterminate left adrenal nodule."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  However, there are multiple scattered\nsubcentimeter hypodense lesions, which are too small to further characterize\nbut likely represent cysts or biliary hamartomas.  These are unchanged\ncompared to the prior study.  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 is normal in size and shape.  There is\nredemonstration of an 8 mm x 8 mm left adrenal gland nodule (series 4, image\n119).\n\nURINARY: Patient is status post partial left nephrectomy.  In the site of the\nnephrectomy bed, the parenchyma is hypoattenuating.  No enhancing masses\nidentified.  The right kidney is of normal size with normal nephrogram.  There\nis no evidence of solid renal lesions.   There is no perinephric abnormality. \nThere is no hydronephrosis or hydroureter.  The bladder wall is thickened,\npossibly due to incomplete distension.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin 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: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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.  There is\npartial visualization of postoperative changes in the right anterior thigh,\nbetter visualized on same-day CT lower extremity.",
            "output": "1. Interval partial left nephrectomy.  No abnormal enhancement or mass is seen\nin the nephrectomy bed to suggest residual or recurrent disease.\n2. No suspicious masses or lesions in the abdomen or pelvis seen to suggest\ndistant metastases.\n3. Please see separate same day CT chest report for description 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.  Few\nsubcentimeter nonenhancing hypodensities scattered throughout the liver are\ntoo small to characterize but statistically likely represent 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. \nArising from the anterior interpolar region of the left kidney, there is a\nheterogeneously relatively hypoenhancing exophytic mass measuring 3.3 x 3.0 x\n3.1 cm (6:70, 9:32).  No perinephric or adrenal invasion, or renal vein or\nvena caval thrombosis.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Multiple areas of\napparent short-segment narrowing of the sigmoid and rectum is most likely\nperistaltic in nature.  The appendix 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 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: 24.6 x 13.3 x 14.7 cm ovoid, heterogeneous, centrally necrotic\nright thigh mass (09:23, 10:17) better characterized on the reference MR of ___.  This mass appears to abut the femur but no cortical erosion is\nseen.  Notably, the morphology of this mass is different than that of the\nrenal mass.",
            "output": "1. 3.3 cm left renal mass concerning for a primary renal cell carcinoma. \nFurther workup with contrast enhanced renal MRI should also be considered.\n2. Large heterogeneous right thigh mass, the latter better characterized on\nthe reference MR of ___, concerning for a soft tissue sarcoma.\n3. The differing morphologies of the 2 lesions are suggestive of two separate\nprimary malignancies, with metastatic disease considered less likely. \nFurthermore, given the relatively small size of the left renal mass along with\nlack of lymphadenopathy, venous or perinephric involvement, the right thigh\nmass is unlikely to represent metastatic disease from the kidney mass.\n4. Please refer to separate report of CT chest and thigh performed on the same\nday for description of the thoracic and lower limb findings.\n\nRECOMMENDATION(S):  Urology consult advised.  Further workup with contrast\nenhanced renal MRI should also be considered."
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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  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: Patient is status post right total nephrectomy. There is a 3.5 x 3.0\ncm parapelvic cyst in the left kidney, appearing larger than when it was 3.5 x\n2.5 cm on ___. The two calyceal stones measure 9mm and 5mm and are larger\ncompared to ___, when they measured 8 mm and 3 mm, respectively.  There is\nno evidence of hydronephrosis. There there is no perinephric abnormality.\nGASTROINTESTINAL:  Colon and small bowel loops demonstrate normal caliber and\nwall thickness. .\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is no calcium burden in the abdominal aorta .\n\nPELVIS:\n\nThere are 3 known bladder stones measuring 2.5 x 1.7 cm, 1.7 x 1.3 cm, and 1.1\nx 0.8 cm. There is a new fourth bladder stone which is faintly calcified and\nmeasures 2.3 x 1.6 cm.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of lesions suspicious of malignancy.",
            "output": "1.  Patient is status post right total nephrectomy.  There is no evidence of\nlocal recurrence or metastasis in the abdomen or pelvis.\n\n2.  The parapelvic cyst in the left kidney and the 2 calyceal stones are\nslightly larger compared to ___. No evidence of hydronephrosis.\n\n3.  There are 4 bladder stones in the bladder including 1 new stone 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. 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\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: Patient status post right nephrectomy with re- demonstrated\npostsurgical changes and hardware. In comparison to the previous examination,\nthere is a re- demonstrated JJ drain in unchanged position. In the inferior\npole of the left kidney there is a 10 mm nonobstructing, linear stone (series\n3, image 41). 3 large bladder stones are re- demonstrated, the largest\nmeasuring 3 cm (series 5, image 15.)\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix has\nnormal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries. There is no evidence of clot\nwithin the main portal vein, splenic vein and SMV.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy. Reproductive organs are within\nnormal limits\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Multiple, benign appearing lytic lesions are noted in the posterior\naspects of the ilium, bilaterally.  These appear unchanged since ___. Abdominal and pelvic wall is within normal limits.",
            "output": "1.  The JJ drain appears unchanged and appropriately positioned. There is a 10\nmm nonobstructing stone in the inferior pole of the left kidney. Three large\nbladder stones are re- demonstrated, the largest measuring 3.0 cm in diameter.\n\n2. Patient is status post right nephrectomy."
        },
        {
            "input": "LOWER CHEST: Airspace consolidation in the right middle lobe and left lower\nlobe is concerning for pneumonia.  Please note, multifocal pneumonia was also\nseen on a prior CT from ___ though with clearance of previously\nseen opacities from the lingula and imaged right lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 1.8 cm hypodensity in segment VI (2; 44) correlating with\npreviously known previously characterized hemangioma on prior MR. ___ is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains sludge without gallbladder wall thickening or pericholecystic fluid\nor 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is a nonobstructing 4 mm stone in the left lower pole. \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 prominent in caliber measuring 8 mm, similar to\nprior (2; 21), without adjacent fatty stranding.\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: Patient is status post right external iliac and common femoral\nstenting.  There is no abdominal aortic aneurysm.  Mild atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post posterior fusion of the L4 and L5 vertebral body with\nstable grade 1 anterolisthesis of L4 on L5.  Patient is status post anterior\nfusion of L5-S1.  There is no evidence of perihardware complication.\n\nSOFT TISSUES: There is subcutaneous stranding in the lumbar paraspinal soft\ntissues, which may be posttraumatic.",
            "output": "1. No evidence of retroperitoneal hematoma or acute fracture.  No acute\nintra-abdominal traumatic abnormality.\n2. Nonobstructing 4 mm left renal stone.\n3. Right middle lobe and left lower lobe airspace consolidations concerning\nfor pneumonia.\n\nNOTIFICATION:   The findings were discussed with ___, medical\nStudent by ___, M.D. on the telephone on ___ at 9:47 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "Study is severely limited by motion.\n\nLOWER CHEST: Bilateral pleural effusions are small.  Dense airspace opacities\nare identified in posterior bilateral 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. \nSmall ascites.\n\nPANCREAS: Evaluation of pancreas is due to presence of ascites and motion\nartifact, however the fluid surrounding the pancreas probably reflects\npancreatitis.  There is no evidence of 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 focal renal lesions or hydronephrosis.  There is no\nperinephric 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. Appendix is not visualized.\n\nPELVIS: Foley catheter is in the bladder.\n\nREPRODUCTIVE ORGANS: 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.  A femoral arterial line is in place.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: No suspicious soft tissue lesion is identified.",
            "output": "1. Study is limited by motion.  Evaluation of pancreas is due to presence of\nascites and motion artifact, however the fluid surrounding the pancreas may\nreflect pancreatitis.  There is no evidence of necrosis.\n2. Bilateral lung base opacities are consistent with history of ARDS. \nBilateral pleural effusions are small."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis, otherwise the 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 or\nextrahepatic biliary dilatation.  The gallbladder demonstrates punctate two\nhyperdense lesions within the lumen, one of which is anti dependent\npotentially an adherent gallstone or polyp.  No 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 shows normal size and 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 hydroureteronephrosis\nsecondary to a 3 mm obstructing stone at the right ureteral vesicular junction\n(series 2, image 80).  There is a delayed nephrogram.  Perinephric stranding\nand fluid could be secondary to forniceal rupture.  At least three additional\npunctate nonobstructing right renal calculi are also noted.  The left kidney\nis normal in size without evidence of hydronephrosis.\n\n\nGASTROINTESTINAL: The stomach is 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 grossly within\nnormal limits.  Dilated left gonadal vein 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 atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Obstructing 3 mm stone at the right ureterovesicular junction with moderate\nupstream hydroureteronephrosis.  Perinephric stranding and fluid could\nrepresent forniceal rupture.\n2. Hyperdense structures in the gallbladder, one of which is anti dependent\nand could represent either an adherent stone or polyp.\n3. Dilated left gonadal vein which can be seen the setting of pelvic\ncongestion syndrome, to be correlated clinically."
        },
        {
            "input": "The visualized lung bases are clear.  Coronary artery calcifications are\nnoted. There is no pericardial or pleural effusion.\n\nABDOMEN: The examination is limited secondary to the lack of intravenous\ncontrast. Within this limitation, the non-contrast enhanced appearance of the\nliver, gallbladder, pancreas, and adrenal glands are normal. Punctate\ncalcifications within the spleen likely represent granulomas.  The left kidney\nis atrophic.  The noncontrast appearance of these right kidney is\nunremarkable.\n\nThe stomach is decompressed. The small bowel is normal in caliber without\nfocal wall thickening. The appendix is not visualized but there are no\nsecondary signs of appendicitis in the right lower quadrant.\n\nThere is extensive diverticulosis of the sigmoid colon with multiple tics\nnoted in the remainder of the colon. In the distal sigmoid colon, there is\nminimal fat stranding in the region of multiple diverticula (2:71). The\nremainder of the large bowel is normal in caliber and without wall thickening.\n\nThe patient is status post aorto bi-iliac stent graft of an infrarenal\nabdominal aortic aneurysm. Overall, the appearance of the stent is unchanged\nfrom ___. The aneurysm sac measures approximately 6.9 x 6.2 x 7.1 cm, and has\nincreased in size from ___ when it measured 6.4 x 6.0 x 6.7 cm (02:50). There\nis subtle periaortic haziness surrounding the left aneurysm sac, increased\nfrom prior (02:49). Some calcifications are noted within the aneurysm sac.\nThere is no evidence of retroperitoneal hematoma.\n\nThere is no retroperitoneal or mesenteric lymphadenopathy. Extensive vascular\ncalcifications are noted.\n\nPELVIS: The bladder is well distended and normal in appearance. There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nthroughout the visualized thoracolumbar spine most pronounced at the L4-5\nlevel where there is disc space narrowing and endplate sclerosis. No focal\nlytic or sclerotic lesion concerning for malignancy.",
            "output": "1. Interval increase in size of abdominal aortic aneurysm which now measures\n6.9 x 6.2 x 7.1 cm, likely due to known endoleak. No retroperitoneal hematoma.\n2. Mild fat stranding adjacent to a distal sigmoid diverticulum, please\ncorrelate with symptoms of acute diverticulitis.\n\nNOTIFICATION:  Updated findings were discussed with Dr. ___ by Dr. ___\nthe telephone 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 hepatic metastases are improved.  For example, the masses\ndemonstrate decreased enhancement and size.  A 4 cm more necrotic left hepatic\nmetastasis was previously 5.6 cm; a 3.7 cm left hepatic metastasis is not\nsignificantly changed in size, however demonstrates decreased enhancement and\na 3.6 cm left hepatic metastasis demonstrates decreased size and enhancement,\npreviously 7.3 cm.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Post right adrenalectomy changes again seen.  The left adrenal gland\nis unremarkable.\n\nURINARY: Post radical right nephrectomy changes are redemonstrated.  There are\na few stable hypodense renal lesions too small to characterize corresponding\nto cysts on prior MRI.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.  A small\nbowel lipoma is again seen.  The 0.6 cm right omental implant was previously\n1.8 cm.\n\nPELVIS: There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no abdominal or pelvic adenopathy.  A hypodense fluid\ncollection continues to decrease along the right retroperitoneum measuring 0.6\ncm in thickness, previously 1.2 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The hepatic vasculature is\npatent.\n\nBONES: No worrisome osseous lesions are demonstrated..\n\nSOFT TISSUES: Postoperative changes are noted in the anterior abdominal wall.",
            "output": "1. Interval improvement of metastatic disease.\n2.   Please refer to separate CT chest for findings in the thorax."
        },
        {
            "input": "LOWER CHEST: Multiple heterogeneous intrathoracic masses are grossly similar\nto prior CT on ___ compatible with know renal cell carcinoma\nmetastasis. For example, the largest visualized masses are partially\nvisualized and paramediastinal measuring 5.2 x 4.2 cm right anteriorly and 4.1\nx 3.3 cm on the left (2:1, 2:2).  A 1.3 cm left lower lobe pulmonary\nmetastasis adjacent to the medial basilar segmental left pulmonary arteries is\nbetter seen to reside in the lung outside the pulmonary arteries on CT from\n___ this lesion should not be confused with a pulmonary embolus (2:2).\nStable small pericardial effusion. Slightly increased small bilateral pleural\neffusions with adjacent atelectasis. Bibasilar consolidations demonstrate\nhomogeneous enhancement with associated volume loss, increased since ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  In\nhepatic segment IV, heterogeneous necrotic metastasis measures in total 7.5 x\n3.4 cm, overall stable 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: Small volume perisplenic ascites has increased.  The spleen shows\nnormal size and attenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Post right nephrectomy. No soft tissue in the surgical bed. The left\nkidney appears unremarkable other than several tiny cysts.  No hydronephrosis\nor masses.\n\nGASTROINTESTINAL: Enteric tube terminates at pylorus.  The stomach contains an\nendovascular clip.  Overall similar small-bowel obstruction with dilated loops\nmeasuring up to 4.7 cm, transition point in the right lower quadrant (601:18,\n602:32, 2:63), and multiple enhancing small bowel masses compatible with\nserosal implant metastasis. For example measuring approximately 4.4 x 3.8 cm\nthe left upper abdomen (02:42), 3.5 x 2.2 cm in the right upper abdomen\n(02:48) and 3.5 x 2.6 cm with associated intussusception in the central lower\nabdomen (2:65). There is no pneumatosis or pneumoperitoneum.  Degree of\ndistention appears similar and there are no areas of abnormal small bowel wall\nenhancement to suggest ischemia.  The colon is predominantly decompressed\nalthough there is interval increased conspicuity of wall thickening with\nslight surrounding stranding involving the cecum and ascending colon (601:31\nthrough 42).  Apparent wall thickening at the splenic flexure likely reflects\ndecompression (601:25).  The appendix is normal.\n\nPELVIS: The bladder contains a Foley catheter and air compatible within recent\ninstrumentation.  Trace simple ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Visualized mesenteric vessels are patent.  Patent portal vein common\nIVC, hepatic veins, splenic vein, and left renal artery and vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild subcutaneous edema.  No drainable fluid collection.",
            "output": "1. Increased wall thickening of the cecum and ascending colon may reflect\nunderdistention but raises the possibility of infection especially in this\npatient on chemotherapy. Normal lactate makes ischemic colitis extremely\nunlikely.\n2. Overall stable malignant small-bowel obstruction with transition point in\nthe right lower quadrant.  No pneumatosis, pneumoperitoneum, or evidence of\nsmall bowel ischemia.\n3. Increased small volume perisplenic and pelvic ascites.  No abscess.\n4. Redemonstrated small bowel, hepatic, and pulmonary metastases. No evidence\nof adrenal metastasis.\n5. Slightly grown small bilateral pleural effusions with worsening bibasilar\natelectasis."
        },
        {
            "input": "LOWER CHEST: There is redemonstration of multiple heterogeneous intrathoracic\nmasses measuring up to 4.9 cm, unchanged from prior study and compatible with\nknown renal cell carcinoma metastases.  There is a stable small pericardial\neffusion.  There is mild interval increase in bilateral small pleural\neffusions with adjacent compressive atelectasis.  Bibasilar consolidations are\nunchanged from prior study.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a heterogeneous, necrotic metastatic lesion in hepatic segment IV a\nmeasuring 7.4 x 3.5 cm, unchanged from prior 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 left adrenal gland is normal in size and shape.\n\nURINARY: The patient is status post right nephrectomy.  There is no soft\ntissue density in the nephrectomy bed.  There are multiple hypodense lesions\nin left kidney, unchanged from prior study and compatible with simple cysts. \nThe left kidney is otherwise unremarkable.  There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The enteric tube terminates at the pylorus.  A vascular clip\nis again demonstrated the stomach.  There is interval worsening of the small\nbowel obstruction with dilated loops of bowel measuring up to 5.9 cm,\nincreased from 4.7 cm previously.  There is a transition point in the right\nlower quadrant.  There are multiple enhancing small bowel masses compatible\nwith metastases, unchanged from prior study (2:68 and 2:76).  There is\nredemonstration of intussusception in the central lower abdomen (2:76).  There\nis no pneumatosis or pneumoperitoneum.  There is no abnormal small bowel wall\nenhancement to suggest ischemia.  The colon is largely decompressed and\nunchanged.  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 contains 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.  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 worsening of malignant small-bowel obstruction with increased\nloops of small bowel.  No pneumatosis, pneumoperitoneum or evidence of bowel\nischemia.\n2. Interval increase in small bilateral pleural effusions.\n3. Redemonstration of small bowel, hepatic, and pulmonary metastatic lesions,\nunchanged from prior study.\n\nNOTIFICATION:  The findings were discussed with ___, R.___. by ___\n___, M.D. on the telephone on ___ at 5:38 pm, 5\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is redemonstration of multiple heterogeneous intrathoracic\nmasses measuring up to 5.5 cm, mildly increased from prior study and\ncompatible with known renal cell carcinoma metastases (5:1).  There is a\nstable small pericardial effusion, unchanged from prior study.  There is mild\ninterval increase in bilateral moderate sized pleural effusions with adjacent\ncompressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is redemonstration of the heterogeneous, necrotic metastatic lesion in\nhepatic segment ___ and ___ measuring 7.4 x 3.4 cm, unchanged from prior\nstudy.  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 nephrectomy.  There is no soft\ntissue density in the nephrectomy bed.  There are multiple hypodense lesions\nin the left kidney, too small to accurately characterize and unchanged from\nprior.  There is no evidence of hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is interval removal of the enteric tube.  Surgical\nclips are again demonstrated in the stomach.  The stomach is otherwise\nunremarkable.  There is redemonstration of small bowel obstruction with\ndilated loops of bowel measuring up to 4.9 cm, largely unchanged in appearance\nfrom prior study.  However, enteric contrast extends through the colon\nindicating partial obstruction.  There is no definite transition point with\nmultiple areas of luminal narrowing likely secondary to the multiple\nmetastatic enhancing intra-liminal small bowel masses.  There is no\npneumatosis or pneumoperitoneum.  There is no abnormal small bowel wall\nenhancement to suggest ischemia.  The colon is decompressed.  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: There is unchanged prostatomegaly containing\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.  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. Largely unchanged appearance of the malignant small-bowel obstruction. \nEnteric contrast is seen passing through to the rectum, not previously seen on\nprior study and compatible with a partial obstruction.  No pneumatosis,\npneumoperitoneum, or evidence of bowel ischemia.\n2. Minimal interval increase in bilateral pleural effusions.\n3. Redemonstration of pulmonary, hepatic, and small bowel metastatic lesions,\nunchanged from prior study."
        },
        {
            "input": "CHEST: The tip of the port catheter is seen in the mid right atrium. The lung\nbases demonstrate mild subpleural fibrosis which was noted on the prior CT.\nThere is no effusion or consolidation. Heart is top-normal in size with no\npericardial effusion.\n\nABDOMEN:\nThe patient is status post Whipple procedure with expected pneumobilia. The\nliver is low in attenuation compatible with steatosis, with no focal hepatic\nlesions. The gallbladder is surgically absent. The residual pancreas is\natrophic, with mild stranding near the porta hepatis, with fiducial seeds and\nsurgical drains noted. There is no focal fluid collection in the resection\nbed. The spleen is top-normal in size. The adrenal glands are normal\nbilaterally. The kidneys enhance and excrete contrast normally with no\nhydronephrosis. The stomach and small bowel are decompressed with no evidence\nof obstruction. The large bowel contains a significant amount of stool, with\nno evidence of colitis. There is haziness of the upper central mesentery, and\nprominent mesenteric and retroperitoneal lymph nodes, some of which were seen\non the prior CT from ___. These likely represent postoperative changes.\nThere is no free intraperitoneal fluid.\n\nPELVIS:  Urinary bladder, prostate, and seminal vesicles are normal. There is\nno pelvic free fluid or pelvic sidewall or inguinal lymphadenopathy. Fat\ncontaining inguinal hernias are noted bilaterally.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Status post Whipple procedure with intra-abdominal drains near the porta\nhepatis and in the mid upper abdomen.  Haziness of the upper central mesentery\nalong with scattered mesenteric lymph nodes likely represent inflammatory\nchanges related to recent surgery.  Findings expected after recent surgery.\n2.  No evidence of bowel obstruction, or perihepatic fluid collection.\n3.  Moderate colonic stool burden."
        },
        {
            "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 is diffusely hypo-attenuating relative to the\nspleen, compatible with hepatic steatosis.  There is a 1.3 x 1.2 cm simple\ncyst in hepatic segment IVB/VIII (6:42).  Additional note is made of a 3mm\narterially-enhancing vascular focus in segment VIII of the liver (5:29) that\nis unchanged from ___.  Remaining liver is otherwise homogeneous in\nattenuation throughout. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Gallbladder is surgically absent.\n\nPANCREAS:  Patient is status post Whipple procedure, with atrophic appearance\nof the residual pancreas.  No evidence of recurrence.  No pancreatic ductal\ndilatation.\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.  Left adrenal\ngland appears mildly thickened, but no discrete nodules are identified.\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.  Normal\nappendix.  No free fluid within the abdomen or pelvis.\n\nLYMPH NODES:\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 gland contains calcifications.  Seminal vesicles\nare unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild multilevel degenerative changes are noted throughout the thoracolumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post Whipple procedure, without evidence of local recurrence or\ndistant metastases within the abdomen or pelvis.\n2. A 3mm non-specific vascular entity in hepatic segment VIII is stable from\n___.\n3. Hepatic steatosis.\n4. CT chest dictated separately."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is diffusely hypodense consistent with steatosis.  A tiny\nhypo attenuating focus in hepatic segment 2 (07:22), is not confirmed on the\ncoronal reformation and may simply represent heterogeneous perfusion.  Simple\ncyst in hepatic segment 4B is slightly decreased in size measuring 1.1 cm. \nThe hyper enhancing focus seen previously in hepatic segment 8 is unchanged,\nmeasuring 4 mm (07:33).  No new discrete hepatic lesions are identified.  The\ngallbladder is is resected.\n\nPANCREAS: Patient has undergone Whipple.  The pancreatic remnant appears\nwithin normal limits.  There is no ductal dilation in the remnant pancreas. \nNo masses are identified at the anastomosis.  Narrowing of the superior\nmesenteric vein just proximal to the anastomosis (07:59), is unchanged.  The\ndegree of stranding about the operative bed is decreased.  Some stranding\nremains about the common hepatic artery (07:48), and a crescentic focus of\nhypodensity curving adjacent to the inferior vena cava (07:53), persists\nthough slightly less conspicuous.  Small lymph nodes at the root of the\nmesentery are unchanged in size.  A portacaval node (07:56), not enlarged, is\nalso 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.\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 appears normal.\n\nRETROPERITONEUM: Small aortocaval lymph nodes do not meet CT criteria for\npathologic enlargement.\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 and seminal vesicles appear unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nfocal hypodensity in the anterior aspect of the T12 vertebral body (607 be: \n74), is unchanged since the earliest available CT in likely reflects\ntrabecular rarefaction.\n\nSOFT TISSUES: Small fat containing left inguinal hernia.",
            "output": "1. Post Whipple.  No evidence of metastatic disease in the abdomen or pelvis.\n2. Hepatic steatosis.  Stable 3 mm hyper enhancing focus in hepatic segment 8,\nand slight decrease in size of a cyst in hepatic segment 4 B.  No definite new\nliver lesions identified.\n3. Mild stranding in the operative bed about the Whipple anastomosis persists,\nbut is slightly less conspicuous than on the prior study, as are small\nsurrounding lymph nodes."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. Proximal appendix is gas-filled and of normal\ncaliber.  The distal appendix, is of normal caliber, but is hyperenhancing\nwith mild surrounding fat stranding, raising concern for tip appendicitis.  No\nevidence of complication.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  Adnexa are normal 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.  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": "Hyperenhancement and mild surrounding fat stranding around the distal appendix\nraising concern for possible tip appendicitis.  Proximal appendix appears\nnormal.  No evidence of complication."
        },
        {
            "input": "LOWER CHEST: Mild increased density at both lung bases, left greater than\nright, likely represents resolving pneumonia from ___.  Additionally,\nthere is bibasilar atelectasis.  No pleural or pericardial effusion.  There\nare mild calcifications of the aortic annulus.\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.  Hypodensity\nat the superior aspect of the spleen is consistent with small cyst or\nhemangioma, unchanged compared to ___.\n\nADRENALS: There is an unchanged 3 cm adrenal adenoma in the left adrenal\ngland.  Right adrenal gland is within normal limits.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis.  Tiny, bilateral renal hypodensities are too small\nto characterize but likely represent cysts.  Tiny density in the mid right\nureter (series 2; image 61) may represent a possible, nonobstructing ureteral\nstone, although there are multiple vascular calcifications in this region.  No\nleft-sided nephrolithiasis.  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\ncolonic 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: 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 fat containing umbilical hernia. Multiple nodules\nthroughout the anterior abdominal wall likely represent injection granulomas.\nSoft tissues of the abdomen and pelvis are otherwise unremarkable without\nevidence of right-sided hematoma.",
            "output": "1. No etiology identified for left flank pain.  No left-sided nephrolithiasis.\nPossible, nonobstructing, right-sided, mid ureteral stone versus vascular\ncalcification.  No hydronephrosis in either kidney.  No right-sided flank\nhematoma.  No abdominal aortic aneurysm.\n2. Mildly increased density at both lung bases, left greater than right,\nlikely representing resolving pneumonia from ___.  Bibasilar\natelectasis.\n3. Hypodensity in the superior aspect of the spleen is unchanged since ___\nand likely consistent with small cyst or hemangioma.\n4. Unchanged 3 cm left adrenal adenoma."
        },
        {
            "input": "LOWER CHEST:\n\nThere is no pleural or pericardial effusion.  The bases of the lungs are\ngrossly clear.\n\nABDOMEN:\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  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:\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 2.9 x 3.2 x 2.8 cm cyst arising from the left ovary, with rim\nenhancement, likely a corpus luteum (601b:22, 602b:50).  No concerning adnexal\nmasses are identified.  Numerous enhancing fibroids are present within the\nuterus.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "3.2 cm left ovarian corpus luteal cyst.\nFibroid uterus.\nNo abdominal or pelvic free air, free fluid, or signs of diverticulitis."
        },
        {
            "input": "LOWER CHEST:\nMinimal bibasilar dependent atelectasis is noted. There is no pleural or\npericardial effusion.\n\nABDOMEN:\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  There is slightly decreased perfusion of the inferior right\nhepatic lobe, otherwise, 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 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 ureters. There is no perinephric\nabnormality.\nGASTROINTESTINAL:  There is no evidence of bowel obstruction.  Mildly\nprominent left hemi-abdominal jejunal loops are fluid-filled, and slightly\nmore laterally positioned than typically seen, but not significantly dilated,\nonly measuring up to 2.1 cm.  There is suggestion of mild mucosal\nhyperenhancement of these loops (601b:21, 02:53), however there is no bowel\nwall edema or significant surrounding inflammatory fat stranding or fascial\nthickening.  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:\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 are within normal limits\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome osseous lesions. Note is made of diastasis\nof the rectus abdominis.  Note is made of sacralized L5 vertebral body.",
            "output": "Findings possibly represent mild nonspecific enteritis. Normal appendix. No\nbowel obstruction."
        },
        {
            "input": "CT ABDOMEN:  The lung bases are clear. The visualized portions of the heart\nand pericardium are normal.\n\nThe liver enhances homogeneously without evidence for a focal liver lesion.\nThe hepatic and portal veins are patent. The patient is s/p cholecystectomy.\nThe pancreas, spleen, and adrenals are normal. The kidneys enhance\nsymmetrically and excrete contrast without evidence of hydronephrosis or mass.\n\nThere is minimal stranding along the anti mesenteric aspect of the ascending\ncolon with mild engorgement of the vasa recta (601b:34), but no evidence for\ncolonic wall thickening. A tiny diverticulum is seen in area fat stranding\nwithout evidence for wall thickening (series 2, image 46).  The remainder of\nthe colon, as well as the small bowel, are unremarkable. There are right lower\nquadrant mesenteric lymph nodes which is not enlarged, up to 5 mm in short\naxis diameter. The appendix is not seen, but there is no secondary evidence of\nappendicitis. There is no free air or free fluid.  The aorta is not\naneurysmal. The main intra-abdominal vessels are grossly patent.\n\nCT PELVIS:  The urinary bladder, uterus and adnexa are remarkable. There is no\npelvic wall or inguinal lymphadenopathy.  No pelvic free fluid.\n\nOSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for\nmalignancy.",
            "output": "Minimal stranding along the anti mesenteric wall of the ascending colon with\nmild engorgement of the vasa recta. Differential diagnosis includes mild\ninfectious/inflammatory colitis versus uncomplicated diverticulitis, given a\nsmall diverticulum in the area of fat stranding."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar atelectasis.  No pericardial or pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely low homogenous attenuation\nthroughout, compatible with mild hepatic 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. \nThere is no evidence of focal renal lesions 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 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 of the lumbar spine are mild.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No evidence of pancreatitis or colitis.  Normal appendix.\n2.  Mildly fatty liver.\n3.  Sigmoid diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LUNG BASES:  The partially imaged lung bases are clear.  There is no pleural\nor pericardial effusion.\n\nCT ABDOMEN:\nThere is a normal noncontrast appearance of the liver with uniform homogeneous\nattenuation.  The gallbladder is unremarkable.  There is mild fatty\nreplacement of the pancreas, which is otherwise homogeneous without\nperipancreatic stranding or ductal dilation.  Again seen is a hypoenhancing\nright adrenal mass measuring 13 x 8 mm, not appreciably changed since prior CT\nfrom ___.  Otherwise, there adrenals are unremarkable.  There is normal\nhomogeneous attenuation of the spleen.\n\nMild perinephric stranding is symmetric bilaterally, and a common finding in\nelderly patients.  The kidneys otherwise have a normal noncontrast appearance.\nSmall radiodensities in the bilateral renal collecting systems measuring up to\n3 mm are compatible with nonobstructing bilateral renal calculi.  There is no\nevidence of hydronephrosis.  There is no evidence of renal calculi.\n\nNondilated small bowel loops are normal in course and caliber without evidence\nof wall thickening or obstruction.  There is mild colonic diverticulosis;\notherwise, the colon is unremarkable.  The appendix is normal.\n\nMild atherosclerotic calcification is seen in the abdominal aorta.  There is\nno evidence of aneurysm or dilation.  There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria.  There is no free\nintraperitoneal air or fluid.\n\nCT PELVIS:\nEvaluation of the pelvic organs is somewhat limited by significant hardware\nartifact from bilateral hip prostheses.  Within this limitation, the bladder\nappears unremarkable.  There is no evidence of bladder calculus.  There is no\nevidence of free pelvic fluid.  The right common femoral stent is seen.  There\nis no inguinal lymphadenopathy bilaterally.\n\nMUSCULOSKELETAL:\nBilateral hip arthroplasty prosthetic hardware is noted.  Otherwise, there is\nmild-to-moderate degenerative change of the imaged thoracolumbar spine. \nAlignment is normal.  No focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. Bilateral non-obstructing renal calculi measuring up to 3 mm.  No\nhydronephrosis.\n2. Colonic diverticulosis.\n3. Stable 13 x 8 mm hypoenhancing right adrenal lesion, compatible with an\nadenoma."
        },
        {
            "input": "LOWER CHEST: There is moderate 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. Very mild periportal edema versus is\nminimal prominence of the central intrahepatic bile ducts, likely of no\nclinical significance but correlation with liver function tests is\nrecommended.  The gallbladder is borderline distended and contains\nhigh-density sludge along the fundus (series 602, image 16).  There is no\nsignificant gallbladder wall thickening or pericholecystic edema or stranding.\nAn area of hypodensity along the gallbladder wall likely represents focal\nfatty sparing of the liver versus trace pericholecystic fluid however no fluid\nwas seen on ultrasound.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys 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 renal cortical hypodensity is too small to\ncharacterize by CT, however likely represents a benign entity.\n\nGASTROINTESTINAL: The stomach is 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.  There is a retroaortic left renal 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. Borderline distention of the gallbladder with gallbladder sludge layering\nat the fundus is demonstrated.  The gallbladder wall measures 2 mm with\nequivocal trace pericholecystic fluid.  If there is clinical concern for acute\ncholecystitis, recommend a HIDA scan."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  The heart is\npartially imaged with valvular calcifications and a minimal pericardial\neffusion, unchanged since ___.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver is slightly nodular in contour with partial\ncavernous transformation, re- demonstrated.  The remaining portal vein is\npatent.  The spleen is top-normal in the anterior-posterior direction at 12.2\ncm.  The spleen has grossly unchanged perisplenic varices.  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.\n\nSPLEEN: The spleen is top-normal in size.\n\nADRENALS: The right adrenal gland is normal.  There is induration of the fat\nadjacent to the left adrenal gland, unchanged.\n\nURINARY: The kidneys are of normal and symmetric size.  Left renal hypodensity\nis too small a characterize (02:36).  There is no hydronephrosis.\n\nGASTROINTESTINAL:  There is minimal fascial thickening along the sigmoid\ncolonic diverticulosis, present since at least ___.  An additional area of\nfascial\nthickening/ possible fluid seen adjacent to the right ascending colon,\npossibly\nfluid in the pericolic gutter, also has not changed since ___.  Small\nbowel loops demonstrate normal caliber and wall thickness throughout.   The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS:  A 2.4 cm uterine fibroid is 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: Bilateral pars defect at L5 and mild anterolisthesis of L5 on S1 is\nunchanged.  There are no concerning osseous lesions for infection or\nmalignancy.\n\nSOFT TISSUES: The abdominal and pelvic wall are without definite abnormality.",
            "output": "1. No renal or ureteral stone.  No hydronephrosis.\n2. Urinary bladder is decompressed, making it difficult to exclude passed\nstone.\n3. Fascial thickening along the sigmoid colon is ___ be\ndue to prior diverticular episodes. No enhancing fluid collection.\n4. Trace free fluid along right paracolic gutter of unknown clinical\nsignificance"
        },
        {
            "input": "LOWER CHEST: Mild bibasilar dependent atelectasis, without pleural effusions. \nHeart size is normal, without pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Mildly nodular liver contour with cavernous transformation is\nre-demonstrated.  There is no evidence of focal lesions.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  Portal venous system is patent.\n\nPANCREAS:  There is a 5mm cyst versus interdigitating fat in the pancreatic\nfat is unchanged from ___ (2:30).  Remainder of the pancreas demonstrates\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.\n\nADRENALS:  There is a 1.8 x 2.4cm myelolipoma is present in the left adrenal\ngland.  Adrenal glands are otherwise 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.  Trace free fluid\nalong the right pericolic gutter (601b:31) is nonspecific and unchanged from\nmultiple prior exams dating back to ___.  No evidence of adjacent\ncolitis.  There is chronic stranding extending between the sigmoid colon and\nleft adnexa, which is unchanged since at least ___ and is unlikely to\nrepresent acute diverticulitis.  Appendix is not visualized.  No\npneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\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. \nLevoconvex scoliosis of the lumbar spine, with severe degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No findings to explain patient's right-sided abdominal pain.\n2. Little change in chronic fat stranding extending from the sigmoid colon to\nthe left adnexa with trace surrounding free fluid, likely representing\nsequelae of prior episode of diverticulitis.\n3. 5 mm cyst versus interdigitating fat within the pancreatic tail, stable,\nfor which follow-up is not indicated.\n4. 1.8 x 2.4 cm left adrenal myelolipoma.\n5. Fibroid uterus."
        },
        {
            "input": "VASCULAR:\nThere is a large multiloculated right groin hematoma with multiple fluid-fluid\nlevels suggesting recent hemorrhage, measuring at least 6.3 x 3.8 x 7.2 cm. \nThere is a linear blush of contrast along the anterior aspect of the larger\nloculation/collection best seen on sagittal imaging (605 B, 45) which\ndisperses slightly on portal venous imaging and is not seen on delayed imaging\nsuggesting it diffuse completely into the hematoma.  This is consistent with\nactive extravasation.  On the portal venous imaging there is a small blush of\ncontrast seen a smaller posterior collection (4 B, 180) which may represent a\nsmall arterial or slightly delayed (venous bleed) or may be due to contrast\npassing from the anterior larger loculation (in which arterial extravasation\nwas seen) to the smaller posterior collection.\nThere is no abdominal aortic aneurysm.  There is moderate to severe calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Aortic valve in situ.  Central line in situ terminating in the\nright atrium.  Severe coronary artery calcification.  Normal cardiac\nconfiguration.  No pericardial effusion.  No pleural effusion.  Multiple\nsubpleural cysts in the lower lobes appeared fairly similar compared to prior\nimaging.  Associated mild bronchiectasis.  No confluent airspace\nconsolidation.  Pulmonary micronodule nodule in the right middle lobe (2, 5).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter calcified granuloma present in segment 4 a of the liver or\nalternatively a calcified peritoneal mice immediately superior to the liver. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nHyperdense material present dependently in the neck and ___ body of the\ngallbladder which may represent sludge/gravel or alternatively vicarious\nexcretion 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 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.  Multiple colonic diverticulae but no features of\ndiverticulitis.  No colonic wall masses on this nondedicated study.  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.  No\nretroperitoneal hematoma.\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. \nLeft femoral nail in situ.  Marked degenerative changes.\n\nSOFT TISSUES: Stranding in the left inguinal area in keeping with left femoral\npuncture.  No extravasation of contrast in this area.  Multiple injection\ngranulomas in the buttocks.  Very small fat containing umbilical hernia.",
            "output": "Large right groin hematoma with active extravasation of contrast as described\nabove.  No pseudoaneurysm formation.  No retroperitoneal hematoma.\nRelative hypodensity of the blood pool suggesting anemia.\n\nCholelithiasis or alternatively vicarious excretion of contrast as described\nabove.  Multiple colonic diverticula, but no features 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 are 2 subcentimeter well-circumscribed lesions in the liver that are too\nsmall to characterize however this likely represent hemangiomas (images 17 and\n30).  There additionally 2 larger more geographic hypodensities in segments 3\nand 5 of the liver, which do not represent cysts and are (images 32 and 53)\nincompletely characterized.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder has been removed as per\nhistory with surgical clipping in place.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 cystic lesion in the right kidney that is too small\nto characterize.  there is no evidence of solid 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.\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 region of hyperdensity in the sacrum that likely represents\na bone island 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. 2 distinct hypodensities in segments 3 and 5 of the liver, do not represent\ncysts and are incompletely characterized, while they may represent atypical\nhemangiomas, in the setting of recent weight loss, MRI of the liver is\nrecommended for better characterization.\n2. No acute abdominal processes.  No hernia present.  Status post\ncholecystectomy\n\nRECOMMENDATION(S):  MRI of the abdomen for better characterization of liver\nhypodensities in the setting of recent weight loss.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:51 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "Please see dedicated CT chest report from the current date for the thoracic\nfindings.\n\nLIVER: Within the limitations of this noncontrast study, the liver is\nhomogeneous without focal lesion. The non-distended gallbladder is within\nnormal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: Calcification of the splenic capsule is unchanged from the prior study\n(3:67). The spleen is otherwise homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.\n\nADRENALS: The right adrenal gland is not seen and may have been surgically\nremoved. The left adrenal gland is unremarkable.\n\nKIDNEYS: Patient is post total right nephrectomy, without evidence of\nrecurrence in the surgical bed.  There is an unchanged 2.7 cm parapelvic\nsimple cyst in the left kidney, with an internal attenuation of 3 ___.  There\nis a more hyperdense cyst, measuring 1.0 cm, which appear to be hemorrhagic on\nthe MRI from ___ (3:64). There is a small coarse calcification in the left\nupper kidney, which appears to be equivocally associated with a small cyst and\nis unchanged since the prior CT.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction.  The appendix is unremarkable.  There\nis extensive colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith moderate atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder wall appears concentrically thickened, out of\nproportion to the amount of underdistention, suggesting possible underlying\ncystitis.No pelvic wall or inguinal lymph node enlargement by CT size criteria\nis seen.There is no pelvic free fluid.The prostate and seminal vesicles are\ngrossly unremarkable.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.  There are\nunchanged bone islands in the L4 and L5 vertebral bodies.",
            "output": "1. Within the limitations of non-contrast CT, no evidence of intra-abdominal\nor intrapelvic metastasis.\n2. Post right nephrectomy with no evidence of local recurrence.\n3. Concentrically thickened bladder appears disproportionate to the degree of\nunderdistention, suggesting possible underlying cystitis.  Correlate with any\nurinary symptoms or urinalysis.\n4.  Extensive colonic diverticulosis.\n5. Please see the dedicated CT chest report from the current date for the\nthoracic findings."
        },
        {
            "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:  59 ___ on non-contrast scan (normal 60-70 ___ is\nno evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\nPANCREAS:\n Bulky head of pancreas is again seen with no significant change in size or\nappearance compared to ___.  Within the limitation of noncontrast\nscan the the pancreatic parenchyma and has a homogeneous attenuation with no\nperipancreatic stranding cystic collection or pancreatic duct dilatation.\nSPLEEN:\nThe spleen shows normal size and attenuation throughout, without evidence of\nfocal lesions.  Linear calcification of the and the splenic capsule again seen\nas previously, sequela wire all trauma or due to peritoneal dialysis\nADRENALS:\nThe right and left adrenal glands are normal in size and shape.\nURINARY:\nPost right nephrectomy with no evidence of local recurrence or regional lymph\nnode enlargement.  The patient cyst or small exophytic and lesion in the upper\npole is again seen and measures 1.3 cm, unchanged since ___.  Again a 3 mm\ncortical calcification in the upper pole is noted with no interval change.\nWithin the limitations of the noncontrast scan there are no urothelial lesions\nin the kidneys or ureters.  There is no hydronephrosis or perinephric\nabnormality.\nGASTROINTESTINAL:\nThe stomach is not distended.  There is no abnormality in the duodenum.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the ascending colon with no signs of\ndiverticulitis.\nAppendix is not visualized.\nRETROPERITONEUM & MESENTERY:\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement.  No solid or cystic mass.\nPeritoneal dialysis catheter is not present.  Mild sub subcutaneous at the\nsite of the previous insertion in the left lower quadrant.\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nAs previously the urinary bladder is contracted and its wall is markedly\nthickened..\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nProstate is not enlarged.\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. Status post a right nephrectomy with no evidence of local recurrence or\ndistal metastasis.\n2. Persistent bulkiness of the head of the pancreas with no interval change\nsince ___. 1.3 mm toe soft tissue exophytic lesion, in the upper pole left kidney with\nno interval change since ___.  Hyperdense cyst versus small renal lesion.\n4. Ascending colon diverticulosis with no signs of diverticulitis\n5. Thick wall urinary bladder, stable."
        },
        {
            "input": "VASCULAR:\n\nExtensive upper abdominal varices.\n\nAorta is normal in caliber throughout.  All arteries appear patent with mild\natherosclerotic plaque, however due to bolus timing difficulties, unable to\ncompletely evaluate.\n\nLOWER CHEST: Mitral annulus calcifications.  Interstitial edema.  Dependent\natelectatic changes with trace pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular liver compatible with patient's history of cirrhosis. \nThe gallbladder 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: Enlarged measuring 17.5 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  The left kidney is low and malrotated. The kidneys are otherwise  of\nnormal and symmetric size with normal nephrogram. 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. Colon and rectum are within normal limits.   There\nis no evidence of mesenteric lymphadenopathy.\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:\n\nThere is no evidence of worrisome lesions.  Anterior abdominal wall soft\ntissue nodularity, possibly related to injections.  Atrophy of the right\ngluteal and semimembranosus muscles.\n\nLarge right inguinal node measuring 3.6 x 2.1 cm.",
            "output": "1. Cirrhotic morphology of liver with evidence of portal hypertension.  No\nascites.\n2. Aorta is normal in caliber throughout.  All arteries appear patent with\nmild atherosclerotic plaque, however due to bolus timing difficulties, unable\nto completely evaluate.\n3. Pulmonary edema.\n4. Large right inguinal node.  Clinical correlation and/or FNA is recommended."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm. There is a 7 x 9 mm atheroma\nin the distal thoracic aorta (04:17).  There is what appears to be a chronic\ndissection in the abdominal aorta proximal to the iliac bifurcation (4:78). \nThe common hepatic, splenic and left gastric arteries arise directly off the\naorta.  More distally, there is extensive atherosclerotic disease in the\nsplenic artery.  However, there is no definite splenic artery aneurysm.  The\nSMA is widely patent.  There is severe narrowing at the origin of the ___,\nalthough it remains patent.  There is also severe narrowing at the origin of\nthe right renal artery although it also remains patent.  There is at least\nmild narrowing at the origin of the left renal artery.  There is moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.  There is\nsevere, diffuse soft and calcified atherosclerotic disease throughout the\nabdominal aorta and its major branches.\n\nLOWER CHEST: There are trace bilateral pleural effusions as well as\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout aside\nfrom hyperemia adjacent to the gallbladder fossa. There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains multiple gallstones and is significantly\ndistended with wall thickening and edema and adjacent fat stranding,\nsuggestive of acute cholecystitis.  There is no clear evidence of gallbladder\nperforation.\n\nPANCREAS: The pancreas demonstrates normal attenuation, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 is a 3.3 cm simple cyst in the left upper pole.  Additional\nsubcentimeter hypodensities bilaterally are too small to characterize, but\nstatistically likely represent simple cysts.  There is no evidence of stones,\nfocal renal lesions, or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Diverticulosis of the descending and sigmoid\ncolon is noted without wall thickening or adjacent fat stranding.  There is\nmild secondary inflammation in the colonic loops in the right upper quadrant. \nThe appendix is normal.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is collapsed around a Foley catheter and appears to have a\nthickened and hyperemic wall.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrial cavity appears prominent measuring up to\n1.1 cm in thickness (602:77).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are severe degenerative changes in the thoracolumbar spine.\n\nSOFT TISSUES: There is diffuse subcutaneous edema.  There is a fat containing\numbilical hernia.  The PEG tube is malpositioned, residing within the anterior\nbody wall, outside of the stomach.",
            "output": "1. Marked distension of the gallbladder with stones and wall thickening as\nwell as adjacent inflammatory fat stranding and hyperemia of the adjacent\nliver.  Findings are highly concerning for acute cholecystitis.  No gross\nsigns for perforation.\n2. Extensive atherosclerotic disease without evidence of active bleeding.\n3. Mild thickening and hyperemia of the bladder wall may be due to under\ndistension.  However, correlation with urinalysis is recommended.\n4. Trace bilateral pleural effusions and bibasilar atelectasis.\n5. Diverticulosis without evidence of acute diverticulitis.\n6. Relative thickening of the endometrium, measuring up to 1.1 cm.  Given the\npatient's age, a non-urgent pelvic ultrasound may be obtained for further\nevaluation if clinically indicated.\n7. PEG tube is malpositioned and resides within the anterior body wall outside\nof the stomach.\n\nRECOMMENDATION(S):\n-Surgical consult.\n-Nonemergent pelvic ultrasound.\n-Repositioning of the PEG tube.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:27 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 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: Slightly malrotated right kidney with anteriorly oriented renal\nhilum.  Otherwise the kidneys are of normal and symmetric size with normal\nnephrogram.  There is no evidence of solid renal lesions.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  Atherosclerotic plaques at\nthe origin of the celiac axis causing mild narrowing.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Otherwise the abdominal\nand pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal process.  No CT findings directly correlating to the\nreported history of left lower quadrant pain and increased girth."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis.  No pleural pericardial effusion. \nExtensive coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Few\nsubcentimeter hypodensities are too small to characterize, but likely\nrepresent simple cysts.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is distended and there is a stone seen\nnear the neck of the gallbladder.  No significant gallbladder wall edema.  No\nsignificant inflammatory changes are seen around the gallbladder.\n\nPANCREAS: Mild fatty atrophy of the pancreas which is otherwise unremarkable\nwithout evidence of focal lesions.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is an indeterminate 1.7 cm left adrenal nodule.  Right adrenal\ngland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo focal lesions.  Simple cysts are noted in the kidneys bilaterally. \nAdditional subcentimeter hypodensities are too small to characterize, but\nlikely represent simple cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. Appendix is not\nvisualized, but 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: 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 focal ectasia of the infrarenal abdominal aorta measuring\nup to 2.9 cm.  Severe atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight hip prosthesis is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Gallbladder is distended and contains stones, though there is no\nsignificant gallbladder wall edema or surrounding inflammatory changes. \nFindings are overall equivocal for acute cholecystitis.\n2. Indeterminate 1.7 cm left adrenal nodule.\n\nRECOMMENDATION(S):\n Incidentally 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": "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 appears diffusely hypoattenuating relative to the spleen\nsuggesting steatosis.  Main portal vein is patent.  No worrisome focal liver\nlesion is identified.  The gallbladder is normal.  No intrahepatic or\nextrahepatic biliary ductal dilation.  The pancreas appears slightly atrophic\nthough otherwise unremarkable.  No signs of acute or chronic pancreatitis. \nThe spleen is normal in size.  The adrenal glands appear normal bilaterally. \nThe kidneys enhance symmetrically.  Simple appearing renal cysts arising from\nthe left kidney noted measuring up to 3.7 x 3.8 cm.  No definite concerning\nrenal lesion is identified.  The abdominal aorta is normal in course and\ncaliber without appreciable atherosclerotic calcifications.  No\nretroperitoneal lymphadenopathy is seen.  The stomach and duodenum appear\nnormal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is normal.  The colon is unremarkable without signs of colitis or\npericolonic inflammation.  Scattered mild diverticulosis is noted.  The uterus\nis surgically absent.  No adnexal mass.  Urinary bladder is partially\ndistended appearing normal.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Facet\narthropathy is severe in the lower lumbar spine.",
            "output": "1. Hepatic steatosis.\n2. Renal cysts.\n3. Normal appendix.\n4. No signs of acute or chronic pancreatitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no significant calcium burden\nin the abdominal aorta or great abdominal arteries.  There are bilateral\naccessory renal arteries.  There is a replaced right hepatic artery.\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 hepatic and portal veins are patent. \nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.  There is vicarious excretion of contrast within the gallbladder.\n\nPANCREAS: The pancreas shows moderate atrophy 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 a stable appearing 3.7 x 3.8 cm simple peripelvic cyst within the\ninterpolar region, as well as an adjacent 2.2 x 2.2 cm simple cyst on the\nleft.  There are multiple additional subcentimeter hypodensities within the\nbilateral kidneys, which are too small to characterize, but most likely\nrepresent cysts.  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: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits aside from scattered diverticula without signs\nof diverticulitis..  The appendix is normal.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is a 6 mm porta hepatis node, which is nonspecific (6:34) and does not\nmeet size criteria for 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 seen and there are no adnexal masses.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild diastasis rectus and a tiny fat-containing\numbilical hernia.",
            "output": "1. There is no CT finding to explain the patient's acute on chronic abdominal\npain and no sign of acute or chronic mesenteric ischemia.  There is no sign of\natherosclerotic disease.  Incidental note of bilateral accessory renal\narteries and replaced right hepatic artery.\n2. Mild diastasis rectus and tiny fat containing umbilical hernia.\n3. Bilateral renal cysts, as described above.\n4. Moderate pancreatic atrophy."
        },
        {
            "input": "GASTROINTESTINAL: Visualizes intrapelvic loops of small large bowel are\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: Prostate is mildly enlarged.  Seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Unchanged mild ectasia of the infrarenal abdominal aorta measuring\nup to 3.2 cm.  Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Within the subcutaneous tissues of the dorsal penis overlying\nthe corpus cavernosum there is a 1.3 x 2.2 x 2.0 cm hypodense collection\n(2:51, 602:44).  There is significant swelling within soft tissues tiny foci\nof air in the distal penis likely air trapped around the foreskin and glans of\nthe penis.  The collection itself does not appear to contain any foci of air. \nThere is no pelvic soft tissue stranding or subcutaneous air to suggest\nnecrotizing infection of the pelvis.",
            "output": "A 2.0 cm collection in the subcutaneous tissue of the dorsum of the mid shaft\nof the penis in the region of the glans. Tiny foci of air in the subcutaneous\ntissue of the distal penis may represent air trapped between the foreskin and\nglans of the penis. No pelvic or peroneal stranding or subcutaneous air to\nsuggest ___ gangrene."
        },
        {
            "input": "PELVIS:  There are scattered diverticula throughout the visualized sigmoid\ncolon.  Otherwise, the partially visualized small and large bowel are\nunremarkable.  The appendix is also normal in appearance.  The urinary bladder\nand distal 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: Posterior fixation hardware with bilateral pedicle screws and an\nintervertebral spacing device is partially imaged at L4-5.  There is\npersistent grade 1 anterolisthesis of L4 on L5.  There is no evidence of\nhardware complication.  2 subcentimeter lucent lesions within the left iliac\nwing (series 2, image 17 and 19) are indeterminate, but unchanged since at\nleast ___.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: There is fat stranding and fascial thickening overlying the\nright gluteal muscles.  Within the subcutaneous soft tissues, there is a 3.1 x\n1.8 x 5.4 cm intermediate density fluid collection (series 3, image 87 and\nseries 402b, image 88), which likely represents a hematoma.",
            "output": "Fat stranding overlying the right gluteal muscles with a subcutaneous\nintermediate density fluid collection measuring up to 5.4 cm, likely a\nhematoma.  No evidence of underlying 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 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\nprominent wall thickening, mucosal hyperenhancement, and surrounding fat\nstranding involving the cecum, ascending, transverse, and proximal descending\ncolon which is worst involving the right colon (601:21).  There is small\nvolume free fluid adjacent and small volume free fluid in the pelvis.  No\norganized abscess.  No free air or pneumatosis.  The appendix is fluid filled\nmeasuring up to the 9 mm, also with wall thickening and slight mucosal\nhyperenhancement, but similar in appearance to the surrounding colon.  The\ninflammatory process appears to be centered on the right colon (2:65; 601:19).\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: Mesenteric lymph nodes are prominent quadrant although not\npathologically enlarged.  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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive colitis involving the cecum, ascending colon, transverse, and\nproximal descending colon.  Differential considerations include infectious or\ninflammatory etiologies, or ischemic.\n2. Prominent hyperenhancing appendix, likely reactive to adjacent colitis.\n\n3. No evidence of perforation or organized abscess.\n4. Small volume free fluid in the right lower quadrant and pelvis."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis or chronic scarring.  The\nheart is moderately enlarged.  There are mild aortic valvular calcifications. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n1.8 cm slightly exophytic hypodensity within the periphery of segment IV\n(02:36) is incompletely characterized, but may represent a ciliated\nduplication foregut cyst, simple cyst, or 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 within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilatation.  There is thickening of Gerota's fascia adjacent\nto the pancreatic tail which is nonspecific in the presence of a normal\nlipase.\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 which is\nnonspecific but without focal nodularity.\n\nURINARY: There is no evidence of focal renal lesions within the limitations of\nan unenhanced scan.  There is no hydronephrosis.  There is no nephrolithiasis.\nThere is mildly asymmetric left perinephric stranding with thickening of the\nGerota's fascia.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is moderate\ncircumferential wall thickening about the rectum which is filled with a large\nstool ball.  No pneumatosis.  There is normal variant colonic interposition of\nthe colon between the liver and abdominal wall.  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.\n\nPELVIS: Diffuse urinary bladder wall thickening is likely due to bladder\ndecompression and chronic outflow obstruction.  Component of superimposed\ncystitis cannot be excluded.  The distal ureters are unremarkable.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is moderately 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\n1.0 cm sclerotic focus within the right iliac bone (2:141) likely represents a\nbone island.  Mild retrolisthesis of L2 on L3 is age indeterminate but likely\ndegenerative in etiology.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Circumferential rectal wall thickening with large rectal stool burden may\nsuggest stercoral colitis.  No associated pneumatosis or pneumoperitoneum.\n2. No urinary stones.  Questionable mild asymmetric perinephric stranding\nabout the left kidney is nonspecific but could be infectious in the proper\nclinical setting.\n3. Diffuse urinary bladder wall thickening likely due to decompression and\nchronic outflow obstruction.  Superimposed cystitis cannot be excluded. \nCorrelation with urinalysis is recommended.\n4. Incompletely characterized 1.8 cm hypodensity within the hepatic segment IV\nmay represent a ciliated foregut duplication cyst, simple cyst, or biliary\nhamartoma which can be further evaluated with non urgent ultrasound.\n5. Diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "LOWER CHEST: Enhancing right lower lobe consolidation is presumably\natelectasis, though superimposed infection is possible.  No pleural effusion\nis seen.  Left lower lobe atelectasis is mild.  The heart size is within\nnormal limits.  Coronary calcifications are mild.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.6\ncm hypodensity in the segment IV is similar to prior exam and presumably a\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 pancreatic\nductal dilatation.  Better seen on today's contrast enhanced exam is a 9 mm\nhypodensity at the neck (02:31).  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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is not visualized.  Large amount of stool is seen\nwithin the rectum.  However, the perirectal fat is unremarkable.\n\nPELVIS: The urinary bladder wall is diffusely thickened.  A Foley is in place.\nThe distal ureters are unremarkable.  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.  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.  Small\nintramuscular lipoma is seen in the pectoralis minor on the right (2:3).",
            "output": "1. Diffusely thickened bladder wall, which may be related to under distension\nin the setting of Foley placement.  However, please correlate with urinalysis\nand symptoms for cystitis.\n2. Large amount of stool within the rectum without surrounding fat stranding.\n3. No hydronephrosis or evidence of nephrolithiasis.\n4. Right lower lobe consolidation, presumably atelectasis.  However,\nsuperimposed infection is possible.\n5. 9 mm cystic lesion at the pancreatic neck, potentially an IPMN."
        },
        {
            "input": "LOWER 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: There is fatty infiltration of the head of the pancreas.  The\npancreas has normal attenuation throughout, 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. \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. 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 uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Partially calcified thrombus\ninvolving the abdominal aorta and common iliac arteries.\n\nBONES: Wedge deformity involving L2 is visualized, however no priors are\navailable for comparison purposes.\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 separately dictated report of the chest performed on the\nsame day for findings above the 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 is diffusely hypoattenuating relative to the spleen\nsuggestive of hepatic steatosis. An unchanged sub-centimeter hypodensity\nwithin hepatic segment II is too small to characterize but likely a simple\ncyst or biliary hamartoma. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas is somewhat truncated, a normal variant. There is\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.\n\nADRENALS: There is slightly nodular appearance of the medial left adrenal\ngland, unchanged. The adrenal glands are otherwise unremarkable.\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 an\nextra-renal left renal pelvis. There is an unchanged 0.9 cm hypodensity within\nthe interpolar region of the right kidney, too small to characterize but\nlikely a simple cyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia. No small bowel obstruction. \nThere are scattered colonic diverticula without evidence of diverticulitis.\nThe colon and rectum are otherwise unremarkable within limitations of CT. No\nfree fluid in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is suggestion of possible enlargement of the\nendometrial cavity measuring up to 6 mm. No adnexal lesions.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There is atherosclerotic disease being\nat least moderate in the proximal SMA.  The hepatic veins are patent. The main\nportal vein is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nStable interval appearance of mild compression deformity involving the\nsuperior endplate of L2.  There is grade 1 anterior spondylolisthesis of L5 on\nS1 secondary to bilateral pars defects.\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. Findings suggestive of hepatic steatosis.\n3. The endometrial cavity appears slightly prominent, suboptimally evaluated\non the current exam but measuring up to 6 mm. Correlation with pelvic\nultrasound is recommended if not recently performed.\n4. Please refer to the separately dictated CT chest for full description of\nthe subdiaphragmatic findings.\n\nRECOMMENDATION(S):  1.  Pelvic ultrasound if not recently performed."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously and demonstrates\ndiffuse hypoattenuation as before, likely related to steatosis.  Stable 2 mm\nhypodensities at the dome, likely biliary hamartomas.\nNo new focal liver lesions.  No intrahepatic biliary ductal dilation.\nThe gallbladder is dilated with no radiopaque calculi within it.\nPANCREAS: There is fatty replacement within the pancreatic head.  No main duct\ndilation or focal pancreatic lesion.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  Stable mild uniform thickening of the left adrenal gland.  No focal\nadrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is no bowel obstruction\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Moderate calcified atherosclerotic plaques within the abdominal\naorta and it branches.  No aneurysmal dilation.  There is focal mild (less\nthan 50%) narrowing within the proximal SMA (9:67) due to non-calcified\natherosclerotic plaque.\n\nPELVIS:\nThe bladder is unremarkable.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\nThere is a chronic superior end plate deformity of the L2 vertebra.  Bilateral\npars interarticularis lysis with grade 1 anterolisthesis of L5 over S1 noted.",
            "output": "1. No metastatic disease seen in the abdomen or pelvis.\n2. Hepatic steatosis; bilateral pars interarticularis lysis with grade 1\nanterolisthesis of L5 over S1 noted.\n3. There is focal mild (less than 50%) narrowing within the proximal SMA\n(9:67) due to non-calcified atherosclerotic plaque."
        },
        {
            "input": "The chest is reported separately.\n\nA couple of sub 5 mm hypodense foci in the liver are too small to characterize\nbut doubtful in clinical significance, and regardless, stable.  There is no\nbiliary dilatation.  The gallbladder appears normal.  Pancreas is\nunremarkable.  Spleen is normal in size and appearance.  The adrenals also\nappear within normal limits.  There is no evidence for hydronephrosis,\nperfusion defect, or solid mass in either kidney.  Small simple cyst in the\nright interpolar region.  In the left, a tiny stone measures 2-3 mm in the\nupper pole of the left kidney, unchanged.\n\nThere is a very small paraesophageal type hiatal hernia.  Small bowel appears\nnormal.  Sigmoid diverticulosis is mild.  There is a very small fat containing\numbilical hernia with a wide neck.\n\nBladder appears normal.  Suggestion of endometrial thickening, slight\nendometrial thickening up to perhaps about 6 mm in diameter.  Uterus and\nadnexa are otherwise unremarkable.  No lymphadenopathy or free fluid. Major\nvascular structures appear patent. Along the proximal superior mesenteric\nartery, short stenosis of about 40-50% by size with soft tissue plaque.\nModerate atherosclerotic disease along the aorta and its major branches.\n\nBones appear demineralized.  Very similar defect along the superior endplate\nof L2.  Mild spondylolisthesis of L5 on S1 associated with bilateral pars\ninterarticularis defects.  Also moderate associated degenerative changes at\nthe same level.",
            "output": "1.  No evidence of metastatic disease.\n\n2.  Mild endometrial thickening up to about 6 mm.  If there is postmenopausal\nbleeding pelvic ultrasound should be considered although the finding is very\nlikely normal otherwise."
        },
        {
            "input": "LOWER 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\nfew sub 5 mm hypodensities in the liver are unchanged and too small to\ncharacterize.  There is no suspicious focal lesion.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is mildly atrophic, without evidence of focal lesions. \nThere is no pancreatic ductal dilation 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: There is a small hiatal hernia. Otherwise, the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement. There are scattered diverticula throughout the descending\ncolon and sigmoid colon without evidence of diverticulitis.  The appendix is\nnot visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mildly thickened endometrium up to 6 mm is unchanged.  No\nadnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease.  No abdominal aortic\naneurysm.  Major tributaries of the abdominal aorta and portal venous system\nare patent. Moderate stenosis of the origin of SMA secondary to noncalcified\nplaques.\n\nBONES: No suspicious osseous or soft tissue lesions.  Degenerative changes of\nthe lumbar spine are mild.  There is grade 1 anterolisthesis of L5 on S1\nsecondary to bilateral L5 pars defect.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.  No suspicious\nsoft tissue lesions.",
            "output": "1. No evidence of metastatic disease within the abdomen pelvis.\n2. Unchanged mild endometrial thickening up to 6 mm.  Further evaluation can\nbe performed with pelvic ultrasound if clinically indicated.\n3. Please see separate report performed the same day for detailed evaluation\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 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 a focal lobulation\nmeasuring 2.4 cm which most likely represents the normal contour of the\npancreas as it is unchanged dating back to ___. 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 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. The colon and\nrectum are within normal limits.\n\nPELVIS: There are postsurgical changes from cystectomy and neobladder\ncreation.  Again seen are surgical clips anterior to the sacrum.  There is no\nenhancing mass or lesion to suggest local recurrence.  There is no free fluid\nin 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. Stable postsurgical changes from cystectomy and neobladder creation.  There\nis no evidence of local recurrence or distant metastases.\n2. Please refer dedicated CT chests for further characterization."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day.\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 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, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 suture\nline in the sigmoid colon\n\nPELVIS: Surgical clips are seen anterior to the sacrum.  The patient is status\npost cystectomy.  A neobladder is identified in the right hemipelvis on series\n2, ___ 110 in 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of tumor recurrence or metastatic disease\n2. For full description of the lung bases please refer to chest CT report from\nthe same day"
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusion and bibasilar consolidations 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 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: There is a nasogastric tube ending in the fundus of the\nstomach.  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 bladder is collapsed on a Foley catheter.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\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 or acute fracture.\n\nSOFT TISSUES: There fat stranding around the pelvis with scarring in the left\nthe inguinal region.  There is a 2.3 x 1.3 cm left inguinal hematomas.",
            "output": "1. No intra-abdominal bleed.\n2. Small 2.3 cm hematoma in the left groin.\n3. Bilateral pleural effusions and consolidation could be due to aspiration."
        },
        {
            "input": "LOWER CHEST: There has been interval removal of the bilateral pigtail\ncatheters as compared to the prior CT chest examination.  Small left loculated\npleural fluid remains.  Trace right possibly loculated fluid is also seen at\nthe right lung base.  There is dense overlying consolidative opacities, likely\nreflecting a combination of atelectasis and pneumonia.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is not distended and contains a single gallstone (series 2, image\n26).\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: Splenosis of the left upper quadrant is noted.\n\nADRENALS: Large right adrenal nodule measures 4.7 x 3.3 cm and measures an\ninternal density most compatible with an adrenal adenoma (series 2, image 21).\nThe left adrenal gland is normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic with multiple bilateral cystic\nlesions, measuring up to 6.0 x 4.3 cm in the left upper pole kidney. \nAdditional hypoattenuating cystic lesions in the right upper pole kidney and\nleft mid to upper pole kidney demonstrate coarse calcifications.  The left\ncyst was previously characterized as a Bosniak 2 cyst on recent renal\nultrasound performed ___.  Multiple nonobstructing renal stones\nare seen in the bilateral kidneys and renal collecting systems measuring up to\n1.0 cm in the right lower pole kidney (series 2, image 40), and 6 mm in the\nproximal right ureter (series 2, image 43).  No evidence of hydronephrosis. \nThe urinary bladder is underdistended with suprapubic catheter in place. \nThere is a small right posterior wall bladder diverticulum (series 303, image\n47).\n\nGASTROINTESTINAL: Status post percutaneous gastrostomy tube, in appropriate\nposition.  Patient is status post left colectomy with a right upper quadrant\nostomy.  The rectal stump is unremarkable.  Visualized small large bowel loops\nare within normal limits without evidence of bowel obstruction.\n\nPELVIS: There is a trace amount of free fluid in the left lower quadrant of\nthe abdomen.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Small retroperitoneal and mesenteric lymph nodes are not\npathologically enlarged by CT size criteria.  No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Mild body wall anasarca.  Postsurgical changes are seen related\nto prior right upper quadrant ostomy.  There is a small bowel containing\numbilical hernia.  No evidence of bowel incarceration.  Scattered soft tissue\nnodules in the anterior abdominal fat are likely related to prior injection.",
            "output": "1. No evidence of acute pathology in the abdomen or pelvis to account for\npatient's symptoms.\n2. Small left loculated pleural fluid with trace right possibly loculated\nfluid at the lung bases are associated with dense overlying consolidative\nopacity likely reflecting a combination of atelectasis and pneumonia.\n3. Large right adrenal nodule is most compatible with an adenoma.\n4. Nonobstructing bilateral renal and right ureteral calculi with slightly\ncomplex left renal cyst previously characterized as a Bosniak 2 cyst on the\nrecent renal ultrasound."
        },
        {
            "input": "Pelvic large and small bowel loops are normal in caliber with no acute\ninflammatory changes or suspicious mass lesions.  Urinary bladder is halfway\nopacified with contrast and demonstrates normal contour with no significant\nbladder wall thickening.  Prostate gland is mildly enlarged.  Seminal vesicles\nare unremarkable.  There are no pelvic adenopathy.\n\nOsseous structures demonstrate minimal degenerative changes with no suspicious\nosseous destructive lesions.  There are no acute osseous abnormality is\nidentified neither.  Soft tissues are unremarkable.\n\nBilateral inguinal regions are unremarkable with no adenopathy.\n\nBilateral iliac vessels are opacified and appear normal in caliber.",
            "output": "No suspicious pelvic masses identified on this contrast enhanced CT of the\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: Interval marked increase in the size and extent now innumerable\nhepatic lesions.  The dominant lesion centered in segments 2, 3, and 4\nmeasures approximately 11 x 6 cm, previously 7 x 5.5 cm.  Additionally,\nnumerous other lesions scattered throughout both hepatic lobes have increased\nin both size and number.  For example a segment 8 lesion previously measuring\n1.4 cm now measures 1.8 cm (10:95).  A segment 7 lesion previously measured\n1.1 cm now measures 2.5 cm (10:94).  A segment 5 lesion that was previously\nnot seen now measures 3.5 cm (10:13).\n\nLymph node conglomerate in the porta hepatis is also increased in size, now\nmeasuring 3 x 3 cm, previously 2.2 x 3.3 cm (10:105).\n\nNo biliary dilation.  The portal venous system appears patent.  Small volume\nnonhemorrhagic ascites has increased.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\na left inferior pole renal cyst, unchanged.  There is no perinephric\nabnormality.\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.  There is increase in hazy\nappearance of the omentum, with a 6 mm nodule that was not previously seen\n(10:165).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid uterus.  There is a stable 2.6 cm\nright adnexal cyst.\n\nLYMPH NODES: Bulky retroperitoneal lymphadenopathy is re-demonstrated,\nunchanged.  For example a conglomerate just inferior to the left renal vein\nmeasures 3.5 x 2.2 cm (10:23). Left common and external iliac lymphadenopathy\nis also unchanged.\n\nVASCULAR: 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 patient is status post right total hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval marked increase in the size and number of innumerable hepatic\nlesions.\n2. New/increasing omental nodularity, compatible with peritoneal spread of\ndisease.\n3. Interval increase in small volume ascites.\n4. Stable bulky retroperitoneal lymphadenopathy."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  There is a new trace right\npleural effusion.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is an overall grossly similar burden of hepatic\ninnumerable lesions likely representing metastatic disease.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Again\ndemonstrated, is gallbladder wall edema with a relatively contracted\ngallbladder.  The main portal vein is patent.  Left portal vein is not well\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 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 acute diverticulitis.  The rectum is within normal limits.\nThe appendix is not definitively visualized, however there are no secondary\nsigns of acute appendicitis. There is interval increase in abdominal ascites,\nnow moderate.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsimilar volume pelvic ascites.\n\nREPRODUCTIVE ORGANS: Again demonstrated is a right adnexal cystic lesion which\nmay represent the ovary measuring approximately 2.4 cm, similar prior.  Uterus\nis unremarkable.\n\nLYMPH NODES: Again demonstrated is a 2.3 cm necrotic pericaval/porta hepatis\nlymph node.  A large bulky partially necrotic conglomerate retroperitoneal\nlymph node similar in size measuring 2.7 x 3.4 cm (03:28).  No definite\nmesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Patient status post right hip arthroplasty without evidence of\ncomplication.  There is no evidence of worrisome osseous lesions or acute\nfracture. Stable multilevel degenerative changes of the visualized\nthoracolumbar spine are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Overall similar burden of innumerable hepatic lesions likely representing\nmetastasis in the setting of cholangiocarcinoma.\n2. Overall grossly similar burden of retroperitoneal bulky lymphadenopathy.\n3. Interval increase in abdominal ascites, now moderate volume.  Similar\nvolume pelvic ascites.\n4. Bibasilar atelectasis, with new trace right pleural effusion."
        },
        {
            "input": "The lung bases are clear.  There is no pericardial or pleural effusion.  The\nheart size is normal.\n\nThe liver density appears slightly decreased.  Centered at segment IV a is an\nill-defined 7.0 x 5.7 cm heterogeneous hypodense mass, demonstrating a\nlobulated contour.  Numerous (greater than 10) additional ill-defined\nhypodense hepatic lesions are scattered throughout the remaining hepatic\nlobes, sparing only segment VII.  There is extensive porta hepatis adenopathy,\nincluding a 3.3 x 2.2 cm portacaval node (series 2, image 54, 47, 46).  There\nis mild intrahepatic bile duct dilation.  The CHD and CBD are not dilated. \nThe gallbladder is decompressed, demonstrating an edematous wall (series 2,\nimage 51), without significant adjacent fat stranding.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal mass.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is moderate sigmoid diverticulosis.\n\nThe bladder is mildly distended, and appears grossly normal.  The uterus is in\nmid position, and normal in size.  There is a 2.3 x 2.0 cm right adnexal\ncystic lesion (series 4, image 5).  The left ovary is not visualized.\n\nThere is retroperitoneal lymphadenopathy, with aortocaval and left para-aortic\nnodes measuring up to 1.4 cm along the short axis (series 2, image 67), and\nabnormal enlarged nodes extending to the left common iliac chain measuring up\nto 10 mm (series 2, image 97).  No intrapelvic adenopathy is detected.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  The portal and hepatic veins are\npatent.\n\nThere is a small fat-containing umbilical hernia (series 2, image 88).\n\nThere are no osseous lesions concerning for malignancy or infection.  There\nare moderate degenerative changes throughout the thoracolumbar spine.",
            "output": "1. 7.0 x 5.7 cm segment IV hepatic mass, with CT features favoring a\ncholangiocarcinoma, though more definitive characterization is limited on this\nsingle-phase study.  Numerous additional metastases are scattered throughout\nthe liver, sparing only segment VII.  If biopsy is indicated, the main mass\ncan be sampled via percutaneous approach under ultrasound guidance.\n2. Extensive porta hepatis and retroperitoneal metastatic lymphadenopathy,\nextending to the left common iliac chain.\n3. Mild intrahepatic bile duct dilation.  The CBD is normal caliber.\n4. 2.3 cm right adnexal cystic lesion can be followed on subsequent\nsurveillance studies, or with a annual pelvic ultrasound.  Correlate with any\nrecent pelvic ultrasound examinations.\n5. Moderate sigmoid diverticulosis.\n6. Small fat containing umbilical hernia."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is normal and without gallstones.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.\nSubcentimeter hypodensities in the kidneys bilaterally are too small to\ncharacterize.  There is no hydronephrosis. The ureters are normal in caliber\nand course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. Small and large bowel are normal in appearance.\nThe appendix is well visualized and normal (301:18).\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute intra-abdominal process."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits besides a 3 mm\nright lung base pulmonary nodule, not definitely changed since prior.  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 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\na 3 mm stone seen at the left ureterovesicular junction, without significant\nassociated left-sided hydroureteronephrosis.  No evidence of right-sided\nhydronephrosis.  Several punctate nonobstructing stones are seen within the\nright kidney.  No perinephric abnormality is detected.\n\nGASTROINTESTINAL:  Small hiatal hernia.  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 is unremarkable.  There is no free fluid in the\npelvis.\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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nInterval development of mild anterior wedge compression deformity of L2\n(602B;35).\n\nSOFT TISSUES: Within normal limits.",
            "output": "1. A 3 mm left ureterovesicular junction stone, without significant associated\nleft-sided hydroureteronephrosis.\n2. Several punctate nonobstructing right renal stones.\n3. Small hiatal hernia.\n4. Interval development of mild anterior wedge compression deformity of L2. \nRecommend correlation with history of interval trauma."
        },
        {
            "input": "LOWER 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 subcentemeter hypodensity in hepatic segment 8 consistent with a hepatic\ncyst (2:55, 601b:18).  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.\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: 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 CT of   the abdomen or pelvis."
        },
        {
            "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: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Ill-defined segment 8 hepatic mass measures 1.3 x 2.2 cm (6 a:\n31).  No other discrete liver masses are appreciated.  No intra or\nextrahepatic biliary ductal dilation.  The gallbladder is nondistended.  Some\nfocal fluid is seen in the right upper quadrant consistent with trace ascites,\nincluding adjacent to the gallbladder.\n\nPANCREAS: A 3.9 x 4.7 cm mass, it generally iso enhancing to the remainder of\npancreas with internal hypo enhancing foci, replaces the head and neck of the\npancreas with no significant upstream pancreatic ductal dilation in the\npancreatic tail.  There is extensive vascular encasement including the\nbranches of the celiac trunk, a portion of the celiac trunk itself, the\nconfluence of the splenic and superior mesenteric veins and proximal portal\nvein.  The mass abuts the posterior aspect of the left lateral segment of\nliver with possible invasion (6a:43).  There is no intrahepatic biliary ductal\ndilation despite extensive involvement of the pancreatic head.\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): isoattenuating\nSize (maximal axial dimension in cm): 3.9 x 4.7 cm.\nLocation (head right of SMV, body left of SMV): head/uncinate and body\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 (6 a: 49)\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: present\nSolid soft-tissue contact: Absent\nIncreased hazy attenuation/stranding contact: ?180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\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, narrowing\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: present\n\nVariant anatomy: none\n\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\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: present\nSuspicious lymph nodes: Retroperitoneal and pelvic\nOther extrapancreatic disease (invasion of adjacent structures): Left lobe of\nliver\n\nSPLEEN: Top-normal in size, 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 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: 7 x 10 mm aortocaval lymph node (6b:97), and additional left\ncommon iliac nodal conglomerate measuring approximately 1.4 x 2.0 cm (6b:108),\nare representative of a several foci of pelvic lymphadenopathy.  Additional\nprominent nodes are located along the external iliac arteries bilaterally. \nLeft inguinal nodes are morphologically normal though slightly enlarged and\nasymmetrically enhancing in comparison with the right.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized.  No adnexal masses are\nappreciated.\n\nBONES: Sclerotic foci in lumbar and thoracic spine are noted and\nindeterminate, possibly related to degenerative change.  Vertebral body\nheights are preserved.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 3.9 x 4.7 cm pancreatic head and neck mass with extensive vascular\nencasement but lack of vascular or ductal occlusion, shows imaging features\nmore compatible with lymphoma than pancreatic adenocarcinoma, and correlation\nwith results of recent EUS/ fine-needle aspiration is recommended.  Metastatic\ninvolvement of the pancreas or other less common primary neoplasms of the\npancreas with abdominal pelvic metastasis would be alternate considerations.\n2. Retroperitoneal and pelvic lymphadenopathy worrisome for additional\ninvolvement by malignancy.\n3. Ill-defined hepatic segment 8 lesion potentially worrisome for malignant\ninvolvement.\n4. Small ascites."
        },
        {
            "input": "LOWER CHEST: Minimal dependent atelectasis with a small left pleural effusion.\nPartially visualized heart is borderline enlarged with no 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 metallic density upper pole the left kidney, likely\nrepresenting embolization coils from prior procedure following traumatic\nkidney injury.  The left upper pole demonstrates volume loss and striated\nnephrogram as well as a rim enhancing fluid collection with subcapsular\nextension tracking inferiorly along the medial aspect of the left kidney with\nmild surrounding fat stranding.  There is no hydronephrosis.  The right kidney\nis normal in appearance.\n\nGASTROINTESTINAL: The stomach is 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: Mild prostatomegaly with prostate measuring 4.5 cm.  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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are chronic appearing fracture of the lateral left ninth and tenth ribs.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Embolization coils present in the upper pole of the left kidney with\nparenchymal volume loss, mild surrounding fat stranding, and a rim enhancing\nfluid collection with subcapsular extension.  These findings may be traumatic\nand/or postprocedural with serous collection; however superimposed infectious\nprocess cannot be entirely excluded by this study.  Recommend clinical\ncorrelation with symptoms, urinalysis, and laboratory data.  Comparison is any\nprior imaging that may be available could also be helpful.\n2. No evidence of cholecystitis, pancreatitis, or other acute abdominopelvic\nprocess.\n3. Mild left-sided pulmonary atelectasis with a small pleural effusion.\n4. Chronic appearing fractures of the left lateral ninth and tenth ribs."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusion with mildly increased adjacent\ncompressive atelectasis of the bases.  Moderate cardiomegaly.  No evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous lower attenuation relative to\nthe spleen 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: There is severe pancreatic edema, peripancreatic fat stranding and\nareas of non enhancement predominantly within the pancreatic tail consistent\nwith necrotizing pancreatitis.  The area of non enhancement of the pancreatic\ntail measures approximately 4.3 x 6.1 cm and is unchanged since ___.\n\nThere is evidence of liquefactive fat necrosis extending inferiorly along the\nanterior pararenal space, posterior cul-de-sac, and to a lesser degree along\nthe lesser curvature of the stomach and around the porta hepatis.  A slightly\norganized fluid collection is redemonstrated along the greater curvature the\nstomach and measures approximately 10.8 x 3.9 cm (6:42), stable compared to ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Sub-centimeter\nhypodensity likely representing a renal cyst.  No evidence of solid renal\nlesions or hydronephrosis.  No perinephric abnormality.\n\nGASTROINTESTINAL: There is a Dobbhoff tube extending from the partially\nvisualized distal esophagus into the stomach.  The tip of the Dobbhoff tube\nterminates within the first portion of the duodenum.  Otherwise, the stomach\nis unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is a rectal tube in situ.\n\nThere is mild sigmoid and descending colonic enhancement and wall thickening,\nmoderate of the ascending colon.  Presence of submucosal fat within the\nascending colonic wall suggests sequelae of chronic colitis. There is a short\nsegment of focal narrowing at the hepatic flexure (6:63, 8:12), but no\ndiscrete mass and likely due to spasm.\n\nPELVIS: The urinary bladder is completely decompressed with a Foley catheter\nin situ.  There is a moderate foci of air within the urinary bladder likely\nsecondary to catheterization.\n\nREPRODUCTIVE ORGANS: Prostate appears normal.\n\nLYMPH NODES: Redemonstrated 89 mm peripancreatic lymph node (6:45), reactive. \nNo retroperitoneal lymph lymphadenopathy.  No pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  No atherosclerotic disease is noted. \nThe celiac axis and branch vessels appear patent.  There is no pseudoaneurysm\nformation of the splenic artery.\n\nCompared to the CT of ___, there is similar portal vein thrombus\n(6:51-53) extending into the proximal SMV (6:56) with total occlusion of the\nsplenic vein.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia and soft tissue edema,\notherwise the abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent acute necrotizing pancreatitis predominantly involving the\npancreatic body and tail.  Liquefactive fat necrosis extending inferiorly\nalong the anterior pararenal space, into posterior cul-de-sac, and around the\nporta hepatis is unchanged.\n2. 10.8 x 3.9 cm mildly organized fluid collection along the greater curvature\nof the stomach stable in size.\n3. Similar portal vein thrombus extending into the proximal SMV with total\nocclusion of the splenic vein.\n4. Chronic colitis\n5. Similar trace bilateral pleural effusions, but mildly increased atelectasis\nof the lung bases."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with subjacent\natelectasis, similar in size compared to prior.  There is no pericardial\neffusion.\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 contains hyperdense material likely representing biliary excretion\ncontrast.\n\nPANCREAS: There is hypodensity within the pancreas, most pronounced in the\ndistal pancreatic body and tail with peripancreatic stranding and surrounding\nfree fluid consistent with necrotizing pancreatitis.  Fluid is seen along the\ngreater curvature of the stomach, with evidence of organization with a rim of\nenhancement surrounding part the collection in the left upper quadrant\nmeasuring 8.9 x 4 cm (7:22).  Free fluid is also seen tracking along the\nlesser curvature of the stomach and in the portal hila and extending\ninferiorly through the abdomen along the root of the mesentery with associated\nfascial thickening.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  An 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 solid renal lesions or hydronephrosis.  A\nsubcentimeter hypodensity in the left kidney is too small to characterize but\nlikely represents a simple cyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  A nasogastric tube terminates\nwithin the stomach.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Prominent submucosal fat is seen in the\nascending colon extending up to the hepatic flexure.  This may be secondary to\nchronic inflammation.  The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed by Foley catheter.  The distal\nureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.\n\nLYMPH NODES: A 9 mm peripancreatic lymph node is noted (5:27).  There is no\nretroperitoneal lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No calcified atherosclerotic\ndisease is noted.  The splenic artery is patent without evidence of\npseudoaneurysm.  The splenic vein and the upper portion of the SMV are\nthrombosed, thrombus is seen extending into the main portal vein (5:34).\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 necrotic pancreatitis involving the distal pancreatic body and tail\nwith thrombosis of the splenic vein and superior mesenteric vein extending\ninto the main portal vein, similar to prior.\n2. Very similar ill-defined peripancreatic fluid collections, but including\nearly a sign of of organizing rim enhancement along the collection at the\ngreater curvature of the stomach.\n3. Stable small bilateral pleural effusions."
        },
        {
            "input": "Small nodule at the base of the left lung measures 5-6 mm in width but only 1\nmm in height is doubtful in significance (6:8).  Coronary calcification is\ndetected.\n\nThere is no biliary dilatation.  Few small hypodense foci in the liver,\nlargest measuring up to 9 mm in the sixth segment, are too small to\ncharacterize, but doubtful in clinical significance.  Gallbladder is mostly\nempty and appears normal.  The pancreas is unremarkable.  Spleen is normal in\nsize and appearance.  Adrenals appear normal.  There is no evidence for\nstones, solid masses or hydronephrosis involving either kidney.\n\nThe stomach appears normal.  Fat in the wall of the terminal ileum is\nnonspecific but not suggestive of an acute process.   Sigmoid diverticulosis\nis moderate in severity.  No evidence for active inflammatory change, however.\nNo evidence of colitis.  Appendix appears normal.  Very small fat containing\numbilical hernia.\n\nProstate is moderately enlarged with central hypertrophy and fairly heavy\ncalcification.  Seminal vesicles appear normal.  Bladder is unremarkable. \nAtherosclerotic changes are moderate.  Major vascular structures are widely\npatent.  No lymph adenopathy, free air, or free Fluid.\n\nThere are no suspicious bone lesions. The L4-L5 interspace is moderately\nnarrowed.",
            "output": "No evidence of acute abnormality involving the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There is a bell-shaped thorax, better appreciated on the chest\nradiograph ___.  Mild bibasilar atelectasis.  There are aortic\nannulus and multivessel moderate coronary artery calcifications.  No\npericardial or pleural effusion.  4 mm granuloma right middle lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains numerous calcified gallstones without wall thickening or\nsurrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Punctate granuloma within the splenic parenchyma\nmay reflect prior granulomatous exposure.  An 8 mm accessory spleen is noted\nin the inferior 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.  Small bilateral\ncortical hypodensities are too small to characterize.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: A small hiatal hernia is present.  The stomach is otherwise\nunremarkable.  Small bowel loops demonstrate normal caliber and wall\nthickness. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening or fat stranding. Appendicoliths in the appendix.  No features\nof appendicitis.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not well visualized and likely surgically\nabsent.  No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  Slightly prominent/dilated vessels in the right posterior\nmediastinum (series 4, image 16) appear similar compared to prior imaging.\n\nBONES: Bone mineralization is markedly reduced.  Pagetoid changes noted in the\npelvis.  There is a partially imaged intramedullary rod with fixation screw in\nthe right femur.  Chronic right lower rib fracture.  No acute fracture or\nsuspicious lesions.\n\nSOFT TISSUES: There is a small fat-containing umbilical hernia.",
            "output": "1. No evidence of stones in the kidneys or collecting system.\n2. No hydronephrosis or perinephric abnormalities.\n3. Cholelithiasis, without signs of cholecystitis.\n4. Sigmoid diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nScattered mild atherosclerotic calcification of the abdominal aorta and its\nmain branch vessels without aneurysmal dilatation.  On the radiographic\ncoarsened study, there is no filling defect identified in the IVC or it's\nvisualized main branch vessels.\n\nLOWER CHEST: Bell-shaped thorax is again noted better appreciated on chest\nradiograph from ___.  Calcified granuloma in the right middle lobe\nimage 4 series 2.  Calcified granuloma in the lingula image 1 series 2.  Lung\nbases are otherwise clear.  Visualized heart is normal size.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in size and contour.  No focal hepatic\nlesion is identified.  No intrahepatic or extrahepatic biliary ductal\ndilatation.  Gallstones are noted.  No pericholecystic fluid or gallbladder\nwall thickening.\n\nPANCREAS: Pancreas is unremarkable.  No pancreatic ductal dilatation.\n\nSPLEEN: Calcified splenic granuloma image 8 series 2.  Small splenule noted. \nSpleen is normal in size.\n\nADRENALS: No nodules.\n\nURINARY: Kidneys are unremarkable without evidence of nephrolithiasis,\nhydronephrosis or hydroureter.  The urinary bladder is under distended,\nlimiting evaluation.\n\nGASTROINTESTINAL: Stomach is underdistended, limiting evaluation.  Small large\nbowel loops demonstrated normal wall thickness and caliber.  Scattered\ndiverticula in the distal colon.  Moderate colonic stool burden.  Normal\nappendix.\n\nRETROPERITONEUM: No free fluid or free air.\n\nPELVIS: The uterus is not well visualized and is potentially surgically\nabsent.\n\nLymph nodes: Enlarged retrocrural nodes measuring up to 13 mm short axis are\nunchanged compared to examination from ___.  No enlarged mesenteric\nor inguinal nodes are identified.\n\nBONES: Diffuse osteopenia is noted.  Pagetoid changes of the pelvis are noted.\nPartially visualized rod and screw fixation of the proximal right femur.  Old\nright lower rib fracture noted.  Stable mild endplate deformities of the\nlumbar spine noted.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Stranding and gas within\nthe anterior abdominal wall soft tissues is likely related to subcutaneous\ninjections.  Mild stranding in the lateral right gluteal soft tissues is\nlikely secondary to supine positioning..",
            "output": "1. No evidence of venous clot in the abdomen, pelvis or visualized portions of\nthe lower extremities.\n2. Stable enlarged retrocrural nodes measuring up to 13 mm short axis which\nare unchanged since ___.\n3. Additional stable findings compared to recent CT evaluation from ___ including cholelithiasis, colonic diverticulosis and pagetoid changes as\ndescribed."
        },
        {
            "input": "ABDOMEN:\n\nLung Bases: clear.\n\nHepatobiliary:  The liver demonstrates homogenous attenuation throughout.  The\nliver is of mildly decreased attenuation, as before.  There is no evidence of\nfocal lesions.  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.\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. \nA left renal cyst is seen in the upper pole which measures 2.3 cm.\n\nBowel:  Infiltration has increased about the sigmoid colon consistent with\nadvancing diverticulitis. Additionally there is an approximately 2.8 cm\nair-fluid level between the area of diverticulitis and adjacent small bowel\nhighly suspicious for an interloop abscess. There is thickening of the right\nlateral conal ligament.\n\nRetroperitoneum:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVascular:  The abdominal vasculature is normal.\n\nPELVIS:\n\nThe bladder is normal. There is no free fluid. The appendix is normal.  No\npelvic mass is identified. There is no adenopathy.\n\nMesh is again seen with an umbilical hernia repair.\n\n\nBONES AND SOFT TISSUES:\n\nNo significant osseous lesion is seen.",
            "output": "Increasing ___- sigmoid infiltration consistent with worsening diverticulitis\nwith high suspicion for a small interloop abscess. When a followup scan is\nobtained it should be performed with oral contrast."
        },
        {
            "input": "LOWER CHEST: There is trace 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Compared with ___, patient has undergone interval\npancreaticojejunostomy, with interval resolution of previously seen pancreatic\nductal dilatation.  The body in the tail the pancreas are slightly atrophic. \nNo focal pancreatic lesion.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is mildly enlarged, measuring up to 15 cm, stable.  No\nfocal 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 chronic cortical scarring in the left lower pole.  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 colon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal (05:56).\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 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.  The portal vein and SMV are patent.  There is unchanged chronic\nocclusion of the splenic vein with multiple collateral vessels.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes along the midline of the anterior\nabdominal wall.  No fluid collection.",
            "output": "1. Status post interval pancreaticojejunostomy with interval resolution\npreviously seen pancreatic ductal dilatation.  No findings to suggest acute\npancreatitis.\n2. Unchanged chronic occlusion of the splenic vein.\n3. Diverticulosis with no 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 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.  There are\nseveral hypodensities measuring up to 4 mm  near the hilum (series 2, image\n15), likely of no clinical 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: The stomach is 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 retroflexed uterus is within normal limits for age. \nThe bilateral adnexa 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 intrapelvic findings to correlate with the\npatient's symptoms.  Normal appendix.  No renal stones or hydronephrosis."
        },
        {
            "input": "LOWER CHEST: There is a new subpulmonic effusion at the right lung base, which\nmay be due to a diaphragmatic defect.\n\nABDOMEN:\n\nHEPATOBILIARY:\n\nLiver contours are nodular, consistent with cirrhosis. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The ablation zones in\nhepatic segments III and segment VIII are unchanged, without evidence of local\nrecurrence.   An arterioportal fistula adjacent to the segment VIII ablation\nzone is unchanged (4:18).\n\nIn hepatic segment V, there is an arterially enhancing lesion with washout\nthat measures 2.0 x 3.7 x 4.2 cm TV x AP x CC (4:39, 601b:52), meeting OPTN 5B\ncriteria for HCC.  This has grown from 1.6 x 2.4 x 2.6 cm in ___. \nThis lesion is bilobed in appearance, with the superior component measuring\n1.3 x 2.2 x 1.2 cm TV x AP x CC (4:34), and the inferior component measuring\n2.0 x 3.7 x 2.9 cm (4:39).\n\nMore inferiorly in segment V, there is a 1.4 x 1.3 cm arterially enhancing\nlesion with minimal washout (4:55, 5:109), not significantly changed from the\nprior study.\n\nThe gallbladder is within normal limits.  Portal venous system is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without pancreatic\nductal dilatation.  There is a 1.5 x 1.1 cm cystic lesion in the pancreatic\ntail (5:180), unchanged from the prior study.  This most likely represents an\nintraductal papillary mucinous neoplasm (IPMN).  There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is enlarged, measuring up to 16.4 cm.  No focal lesions are\nidentified.\n\nADRENALS: A 1.0 x 0.7 cm right adrenal adenoma is stable in size (2:26).  Left\nadrenal gland is normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.4 cm simple cyst arising from the lower pole of the left kidney. \nNo hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Other than\ncolonic diverticulosis, the colon and rectum are unremarkable in appearance. \nTrace nonhemorrhagic ascites.  No pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland 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.  Celiac artery is patent.  The common hepatic artery is replaced to\nthe superior mesenteric artery, both of which are patent.  Bilateral renal\narteries and inferior mesenteric artery are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes throughout the thoracolumbar spine, with\nendplate sclerosis at L4-L5.\n\nSOFT TISSUES: Nonspecific soft tissue densities in the low anterior abdominal\nwall likely represent injection sites (5:173).",
            "output": "1. Interval enlargement of a segment V lesion with arterial enhancement and\nwashout, now measuring 4.2 x 3.7 x 2.0 cm, meeting OPTN 5b criteria for HCC. \nThe lesion is bilobed in appearance, with the superior component measuring 1.3\nx 2.2 x 1.2 cm TV x AP x CC (4:34), and the inferior component measuring 2.0 x\n3.7 x 2.9 cm.\n2. A 1.4 x 1.3 cm segment V lesion with arterial enhancement and washout,\nsimilar in size to the prior study, not meeting OPTN criteria for HCC.\n3. Stable appearance of hepatic segment V and VIII ablation zones, without\nevidence of local recurrence.\n4. Sequela of portal hypertension including splenomegaly and ascites.\n5. Stable 1.0 cm right adrenal adenoma and 1.5 cm pancreatic tail IPMN.\n6. New subpulmonic effusion at the right lung base, may be due to ascites\nfluid traversing a diaphragmatic defect."
        },
        {
            "input": "This examination was imported from an outside hospital for second opinion\nread.\n\nWidespread bilateral pulmonary opacities are partially visualized,\ndemonstrating subpleural sparing (series 2, image 3).  These appear improved\non the subsequent follow-up reference study from ___.\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 appears\nnormal.  No ductal stones are seen.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen is mildly enlarged, measuring 15.5 cm (series 601, image 64). \nThere is mild heterogeneous attenuation of the spleen, which is nonspecific\n(series 2, image 19).  A 1 cm wedge-shaped hypodensity along the periphery of\nthe spleen seen on the ___ examination is no longer seen.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.\n\nThe bladder is moderately distended, appears normal.\n\nThe uterus is in mid position, and normal in size.  No concerning adnexal\nlesions are detected.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, and iliac branches are\npatent and normal in caliber.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy.\n\nModerate abdominopelvic ascites is unchanged since the ___\nexamination.  Again seen is extensive subcutaneous edema throughout the\nabdominal and pelvic walls.\n\nThere are no osseous lesions concerning for malignancy or infection. A\nsubcentimeter sclerotic focus along the right inferior pubic ramus is likely a\nbone island (series 2, image 88).  No acute fracture is detected.",
            "output": "1. Mild splenomegaly.  No focal splenic lesion.  The spleen demonstrates\nminimally heterogeneous enhancement, which is nonspecific.  This does not have\nthe appearance of an infarct, and there is no focal fluid collection.  The\npreviously-seen 1 cm wedge-shaped hypodensity along the periphery on the\nrerference ___ examination may have been a small peripheral\ninfarct, but is no longer visualized.\n2. Moderate abdominopelvic ascites.  Severe anasarca.\n3. Widespread bilateral pulmonary opacities, which could represent infection\nor hemorrhage, appears improved on the followup reference study from ___."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\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 stomach is unremarkable.  The small bowel is normal.  The large\nbowel and appendix are normal.  There is no evidence of diverticulosis.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: There is a 2.1 x 2.5 x 2.0 cm simple cyst in the right ovary likely\nreflecting a follicle. Left ovary is normal. A 2.3 cm rounded lesion appearing\nto arise from the left aspect of the uterus likely reflects an exophytic\nfibroid, with similar enhancement characteristics as that of the adjacent\nmyometrium.  There is air in the vaginal vault.  The bladder is unremarkable.\nThe rectum and sigmoid colon are within normal limits.  There is moderate free\nfluid seen within the cul-de-sac.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. No acute abnormalities seen to account for the patient's upper abdominal\npain. Normal appendix.  No diverticulosis.\n2. 2.5 cm right ovarian simple cyst likely physiologic, with moderate simple\nfluid seen in the pelvis.  If there is clinical concern for ovarian torsion, a\npelvic ultrasound could be obtained for further evaluation.\n3. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Low-density of the blood pool suggests\nanemia.  Coronary artery calcifications are noted.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, 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.  There is a 3.0 x 2.7\ncm heterogeneously enhancing lesion arising from the medial aspect of the\nupper pole of the left kidney (series 4, image 45; series 604, image 85).  The\ndegree of enhancement is less than that of the renal cortex.  There is a 1.2\ncm cyst arising from the upper pole the left kidney as well.  Additional\nhypoattenuating lesions are too small to completely characterize, but likely\nsimple cysts.  There is trace left hydronephrosis.  No obstructing lesion or\ncalculus is identified. No right hydronephrosis.\n\nGASTROINTESTINAL: There is a large hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  There\nis diverticulosis without focal wall thickening or adjacent fat stranding. \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.  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\nVASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nBONES: There is a lucent fatty lesion within the right iliac bone with a\nnarrow zone of transition, possibly dysplasia.  There is lumbar levoscoliosis.\n\nSOFT TISSUES: There is an approximately 9.5 x 8.3 x 4.0 cm right rectus sheath\nhematoma with evidence of active extravasation (series 4, image 87; series 4,\nimage 260; series 608, image 69; series 605, image 69).  Scattered foci of\nsubcutaneous fat stranding and emphysema likely reflect medication injection\nsites.",
            "output": "1. Approximately 9.5 x 8.3 x 4.0 cm right rectus sheath hematoma with evidence\nof active extravasation.\n2. A 3.0 cm heterogeneously enhancing renal mass arising from the medial\naspect of the upper pole of the left kidney is most consistent with a renal\ncell carcinoma, potentially papillary subtype.  Urology consultation is\nsuggested.\n3. Large hiatal hernia.\n4. Diverticulosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:20 pm, approximately 10\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is a 2 mm noncalcified lung nodule in the right lower lobe\non series 5 ___ 6.  This is identified on the prior study and is stable. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.2 cm hypodense lesion in the dome of the liver.  This is too\nsmall to characterize but most consistent with a cyst.  A second subcentimeter\nlesion is identified in the posterior right lobe on series 5 ___ 21.  This\nalso most likely represents a cyst.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains a stone.  There is\nno adjacent 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.  2 splenules are identified in the left upper\nquadrant on series 5 ___ 24.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is\nextensive fat stranding around the sigmoid colon such as on series 5 ___ 64. \nMultiple diverticula are noted.  There is a small fluid collection between the\nuterus and the bladder on series 5 ___ 68 measuring 2.1 x 1.6 cm.  There is\nadjacent bladder wall thickening posteriorly best seen on sagittal images\nseries 8 ___ 44.\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. Complicated diverticulitis with 2.1 cm abscess between the uterus and the\nbladder.  There is involvement of the posterior bladder wall.\n2. Cholelithiasis without evidence for cholecystitis\n3. Hypodense liver lesions are too small to characterize but most consistent\nwith cysts\n\nNOTIFICATION:  The findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:57 am, 10\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: No consolidation or pleural effusion.  The 2 mm peripheral nodule\nin the right lower lobe (image 5:9) is again seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of solid focal lesions.  A 1.2 mm hypodensity at the\ndome, likely cysts (image 5:13) and a 4.9 mm hypodensity in the caudate lobe\n(image 5:260 again seen, too small to characterize, likely cysts.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains a gallstone 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.  2 splenules are again seen the previously\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The ascending,\ntransverse and descending colon appear within normal limits.\nThere is again thickening of the wall of the sigmoid colon with multiple\ndiverticula and fat stranding extending to there vesico-uterine space where\nagain a 2.5 cm collection is seen with a large air-fluid level and a smaller\nair bubbles.  This is not changed much or minimally enlarged compared to the\nprevious examination of ___.\n\nPELVIS: There is thickening of the posterior wall of the bladder, likely\nreactive.  There is no free fluid or air in the abdomen and pelvis.\n\nREPRODUCTIVE ORGANS: There is no uterine or 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. Persistent abscess in the vesico-uterine space, associated to sigmoid\ndiverticulitis.\n\nRECOMMENDATION(S):  Because of the persistence of retro-vescical abscess, an\nattempt with percutaneous drain placement could be considered"
        },
        {
            "input": "PELVIS:  The degree of inflammatory stranding and appearance of the collection\nhave improved over multiple recent CT abdomen pelvis examinations.  There is a\nright upper gluteal approach pigtail drainage catheter in place with the tip\nin posterior rectouterine space.  The previously seen abscess in the posterior\nmid pelvis in rectouterine space has decreased in size with a small residual\nfluid collection anterior to the tip of drainage pigtail catheter noted\nmeasuring 2.1 x 2.3 x 2.6 cm (series 2, image 43).  The pigtail catheter\nappears to be at least partially within the posterior aspect of the\ncollection.  The collection appears more well-organized and no longer contains\ngas within it.  Additionally, it abuts the posterior aspect of uterus however\nno definite air seen in the uterus or vagina to suggest fistula.  No other\ncollection is seen.  Again noted is diffuse diverticulosis of the sigmoid\ncolon.\n\nThe included liver, gall bladder, right kidney and pancreas are unremarkable. \nThe left kidney is normal except for punctate low-density lesions.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSuperior endplate compression fracture deformity of L5 is unchanged.\n\nSOFT TISSUES: Small fat containing umbilical hernia is noted.",
            "output": "1. Interval decrease in size of the known pelvic collection located anterior\nto the tip of right gluteal approach pigtail drainage catheter in rectouterine\nspace abutting the posterior aspect of uterus.  The collection measures up to\n2.6 cm and appears more organized than on prior imaging.  No evidence of\nfistulous formation.\n2. Interval decrease in extent of inflammatory stranding associated with\ndiverticulitis.\n3. Stable compression fracture deformity of the superior endplate of L5."
        },
        {
            "input": "LOWER CHEST: There are new small right and trace left pleural effusions with\nassociated atelectasis.\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: Punctate low-density lesions in both kidneys are unchanged and too\nsmall to characterize.  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.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nThe degree of inflammatory stranding surrounding the sigmoid colon and rectum\nhas decreased compared to prior exam.  The previously seen drainage catheter\nterminating at the mid posterior pelvis collection is no longer present. \nThere is residual mid-posterior pelvic collection seen measuring 2.1 x 4.4 cm\n(series 2, image 64) containing air and a small amount of flui.  Extensive\nsigmoid diverticulosis is again seen\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.  No evidence of air is seen in uterus to suggest fistulous\nformation.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Superior endplate compression fracture deformity of L5, unchanged.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Interval decrease in extent of inflammatory stranding related to\ndiverticulitis.\n2. Interval removal of pelvic drainage catheter with persistent 2.1 x 4.4 cm\nposterior pelvis collection.\n3. New small right and trace left pleural effusions with associated\natelectasis."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with adjacent\natelectasis.\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 a subcentimeter hypodensity in the upper pole of the right kidney\nthat is too small to characterize, but likely represents a cyst (02:20). \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The previously\nplaced pelvic drain is in unchanged position.  The collection around the drain\nhas largely collapsed.  However, there is a small amount of the administered\nrectal contrast that extends into the perirectal collection surrounding the\npigtail catheter, consistent with ongoing leak (2:62, 2:61).  There is no\npneumoperitoneum or ascites.\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: Unchanged mild compression fracture at L5.\n\nSOFT TISSUES: There is a mildly rim enhancing fluid collection containing tiny\nlocules of gas in the right gluteus muscles that measures approximately 4.2 x\n1.7 cm (2:65).  This has newly developed since ___, and the medial\naspect of this collection appears to be in contiguity with the catheter tract,\nsuspicious for tracking along the catheter resulting in intramuscular abscess.\nThere is mild generalized body wall edema.",
            "output": "1. Administered rectal contrast is seen within the perirectal collection\nsurrounding the pigtail catheter, consistent with an ongoing leak.\n2. New 4.2 x 1.7 cm right gluteal intramuscular collection, likely an abscess\nthat has developed as a result of tracking along the pigtail catheter.\n3. Small bilateral pleural effusions.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:00 pm, 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 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. \nTiny hypodensity at the upper pole the right kidney is too small to\ncharacterize though likely a cyst.  There is no evidence of focal suspicious\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 sigmoid\ndiverticulosis.  In ___'s pouch, there is a 6.0 x 2.8 cm fecalized\napparent collection, definitively separate from the colon and felt most likely\nto be extraluminal.  However, the presence of adjacent small bowel loops\nraises the possibility that the apparent collection is a small bowel loop. \nThere is an apparent sinus tract between this collection in the gluteal\nabscess (02:57).  The 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: Mildly displaced distal right superior and inferior pubic rami and left\nsacral fractures are again seen (601:24, 27).  Superior endplate deformity of\nL5 is again noted.\n\nSOFT TISSUES: Right posterior gluteal subcutaneous tract is again seen. \nPosterolateral to the tract within the right gluteal muscles, there is a 4.9 x\n1.7 cm rim enhancing collection (2:62).  There are additional foci of air\nwithin the right gluteal muscles, new from prior.",
            "output": "1. In ___'s pouch, there is a 6.0 x 2.8 cm fecalized collection, separate\nfrom the colon and felt most likely to be extraluminal.  However, the presence\nof adjacent small bowel loops raises the possibility that the apparent\ncollection is a small bowel loop.  Given this uncertainty, a repeat CT pelvis\nwith prolonged enteric preparation is recommended for more definitive\nevaluation.\n2. Right posterior gluteal abscess measuring up to 4.9 cm.  Additional, new\nfoci of air also seen within the right posterior gluteus muscles.  There is\napparent tract between this gluteal collection and the questionable\nextraluminal collection of ___'s pouch described above."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions with compressive atelectasis in\nboth lung bases.  No pericardial effusion.\n\nABDOMEN AND 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 is decompressed, surrounded\nby mild amount of 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 and symmetric in size with normal nephrogram.\nThere is no evidence of hydronephrosis.  Small subcentimeter hypodense nodule\nin the right superior pole (02:22), too small to characterize.  There is no\nperinephric abnormality.\n\nGastrointestinal: Enteric tube with tip in the stomach body.  The stomach is\notherwise unremarkable.  Postsurgical changes of a sigmoid colectomy.  There\nis significant less bowel wall thickening as compared to prior study with\nnormal caliber of small and large bowel throughout.  There is scattered\ncolonic diverticula noted in the remaining large bowel loops with no evidence\nof diverticulitis.\n\nPelvis: The urinary bladder has an indwelling Foley catheter.  There is\nminimal 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. Moderate atherosclerotic\ndisease is noted.  The previously mentioned filling defect in a distal branch\nof the colic vein is no longer visualized (02:53).\n\nBones: Degenerative changes are seen in the lumbar spine.  The L5 compression\ndeformity and healed fracture deformities of the bilateral inferior pubic rami\nand right superior pubic ramus/pubic bone are unchanged.\n\nSoft Tissues: Further decrease in size of the soft tissue swelling in the\nright posterior gluteus (02:54), likely a resolving abscess.  Moderate\nanasarca.",
            "output": "1. Interval improvement of the suggested enteritis/colitis involving the\ndistal ileum and ascending colon.\n2. No evidence of intra-abdominal abscesses or fluid collections.\n3. No evidence of small-bowel obstruction.\n4. Moderate anasarca."
        },
        {
            "input": "LOWER CHEST: Small bilateral nonhemorrhagic pleural effusions with compressive\natelectasis, similar to prior.  Otherwise, the visualized lung fields are\nwithin normal limits.  Coronary artery calcifications.  There is no evidence\nof pericardial 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. \nSmall 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. \n5 mm nonobstructing stone seen in the left ureteropelvic junction.  No\nhydronephrosis.  Redemonstration of a subcentimeter hypodense lesion in the\ninterpolar region of the right kidney, too small to further characterize, but\nstatistically a cyst..  Symmetric bilateral perinephric stranding.\n\nGASTROINTESTINAL: There has been interval placement of a percutaneous\ngastrojejunostomy tube, with the tip coiled in jejunal loop.  There is a long\nsegment of distal ileum and ascending colon with mild wall thickening, not\nsignificantly changed compared to CT abdomen/pelvis dated ___, but\nimproved compared to CT abdomen/pelvis dated ___.  No new areas of\nbowel wall thickening, bowel obstruction, or discrete fluid collection. \nPatient is status post sigmoid colectomy.  Colostomy seen overlying the left\nlower quadrant.  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.\n\nBONES: Anterior compression deformity of the L5 vertebral body, unchanged\ncompared to prior exams.  Chronic healed bilateral inferior pubic rami\nfractures.  An additional chronic unhealed right superior pubic rami fractures\nagain seen (series 601, image 21).  There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Redemonstration of similar-appearing anasarca.  The abdominal\nand pelvic wall is within normal limits.",
            "output": "1. Similar appearing mild wall thickening of a long segment of distal ileum\nand ascending colon.  No new areas of bowel wall thickening, bowel\nobstruction, or discrete fluid collection.\n2. Small bilateral pleural effusions with compressive atelectasis, similar\ncompared to prior.\n3. A percutaneous gastrojejunostomy tube with tip coiled in a jejunal loop.\n4. Similar-appearing small volume ascites and anasarca."
        },
        {
            "input": "LOWER CHEST: There are trace bilateral pleural effusion, left greater than\nright, with subjacent lower lobe atelectasis.\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 mild periportal edema.  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.  Bilateral kidneys\ndemonstrate abnormal striated nephrogram with peripheral wedge-shaped areas of\nhypoenhancement (606; 30).  There is no evidence of solid renal lesions or\nhydronephrosis.  Subcentimeter rounded hypodensities in bilateral kidneys are\ntoo small to characterize but are statistically likely to be simple cysts. \nThere is nonspecific bilateral perinephric stranding.\n\nGASTROINTESTINAL: A GJ tube is seen in place.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The patient is\nstatus post sigmoidectomy.  The ___ pouch is unremarkable.  A left\nlower quadrant end colostomy is seen.  There is diverticulosis of the colon\nwithout evidence 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: Small hyperdense lesion in the fundus of the uterus\nlikely represents a fibroid.  No adnexal abnormality is seen.\n\nLYMPH NODES: Small retroperitoneal lymph nodes measure up to 8 mm (304; 28). \nThere are no pathologically enlarged retroperitoneal lymph nodes.  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.  There is moderate atherosclerotic narrowing at the left\nrenal ostium.  A small focus of soft plaque is seen in the left common iliac\nartery (304; 43).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nchronic L5 compression deformity is again seen.  Chronic bilateral inferior\npubic rami fractures and a chronic right superior pubic ramus fracture are\nagain seen.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Bilateral striated nephrograms are suggestive of pyelonephritis, recommend\ncorrelation with urinalysis.  The differential would also include bilateral\nrenal infarcts, however given absence of other infarcts (e.g.  spleen) this is\nconsidered less likely.\n2. Please see the separate report of the same day CT chest for intrathoracic\nfindings.\n\nRECOMMENDATION(S):  Recommend correlation with urinalysis\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:35 pm, 10\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Pacer leads are\npartially visualized in the right ventricle.  There is moderate cardiomegaly. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is suggestion of linear 0.4 cm hypodensity within the\nperiphery of segment V (02:25).  There is no adjacent hematoma.  The liver\notherwise demonstrates homogenous attenuation throughout.  No definite\nintrahepatic biliary ductal dilatation.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  Calcific density near the cystic duct\nlikely represents adjacent vascular calcifications.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is atrophic 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, without\nevidence of focal lesions.\n\nADRENALS: The bilateral adrenal glands are thickened, but without focal\nnodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSubcentimeter hypodensities within the bilateral kidneys are too small to\ncharacterize statistically likely represent cysts.  There are bilateral\nextrarenal pelvises.  There is no hydronephrosis.  There is no perinephric\nabnormality.  No periureteral stranding.\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 wall is mildly thickened throughout with potential\nasymmetric thickening of the posterior wall.  There is a small amount of\nintraluminal air.  No fluid collections are seen about the bladder, although\nthe right inferior aspect is obscured by streak artifact.  The distal ureters\nare unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus potentially contains partially calcified\nfibroids.  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.  Comminuted left\nintertrochanteric femur fracture.  Subacute, healing nondisplaced fracture of\nthe left inferior pubic ramus.  Patient is status post right total hip\narthroplasty.  No definite hardware related complications within the\nlimitations of extensive surrounding streak artifact.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Urinary bladder wall thickening is unlikely traumatic and may suggest\ncystitis.  Intraluminal bladder air is likely due to recent catheterization or\ninfection.  Clinical correlation recommended.\n2. No intraperitoneal fluid collections or free air, specifically about the\nureters or bladder, to suggest injury.  However, if there is persistent\nclinical concern, additional CT urographic or cystographic studies may be\nobtained.\n3. No definite evidence for traumatic injury of the parenchymal organs.\n4. Comminuted left intertrochanteric femur fracture.  Subacute nondisplaced\nfracture of the left inferior pubic ramus."
        },
        {
            "input": "LOWER CHEST:\nVisualized lung bases are clear. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  There is known hepatic steatosis. No focal hepatic mass lesion\nidentified. There is no intrahepatic biliary ductal dilatation.\nThe gallbladder is distended, unremarkable .\nPANCREAS: The pancreas enhances homogeneously. No pancreatic ductal dilatation\nor focal enhancing mass lesion identified.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY:  There is a 3.4 x 3.8 x 3.8 cm simple appearing cyst in the upper\npole of the left kidney. An additional 5 mm, likely simple cyst seen in the\nouter cortex of the left renal upper pole. No solid enhancing masses or\nhydronephrosis seen bilaterally.\nGASTROINTESTINAL:  There is no bowel wall thickening. Scattered colonic\ndiverticulosis without evidence of diverticulitis. No evidence of bowel\nobstruction noted.\nLYMPH NODES: There is no abdominopelvic lymphadenopathy\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is unremarkable.  The prostate is mildly enlarged and measures 5.6\nx 2.5 x 2.6 cm. Seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\nThere is a 6 mm sclerotic focus in the right inferior pubic ramus (2:73)\nlikely a bone island. There is sclerosis along the iliac aspect of the left\nsacroiliac joint without adjacent articular margin erosions. Sacroiliac joint\nspaces are maintained bilaterally. Nodes suspicious osteolytic or blastic\nlesions identified.",
            "output": "1.  No intra-abdominal or pelvic mass lesion identified. Specifically the\npancreas appears normal. There is no thickening of the gastric wall, no bowel\nwall thickening or bowel obstruction.\n2.  Scattered colonic diverticulosis without evidence of diverticulitis.\n3.  Known hepatic steatosis with no focal mass lesion in the liver."
        },
        {
            "input": "The bones are diffusely osteopenic , limiting assessment for subtle\nnondisplaced fractures or small intramedullary lesions.  The intramedullary\nspace is mildly heterogeneous likely in part due to patient's underlying\nosteopenia and heterogeneous distribution of marrow fat.  A 12 x 15 mm lucency\nin the right iliac bone just superior to the right sacroiliac joint is\nunchanged compared to the lumbar spine CT of ___ and was shown on\nthe MRI from ___ to correspond to a more prominent focus of marrow\nfat.  This lesion measures fat density on today's examination.  Focal\nsclerotic density in left superior pubic ramus is similar in appearance to a\nskeletal survey radiograph from ___ and therefore thought to\nrepresent a bone island.  Similarly, the sclerotic density in the right\nsubtrochanteric femur appears unchanged.\n\nMild degenerative changes are noted at the sacroiliac and femoroacetabular\njoints bilaterally.  No acute fracture or dislocation is detected.\n\nMuscle mass about the pelvic girdle is grossly preserved.\n\nAssessment intra pelvic soft tissue structures is limited.  Scattered\ndiverticuli are noted.  No free fluid is detected.  No enlarged iliac lymph\nnodes identified.\n\nLimited assessment of the lower lumbar spine is notable for discogenic and\nfacet degenerative changes including neural foraminal narrowing and for\nminimal retrolisthesis of L3 on L4 and degenerative changes of the facet\njoints, unchanged.  Note is made of abutment of enlarged/squared spinous\nprocesses compatible with degenerative change of the spinous processes\n(Baastrup's phenomenon).",
            "output": "Heterogeneous appearance of the intramedullary space in the setting of\npatient's osteopenia limits evaluation for subtle nondisplaced fractures or a\nsmall intramedullary lesions.  Allowing for this, no suspicious lytic or\nsclerotic osseous lesion is detected.  No displaced fracture or a lucent or\nsclerotic fracture line identified.  Focal ovoid lucency in the right iliac\nbone adjacent to the upper right SI joint is compatible with intraosseous fat.\n\nMild degenerative changes of both hips.\n\nDegenerative changes in the lower lumbar spine, not fully evaluated on this\nexamination.\n\nIf there is ongoing concern for CT-occult bone or soft tissue abnormality,\nthen MRI may help for further assessment."
        },
        {
            "input": "CHEST:\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n The liver enhances homogeneously, without concerning focal lesion.  A small\nhypodensity in the right lobe is unchanged and too small to characterize\n2:13). The gallbladder is absent. The biliary tree is normal. The pancreas is\nnormal, without focal lesion or duct dilation. The spleen is normal in size,\nwithout focal lesion. The adrenal glands are normal. The kidneys enhance\nnormally and excrete contrast briskly. There are no solid renal lesions or\nhydronephrosis. The stomach and duodenum are normal.\n\nThere is no bowel obstruction.  There is diffuse mural edema and hyperemia of\na large segment of small bowel.  There is minimal fat stranding around these\nloops in the low pelvis.  There is evidence of prior sigmoid colon resection\nwith colorectal anastomosis present.  The appendix is not seen, but there is\nno secondary signs of appendicitis.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.\n\nThe portal vein and IVC are patent.  This is a non-angiographic study. \nHowever, there is severe atherosclerotic disease with heavy calcification. \nAorta is not aneurysmal or significantly narrowed.. The SMA is markedly\ndiseased, with probable high grade stenoses.  The ___ is occluded.  There is\nlikely a significant stenosis of the left renal artery but is not optimally\nevaluated.  The right renal artery is relatively less involved.  There are\nbilateral areas of renal cortical thinning, with areas of cortical\nhypoenhancement of the left kidney reflecting the high-grade atherosclerosis\nof the left renal artery. There are \"kissing\" bilateral common iliac stents. \nThe external iliac arteries have high grade stenoses.   There is moderate\nstenosis of the bilateral common femoral arteries.  There is high grade\nstenosis of the left SFA proximally.  The right SFA is occluded.\n\nPELVIS:\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The uterus is not seen and may be\nsurgically absent. There is no adnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. No bowel obstruction.\n2. Diffuse uncomplicated enteritis involving the distal jejunum/ileum.  Given\nthe severe atherosclerotic disease detailed above, ischemic enteritis should\nbe considered as an etiology though infectious is also very possible.\n3. No other acute process in the abdomen or pelvis."
        },
        {
            "input": "Lung Bases:  The cluster of small lung nodules measuring up to 5 mm in the\nleft lung base is similar to ___.\n\nAbdomen: The liver, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber with mural calcification.  There is bi-iliac stent.  No\nlymphadenopathy, free air or free fluid is seen.  The stomach and duodenum\nappear normal.\n\nPelvis:  There is circumferential wall thickening of the colon from mid\ntransverse to sigmoid.  Surgical anastomosis is noted at the distal sigmoid. \nLoops of small bowel demonstrate no signs of ileus or obstruction. The\nappendix is not visualized.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Mild left hemicolitis. Differential includes infectious, inflammatory or\nischemic etiologies. Please correlate clinically.\n\n2. The cluster of small lung nodules in the left lung base is similar to\n___. Followup CT is recommended in 6 -12 months depending on patient's\nclinical risk for malignancy."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nThe vessels are severely calcified and contain atherosclerotic plaques. There\nis an aorto-bi-iliac stent that extends from the aortic bifurcation into the\nbilateral common iliac and the right external iliac arteries. There is marked\natherosclerotic narrowing of the infrarenal aorta. The infrarenal aorta\ncontains ulcerated plaques that appears similar compared to the prior studies\nof ___ and ___.  The lumen of the right external iliac stent is\nsignificantly narrowed with filling defect likely due to pseudointimal\nhyperplasia although it remains patent.  There is stenosis of the left\nexternal iliac artery at its origin. The left proximal common femoral and\nsuperficial femoral arteries are also severely narrowed.\n\nThe origin of the celiac artery is moderately narrowed, however, flow is seen\ndistally with mild post-stenotic dilatation. The origin of the superior\nmesenteric artery is severely narrowed by atherosclerotic plaque which extends\nthroughout the course of the vessel (602b:81). The superior mesenteric artery\nremains patent.\n\nThe inferior mesenteric artery is not identified. There are multiple upper\nabdominal collaterals. The distal large bowel is supplied by branches from a\ncollateral vessel arising from the SMA (arc of ___). The hepatic arterial\nanatomy is conventional. The renal arteries are patent. The splenic superior\nmesenteric and portal veins are patent.\n\nABDOMEN:\n\nThe visualized lung bases are clear. There is no evidence of pericardial\neffusion.\n\nThe liver is normal in appearance and without focal abnormality. The portal\nvenous system is patent. There is no evidence of intrahepatic biliary\ndilatation. Prominence of the common bile duct is unchanged. The gallbladder\nis surgically absent. The pancreas, spleen, and bilateral adrenal glands are\nnormal. The kidneys enhance symmetrically and are without suspicious solid\nmass.\n\nThe stomach is grossly unremarkable in appearance. The loops of small bowel\nare normal in caliber and without evidence of wall thickening. The large bowel\ndemonstrates diffuse wall thickening and edema to the level of the distal\nsigmoid colon. Suture material at the rectosigmoid junction denotes prior\nbowel surgery. Colonic diverticulosis is present without evidence of\ndiverticulitis. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder and rectum are grossly unremarkable. There is no pelvic side-wall\nor inguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified. A Tarlov cyst is incidentally noted.\n\nOSSEOUS STRUCTURES: A sclerotic focus in the right iliac wing is unchanged\ndating back to ___. No focal lytic or sclerotic lesion concerning\nfor malignancy.",
            "output": "1. Pancolitis may be of infectious or ischemic etiology. The latter would\nlikely be related to low flow and vascular stenosis involving both the SMA and\n___ distributions.\n2. Occluded ___ with ___ large bowel being fed by branches from a\ncollateral off the SMA (arc of Riolan).\n3. Severe ostial and non ostial narrowing of the superior mesenteric artery,\nwhich remains patent.\n4. Diffuse atherosclerotic disease involving the infrarenal aorta, common\niliac arteries, and external iliac arteries."
        },
        {
            "input": "LOWER CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings, including hazy opacity in the left lower\nlobe.\n\nCTA ABDOMEN AND PELVIS:\n\nAtherosclerotic disease involving the abdominal pelvic aorta and its branch\nvessels appears overall similar and extent and severity compared to prior\nstudies, most recently ___.  Marked intraluminal narrowing of the\ninfrarenal aorta by calcified and soft plaque with multiple ulcerations\n(03:54) is unchanged.  An indwelling bilateral iliac stents remains patent,\nhowever the lumen of the right external iliac stent is severely narrowed, as\ndescribed previously.  Less severe narrowing of the left external iliac stents\nextends throughout the length of the stent.  Narrowing of the bilateral\nproximal common femoral arteries is similar compared to the prior study.\n\nCalcified plaque at the level of the celiac axis origin contributes to\nmoderate to severe narrowing, however minimal poststenotic dilation and distal\nvessel patency persist.  Moderate to severe narrowing of the superior\nmesenteric artery ostium and there is an approximately 3cm length severely\nnarrowed segment beginning approximately 2.4cm from the ___ origin is\n(___:70).  The inferior mesenteric artery is not visualized.  Collateral\nbranches arising from the distal SMA supply the descending colon and sigmoid. \nThe hepatic arterial supply is conventional.  Renal arteries remain patent, as\ndo the superior mesenteric, splenic, and portal veins.\n\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  A subcentimeter hepatic hypodensity in the subcapsular\nanterior segment VII (3j:97) is unchanged.  No new enhancing or concerning\nhepatic lesions are identified.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent. \nProminent common bile duct is expected post cholecystectomy.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.  The pancreas is somewhat truncated in morphology, unchanged.\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: Bilateral renal hypodensities are again noted, compatible with cysts.\nOtherwise, the kidneys enhance symmetrically, with no evidence of solid\nenhancing lesions or hydronephrosis bilaterally.\nGASTROINTESTINAL:  The stomach, duodenum, and intra-abdominal loops of small\nand large bowel are normal in course and caliber with no evidence of wall\nthickening or obstruction.  The previously described pan colonic wall\nthickening has resolved since the prior study from ___.  Suture\nmaterial at the rectosigmoid junction at the site of prior anastomosis is\nagain noted.  Mild colonic diverticulosis is noted, with no evidence of\ndiverticulitis..\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\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\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Severe atherosclerotic disease burden throughout the abdominopelvic aorta\nand major branch vessels, as described above, with non-visualization of the\ninferior mesenteric artery.  Distal colonic supply provided by SMA collateral\nvessels.\n2. Bilateral iliac stents remain patent, however moderate to severe\nintraluminal narrowing persists.\n3. Mild diverticulosis with no diverticulitis."
        },
        {
            "input": "LOWER CHEST: A 6 mm subpleural nodule in the right lower lobe is not\nsignificantly changed.  There is trace atelectasis in the lingula and in the\nleft lower lobe. No pleural effusion.  There are mitral annular\ncalcifications.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is unchanged mild central\nintrahepatic biliary duct dilatation.  Common bile duct measures 10 mm,\nstable.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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.  Left kidney as normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Contrast administered\norally passed into the colon without obstruction.  There is unchanged\nconfiguration of the proximal small bowel with apparent narrowing at the\nduodenal sweep without extrinsic compression, possibly due to slight posterior\ndisplacement of the duodenum in the setting of prior right nephrectomy\n(03:23).  A small air and fluid-filled duodenal diverticulum is noted (02:32).\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Patient is status post partial colectomy.  The remaining 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 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: Patient is status post posterior fusion and laminectomy from L4-L5 with\nunchanged mild to moderate anterolisthesis of L4 on L5.  Multilevel\ndegenerative changes throughout the remainder of the lower thoracic and lumbar\nspine are not significantly changed.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: A sacral nerve stimulator device is present in the right\nposterior soft tissues and courses through the left sacrum to terminate in the\nleft presacral tissues.",
            "output": "1. There is unchanged configuration of the proximal small bowel with apparent\nnarrowing of the duodenal sweep, possibly due to the duodenum being slightly\nposterior displaced in the setting of prior right nephrectomy.  No extrinsic\ncompressing mass or evidence of obstruction.\n2. A 6 mm subpleural nodule in the right lower lobe is stable compared with\n___.  See recommendations below.\n\nRECOMMENDATION(S):   For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "LOWER CHEST: The lung bases are clear.  Trace bilateral pleural effusions\nnoted.  Trace pericardial effusion seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse decreased attenuation of the hepatic\nparenchyma with focal fat sparing around the porta hepatis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 atrophic.  There is a new transplant kidney in\nthe right lower quadrant.  Stranding of fat is seen surrounding the\ntransplanted kidney.  There is trace free fluid surrounding the kidney without\na large loculated collection or a large hematoma.\nA ureteral stent is seen extending from the transplant kidney pelvis to the\nbladder.  Small locules of air in the right lower quadrant and subcutaneous\ntissues are related to the recent procedure.\n\nGASTROINTESTINAL: There is no bowel obstruction.  Mild bowel wall thickening\nin the cecum is likely related to the recent procedure.\n\nPELVIS: The urinary bladder is minimally distended and unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear 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 small amount of subcutaneous air in the right lower\nquadrant along with stranding of fat.  Trace fluid is seen in the subcutaneous\ntissues along the surgical clips.  There is no large loculated fluid\ncollection within the subcutaneous tissues.",
            "output": "1. Right lower quadrant transplant kidney demonstrates no hydronephrosis and\npresence of a stent extending from the transplant renal pelvis to the urinary\nbladder.  There is trace free fluid surrounding the transplant kidney with no\nlarge fluid collection within the right lower quadrant or in the overlying\nsubcutaneous tissues.  No large hematoma noted.\n2. Postsurgical changes in the right lower quadrant in the form of\nsubcutaneous air and trace fluid in the subcutaneous tissues beneath the skin\nsutures noted."
        },
        {
            "input": "LOWER CHEST: There few scattered small calcified pleural plaques along the\nleft lung base (2:1 and 5).  There is minimal bilateral dependent atelectasis.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n1.3 cm peripheral hypodensity within segment ___ (02:12) likely represents a\ncyst, biliary hamartoma, or ciliated hepatic foregut cyst.  There is no\nevidence of intrahepatic biliary dilatation.  The CBD is mildly dilated,\nmeasuring up to 9 mm.  The gallbladder is within normal limits.\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 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 native kidneys are severely atrophic bilaterally.  The native\nrenal vessels are largely calcified.\n\nThe right iliac fossa transplant kidney is severely atrophic.  A 1 cm\nhypodensity in the interpolar region is compatible with simple cyst, as seen\non the ultrasound from ___.  A calcification is seen along the renal\ntransplant vein near the iliac anastomosis.  There are no renal parenchymal or\nureteral stones.\n\nThe left iliac fossa transplant kidney is normal in size, with focal scarring\nof the lower pole.  A 5 mm nonobstructing stone is seen in the lower pole. \nThere is subcentimeter hypodensity in the interpolar region which is\nindeterminate (2:63), likely a cyst, though not definitively seen on prior\nultrasounds.  There is trace perinephric stranding which is nonspecific.\n\nGASTROINTESTINAL: Small bowel loops are normal in caliber.  There is\npancolonic diverticulosis, without evidence of wall thickening and fat\nstranding. The appendix is not seen.\n\nThere is hazy attenuation of the mesentery with prominent lymph nodes\nmeasuring up to 6 mm in short axis within the left upper quadrant (02:35),\nsuggestive of mesenteric panniculitis.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Prominent mesenteric nodes in the left upper quadrant measure up\nto 6 mm in short axis (02:34), not pathologically enlarged by CT size\ncriteria.  There is no retroperitoneal 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. \nThere are mild degenerative changes of the visualized spine and bilateral\nhips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 5 mm nonobstructing stone within the lower pole of the left iliac fossa\ntransplant kidney.  No hydronephrosis.\n2. No source of infection identified in the abdomen or pelvis, within\nlimitations of a noncontrast study.\n3. Mildly dilated common bile duct measuring up to 9 mm.  Correlation with\nLFTs recommended.\n4. Mild mesenteric panniculitis in the left upper quadrant.\n5. Small calcified pleural plaques in the left lung base."
        },
        {
            "input": "ABDOMEN:\n\nA small left pleural effusion is again identified, unchanged in size. Enlarged\nright axillary lymph nodes are partially visualized. The lung bases are\notherwise clear. Please refer to the CT chest report from the same day for\ncomplete details on thoracic findings.\n\nThe liver demonstrates homogeneous enhancement, with no focal lesions\nidentified. The gallbladder, pancreas and adrenal glands are unremarkable. The\nspleen is mildly enlarged measuring 13.8 cm (04:53). Multiple tiny\nsubcentimeter hypodense lesion identified in both kidneys, too small to\ncharacterize, however likely related to simple cysts. Multiple peripelvic\ncysts are identified bilaterally. No hydronephrosis. No ascites. A small\nhiatal hernia is identified. Stomach is unremarkable. Caliber of small and\nlarge bowel is within normal limits. The portal vein is patent. Abdominal\naorta is normal in caliber. Mild atherosclerotic calcifications of the\ninfrarenal abdominal aorta is noted. Innumerable enlarged retroperitoneal\nlymph nodes are identified, similar in extent, however demonstrating slight\ndecrease in size overall. An enlarged right retroperitoneal lymph node (4:73),\nmeasures 4.2 x 3.7 cm, previously measuring 4.2 x 4.0 cm. Multiple enlarged\nmesenteric nodes also demonstrate overall mild interval decrease in size.\n\nPELVIS:\n\nModerately distended urinary bladder is unremarkable. Prostate gland\ndemonstrates dystrophic central gland calcifications the likely in keeping\nwith BPH. Rectum is unremarkable. Moderate colonic diverticulosis is noted,\nhowever no evidence of diverticulitis. No pelvic free fluid. Bilateral fat\ncontaining inguinal hernias are noted, right larger than left. Multiple\nbilateral enlarged inguinal lymph nodes are identified, and demonstrating\ninterval decrease in size overall, largest measuring 3.6 x 1.6 cm (4:112),\npreviously measuring 4.4 x 2.9 cm. Multiple bilateral enlarged pelvic side\nwall and external iliac lymph nodes also demonstrated mild overall decrease in\nsize. Multiple perirectal and internal iliac chain lymph nodes also\ndemonstrate overall decrease in size. Innumerable enlarged lymph nodes are\nidentified in the sigmoid mesocolon, demonstrating mild decrease in size\noverall.\n\nOSSEOUS STRUCTURES:\n\nMild to moderate multilevel degenerative changes of the spine are evident. No\nsuspicious focal osteolytic or osteoblastic lesions are seen.",
            "output": "1. Extensive lymphadenopathy throughout the abdomen and pelvis compatible with\nprovided history of CLL, demonstrating overall interval decrease in size\nsuggestive of treatment response.\n2. Persistent small left pleural effusion. Please refer to the CT chest from\nthe same day for complete details on thoracic findings.\n3. Stable persistent mild splenomegaly.\n4. Stable tiny hypodense lesions in both kidneys, likely cysts. Multiple\nbilateral peripelvic cysts.\n5. Moderate colonic diverticulosis. Bilateral fat containing inguinal hernias,\nright larger than left."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nLIVER:  1.9 x 2.2, irregular and ill-defined low-density area within the left\nlobe of the liver adjacent to the gallbladder fossa is likely an area of focal\nfat.  An additional subcentimeter hypodense area adjacent the falciform\nligament is too small to characterize but also likely represents focal fat. \nThe liver is otherwise normal in size and attenuation.  The hepatic and portal\nveins appear patent.  There is no intra or extrahepatic biliary ductal\ndilatation.\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 stomach is within normal limits.  The small bowel is normal in\ncaliber.  The large bowel is within normal limits.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta.  The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: The appendix is dilated up to 2.1 cm and shows submucosal hyperemia. \nThere is indistinctness of the tip of the appendix, suggesting rupture.  There\nis a 6.1 x 4.9 x 5.2 cm heterogeneous, low-density collection adjacent to the\ninflamed appendix centered in the right adnexa concerning for a\nperiappendiceal abscess.  A 4 mm calcified density is seen at the tip of the\nappendix and may represent a small appendicolith.  The rectum and sigmoid\ncolon are within normal limits.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: No suspicious osseous lesions are\nidentified.",
            "output": "1. Acute appendicitis with 6.1 cm abscess in the region of the right adnexa\nadjacent to the tip of the appendix.  In combination with the findings seen on\nultrasound, this raises the possibility of the appendiceal tip having ruptured\ninto the right Fallopian tube.\n\nNOTIFICATION:   These findings were discussed with Dr. ___\ntelephone at 12:00 on ___ by Dr. ___."
        },
        {
            "input": "LOWER CHEST: Diffuse airspace opacification in 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 or\nextrahepatic biliary dilatation.  The gallbladder is distended.  There is no\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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are postsurgical changes from partial left nephrectomy with\nmultiple surgical clips.  The right kidney is normal size.  There is no\nevidence of focal renal lesions. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is enteric tube with its tip in the stomach.  The\nstomach is otherwise unremarkable.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The transverse,\ndescending, sigmoid colon and rectum are filled with fluid.  There is mild\ndiverticulosis without diverticulitis.  There is a rectal tube in place.  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 fundal fibroid measuring 2 cm in diameter. \nThe 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 transverse, descending, sigmoid colon and rectum are filled with fluid,\nrepresenting colitis/diarrhea.  No marked mucosal thickening.  No colonic\ndistention to suggest toxic megacolon.  No evidence of perforation.\n2. Airspace opacification bilateral lower lung zone suggest multifocal\npneumonia.\n3. Fibroid uterus.\n4. 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 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.  There are multiple fluid\nfilled small bowel loops which are prominent measuring up 2.9 cm, but not\ndilated.  There is passage of contrast throughout the small bowel and into the\nJ-pouch.  The anastomoses appear patent.  Patient is status post colectomy.\n\nPELVIS: The urinary bladder is decompressed but unremarkable.  There is trace\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Several prominent retroperitoneal lymph nodes measure up to 6 mm\nwhich is not 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": "1. Status post colectomy and J-pouch ileoanal anastomosis.  No evidence of\nobstruction.  PO contrast is seen filling the J-pouch.\n2. No acute process within the abdomen or pelvis 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: There is hypoenhancement of the liver, which may be due to\ncontrast timing.  There is no evidence of focal 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. The appendix 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 grossly within\nnormal limits for age.  A vaginal pessary is in place.  There is moderate\ndilatation of the left-sided ovarian and uterine veins with a prominent left\novarian vein measuring 8mm in diameter.\n\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 dilatation of the left-sided ovarian and uterine veins with a\nprominent left ovarian vein.  Findings suggest pelvic vascular congestion.\n2. No bowel obstruction.  No free fluid.  No free air.  The appendix and\ngallbladder are normal.\n3. Hypoenhancement of the liver raises possibility of hepatic steatosis\nsteatosis\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: 3 mm subpleural nodules in the left lung base are new compared to\n___ (2:9, 11).  No pleural effusion 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 left-sided hydronephrosis with an obstructing 2 mm proximal left ureteral\nstone (02:38).  No right-sided hydronephrosis or nephrolithiasis.\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: The uterus and bilateral adnexae are grossly 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 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 hydronephrosis with obstructing 2 mm proximal left ureteral\nstone.\n2. 3 mm left lower lobe pulmonary nodules are new compared to ___. \nPlease refer to ___ criteria below for follow-up recommendations.\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": "CHEST: Left breast implant is partially imaged. The visualized lung bases are\nclear. There is no pleural or pericardial effusion. The heart is normal in\nsize.\n\nABDOMEN:\nThe liver is normal in attenuation with mild central intrahepatic biliary\nprominence, unchanged since ___. The patient is status post\ncholecystectomy with prominence of the common bile duct, expected.  The\npancreas is normal with no peripancreatic stranding. Spleen is homogeneous in\nattenuation with no lesions. The adrenal glands are normal bilaterally. The\nkidneys enhance symmetrically with no hydronephrosis or focal lesions.\n\nThe patient is status post gastric bypass with unremarkable appearance of the\nremnant stomach and gastric jejunal anastomosis. Loops of small bowel are\nnormal in caliber. The appendix, cecum, and transverse colon are normal.\nMultiple sigmoid diverticula are seen, without evidence of diverticulitis.\nMinimal stranding adjacent to distal sigmoid diverticula are unchanged in\nappearance to ___. There is no mesenteric free air or free fluid. Mild\nmesenteric lymphadenopathy is stable since ___.\n\nPELVIS: The urinary bladder is normal. The uterus and adnexae are\nunremarkable.  There is no pelvic free fluid or lymphadenopathy. The rectum\nand sigmoid are normal in caliber.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Sigmoid diverticulosis without diverticulitis.\n2.  Status post cholecystectomy with mild central intrahepatic biliary\nprominence, unchanged since ___\n3.  Normal appendix.\n4.  Status post gastric bypass with no 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 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\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.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction.  Diverticula are seen in the sigmoid with wall\nthickening, likely due to muscular hypertrophy. Appendix contains air, has\nnormal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. A 9 mm porta hepatic lymph node is nonspecific.\nThere is no free fluid and no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is mild calcium burden\nin the abdominal aorta and great abdominal arteries. The main portal vein,\nsplenic vein and SMV are patent.\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. Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Degenerative change is noted in the lumbar spine with multilevel\nvacuum phenomenon and mild retrolisthesis of L5 on S1, L4 on L5, and L3 on L4.\nAbdominal and pelvic wall is within normal limits. A 2.6 cm cystic lesion in\nthe left anterior proximal thigh is noted (5:129).",
            "output": "No evidence of malignancy in the abdomen or pelvis."
        },
        {
            "input": "Soft tissues: The visualized loops of large and small bowel are unremarkable\nwithout evidence of obstruction.  The great vessels of the pelvis are\nunremarkable without significant atherosclerotic disease.  The bladder and\ndistal ureters are unremarkable.  The pelvic wall is within normal limits a\nsmall fat containing umbilical hernia.\n\nOsseous structures: There is complete sacralization of the L5 vertebral body\n(400:62).  A well corticated ossific density at the left lesser trochanter may\nrepresent enthesopathic changes or an unfused apophysis, although there is no\nsimilar apophysis on the right (2:84).  There are no degenerative changes of\neither hips or of the lumbar spine.  Femoral head neck offset is normal. \nMuscle bulk is normal.  There is no acute fracture or dislocation.  Multilevel\nmild concentric disc bulges combine with ligamentum flavum hypertrophy cause\nmild-to-moderate spinal canal stenosis (401:81).",
            "output": "1. No evidence of acute fracture or avascular necrosis of either hip.  MRI is\neven more sensitive for detecting these entities.\n2. Well corticated ossific density at the left lesser trochanter, potentially\nan asymmetric unfused apophysis or adhesive pathic changes.\n3. Mild to moderate spinal canal stenosis at L3-L4 and L4-L5 due to concentric\ndisc bulging and hypertrophy of the ligamentum flavum.\n4. Complete sacralization of the L5 vertebral body."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:Expected postsurgical changes related to hepatic transplant on ___.  Again seen is a nonenhancing subcapsular collection at the\nhepatic dome causing mild mass effect on the adjacent hepatic parenchyma\nmeasuring 4.8 x 2.2 cm (04:13) (previously 4.8 x 1.8 cm).  Enhancement of the\nadjacent liver parenchyma on arterial phase imaging is again noted and is\ncompatible with transient arterial attenuation since this fades out to liver\nparenchyma on 3 min delay.  A new 0.8 x 0.7 cm arterially enhancing lesion\nwithin segment 4a as well as a 1.0 x 0.4 cm area of mild arterial enhancement\nin segment 4 at inferior site of patient's prior RFA treatment site\ndemonstrated fade out to liver parenchyma on delayed imaging (4:16; 4: 2;\n6:99; 08:19) and are most consistent with transient hepatic arterial\nattention.\n\nNo additional focal lesions seen. The portal venous system is patent. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.) The\ngallbladder is surgically absent with a 2.0 x 1.2 cm (04:40) hypodense fluid\ncollection within the gallbladder fossa similar to previous examination where\nit measured 2.1 x 1.1 cm.\n\nThe spleen is enlarged and right adrenal gland is unremarkable.  Left adrenal\ngland not seen.   The pancreas enhances homogenously and is without focal\nlesions.\n\nThe kidneys display symmetric nephrograms. There are no focal renal lesions.\nThere is no hydronephrosis. The proximal ureters are normal in caliber.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance.  The visualized small and large bowel are within\nnormal limits without mucosal hyperenhancement, fat stranding, or focal mass\nlesion.  Diverticulosis seen without diverticulitis.  The appendix is normal\nwithout evidence of acute appendicitis. No retroperitoneal or mesenteric lymph\nnodes enlargement by CT size criteria.  No pneumoperitoneum or free fluid.\n\nOsseous structures: Multilevel degenerative disease is seen throughout the\nthoracolumbar spine. No additional focal lytic or blastic lesions concerning\nfor malignancy. Schmorl's node is noted at a mid thoracic vertebral body along\nits inferior endplate.\n\nPELVIS: The bladder is partially distended and within normal limits. No pelvic\nsidewall or inguinal lymph enlarged. No free fluid. The prostate and seminal\nvesicles are unremarkable.\n\nCTA: The abdominal aorta and its major branches are patent .  The celiac\nartery, SMA, ___, renal arteries are patent. An accessory left renal artery is\nnoted. Hepatic anatomy is conventional. Small amount of calcified\natherosclerotic disease is noted throughout the abdominal aorta. Hepatic veins\nand IVC are patent. The IVC anastomosis is intact. The portal venous\nanastomosis and common hepatic artery anastomoses are intact.",
            "output": "1.  Small areas of arterial hyperenhancement within segment 4 which fades out\nto normal hepatic parenchyma, is most consistent with transient hepatic\nattenuation differences.  No evidence of recurrent hepatocellular carcinoma.\n2.  Expected surgical changes related to hepatic transplant with widely patent\nportal vein, IVC, and hepatic artery anastomosis.\n3.  Stable small collections in gallbladder fossa and hepatic dome compatible\nwith chronic postsurgical seromas."
        },
        {
            "input": "LOWER CHEST:  Please see separately submitted report of Chest CT for full\ndescription of the lungs.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. A small fluid collection at the dome of the liver\nadjacent to segment VII is unchanged from the prior study, likely a stable\npostoperative seroma.  Changes related to the prior liver transplant are\nstable with widely patent IVC as well as widely patent portal and hepatic\nveins. The gallbladder surgically absent.\n\nSPLEEN: The spleen measures up to 14.1 cm, minimally changed from the prior\nstudy.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\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: The stomach is mildly distended without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction. A normal appendix is visualized. There\nis colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with scattered\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS:   The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nSOFT TISSUES: Aside from a postsurgical abdominal wall defect without\nsignificant herniation, the soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES:   No focal lesion suspicious for malignancy present.",
            "output": "1. No evidence of recurrent hepatocellular carcinoma.\n2. Stable postsurgical changes related to hepatic transplant with widely\npatent anastomoses, and a stable postoperative seroma."
        },
        {
            "input": "LOWER CHEST: 3 mm pulmonary nodule (6:57) unchanged compared to the exam from\n3 months ago.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nIll-defined 1.3 x 1.4 cm segment 3 hypodense lesion (6:95) is similar in size\ncompared to the exam from 3 months ago and has significantly decreased in size\ncompared to the MRI from ___ when it measures 2.8 x 2.6 cm.\nInterval exchange of biliary drain for a metallic stent with predominantly\nleft hepatic pneumobilia, similar compared to the prior.  Gallbladder contains\ngallstones, unchanged.\n\nPANCREAS: Ill-defined hypoattenuating lesion in the uncinate process measures\napproximately 7 x 9 mm (6:111) similar compared to the prior exam.  The lesion\ndoes not contact any vessels.  The main 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. \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. 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 gland is not enlarged.\n\nLYMPH NODES: 2 prominent porta hepatis nodes (6:101, 100) measuring up to 1.4\ncm in short diameter, not significantly changed compared to the prior exam. \nStable subcentimeter prominent retroperitoneal and pelvic lymph nodes.  No\nmesenteric lymphadenopathy.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nDegenerative changes of the thoracolumbar spine.",
            "output": "1. No significant interval change compared to ___ of poorly\nvisualized subcentimeter lesion in the pancreatic uncinate process, prominent\nporta hepatis lymph nodes and ill-defined segment 3 lesion.\n2. CBD stent in place.\n3. Please see separately dictated chest CT for full description of the\nintrathoracic findings."
        },
        {
            "input": "Lack of IV contrast, given renal failure, limits assessment of the solid\nabdominal organs.\n\nLOWER CHEST: There is bibasal atelectasis, with suspected overlying\naspiration/pneumonia in the left lower lobe.  Interventricular septum\nspontaneously hyperdense, may relate to anemic states.\n\nABDOMEN: There are few pockets of gas/pneumoperitoneum, interposed between the\nleft lobe of the liver and hemidiaphragms, and tracking along the falciform\nligament.  Given recent peritoneal dialysis catheter exchange, this may relate\nto recent intervention, and there is no definite perforated viscus.  No\ndrainable Fluid collections.\n\nHEPATOBILIARY: A 0.5 cm hypodensity at the liver dome (02:12) is not changed\nsince ___ and is indeterminate but may represent a cyst or biliary\nhamartoma.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: The spleen is normal in size.  2.3 and 0.8 cm hypodensities within the\nspleen are indeterminate on this unenhanced study, but appears similar to the\nstudy performed ___ and have minimally increased in size since\nthe study of ___, could represent a congenital or posttraumatic\ncyst.\n\nADRENALS: Adrenal hypertrophy.\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.  Other than a moderate amount of\nstool throughout the colon, the colon and rectum are within normal limits. The\nappendix is surgically absent.\n\nPELVIS: Mild apparent diffuse bladder wall thickening is likely due to\nunderdistention.  There is trace pelvic free fluid relating to peritoneal\ndialysis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality.\n\nLYMPH NODES: Prominent nodes about the left mesentery are nonspecific but\nappear grossly similar to prior and may be reactive.  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.\n\nSOFT TISSUES: Percutaneous peritoneal dialysis catheter traversing the left\nlower quadrant courses into the anterior pelvis.",
            "output": "1. Suspect aspiration/pneumonia in the left lower lobe.\n2. Recent peritoneal catheter exchange, with a small amount of free-fluid and\npneumoperitoneum, likely related to recent procedure.  No definite perforated\nviscus, or organizing Fluid collection, for close clinical follow-up.\n3. Apparent bladder wall thickening is likely due to underdistention. \nCorrelation with urinalysis is recommended.\n\nNOTIFICATION:  Item 2 discussed with Dr. ___ by ___, M.D. on\n___ at 4:18 pm, 2 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 previous described hypodensity at the liver dome is not\nseen on the current study.The liver demonstrates homogeneous attenuation\nthroughout.  There is no evidence of new focal lesions within the limitations\nof an unenhanced scan.  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: Indeterminate 2.3 and 0.9 cm splenic hypodensities appears similar to\nthe prior study and have minimally increased in size since ___,\npossibly congenital or posttraumatic cysts.  The spleen otherwise shows normal\nsize and attenuation throughout.\n\nADRENALS: The right and left adrenal glands are mildly thickened without focal\nnodularity.\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 hyperdensity within the left renal pelvis (02:22)\nlikely represents vascular calcification.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The distal esophagus appears mildly thickened which could\nsuggest esophagitis.  The stomach is unremarkable.  Small bowel loops\ndemonstrate normal caliber and wall thickness throughout.  There is a small\namount of stool throughout the colon, less so than prior.  The colon and\nrectum are within normal limits. The appendix is surgically absent.  There has\nbeen interval increase in small volume pneumoperitoneum, presumably related to\nperitoneal dialysis.  Additionally, there has been interval increase in\nmoderate volume ascites.\n\nPELVIS: Apparent wall thickening may be related to bladder underdistention. \nThe distal ureters are unremarkable.  There is moderate volume pelvic free\nfluid related to ascites.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality.\n\nLYMPH NODES: Prominent nodes about the left mesentery are not pathologically\nenlarged per CT size criteria and are nonspecific, but appears similar to\nprior and may be reactive.  Otherwise, 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: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative disc disease at L5-S1 with a Schmorl's node in the inferior\nplate of L5.\n\nSOFT TISSUES: Percutaneous peritoneal dialysis catheter traverses the left\nlower quadrant into the anterior pelvis.",
            "output": "1. No evidence of bowel obstruction.  Mild stool burden, improved from prior.\n2. Interval increase in moderate volume ascites.\n3. Interval increase in moderate pneumoperitoneum, presumably related to\nperitoneal dialysis catheterization.  No definite evidence for perforated\nviscus or organizing fluid collection on noncontrast CT."
        },
        {
            "input": "LOWER CHEST: 5 mm left lower lobe nodule (series 2, image 3).  Suggestion of\nnodularity at the right lung base (series 2, image 8) is nonspecific, and may\nbe due to atelectasis.  There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates wedge shaped early hyperenhancement\nthroughout the periphery of the liver, which appears similar to the prior CTA\nas well as the outside MR likely represents transient early enhancement. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.  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 left adrenal gland is normal.  The right adrenal gland\ndemonstrates some mild thickening and high-density material as seen on the\nprior study.\n\nURINARY: There is a 2.9 cm simple right renal cyst.  Multiple areas of\ncortical scarring in the right kidney are unchanged.  Additional 3.0 cm\nintermediate density left renal cyst is unchanged in size from the prior study\nfrom ___, and previously characterized as a metanephric adenoma on prior\nbiopsy.  Multiple bilateral stones are demonstrated within the collecting\nsystem, measuring up to 1.0 cm on the right (series 2 image 25, 28, 31, 35). \nNo hydronephrosis.\n\nGASTROINTESTINAL: Stomach is collapsed.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\ntransverse, descending and sigmoid colon is seen, 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 grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: While the study was not timed for evaluation of intra-abdominal and\npelvic vasculature, there are no filling defects and the large caliber\nintra-abdominopelvic arterial and vascular vessels are without high-grade\nstenosis or occlusion.  The IVC is patent.  There is moderate atherosclerotic\ndisease throughout the abdominal aorta.\n\nBONES: There 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.  No substantial interval change from the\nprior CTA from ___.  No abdominopelvic masses.  No high-grade\nstenosis or occlusion of the abdominopelvic vasculature.\n2. Cholelithiasis without cholecystitis.  Gallbladder somewhat distended, but\nwithout wall thickening or pericholecystic fluid/inflammation.\n3. Bilateral nonobstructing renal calculi measuring to 1.0 cm.\n4. 5 mm left lower lobe nodule.  Please see ___ recommendations below.\n5. 3.0 cm biopsy confirmed metanephric adenoma in the left kidney.\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 recommend 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: Visualized lung 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: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The descending sigmoid colon are\ncollapsed, and therefore cannot be totally assessed.  The colon and rectum are\notherwise within normal limits.  The appendix is normal.\n\nPELVIS: The urinary bladder is distended.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.  Incidental scleral\ncalcifications noted.\n\nLYMPH NODES: Notably, there is haziness of the central mesentery (601:19),\nwith multiple scratch prominent mesenteric lymph nodes, measuring up to 10 mm\nin short axis (2:24).  There is a fat halo surrounding several of these\nmesenteric nodes (2:27).  There is no retroperitoneal 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.  Central mesenteric haziness and fat stranding with associated prominent\nmesenteric lymph nodes, as can be seen in mesenteric panniculitis.\n\n2.  Collapsed descending and sigmoid colon, making the evaluation suboptimal. \nNo definite bowel wall thickening.  No pericolonic fat stranding seen.\n\n3.  Normal appendix."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac trunk is angled\ninferiorly, but widely patent.  The renal arteries are widely patent.  There\nis conventional hepatic arterial anatomy.\n\nLOWER CHEST: Lungs are clear.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Hypodense lesions in the dome of the liver are too small to\ncompletely characterize, but stable since ___, likely representing\nbiliary hamartomas.  The liver otherwise demonstrates homogenous attenuation\nthroughout.  A small amount of pneumobilia is similar in comparison to ___, likely due to a prior sphincterotomy.  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 is not visualized.  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: The uterus is anteverted.\n\nBONES: There 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 celiac artery stenosis.  Specifically, no CTA evidence for median\narcuate ligament syndrome.\n2. Stable pneumobilia without intrahepatic bile duct dilation, reflecting\nprior 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 liver demonstrates homogeneous attenuation.  There are 2\nhypodense lesions, too small to characterize in the left hepatic lobe, likely\nhamartomas or cysts.  There is redemonstration of a nonspecific hypodensity\nwithin hepatic segment VII, that appears slightly increased in size compared\nto CT of the abdomen from ___, likely represents a hemangioma.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains a gallstone 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.  There is a round\nhypodense lesion within the upper pole of the right kidney measuring 1.9 x 1.8\ncm, with adjacent fat stranding and a higher ___ count than would be expected\nfor simple cyst, therefore, concerning for a superinfected cyst in the\npatient's clinical setting.  There is no evidence of solid 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.  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. Round hypodense lesion within the upper pole of the right kidney, with\nadjacent fat stranding, concerning for a superinfected cyst.  No evidence of\nrenal obstruction.\n2. Cholelithiasis without signs of cholecystitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:14 pm, minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: 4 mm subpleural nodule in the left lower is decreased in density\ncompared to prior.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhepatic segment VII non-specific hypodensity is better appreciated on the CT\nfrom ___ and likely represents a hemangioma (2:11).  A hepatic\nsegment IV 1.2 cm hypodensity adjacent to the falciform ligament is stable\nfrom ___ and consistent with a perfusional defect (2:25).  Multiple\nsubcentimeter hypodense lesions within the liver are too small to characterize\nbut likely represent cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder neck\ncontains a gallstone without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesion. There is no peripancreatic stranding.The pancreatic duct\nmeasures at the upper limits of normal.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  A 4 mm\nsplenic hypodensity is unchanged and most likely benign.\n\nADRENALS: The 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 right upper pole renal hypodensity is decreased in size with\ndecreased perinephric stranding when compared to the prior study (2:21).  The\npreviously seen left midpole  cortical hypodensity is faintly seen but\nimproved. Additional hypoattenuating renal lesions are too small to completely\ncharacterize, but statistically likely reflect simple cysts.\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.\n\nPELVIS: There is mild thickening of the urinary bladder which could be related\nto under distention.  The distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL5 loss of vertebral body height is unchanged from ___.\n\nSOFT TISSUES: There is a fat containing umbilical hernia and a fat containing\nright inguinal hernia.  There are subcutaneous gluteal injection granulomas.",
            "output": "1. The 1.4 cm right upper pole renal hypodensity is decreased in size when\ncompared to the prior study, with decreased perinephric stranding.  This may\nrepresent a resolving infected cyst or abscess.\n2. The previously seen left midpole cortical hypodensity is also improved\ncompared to prior, likely representing resolving pyelonephritis.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  The left lower\nlobe subpleural nodule noted on the prior CT has resolved.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHeterogeneous hypodensity in the posterior liver dome (___), is unchanged\ncompared to prior, most consistent with meningioma.\nThere are multiple subcentimeter hypodensities, which are too small to\ncharacterize, but most likely represents hepatic cysts or biliary hamartomas.\nThere is no evidence of suspicious focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits aside from a stable appearing calcified gallstone within the\nneck of the gallbladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without or\npancreatic ductal dilatation.  There is no peripancreatic stranding.  There is\na 7 mm hypodensity within the pancreatic tail (6:30), which likely represents\ninterdigitating fat.  This appears largely similar to the prior CT dated ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Redemonstration of a 4 mm hypodensity within the\nsuperolateral spleen, which appears benign.\n\nADRENALS: The 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 previously described upper pole 1.4 cm hypodensity has nearly completely\nresolved, now measuring approximately 5 mm, with associated cortical\nretraction, representing scarring (6:31), consistent with resolved infection.\nThere are additional subcentimeter hypodensities within the bilateral kidneys,\nwhich most likely represent simple cysts.  There is no evidence of solid 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 aside from stable appearing diverticulosis\nwithout signs of diverticulitis.  The appendix is normal (6:88).\n\nPELVIS: The mild urinary bladder wall thickening appears stable compared to\nprevious, which may be related to under distension.  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.\n\nVASCULAR: 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 of the lumbar spine with unchanged vertebral\nbody height loss at L5, which dates back to ___.\n\nSOFT TISSUES: There is a stable, fat containing right inguinal hernia, as well\nas an umbilical hernia with a neck measuring 3 mm containing a portion of\nnonobstructed small bowel.  Otherwise, the abdominal and pelvic wall is within\nnormal limits.",
            "output": ""
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrates atelectasis in the left lower\nlobe adjacent to the descending thoracic aorta.  There is severe coronary\nartery calcifications.  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 native kidneys are atrophic bilaterally. There is a 1.4 cm cyst\nin the right interpolar region.  There is no hydronephrosis.  There are\nbilateral calcifications measuring up to 3 mm in the left upper pole, which\nmay represent nonobstructing renal stones versus vascular calcifications (3;\n35).\n\nTRANSPLANT: There is a right lower quadrant renal transplant.  Multiple\nhypodense lesions are noted in the renal transplant likely representing renal\ncyst (3; 65).  There is no hydronephrosis.  There is mild stranding adjacent\nto the proximal ureter of the transplant kidney raising question for proximal\nureteritis, correlate clinically for infection.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber and wall thickness throughout.  The appendix is\nnormal.  There is thickening of the colon which is most pronounced along the\nproximal sigmoid and distal descending colon which is most likely due to\ncolitis.  There is diverticulosis without clear evidence for acute\ndiverticulitis.  No associated free fluid or free air.\n\nPELVIS: The bladder is decompressed.  There is no free 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 an infrarenal abdominal aortic aneurysm measuring 3.8 x 3.6\ncm (3; 47).  Extensive 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. Acute colitis most pronounced in the distal descending and proximal sigmoid\ncolon.  Diverticulosis without evidence of diverticulitis.\n2. Fat stranding adjacent to the proximal ureter of the right transplant\nkidney raises question for proximal ureteritis, correlate clinically for\ninfection.\n3. Infrarenal abdominal aortic aneurysm measuring up to 3.8 cm."
        },
        {
            "input": "VASCULAR:\n\nThere is an infrarenal abdominal aortic aneurysm measuring 3.7 x 4.0 cm\n(2:35), similar to prior.  There is severe calcium burden in the abdominal\naorta 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. 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 native kidneys severely atrophic bilaterally, consistent with\nknown medical renal disease.  Nonobstructing renal calculi are visualized,\nsimilar to prior measuring upwards of 4 mm (301:53).  A 1.2 cm exophytic\nhypodensity of the interpolar region of the right kidney is again visualized\n(301:60), likely simple cyst.  Additionally, at the upper pole of the left\nkidney, there is a 8 mm, intermediate density cyst, possibly proteinaceous or\nhemorrhagic (301:53).  There is no evidence of solid renal lesions or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nIn the right iliac fossa there is a transplant kidney with multiple hypodense\nlesions, some too small to characterize measuring upwards of 1.0 cm (301:109),\nlikely simple cyst.  Similar to prior, there remains mild stranding adjacent\nto the proximal ureter the transplant kidney (301:118), which may related to\nureteritis.  Mild perinephric stranding is noted around the transplant kidney,\nsimilar to prior.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The small and large bowel are\nboth largely collapsed.  Redemonstrated mucosal hyperenhancement and wall\nthickening throughout the colon, suggestive of mild and possibly chronic\npancolitis as before.  The appendix is normal.  Scattered diverticulosis\nwithout evidence of diverticulitis.  No evidence of intraluminal contrast\nextravasation to indicate active GI bleed.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed.  The distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.  Coarse calcifications are re-identified within the prostate.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild-to-moderate multilevel degenerative changes including facet arthropathy.\n\nSOFT TISSUES: A small fat containing umbilical hernia is identified (602:59). \nNo evidence of intramuscular hematoma.",
            "output": "1. No evidence of intraluminal active extravasation to suggest acute GI bleed.\nNo evidence of intramuscular or retroperitoneal hematoma.\n2. Transplant kidney is noted in the right iliac fossa.  Unchanged fat\nstranding adjacent to the proximal ureter the right transplant kidney,\nsuggestive of ureteritis.  Clinical correlation is recommended.\n3. Findings suggestive of ongoing pancolitis are re-identified.\n4. Unchanged infrarenal abdominal aortic aneurysm measuring upwards of 4.0 cm"
        },
        {
            "input": "Heart is mild-to-moderately enlarged.  Coronary artery calcification is\nmoderately severe.  Infected appears somewhat larger than in ___. \nThere are new small pleural effusions as well since that time.  No pericardial\neffusion.  Dependent opacities are more extensive in the left lung base than\nright and suggest atelectasis, less likely an infectious process.\n\nGallbladder is mostly empty.  There is no biliary dilatation.  Subcentimeter\nhypodense focus in segment V of the liver suggests a small cyst or biliary\nhamartoma.  Pancreas appears normal.  Spleen is normal in size and appearance.\nAdrenals appear normal.  Kidneys are markedly atrophic.  Two small simple\ncysts are identified in the right kidney few small bilateral calcifications\nsuggests stones or vascular calcifications.  No hydronephrosis on either side.\n\nThe gastric antrum shows wall thickening which suggests gastritis.\nSmall bowel is unremarkable.  Sigmoid diverticulosis is mild.  Mild\ndiverticulosis is also found along the ascending colon and hepatic flexure. \nAppendix appears normal.\n\nRenal graft in the right lower quadrant demonstrates a stable hyperattenuating\nlesion that is not fully characterized on this study measuring up to 14 mm in\nthe interpolar region which is likely to represent a proteinaceous cyst stable\nproteinaceous cysts.  There is still fat stranding about the upper right\nureter and about the right kidney that is nonspecific.\n\nBladder is mostly empty.  Seminal vesicles appear normal.  Prostate is\nborderline in size with central hypertrophy and calcification.  The aorta\nshows moderate mixed type atherosclerotic change.  Infrarenal abdominal aorta\nmeasures 41 x 40 mm in axial ___ without short-term change.  Iliac\narteries are tortuous and ectatic to a similar degree.  There is no\nlymphadenopathy, free air or free fluid.  There is a very small fat containing\numbilical hernia.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Moderate\ndegenerative changes affect lower lumbar facet joints.",
            "output": "1.  Mild wall thickening of the gastric antrum which may be due to gastritis\nor more chronic narrowing due to fibrosis.  Evaluation with upper GI series or\nendoscopy should be considered.\n\n2.  Similar sizable abdominal aortic aneurysm.  When clinically appropriate\nvascular surgery consultation is recommended.\n\n3.  Similar nonspecific stranding about the right renal graft which can be\ncorrelated with urinalysis, physical findings in laboratory data.  This is not\nnecessarily significant clinically, however.\n\n4.  Basilar opacities and pleural effusions, although the opacities seem more\nlikely to represent atelectasis than pneumonia."
        },
        {
            "input": "LOWER CHEST: Please refer to separately dictated CT 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 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: Severe native bilateral renal cortical atrophy.  0.4 cm exophytic\nright renal cyst.  No hydronephrosis of the bilateral native kidneys. \nNonobstructive bilateral native renal stones.  Right lower quadrant renal\ntransplant with multiple low attenuation lesions too small to characterize. \nNo hydronephrosis or peritransplant collection.  Trace fluid and inflammation\nadjacent to the transplant kidney and ureter consistent with ureteritis is\nagain seen.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis without evidence of acute diverticulitis.  Mild inflammatory\nchanges at the rectosigmoid colon with fat stranding.  Normal 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: Redemonstration of infrarenal abdominal aortic aneurysm measuring\n3.8 x 3.8 cm (series 304, image 40), unchanged from prior exam.  Bilateral\ncommon iliac artery aneurysms measuring 1.4 cm on the right and 1.6 cm on the\nleft.  Extensive 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": "Mild inflammatory changes surrounding the right lower quadrant renal\ntransplant and ureter that may represent mild pyelonephritis and/or\nureteritis, however, this finding is stable since prior CT of ___. \nNo hydronephrosis.\n\nMild proctocolitis likely infectious or inflammatory.  No bowel obstruction.\n\nNo intraabdominal abscess or fluid collection.\n\nStable infrarenal aortic aneurysm measuring up to 3.8 cm.  Bilateral iliac\nartery aneurysms (1.4 cm on the right and 1.6 cm on the left).  Recommend\nfollow-up with ultrasound in ___ year for surveillance."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions, right greater than left, larger than\nprior study, notably on the right size.  Right-sided pleural effusion is\nfairly large although not entirely imaged.  Left-sided pleural effusion is\nsmall.  Compressive atelectasis of both lower lobes.  In addition to that,\nhowever heterogeneously enhancing, partly visualized left lower lobe\nconsolidation a suggests pneumonia, unchanged.  Heart is mild-to-moderately\nenlarged.  Coronary artery calcification is identified.\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: Atrophic native kidneys with calcifications, either vascular or\nnonobstructive stones.  There is a transplanted kidney in the right iliac\nfossa.  Simple cysts are noted in all kidneys measuring up to 1.5 cm.  Hazy\nfat stranding is again identified along the extrarenal pelvis and proximal\nureter of the renal graft in the right lower quadrant.  There is no evidence\nof solid renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Enteric line ending in the gastric antrum.  The stomach is\notherwise unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding. The rectum is\nunremarkable.\n\nPELVIS: The urinary bladder is decompressed.  There is no free fluid in the\npelvis.\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: Stable infrarenal aortic aneurysm measuring up to 4.0 cm (2:70) and\nbilateral common iliac artery aneurysms measuring 1.4 cm on the right and 1.6\ncm on the left.  Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSomewhat sclerotic bones suggesting sequela of renal osteodystrophy.\n\nSOFT TISSUES: Very small fat containing paraumbilical hernia.",
            "output": "1. Similar nonspecific stranding along the extrarenal collecting system of the\nrenal graft.  Correlation with urinalysis is recommended.\n2. No evidence for persistent rectal inflammation.\n3. Suspected pneumonia involving the left lower lobe.\n4. Bilateral pleural effusions, sizable on the right.  Atelectasis at each\n___"
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar subsegmental atelectasis.  2 mm\nsubpleural nodularity left hemithorax along the medial right middle lobe\nlikely represent pleural thickening with adjacent atelectasis.  Calcification\nof the aortic valve annulus is again demonstrated.  Atherosclerotic\ncalcification of the coronary arteries.  Stable cardiomegaly.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen are multiple subcentimeter liver hypodensities, that are stable in\nsize and appearance since ___.  These lesions are nonspecific, but\nlikely represent hepatic 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.  The main pancreatic\nduct is mildly prominent, measuring approximately 3 mm of the 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: The kidneys are atrophic bilaterally.  There are multiple bilateral\nsimple renal cysts, the largest of which measures 4.9 x 4.7 cm with simple\nfluid attenuation consistent with a benign renal cyst.  There is no evidence\nof solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is normal.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. There is colonic\ndiverticulosis without evidence of diverticulitis.  The appendix is normal.\n\nPELVIS: There is a 4 mm enhancing soft tissue nodule arising from the right\nlateral aspect of the bladder wall (series 5, image 77).  This may reflect a\nbladder polyp, however assessment is limited due to the relatively\ndecompressed state of the bladder.  The right collecting system is duplicated\nwith a normal insertion of both the ureters.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  There are no adnexal\nmasses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Diffuse aortoiliac arthrosclerotic disease.  No abdominal aortic\naneurysm is identified.  The celiac axis, SMA and ___ appear patent\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative change of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall are normal.",
            "output": "1. No acute intra-abdominal findings to explain the patient's recent onset of\ndizziness.\n2. Multiple hepatic hypodensities, stable since ___, which likely\nrepresent hepatic cysts, hemangiomas or biliary hamartomas.\n3. 4 mm enhancing soft tissue lesion arising from the right lateral aspect of\nthe bladder wall.  Recommend urological evaluation for further management and\npossible direct visualization.\n4. Diffuse atherosclerotic disease involving the aorta, iliac vessels and\naortic valve annulus.  Coronary artery calcifications are partially\nvisualized.\n5. Mild cardiomegaly.\n6. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S):  Neurological consultation for evaluation of 4 mm enhancing\nsoft tissue lesion arising from the right lateral bladder wall."
        },
        {
            "input": "CHEST: The 8 mm right lower lobe pulmonary nodule is stable dating back to\n___.. The heart is enlarged. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. There is a punctate radiopaque stone within the\ngallbladder. There is no evidence of acute cholecystitis.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys are atrophic.  The kidneys demonstrate symmetric nephrograms and\nexcretion of contrast.  There are no focal renal lesions. There is no\nhydronephrosis. The ureters are normal in caliber and course to the bladder.\n\nThere is a small hiatal hernia. The stomach is decompressed. The small bowel\nis normal in caliber without focal wall thickening. The large bowel is also\nnormal in caliber without focal wall thickening. The appendix is\nwell-visualized and normal. There is a small fat containing umbilical hernia.\nThere is no abdominal free fluid or free air.\n\nThe abdominal aorta is normal in caliber without abdominal aortic aneurysm.\nThe abdominal aorta and its major branches are patent. There are no enlarged\nmesenteric or retroperitoneal lymph nodes.\n\nPELVIS:\n\nThe bladder is decompressed with a Foley catheter.  There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nOSSEOUS STRUCTURES:  Partially visualized right hip prosthesis. There are\nsevere degenerative changes of the lumbar spine with mild anterolisthesis of\nL4 on L5.  No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1. No acute intra-abdominal process. Normal appearance of the bowel.\n2. 8 mm right lower lobe pulmonary nodule stable dating back to ___, given two year stability, findings are likely benign.\n3. Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST:  There is a 7 mm right lower lobe pulmonary nodule (2:9) that has\nremained stable since ___, suggestive of a benign process.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  Stones are noted within the gallbladder,\nwhich is otherwise unremarkable.\n\nPANCREAS:  The main pancreatic duct appears borderline prominent, measuring\napproximately 4 mm in greatest dimension (601b:27).  Remainder of the\npancreatic parenchyma otherwise demonstrates homogeneous attenuation\nthroughout.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 cm simple cyst in the interpolar region of the right kidney.  A\nsmaller sub-centimeter hypodensity in the interpolar region of the left kidney\nis too small to characterize, but statistically likely also represents a 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.  The colon and\nrectum are within normal limits.  Normal appendix.  No free fluid or free air\nwithin the peroneal cavity.\n\nPELVIS:  Evaluation of inferior pelvic structures is slightly limited due to\nstreak artifact from adjacent right hip prosthesis.  Visualized portions of\nthe urinary bladder demonstrate no gross abnormalities.  No free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS:  Uterus is grossly unremarkable.\n\nLYMPH NODES:  Several scattered right mesenteric lymph nodes on the right are\nnot pathologically enlarged by CT size criteria.  No retroperitoneal\nlymphadenopathy.  There is 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.  Minimal anterolisthesis of L4 on L5 and L5 on S1.  Severe\nmultilevel degenerative changes are noted throughout the thoracolumbar spine,\nincluding a prominent flowing anterior osteophyte at L3-L4.  Status post right\ntotal hip arthroplasty.\n\nSmall fat containing umbilical hernia.  Abdominal and pelvic wall are\notherwise within normal limits.  Several injection granulomas are noted within\nthe bilateral gluteus muscles.",
            "output": "1.  No acute intra-abdominal process.\n2.  Cholelithiasis, without CT evidence of cholecystitis.\n3.  Small fat containing umbilical hernia.\n4.  ___ year stability of a 7 mm right lower lobe pulmonary nodule, suggestive\nof benignity."
        },
        {
            "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.\n\nHEPATOBILIARY: The liver 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.  Patient is status\npost right hemicolectomy.  Previously noted areas of wall thickening involving\nsmall bowel and sigmoid colon in the right lower quadrant have resolved in the\ninterim.  No ascites.\n\nPELVIS: Evaluation of the pelvic structures is limited by streak artifact from\nthe adjacent hip arthroplasty.  Partially imaged urinary bladder is grossly\nunremarkable.\n\nREPRODUCTIVE ORGANS: Uterus is 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.  Mild atherosclerotic disease\nis noted.  There is a retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post total hip arthroplasty on the right.  There is severe\ndegenerative changes in the lumbar spine.\n\nSOFT TISSUES: Since the prior study on ___, there has been\nsubstantial interval decrease in size of the soft tissue lesion anterior to\nthe left rectus abdominus muscle.  It now measures 3.5 x 1.9 cm, previously\n5.9 x 4.8 cm, likely representing a resolving hematoma.",
            "output": "1. No evidence of tumor recurrence or abdominopelvic metastases.\n2. Interval resolution of wall thickening involving small and large bowel in\nthe right lower quadrant.\n3. Interval decrease in size soft tissue density abutting the left rectus\nabdominus muscle, likely representing a resolving hematoma.\n4. Chest CT dictated separately."
        },
        {
            "input": "The patient is status post gastric bypass surgery.  Oral contrast material\ntraversed the stomach and small bowel without evidence of obstruction.  There\nis no leakage of contrast material.  No free intraperitoneal fluid is\nidentified.\n\nThere is no focal hepatic lesion. The portal vein is patent. The spleen is\nnormal size.  Calcified granulomata are again noted in the spleen.  There is\nno pancreatic mass or ductal dilatation. The adrenal glands are unremarkable. \nThe kidneys are symmetric in size with no hydronephrosis.\n\nThere is no abdominal or pelvic lymphadenopathy.  There is a thinly septated\ncyst in the left adnexa measuring 4.6 x 4.0 cm that has increased in size from\nthe previous exam.  1.4 cm corpus luteum is seen on the right ovary.\n\nThere is moderate fecal loading.  The lung bases are clear.  The bones are\nunremarkable.",
            "output": "*No evidence of bowel obstruction.\n*Thinly septated left adnexal cyst measuring 4.6 x 4.0 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber.  There is mucosal hyperenhancement, mural thickening, and\ncongestion of the Vasa recta, with adjacent reactive mesenteric lymph nodes of\nthe terminal ileum, which implies an acute component of likely chronic\ninflammation.  There is no sign of extramural disease.  No proximal small\nbowel dilation to suggest obstruction.  An additional loop of small bowel in\nthe pelvis (series 2, image 144) demonstrates avid in enhancement, but this is\nmost likely secondary to its collapsed state than a skip lesion.  The hepatic\nflexure is collapsed.  The appendix is unremarkable.\n\nThere is anal intersphincteric hyperenhancement on the left without discrete\nabscess.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of free fluid in the pelvis, which is nonspecific.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple reactive mesenteric lymph nodes, for example with an\nileocolic lymph node measuring 1 cm.  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. \nThere are multiple punctate sclerotic foci in the head of the left femur\nwithout aggressive features, which most likely represent bone islands.  There\nis no CT evidence of sacroiliitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mucosal hyperenhancement, mural thickening, congestion of the Vasa recta,\nand adjacent reactive mesenteric lymph nodes of the distal approximate 25 cm\nof the terminal ileum are in keeping with likely acute on chronic terminal\nileitis in this patient's with Crohn's.  There is no sign of extramural\ninvolvement/abscess formation.  For better characterization of small-bowel\ninvolvement, MR enterography may be obtained after sufficient trial on\nimmunosuppression.\n2. There is suggestion of a perianal fistula, as evidenced by hyperenhancement\nof the intersphincteric anal region on the left.\n\nRECOMMENDATION(S):  For better characterization of small-bowel involvement, MR\nenterography may be obtained after sufficient trial on immunosuppression.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:23 pm, 20 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: The liver is normal in morphology and demonstrates homogeneous\nbackground attenuation.  There are numerous heterogeneously enhancing hepatic\nlesions, with representative lesions measuring 3.7 x 3.5 cm in hepatic segment\nII and 4.7 x 3.7 cm in hepatic segment VIII (2; 54, 56), compatible with\nmetastases.  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.  There is mild bilateral\nhydroureteronephrosis, secondary to obstruction of the distal ureters by the\nlarge pelvic mass.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is circumferential\nthickening of the third portion of the duodenum and jejunum (2; 76, 77),\nnonspecific.  The sigmoid colon is displaced by the large uterine mass without\nevidence of obstruction.\n\nPELVIS: The urinary bladder is decompressed by Foley catheter.  There is a\nsmall amount of air in the bladder.  There is presacral edema and stranding.\n\nREPRODUCTIVE ORGANS: A 10.5 x 7.2 cm partially cystic, heterogeneously\nenhancing mass is seen predominantly within the left hemipelvis, likely\nadnexal in origin.  The mass is inseparable from the uterus.  Multiple\nhypodense lesions are seen within the uterus which may represent involvement\nof tumor (2; 107, 114).  A tubular cystic structure in the right hemipelvis in\nclose association with the uterus is suggestive of a hydrosalpinx.\n\nLYMPH NODES: There are multiple enlarged lymph nodes including a 1.1 cm left\nparaaortic lymph node (2; 83), 1 cm left common iliac lymph node (2; 90), 2 cm\nleft external iliac lymph node (2; 99),  2.2 cm right external iliac lymph\nnode (2; 100), 6 mm presacral lymph node (2; 106), and 6 mm more superior\npresacral lymph node (2; 100).  There is 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 10.5 x 7.2 cm partially cystic, heterogeneous mass predominantly within the\nleft hemipelvis, concerning for malignancy, likely adnexal in origin.\n2. Abdominopelvic lymphadenopathy and multiple hepatic lesions are compatible\nwith metastatic disease.\n3. Bilateral mild hydroureteronephrosis secondary to compression of the distal\nureters by the pelvic mass.\n4. Circumferential thickening of loops of small bowel in the left upper\nquadrant, nonspecific."
        },
        {
            "input": "LOWER 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. \nNumerous predominantly hypoattenuating hepatic lesions, compatible with vastus\nease are again demonstrated.  These appear slightly increased in size compared\nto ___.  For example, a 3.4 x 2.5 cm segment IV B lesion previously\nmeasured 1.9 x 1.6 cm (03:26).  Additionally, a 5.6 x 3.4 cm segment VIII\nlesion previously measured 4.5 x 2.9 cm (03:17).  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 no focal renal lesions.  Delayed left nephrogram with mild bilateral\nhydronephrosis, is not appreciably changed and likely secondary to extrinsic\ncompression due to the large pelvic mass.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild wall\nthickening of the mid sigmoid colon (03:54) with associated extrinsic\ncompression from the large pelvic mass resulting in a caliber change (5:21)\nand large volume stool burden.  Findings appear progressed compared to the\nmost recent prior exam.  Trace ascites.\n\nPELVIS: The bladder is decompressed with Foley catheter in place.  There is\nsmall volume free pelvic fluid.\n\nREPRODUCTIVE ORGANS: Again demonstrated is a large heterogeneous, partially\ncystic, enhancing mass predominately within the left hemipelvis measuring up\nto 10.7 x 9.7 cm, not appreciably changed compared to the prior exams.  This\nmass is inseparable from the uterus and likely adnexal in origin.  Tubular\ncystic structure in the right hemipelvis in close association with the uterus\nis also suggestive of hydrosalpinx, unchanged compared to multiple prior\nexams.\n\nLYMPH NODES: Multiple enlarged lymph nodes are not appreciably changed.  This\nincludes a 1.1 cm left periaortic lymph node (03:48).  A 0.9 cm left common\niliac lymph node is unchanged (03:50).  1.7 cm right external iliac lymph node\nis unchanged (3:63).  2.0 cm left external iliac lymph node (3:60).\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. Redemonstration of a large heterogeneous pelvic mass now resulting in\nworsening mass effect on the midsigmoid colon with partial large bowel\nobstruction causing presence of a large stool burden within the proximal colon\nup to the cecum.  No small bowel obstruction\n2. Interval increase in size of multiple hepatic metastases, as detailed\nabove.\n3. Similar dense of metastatic abdominopelvic lymph nodes, as detailed above.\n4. Bilateral hydronephrosis is not appreciably changed and related to\nextrinsic compression from the large pelvic mass.\n5. Similar appearance of a right hydrosalpinx.\n6. Please refer separately reported CT chest for description of the inthoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Multiple pulmonary nodules are again seen, with the largest\nmeasuring up to 8 mm in the left lower lobe (02:13).  Bibasilar atelectasis.\nSmall right pleural effusion.  Distal tip of a Port-A-Cath terminates within\nthe lower SVC.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable hypodense liver lesions, increased in size and\nnumber from ___. The largest measures up to 6.6 x 4.0 cm in the\nleft lobe (02:19) previously 4.3 x 3.3 cm in ___.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.  Moderate amount of ascites, increased 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 in size.  Again seen is delayed left\nnephrogram with moderate hydronephrosis, likely secondary to the known large\npelvic mass.  A soft tissue density mass in the left midpole measures up to\n1.8 cm (02:37), previously 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\ndemonstration large stool burden, likely secondary to the known large pelvic\nmass.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter in place. \nThere is a small amount of free fluid in the pelvis, unchanged.\n\nREPRODUCTIVE ORGANS: Interval increase in size of a large heterogeneous,\npartially cystic, enhancing mass within the pelvis, measuring 10 x 16.3 x 12.2\ncm (CC x AP x TV), previously 10 x 10.7 x 9.7 cm in ___.\n\nLYMPH NODES: Persistent diffuse lymphadenopathy.  For example, a 1.3 cm left\nperiaortic lymph node (02:48) previously measures 1 cm. 2 cm left external\niliac lymph node (2:71) is unchanged. 1.5 cm right external iliac lymph node\n(2:72) is unchanged.\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. \nPartially imaged posterior fixation device at the level of T7.  Spinal\nalignment is otherwise unremarkable.\n\nSOFT TISSUES: There is new diffuse anasarca of the left lower extremity,\nlikely secondary to venous outflow obstruction.",
            "output": "1. Interval increase in size of a large heterogeneous pelvic mass, now\nmeasuring up to 16 cm, previously 11 cm.\n2. Interval development of innumerable hypodense liver lesions, concerning for\nprogressive metastatic disease.\n3. Mild interval enlargement of a now 1.8 cm left renal mass, which may\nrepresent metastatic disease.\n4. Delayed left nephrogram.  Mild interval worsening of now moderate left\nhydronephrosis, in the setting of a large pelvic mass.\n5. Interval increase of now moderate amount of ascites.\n6. Re-demonstrated diffuse lymphadenopathy, as detailed above.\n7. New diffuse soft tissue edema of the partially imaged left lower extremity,\nlikely secondary to venous outflow obstruction."
        },
        {
            "input": "VASCULAR:\nThe patient is status post right groin approach transcatheter aortic valve\nreplacement.  There is extensive stranding throughout the right inguinal\nregion and extending along the iliac chain into the extraperitoneal pelvis\ncausing mass effect on the bladder (4A:  162).  Hyperdense contrast material\nsuperior to the external iliac artery suggests active extravasation during the\ntranscatheter procedure, unchanged on all phases the present study without\nevidence for ongoing extravasation at this site (2:73, 40:145, 4B:  241). \nBlood products extend along the right abdominal wall musculature as a large\nintramuscular hematoma measuring up to 13.9 x 7.2 x 16.6 cm (AP by TR by CC ;\n4B:  208, 604b:41).  Focal areas of hyperdense contrast anteriorly within the\nhematoma and layering posteriorly are new on the portal venous delayed images\ncompared with noncontrast imaging consistent with active extravasation (4B: \n198, 201).\n\nThe left groin central venous catheter is well positioned, entering the common\nfemoral vein and terminating with the tip at the level of the iliac\nbifurcation (4A:  115).  There is extensive atherosclerotic disease including\nsevere stenoses of the proximal celiac axis and SMA (___ B:  91, 89), although\nthe former may be due to an impression by a the median arcuate ligament rather\nthan atherosclerotic calcification.  There is no evidence of pseudoaneurysm or\nactive extravasation at the right groin puncture site.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 extensive colonic diverticulosis without\nevidence of diverticulitis.  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 is decompressed around a Foley catheter.  Excreted\nIV contrast is seen surrounding the Foley catheter balloon peer  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post left hip total arthroplasty without evidence of\nhardware complication.  Streak artifact somewhat limits evaluation of\nsurrounding structures.  Multilevel degenerative changes are moderate to\nsevere with severe spinal canal stenosis at L3-L4 due to a combination of\nfacet arthropathy and uncovertebral hypertrophy (4A:  97).\n\nSOFT TISSUES: Aside from the above described right abdominal wall hematoma,\nthe abdominal and pelvic wall is notable for a small fat containing umbilical\nhernia (4A:  103).",
            "output": "1. Status post right groin arterial access with extensive blood products\nwithin the right inguinal region and extraperitoneal right pelvis with a large\nright abdominal wall musculature hematoma.\n2. Active extravasation within the right abdominal wall musculature hematoma,\nwhich measures up to 13.9 x 7.2 x 16.6 cm (AP by TR by CC).  Evidence of prior\nextravasation in the right inguinal access site without CT evidence of ongoing\nhemorrhage.\n3. Severe spinal canal stenosis at L3-L4.\n4. Diverticulosis.\n5. Cholelithiasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:03 ___, 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 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 atrophic with multiple well-defined, thin walled\nnon-enhancing lesions, bilaterally, consistent with cystic disease of\ndialysis.  There is no evidence of solid renal lesionsthere 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.\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.  The SMV measures approximately 11 mm.\n\nBONES: There 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 atherosclerotic disease overall, including the infrarenal\nabdominal aorta and bilateral iliac arteries.\n2. The SMV measures approximately 11 mm.\n3. Bilateral renal cystic disease of dialysis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Severe calcifications in the\nmitral annulus and aortic valves.  Coronary calcifications are moderate. \nPatulous distal esophagus.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.8\ncm cystic lesion in the left hepatic lobe is unchanged and likely represents a\nsimple 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly measuring up to 14 cm, slightly increased from prior\npreviously 13 cm.  No focal lesions.\n\nADRENALS: There is new nodular thickening of the right adrenal gland measuring\nup to 1.7 cm.  The left adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple cortical hypodensities are again seen and unchanged.  The largest is\na 5.4 cm simple renal cyst with, probably with thin septation, is seen in the\nupper pole of the left kidney.  There is no hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  A small duodenal lipoma is\nredemonstrated.  Diffuse diverticulosis.\n\nRedundant sigmoid colon with abnormal circumferential wall\nthickening/aneurysmal dilation and heterogeneous enhancement is new from prior\nCT.  The overall measurements are 6.4 x 6.9 x 7.4 cm (5:63). There is\npericolonic stranding.  There is no fascial plane separating the mass with the\nright abdominal wall.  Loops of distal/terminal ileum are in contact with the\nmass and thickened (5:64), without obstruction.\n\n1.5 x 1.7 x 3 cm enhancing soft tissue thickening in the mesorectal fat,\nimmediately posterior to the rectum, (5:84) is increased compared to prior. \nThere is an adjacent enhancing nodule immediately superolateral to the left\nmeasuring 1.2 cm in the craniocaudal plane (previously 0.9 cm).  Thickening in\nthe superior left aspect of the mesorectal fascia slightly increased compared\nto prior (5: 76).  Mild fat stranding in the presacral fat appears new from\nprior (5:73).\n\nSoft tissue thickening along the right mid abdominal represents the appendix\n(5: 46).\n\nSmall amount of fluid is seen in the right lower quadrant surrounding the\nmass, and in the pelvis.  Cystic intraperitoneal structure in the left upper\nquadrant is decreased in size from prior.\n\nPELVIS: 2 adjacent hyperdense soft tissue polypoid masses arise from the\nposterior and inferior aspect of the left bladder wall protruding toward the\nlumen, in the region of the left ureterovesical junction, measure 1.9 x 3.2\ncm, may correlate with findings on renal ultrasound from ___ and increase in\nsize since then.  A 4 mm hyperdense nodule in the superior aspect of the\nposterior wall at midline (5:74) is also noted.  These findings were\nincompletely evaluated on prior study given the lack of contrast and the\npresence of a Foley catheter and clot.  The fat plane between the\naforementioned mass and the left seminal gland is obscured concerning for\nextra vesicular spread.  There is a mild left hydroureter with urothelial\nenhancement and thickening of the mid to distal ureter (5: 73).\n\nREPRODUCTIVE ORGANS: The prostate gland is unremarkable.  Right seminal gland\nis unremarkable.  A described above there is fat plane obscuration between the\nmass and the left seminal gland.\n\nLYMPH NODES/PERITONEAL CAVITY/RETROPERITONEUM: A couple of right 7 mm common\niliac lymph node are unchanged from prior.  A 0.9 cm soft tissue density round\nlesion in the right Morison's pouch (5:35, 7:34) is new from ___.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: No sclerotic or lytic lesions.  No acute fractures.  Degenerative\nchanges are similar to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New irregular circumferential wall thickening/aneurysmal dilation of the\nsigmoid colon with heterogenous enhancement measuring 6.4 x 6.9 x 7.4 cm,\nwithout obstruction.  These findings may represent lymphoma or adenocarcinoma.\nColonoscopy and biopsy advised.\n2. The lack of fascial plane between the mass and the abdominal wall is\nconcerning for involvement of the abdominal wall.  Close contact with loops of\nthe adjacent small bowel are also concerning for involvement.  Pericolonic\nstranding is concerning for omental and mesenteric involvement.\n3. New 0.9 cm nodule in the ___ pouch is concerning for peritoneal\nmetastatic deposit\n4. Worsening splenomegaly measures up to 14 cm, may represent progression of\nlymphoma.\n5. Increase in size of multiple polypoid bladder wall masses compared to renal\nultrasound from ___, are concerning for multifocal TCC.  There is loss of\nfascial plane between the bladder and the left seminal vesicle concerning for\nspread of disease through the bladder wall.  Left hydroureter, urothelial\nenhancement and thickening is concerning for ureteric TCC involvement.\n6. New right adrenal nodular thickening is concerning for metastatic disease.\n7. Increased soft tissue thickening/soft tissue masses seen immediately\nposterior to the rectum as well as thickening of the left mesorectal fascia is\nconcerning for metastatic disease/lymphoma involvement.  This would be\naccessible to CT-guided biopsy\n\nRECOMMENDATION(S):  CT-guided biopsy of presacral soft tissue nodule could\nalso be considered\n___ F FDG PET-CT for metastatic workup\nColonoscopy with sampling\nCystoscopy with sampling\n\nNOTIFICATION:  The findings were discussed with ___.  ___, RN, ___\n___ RN, by ___, M.D. on the telephone on\n___ at 3:42 pm, 45 minutes after discovery of the findings.Findings were\nalso emailed via radiology dashboard at the same time."
        },
        {
            "input": "Please note that evaluation for intra-abdominal and intrapelvic abnormalities\nis limited in the absence of IV contrast.\n\nThe bases of the lungs are clear. There is no pleural effusion.\n\nLIVER: The liver is homogeneous without focal lesion. The non-distended\ngallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys are homogeneous and demonstrate no gross abnormalities.\n\nGI:Again seen is a small hiatal hernia. There is no obvious gastric\nintraluminal mass or wall thickening.The small and large bowel are within\nnormal limits, without wall thickening or evidence of obstruction.A normal,\nair-filled appendix is visualized.\n\nABDOMINAL WALL: Patient is status post left transverse rectus abdominus\nmyocutaneous harvest.  The previously described colon-containing hernia in the\nregion of the left rectus abdominus muscle is no longer visualized. There is\nno new abdominal wall hernia or umbilical hernia. No evidence of bilateral\ninguinal hernias.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith  atherosclerotic calcifications. There are multiple prominent mesenteric\nlymph nodes, however none of these are pathologically enlarged by CT size\ncriteria. No evidence of retroperitoneal lymphadenopathy.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.The uterus and bilateral adnexa are\nunremarkable.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.",
            "output": "1. Within the limitations of this noncontrast CT, there has been interval\nrepair of the previously described large-bowel-containing hernia in the region\nof the left rectus abdominal muscle. No new abdominal wall or inguinal hernia\nis detected."
        },
        {
            "input": "LOWER CHEST: Small nonhemorrhagic bilateral pleural effusions with moderate\nbibasilar atelectasis.  Ground-glass opacity in the inferior medial left upper\nlobe is partially visualized.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout. \nA subcentimeter hypodensity  in hepatic segment VI is too small to\ncharacterize and may represent a cyst or hamartoma (07:32).  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: Extensive peripancreatic stranding and low-density fluid tracks\nalong the bilateral anterior pararenal space, lateral conal fascia, and\nretroperitoneum into the upper pelvis.  Areas of subtle hypoenhancement within\nthe pancreatic neck, head, and uncinate process suggest early necrosis (07:36;\n09:26).  No organized or rim enhancing collection currently. No discrete\npancreatic lesions or main 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 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 stomach.  There is reactive\nhyperemia of the duodenum which is not dilated.  Scattered loops of jejunum\nare mildly dilated in the left and central abdomen which gradually taper to\nnormal caliber and decompressed ileum as it enters the cecum.  No abrupt\ntransition point.  The colon, appendix, and rectum are normal.\n\nPELVIS: Air in the bladder suggests recent instrumentation.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: A reactive gastrohepatic lymph node measures 10 mm in short axis.\nNo other lymphadenopathy in the abdomen or pelvis is definitively identified.\n\nVASCULAR: Portal, splenic, and superior mesenteric veins and IVC are patent. \nThe superior mesenteric vein is moderately attenuated as it traverses the\nphlegmonous changes adjacent to the pancreas (07:45).  No evidence of acute\narterial injury.  Incidental note of separate origins of the common hepatic\nartery from the aorta (07:35; 9: 29).  The celiac axis, superior inferior\nmesenteric arteries, hepatic arteries, and GDA are patent.  No abdominal\naortic aneurysm.  Minimal atherosclerotic disease.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anasarca without abscess.",
            "output": "1. Acute necrotizing pancreatitis with acute peripancreatic fluid collections\nand no evidence of vascular complication.\n2. Reactive bowel changes with findings suggesting ileus.\n3. Likely hepatic steatosis or acute hepatitis.  No biliary dilation.\n4. Small bilateral pleural effusions with moderate bibasilar atelectasis.\n5. Partially visualized left upper lobe opacity may represent atelectasis,\npulmonary edema, or infection."
        },
        {
            "input": "LOWER CHEST: There is a persistent small left pleural effusion with associated\ncompressive atelectasis.  There is persistent partial right lower lobe\ncollapse.  However, there is resolution of prior small right pleural effusion.\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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nIndependent origin of the common hepatic artery from the aorta.\n\nPANCREAS: Again demonstrated is peripancreatic stranding/fluid around an\nenhancing pancreas, consistent with known history of pancreatitis. Fluid\ntracks along the anterior pararenal space.  This is narrowing though patency\nof the splenic vein.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 portion of the\nduodenum.  Otherwise the stomach is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  There\nis increased inflammatory changes involving the distal transverse colon and\ndescending colon from adjacent i pancreatitis.  The colon is fluid-filled,\nconsistent with diarrheal disease.  There is loss of typical colonic haustral\nsignature which is likely secondary to inflammation from adjacent\npancreatitis.  The appendix 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 similar degree of prominence of the mediastinal lymph\nnodes which are not pathologically enlarged by CT size criteria.  There is no\nretroperitoneal 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Redemonstration necrotizing pancreatitis with slightly larger and more\norganized peripancreatic fluid collections.  However, do not show definitive\nfeatures walled-off necrosis.\n2. Persistent small left pleural effusion with associated compressive\natelectasis.  Persistent partial right lower lobe collapse.  Resolution of\nprior small right pleural effusion.\n3. Fluid-filled colon likely reflecting diarrheal disease."
        },
        {
            "input": "The imaged lung bases are clear.\n\nThe kidneys are normal in size and symmetric. In the right kidney, there is a\nsub-centimeter calcific density in the posterior mid-pole. In the left kidney,\nthere is a sub-centimeter calcific density in the anterior mid pole. There is\nno hydronephrosis. There is no concerning focal renal lesion. The bladder\nappears normal.\n\nPost-operative changes from the patient's prior duodenal switch surgery are\nnoted. The un-enhanced appearance of the liver, spleen, pancreas, and adrenal\nglands are normal.  There is no bowel obstruction. The abdominal aorta appears\nnormal. Incidental small vascular calcifications in the right iliac artery are\ndemonstrated. There is no lymphadenopathy or free fluid.\n\nThere is no worrisome bony lesion. Multi-level degenerative changes are noted\nin the thoracic and lumbar spine and bilateral hips. The visualized abdominal\nand pelvic walls are within normal limits.",
            "output": "Bilateral, non-complicated renal stones."
        },
        {
            "input": "The imaged lung bases are clear.\n\nAbdomen: The kidneys are normal and symmetric in size.  Nonobstructive calculi\nare seen in the upper pole of the right kidney measuring on 3 and 7 mm\nrespectively (03:34).  At least 1 of these was seen on the prior CT scan and\nboth were appreciated on recent renal ultrasound.  A 4 mm nonobstructive\ncalculus is seen in the lower pole of the left kidney, and is unchanged since\n___.  A new, millimetric calculus is seen in the lower pole of the left\nkidney.  No ureteral calculi are identified.  There is no hydronephrosis or\nperinephric abnormality.\n\nSurgical clips are seen in the upper abdomen from patient's prior bowel\nsurgery.  Suture materials also seen in the left lower quadrant.  Stomach and\nsmall bowel are otherwise unremarkable.  There is no evidence of bowel\nobstruction.  The liver is homogeneously hypodense, consistent with hepatic\nsteatosis. The unenhanced appearance of the liver, spleen, gallbladder,\npancreas, and adrenal glands is normal. The abdominal aorta appears normal in\ncourse and caliber.  Minimal vascular calcifications are noted.\n\nPelvis: Loops of small and large bowel show no signs of ileus or obstruction.\nThe appendix is not definitively visualized. Bladder and distal ureters are\nwithin normal limits. No free fluid.  Several linear radiopaque densities are\nnoted within the pelvis, potentially dropped clips.\n\nBones: Multilevel degenerative changes are seen in the lower thoracic and\nlumbar spine, not significantly changed since the prior examination.  There is\nmild anterior vertebral body height loss of T11, which is also unchanged since\nthe prior examination.",
            "output": "1. Bilateral nonobstructive renal calculi.  Stone burden has minimally\nincreased from the previous CT from ___.\n2. Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are clear. There is no pleural or\npericardial effusion. There is no hiatus hernia.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously without evidence of concerning\nfocal lesion. There is no intrahepatic biliary ductal dilation. The portal\nvein is patent.  The gallbladder is unremarkable without evidence of wall\nthickening or inflammation.\n\nPANCREAS: The pancreas enhances homogeneously. There is no peripancreatic\nstranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The kidneys enhance normally and symmetrically.  There is no\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach and duodenum are unremarkable.  Non-dilated\nsmall bowel loops are normal in course and caliber without evidence of wall\nthickening or obstruction.  The colon is unremarkable.  The appendix is\nnormal.\n\nVASCULAR AND LYMPH NODES: The abdominal aorta is normal in caliber without\nevidence of aneurysm or dilation.  Major proximal tributaries are patent. \nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air.\n\nCT PELVIS:\nA small amount of layering free simple pelvic fluid is noted (series 2, image\n65), abnormal in a male patient, nonspecific.  There is mild diffuse bladder\nwall thickening.  The prostate is unremarkable.  There is no pelvic sidewall,\niliac chain, or inguinal lymphadenopathy.\n\nMUSCULOSKELETAL: The thoracolumbar vertebral bodies are normally aligned.  No\nconcerning focal lytic or sclerotic osseous lesions are identified.",
            "output": "1. Normal appendix.\n2. Diffuse bladder wall thickening may relate to cystitis, or possibly simply\nunderdistention.  Correlate with urinalysis values and symptoms.\n3. Small amount of layering free simple pelvic fluid is abnormal in a male\npatient, but nonspecific."
        },
        {
            "input": "ABDOMEN:\n\nIncidental bilateral breast prostheses are identified. Heart size is within\nnormal limits. No pericardial effusion. A new small left pleural effusion is\nidentified with associated basal atelectasis. Linear atelectasis is identified\nat the right lower lobe. A small calcified granuloma is identified in the\nright lower lobe (3B: 9). A new 7 mm nodule is identified at the visualized\nleft lower lobe (3b:10) and 5 mm subpleural nodule identified abutting the\ndiaphragmatic surface in the right lower lobe (3b:14), suspicious for\nmetastases. Tiny 3 mm nodule (3b:8) in right upper lobe is nonspecific.\n\nThe liver demonstrates homogeneous attenuation and enhancement, with no focal\nhepatic lesion identified. No intrahepatic or extrahepatic biliary ductal\ndilatation. The hepatic veins and portal veins are patent. The slightly\ndecompressed gallbladder is unremarkable. Pancreas is within normal limits.\nLarge bilateral necrotic adrenal metastases are again noted. The right adrenal\nmetastasis measures 4.5 x 2.9 cm (previously measuring 3.2 x 1.9 cm) and the\nleft adrenal metastasis measures 6.0 x 4.3 cm (previously measuring 4.0 x 2.7\ncm). The left adrenal metastasis now are demonstrates all extension into the\nupper pole of the right kidney suggestive of contiguous metastatic involvement\n(08:17, 11:30). The right adrenal metastasis also demonstrates subtle\ncontiguous involvement of the upper pole of the right kidney (8:24, 11:28). No\nhydronephrosis.\n\nA 2.2 x 1.8 cm hypodense mass is identified within the spleen, in keeping with\nsplenic metastasis (08:17). Additional ill-defined hypodensity at the inferior\naspect of the spleen is nonspecific and may relate to a developing infarct or\nalternatively tumor infiltration.\n\nMultiple enlarged retroperitoneal lymph nodes are identified (08:35, 31, 28),\nlargest measuring 1.9 x 1.5 cm in the left para-aortic region (08:26). The\nstomach is moderately distended. There is moderate to advanced colonic all\nfecal loading. The caliber of small and large bowel is within normal limits.\nNo ascites. The abdominal aorta is normal in caliber. Mild atheromatous\ncalcification of the abdominal aorta is noted. No soft tissue abnormality is\nseen.\n\nPELVIS:\n\nThe well-distended urinary bladder is unremarkable. The rectum is\nunremarkable. Anteflexed uterus and adnexa are unremarkable. No pelvic free\nfluid. Multiple enlarged pelvic lymph nodes are identified, including a large\n2.5 x 1.4 cm lymph node at the right external iliac chain (8:61). Numerous\nadditional enlarged pelvic lymph nodes are identified bilaterally including\nright common femoral region (8:64), right iliac bifurcation, right common\niliac region, left inguinal region, left external iliac region, left iliac\nbifurcation and left common iliac region.\n\nOSSEOUS STRUCTURES:\n\nMild levoconvex scoliosis of the lumbar spine is noted. Subtle focus of\nsclerosis at the L2 vertebral body is nonspecific (12:31, 11:25). No definite\nosteolytic or osteoblastic lesions are identified in the abdomen or pelvis.",
            "output": "1. New small left pleural effusion. New 7 mm nodule at the visualized left\nlower lobe and 5 mm subpleural nodule in the right lower lobe are suspicious\nfor new foci of metastases.\n2. Interval increase in size of the large bilateral necrotic adrenal\nmetastases. Both left adrenal metastases now low involve the upper pole of\nboth kidneys via contiguous spread, left side more conspicuous than right.\n3. 2.2 cm splenic metastasis. Additional ill-defined hypodensity in the\ninferior aspect of the spleen is nonspecific and additional tumor infiltration\nis not excluded.\n4. Multiple new enlarged retroperitoneal lymph nodes and pelvic lymph nodes,\nin keeping with nodal metastases.\n5. Subtle focus of sclerosis at L2 vertebral body is nonspecific. No definite\nosteolytic or osteoblastic lesions identified. If osseous metastases is\nclinically suspected, nuclear medicine bone scan could be obtained."
        },
        {
            "input": "Lower Thorax: Please see CT thorax from same day for further details.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\n\nLiver: There is an unchanged subcentimetric hypodense lesion in segment VII\nthat is too small to characterize but likely a benign cyst or hemangioma (\n02:51 ).\n\nGallbladder and Biliary System: There are multiple gallstones again seen with\nno evidence of cholecystitis ( 2:65 ).There is no significant intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is enlarged to 15.2 cm (601b:34).There is no focal splenic\nlesion.\n\nKidneys and Adrenals: There in unchanged subcentimetric hypodensity in the\nleft kidney upper pole and another in the right lower pole that are too small\nto characterize but may represent cysts (02:59 ).  The kidneys demonstrate\nnormal symmetric enhancement and no hydronephrosis bilaterally.\nThe adrenal glands are normal bilaterally.\n\nBowel:  There is an unchanged rectal mass with adjacent mesorectal fat\nstranding and presacral fat stranding - local staging is better assessed by\nMRI from today. There is no bowel obstruction.\n\nPelvis:  The urinary bladder is unremarkable.  The patient is status post\ntotal hysterectomy and bilateral salpingo-oophorectomy with unchanged\npresacral fluid and fat stranding in the pelvis related to previous\nradiotherapy (02:107 ).\n\nLymph Nodes:  There is a tiny unchanged retroperitoneal lymph node ( 2:80 )\nwith no suspicious lymph nodes by size criteria.\n\nVessels: There is atheromatous calcification of the aorta with no aneurysm.\nThe abdominal vasculature is otherwise normal and widely patent.\n\nBones: There is diffuse degenerative disease in the lower lumbosacral spine\nwith levoscoliosis that is unchanged from previous ( 601b:42).  There is no\nsuspicious bone lesion.",
            "output": "1.  Rectal mass with no evidence of lymphatic or distant metastases in the\nabdomen or pelvis.\n2. For local staging please refer to MRI from same day for further details.\n3. Cholelithiasis and splenomegaly."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously. A tiny hypodensity in the right dome of the\nliver is unchanged and too small to characterize (series 2, image 12). The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is cholelithiasis without evidence of\nacute cholecystitis.\n\nThe spleen is borderline enlarged. Adrenals are unremarkable.  The pancreas\nenhances homogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThe stomach contains oral contrast. The small bowel is diffusely dilated\nmeasuring up to 4.0 cm with a transition at the site of prior surgery within\nthe deep pelvis (601 b,37, 41). The terminal ileum is decompressed (series\n601b, 41).  There is a low-density enhancing mass, just posterior and inferior\nto the site of transition which measures approximately 4.5 x 4.9 cm and is\nconcerning for local recurrence (series 2, image 69).\n\nThe abdominal aorta is normal in caliber without aneurysmal dilation. The\nabdominal aorta and its major branches are patent although atherosclerotic\ndisease is present. There is no mesenteric or retroperitoneal lymphadenopathy\nby CT size criteria.\n\nPELVIS:\n\nThe bladder is moderately distended and normal. Fiducial markers are present\nwithin the pelvis.  Stranding in the presacral space is most likely secondary\nto radiation. Probable local recurrence in the posterior pelvis, as described\nabove (series 2, image 69).\n\nOSSEOUS STRUCTURES/SOFT TISSUES: Multilevel, multifactorial degenerative\nchanges are seen within the visualized thoracolumbar spine. No focal lytic or\nsclerotic lesion concerning for malignancy. A soft tissue enhancing focus\nalong the right abdominal wall may relate to prior injection site (series 2,\nimage 53).",
            "output": "1. Small bowel obstruction with the transition in the deep pelvis near site of\nprior surgery. No evidence of free air.\n2. 4.5 x 4.9 cm hypodense rim enhancing mass in the pelvis, just inferior and\nposterior to the site of transition, concerning for local recurrence.\n3. Cholelithiasis without evidence of acute cholecystitis.\n\nNOTIFICATION:  Updated findings impression # 2 discussed with Dr. ___ by\nDr. ___ the telephone on ___ at 19:20."
        },
        {
            "input": "Please see the dedicated CT chest report from the current date for a thoracic\nfindings.\n\nABDOMEN:\n\nThe liver enhances homogenously. There is a small hypodense lesion in segment\n7 of the liver, which is too small to characterize on the current study. The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is not distended, however\nmultiple gallstones are noted.  The pancreas, spleen, and bilateral adrenal\nglands are visualized and within normal limits.  The kidneys enhance\nsymmetrically, excrete contrast promptly, and show no evidence of suspicious\nsolid mass.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. Colonic\ndiverticulosis is present without evidence of diverticulitis. There is no\nretroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches contain mild\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\n\nPELVIS:\n\nThe bladder and sigmoid colon are grossly unremarkable.  There is thickening\nof the rectal wall, extending upwards approximately 6 cm. In addition, there\nis a distal rectal, fungating mass measuring approximately 2 cm, close to the\nanus.  There is associated stranding in the mesorectum with direct extension\nof this mass into the mesorectum and into the levator ani. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria.  The patient is\nstatus post TAH BSO.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Fungating rectal mass and rectal wall thickening with direct extension\ninto the mesorectum and into the levator ani with associated mesorectal\nstranding, compatible with known rectal adenocarcinoma.\n\n2. Please see the dedicated CT chest report from the current date for thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: There is a right lower lobe 3 mm intermediate density nodule\n(series 2, image 9).  A left basilar calcified granuloma measures 3 mm. There\nis no evidence of pleural or pericardial effusion.\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates cirrhotic morphology, consistent with\nthe prior MRI.  There is a recanalized umbilical vein which demonstrates a\nsomewhat tortuous varicosity along the falciform ligament (series 2, image\n15).  A segment II hypodensity is consistent with a known cyst from prior MRI\n(series 2, image 9).  No suspicious focal lesions.  No evidence of intra\nhepatic biliary dilatation.  The common bile duct measures up to 0.9 cm,\npreviously 0.8 cm on the prior MR. ___ gallbladder contains stones near the\ngallbladder neck (series 2, image 25).  There is mild pericholecystic fluid\nwithout wall edema, which may be secondary to cirrhosis.\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 up to 15.1 cm, with out evidence of focal\nsplenic 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. 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: Evidence of bilateral mesh plugs within the inguinal canals. \nThere is a focus of intermediate density fluid along the right inguinal canal\nmeasuring up to 3.2 cm (series 2, image 90), as well as a right hydrocele,\nincompletely visualized.  No herniation of the peritoneal fat into the right\ninguinal canal seen.",
            "output": "1. Intermediate density fluid collection within the right inguinal canal as\nwell as a right hydrocele.  Recommend evaluation with scrotal ultrasound.  No\ndefinite fat tracking from the peritoneal cavity to indicate hernia\nrecurrence.  No definite herniation of intra-abdominal contents is seen.\n2. Redemonstration of a cirrhotic liver with splenomegaly and a patent\numbilical vein.  No ascites.\n3. Cholelithiasis without gallbladder wall thickening.  Mild pericholecystic\nfluid likely secondary to the underlying liver disease.  Dilatation of the\ncommon bile duct to 0.9 cm, not significantly changed from the prior MR."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 subtle hypodense lesion in the right lobe of the liver, and is\nnot well characterized on this exam.  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 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. 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 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 a chronic fracture of the left eleventh posterior rib.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute intra-abdominal process.\n2. Chronic left eleventh posterior rib fracture.\n3. 7 mm subtle hypodensity in the right lobe of the liver, not well\ncharacterized on this exam.  If the patient has risk factors for chronic liver\ndisease, recommend nonemergent MRI for further evaluation.\n\nRECOMMENDATION(S):  7 mm subtle hypodensity in the right lobe of the liver,\nnot well characterized on this exam. If the patient has risk factors for\nchronic liver disease, recommend nonemergent MRI for further evaluation."
        },
        {
            "input": "LOWER CHEST: Please see the dedicated CT chest report from the same day for\ndetails of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of 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.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation.  10 mm\nwell-circumscribed hypodense lesion at the splenic tip (3:51, 601:44) likely\nrepresents a splenic 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. \nNo evidence of solid renal lesions or hydronephrosis.  Left upper pole renal\ncysts.  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 peritoneal, omental or mesenteric studding\nor thickening.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a fibroid, partially calcified uterus. \nEvaluation of bilateral adnexa is limited secondary to streak artifact from\nbilateral total hip arthroplasties.  Within these limitations, no large\nmasses.\n\nLYMPH NODES: There are multiple sub-centimeter periaortic lymph nodes noted\nmeasuring up to 8-9 mm (3:78).  None are pathologically enlarged.  No\nmesenteric lymphadenopathy.  No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Minimal atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStatus post bilateral total hip arthroplasties.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Fibroid, partially calcified uterus.  Evaluation the adnexa is limited\nsecondary to streak artifact from bilateral total hip arthroplasties.  Within\nthese limitations, no large masses.\n2. No peritoneal or omental studding/thickening, or evidence of distant\nmetastases.\n3. Please refer to dedicated CT chest report from the same day for details 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: Several previously identified hypodense lesions are seen\nthroughout the liver, difficult to characterize by CT, however are likely\nsecondary to hepatic cysts.  The liver demonstrates homogenous attenuation\nthroughout.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Pneumobilia seen in prior study has improved.  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 duodenal resection and\ngastrojejunostomy, with reimplantation of the common bile duct and pancreatic\nduct.  No evidence of obstruction.  Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening and fat stranding. The appendix is\nnormal.\n\nPELVIS: The urinary bladder is under distended and the distal ureters are\nunremarkable.  There is no free 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. \nMild bilateral osteoarthritis seen in both femurs.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intraabdominal pathology that could explain the patient's\nsymptoms."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. d a\n0.9 cm hypodensity in the right hepatic lobe (02:22) is unchanged, likely a\ncyst.  There are no suspicious focal lesions.\n\nPatient is status post interval placement of left PTBD for stricture at the\nhepaticojejunostomy.  Compared with the outside CT abdomen and pelvis ___ and MRCP of ___, there has been interval improvement in\nintrahepatic biliary ductal dilatation within the left hepatic lobe, nearly\nresolved overall.  However, there is persistent focal dilatation of the\nintrahepatic bile ducts within segments II (2:17, 18).  No new hepatic\nabscess.  There is no 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. \nA subcentimeter hypodensity in the right kidney is too small to characterize\nbut statistically likely represents a cyst.  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 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\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: Midline ventral abdominal wall surgical changes are again seen.",
            "output": "Interval placement of left PTBD for stricture at the hepaticojejunostomy with\noverall improvement in intrahepatic biliary ductal dilatation within the left\nhepatic lobe, now nearly resolved.  However, there is persistent mild residual\ndilatation of several focal intrahepatic bile ducts within segment II which\nappears similar to prior.  No new hepatic abscess or other acute process\nwithin the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  Portal vein is patent.  Hepatic\nveins are patent.\n\nLOWER CHEST: Nonspecific ground-glass opacities in the right middle lobe are\nnot suspicious.  ___ fissural nodules, nonsuspicious.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Nonspecific diffuse arterial hyperenhancement of the left hemi\nliver similar to prior MRCP is probably secondary to inflammation.  The left\nportal vein is patent.  A left transhepatic approach percutaneous biliary\ndrain catheter is in place with the pigtail in the hepaticojejunostomy. \nPreviously seen multiple hypoenhancing lesions are no longer evident.  1 cm\nlow-density lesion at the origin of the right hepatic vein (305:45)\ncorresponds to a cyst on recent MRCP.  Small amount of pneumobilia in the left\nhepatic lobe.  Mild intrahepatic biliary dilation in segment 2 has markedly\nimproved and nearly resolved compare to ___.\n\nThere is no extrahepatic biliary dilatation.  The gallbladder is is 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.  An 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. \nFew very small bilateral hypodensities are too small to characterize, likely\nsimple cysts.  There is no evidence of stones, focal renal solid lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the distal stomach.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.\n\nLYMPH NODE: No lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A urethral\ndiverticulum with small stones is incidentally noted (303:166).  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: Locules of air in bilateral anterior abdominal wall soft tissues\ncould be result from injections.  The abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Markedly improved and nearly resolved intrahepatic biliary dilation of\nsegment 2.  An external internal left transhepatic PTBD remains in place.\n2. Nonspecific diffuse arterial hyperenhancement of the left hemi liver is\nsimilar to prior MRCP and likely secondary to inflammation given the patency\nof the portal vein.\n3.   No hepatic abscess.\n4.   Incidental note is made of a small urethral diverticulum containing\npunctate calculi, similar compared to prior"
        },
        {
            "input": "LOWER CHEST: No pleural effusion.  No pericardial effusion.  Normal sized\nheart.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHepaticojejunostomy again noted.  There is a left sided internal-external\npercutaneous transhepatic biliary drain in grossly stable position compared to\nthe prior study.  The pigtail of the drain terminates within the jejunum past\nthe anastomosis.  There is moderate intrahepatic biliary ductal dilatation\nwhich appears similar to the prior study.  Findings are slightly more\npredominant in the left hepatic lobe, is also stable.  The portal venous\nvasculature is patent.  The gallbladder has been resected.\n\nPANCREAS: Prominent pancreatic duct which appears similar to prior studies. \nPancreatic divisum is noted.  No pancreatic lesions.  No peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 hypodensity at the lower pole of the right kidney is too small to\ncharacterize but likely a cyst.  There is no evidence of solid renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A Dobhoff tube terminates at the pylorus.  There is fluid\ndistention of the duodenum and jejunum proximal to the small bowel-small bowel\nanastomosis, which decompressed distally.  The appendix is normal however\ncontains an appendicular with at the appendiceal base (series 601, image 30). \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 uterus and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: Numerous areas of focal stranding and subcutaneous emphysema\ndenote injection sites.  Otherwise the abdominal wall is normal.",
            "output": "1. Overall similar position of the left transhepatic percutaneous biliary\ndrain which traverses the pedicle jejunostomy and terminates in the jejunum. \nNo evidence of hepatic abscess.  No acute intra-abdominal process.\n2. Prominent duodenal and proximal jejunal loops proximal to the small\nbowel-small bowel anastomosis without definite obstruction could reflect slow\nflow of enteric contents.\n3. Incidental note is made of a 6 mm appendicolith, at the base of an\notherwise normal appearing 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. \nRe-demonstration of a hepaticojejunostomy.  The left-sided internal external\npercutaneous transhepatic biliary drain is grossly unchanged in position\ncompared to prior study.  The pigtail of the drain terminates within the\njejunum past the anastomosis, unchanged.  Moderate intrahepatic biliary ductal\ndilatation is similar comparison to prior study.  Minimal pneumobilia in the\nleft hepatic lobe is also unchanged.  There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: No focal pancreatic lesions.  No peripancreatic stranding. \nIncidental note is made of pancreatic divisum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 within the inferior pole of right kidney is too small\nto fully characterize and CT but statistically a renal cyst.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A Dobhoff terminates within the pylorus, unchanged in\nposition.  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.  There is a moderate stool\nburden in the 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Along the anterior abdominal wall are numerous areas of focal\nstranding and subcutaneous emphysema are likely sequela of prior injection.",
            "output": "1. Overall similar position of a left transhepatic percutaneous biliary drain\nwhich traverses the pedicle jejunostomy and terminates in the jejunum.  No\nevidence of hepatic abscess.  No acute intra-abdominal process."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis, otherwise lungs are clear.  There\nis no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\npatient is status post hepaticojejunostomy.  There has been interval removal\nof a percutaneous transhepatic biliary drain.  There is mild edema of the\njejunal bowel wall at the prior site of the pigtail biliary drain, without\nevidence of an organized fluid collection.  A ghost tract is seen within the\nliver along the course of the prior drain.  There is no evidence of a\nsuspicious focal lesions. There is improved, mild intrahepatic biliary\ndilatation, without evidence of 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.  An accessory spleen is noted adjacent to the\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 with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  Renal cortical\nhypodensities are incompletely characterized on this study, however likely\nrepresent simple renal cortical cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post hepaticojejunostomy.  The stomach\nis unremarkable.  There is bowel wall thickening of the jejunum at the\nhepaticojejunostomy, likely related to inflammation from the prior\npercutaneous trans hepatic biliary drain.\n\nThere is prominence of the duodenaljejunal limb proximal to the jejunojejunal\nanastomosis, measuring up to 2 cm.  Jejunum distal to the jejunojejunostomy is\nunremarkable.  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 hysterectomy.  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: Aside from minimal subcutaneous fat stranding about the site of\nthe prior percutaneous biliary drain, the abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Prominence the duodenojejunal limb proximal to the jejunojejunostomy, new\nsince the prior exam, suggesting narrowing at the anastomosis.\n2. Mild wall thickening at the hepatojejunostomy near the vicinity of the tip\nof the recently removed percutaneous transhepatic biliary drain, likely\nsecondary to irritation from prior drain.  No drainable fluid collection.\n3. Interval improvement of intrahepatic biliary 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. \nThere is no evidence of focal lesions.  Patient is status post\nhepaticojejunostomy revision for stricture.  Pneumobilia predominantly within\nthe left hepatic lobe is in keeping with hepaticojejunostomy.  Allowing for\ndifferences in modality, mild intrahepatic biliary dilatation within the left\nhepatic lobe appears similar to prior and was better assessed on the prior\nMRI.  The gallbladder is surgically absent.\n\nPerihepatic inflammatory changes anterior to the left hepatic lobe have\nmarkedly improved.  No definite fluid collections identified.  No ___ or\nsubhepatic fluid collections identified elsewhere.\n\nPANCREAS: Pancreas divisum is again seen.  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 hydronephrosis.  Few subcentimeter hypodensities throughout the\nbilateral kidneys are too small to characterize but statistically likely\nrepresent cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Apparent thickening of the antral wall may be due to gastric\nmotility, although given its proximity to the adjacent perihepatic\ninflammatory changes, gastritis can not be excluded.  The stomach is otherwise\nunremarkable.  Status post hepaticojejunostomy, unremarkable in appearance. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  There is mild diverticulosis of the sigmoid colon.  No 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.\n\nBONES: There 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 revision, unremarkable in appearance, with\nexpected pneumobilia.  Mild intrahepatic biliary duct dilatation within the\nleft hepatic lobe was better assessed on the recent MRCP but appears overall\nsimilar to prior.\n2. Perihepatic inflammatory changes anterior to the left hepatic lobe which\nextend to the skin surface have markedly improved and are likely postsurgical.\nNo drainable fluid collections.\n3. Apparent thickening of the gastric antral wall may be due to motility,\nalthough given its proximity to the adjacent perihepatic inflammatory changes,\na component of gastritis could not be excluded.  If indicated, this can be\nfurther assessed with endoscopic evaluation.\n4. Mild diverticulosis without acute diverticulitis.\n5. 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 persistent pneumobilia with\nmild prominence of the intrahepatic biliary tree, particularly in the left\nhepatic lobe, overall similar in configuration and appearance to the prior\nstudy from ___.  The patient is status post hepaticojejunostomy\nrevision.  The hepaticojejunostomy is again seen anterior to the porta hepatis\nand appears decompressed.  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 solid renal lesions or hydronephrosis.  Several\nsubcentimeter hypoattenuating lesions are too small to characterize by CT but\nlikely represent renal cyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops in the\nproximal small intestine are mildly prominent but not substantially dilated. \nHowever, just proximal to the jejunojejunostomy staple line, the proximal\nsmall bowel loop is mildly dilated to 3.2 cm, with fecalization of bowel\ncontents, suggesting at least partial obstruction.  Distal small bowel loops\nto this area are relatively decompressed.  There is a heavy stool burden\nwithin the colon.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Very trace\npelvic free fluid is seen in the deep 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.  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 dilatation to 3.2 cm of the small bowel loop just proximal to the\njejunojejunostomy anastomosis, with fecalization of small bowel contents,\nsuggestive of partial obstruction.  Very trace pelvic free fluid.\n2. Unremarkable appearance of the hepaticojejunostomy, with similar\nconfiguration of pneumobilia and mild biliary ductal dilatation in the left\nhepatic lobe."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  4 mm pulmonary nodule in the\nleft lower lobe is unchanged (series 2: Image 4).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nWithin the left hepatic lobe, anterior to the left hepatic vein there is an\nindistinct area of hypodensity measuring approximately 2 cm extending to the\nperiphery (series 2: Image 23, 601:35), new from prior.  There is persistent\npneumobilia with mild prominence of the intrahepatic biliary tree,\nparticularly in the left hepatic lobe, overall similar in configuration and\nappearance to the prior study from ___.  The patient is status\npost hepaticojejunostomy revision.  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 solid renal lesions or hydronephrosis.  Several\nsubcentimeter hypoattenuating lesions are too small to characterize by CT but\nlikely represent renal cyst. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Again seen is a\nhepaticojejunostomy anterior to the porta hepatis.  Small bowel loops\ndemonstrate normal enhancement in caliber throughout without evidence of\nobstruction.  Anastomoses are intact without evidence for leak.  There is a\nheavy stool burden within the colon. The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No free\nfluid is present.\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.  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. Approximately 2 cm focal indistinct area of hypodensity in the left hepatic\nlobe anterior to the left hepatic vein which is new from prior and may\nrepresent cholangitis or edema.  No distinct fluid collection is visualized. \nIf clinically indicated, this could be further evaluated with MRI.\n2. Stable appearance of the hepaticojejunostomy with similar pneumobilia and\nmild biliary ductal dilatation in the left hepatic lobe.\n3. No evidence of obstruction, leak, or perforation."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Interval improvement in indistinct area of hypodensity and\nbiliary ductal dilatation in segment 2.  Minimal residual hypodensity in the\nperiphery (series 5, image 25).  Persistent pneumobilia..  The patient is\nstatus post hepaticojejunostomy revision. Gallbladder 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: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. Again seen is a hepatic\njejunostomy anterior to the porta hepatis. Small bowel loops are unremarkable.\nAnastomoses are intact without evidence of leak or intra-abdominal abscess\nformation. The appendix is unremarkable.  Moderately large amount of retained\nstool in the colon\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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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": "Significant interval improvement in indistinct area of hypodensity in the left\nhepatic lobe with minimal residual.\n\nStable appearance of hepaticojejunostomy with pneumobilia and mild ductal\ndilatation.\n\nNo acute infectious or inflammatory process in the abdomen or pelvis.\n\nModerate amount of retained stool throughout the colon and rectum, correlate\nfor constipation"
        },
        {
            "input": "Lung bases, visualized pleural spaces, and lower mediastinal structures\nunremarkable.\n\nABDOMEN:\n\nPatient is status-post partial colectomy.  An end colostomy is identified in\nthe left hemiabdomen.  There is a small pocket of fluid within the\nsubcutaneous fat, posterior to the colostomy (series 6, image 53), without\nevidence of rim enhancement or significant surrounding fat stranding to\nsuggest organized fluid collection.  Colostomy otherwise unremarkable.  No\nupstream dilatation.  Residual colon proximal to the stoma demonstrates\nuncomplicated diverticulosis.\n\nA rectal stump is identified the level of the pelvis.  There is a small pocket\nof air anterior to the rectal stump, which appears extraluminal in nature\n(series 6, image 68 and series 9, image 42).  Additional note is made of\nseveral pockets of air more anteriorly, between the uterus and the left pelvic\nsidewall (series 6, image 67).  This again does not conform to bowel lumen. \nThere is surrounding soft tissue attenuation, inseparable from the uterus,\npotentially representing an inflammatory phlegmon.  There is additionally\ntethering of multiple loops of small bowel to this area of inflammatory\nchange, and further tethering of these structures to the left pelvic sidewall.\nThere is pronounced surrounding fat stranding, although overall improved from\nthe images acquired at time of drain placement on ___.  There is no\nevidence of residual drainable abdominal or pelvic fluid collection. \nPreviously placed left pelvic drain has been removed. The pockets of air\ndescribed above may reflect persistent fistula, but the exact structures\ninvolved with the fistula are difficult to characterize on this study.  An air\nleak is also possible, although this appears to be contained within the\ninflammatory changes localized to the pelvis, as there is no evidence of gross\nfree intra-abdominal air or free fluid.\n\nThere is persistent thickening and stranding of the perirectal fascia.\n\nThere is thickening and mural stratification in several loops of small bowel\nin the pelvis, likely reactive in nature. Small bowel more proximally is\nnormal in appearance. Normal stomach.\n\nLiver is normal in contour and attenuation.  Millimetric hypoattenuating\nlesion in segment ___ of the liver unchanged from the study performed in\n___ (series 6, image 16).  No focal parenchymal lesions otherwise\nidentified.  Uncomplicated cholelithiasis.  No intrahepatic or extrahepatic\nbile duct dilatation.\n\nPancreatic parenchyma normal in bulk and attenuation.  No focal parenchymal\nlesions identified.  No main duct dilatation.\n\nThe spleen is not enlarged (12 cm).  No focal parenchymal lesions.\n\nAdrenal glands are normal.\n\nThere is symmetric perfusion of the renal parenchyma.  There is mild residual\nleft-sided hydronephrosis.  Previously seen right-sided hydronephrosis\ndemonstrates interval resolution.  No nephrolithiasis or hydronephrosis.\n\nUrinary bladder is unremarkable.  No intraluminal air.  No mural thickening.\n\nMildly prominent right external iliac lymph node measuring 11 mm in short\naxis, unchanged (series 6, image 77).  Similarly, mildly prominent para-aortic\nlymph nodes measuring up to 10 mm in short axis, and maintaining normal fatty\nhilum (series 6 image 43).  These are likely reactive in nature.  No inguinal,\npelvic, retroperitoneal, or periportal lymphadenopathy otherwise.\n\nAbdominal aorta normal in caliber.  Major branch vessels patent.  Portal vein,\nportal confluence, SMV, and splenic vein patent.\n\nNo acute or focal destructive osseous lesions.  Multilevel degenerative disc\ndisease throughout the visualized spine, most pronounced at L5-S1.\n\nHealing midline laparotomy scar.",
            "output": "1. Patient is status-post partial colectomy.  End colostomy in the left\nhemiabdomen intact.\n2. Persistent inflammatory changes in the pelvis, as evidenced by presence\ntethering of multiple loops of small bowel to the uterus and the left pelvic\nsidewall.  Multiple pockets of air near the rectal stump, which do not conform\nto bowel lumen, and may reflect contained air leak, or persistent fistula.  If\nthis does indeed represent a fistula, the exact structures involved with the\nfistula are difficult to characterize on this study.\n3. There is no evidence of residual drainable abdominal or pelvic fluid\ncollection.  Previously placed left pelvic drain has been removed.\nFindings were reviewed with Dr. ___ surgery fellow, at 16:40 on ___"
        },
        {
            "input": "LOWER CHEST: Moderate basilar atelectasis.  No large pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The visualized liver demonstrates homogenous attenuation\nthroughout. The hepatic dome was not imaged.  There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder contains a prominent gallstone without evidence of\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 hyperdensity in the inferior right renal collecting system measuring 3\nmm likely represents a stone (series 2, image 36).  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Status post\npartial colectomy with a left mid abdominal diverting colostomy.  A loop of\ntransverse colon is demonstrated within a small parastomal hernia.  The hernia\nis 5.6 cm in width, increased in prominence from the prior study.  no bowel\nobstruction.  There is some stranding noted along the mesentery approaching\nthe parastomal hernia which is not substantially changed from the prior study\n(series 2, image 37).\n\nRectal contrast is demonstrated partially filling a rectal stump. \nExtraluminal contrast is noted filling the vaginal vault. There is soft tissue\nseen between the rectal stump and vagina showing the fistulous tract (series\n2:image 82).  Air and contrast are demonstrated within an additional loop of\nsmall bowel (series 2, image 58).  The small bowel is in close proximity to\nthe unenhanced uterus, which is poorly visualized.\n\nPELVIS: The urinary bladder is decompressed.  The distal ureters are not\nvisualized.  Trace fluid and mesorectal stranding is demonstrated which\nappears similar to the prior study (series 2, image 65).\n\nLYMPH NODES: Prominent periaortic nodes measure up to 1.0 cm in the short axis\n(series 2, image 33), which are unchanged.  A right external iliac node\nmeasures 0.9 cm in the short axis, also stable.  Several prominent mesenteric\nnodes are not enlarged by size criteria likely reactive, stable in appearance\ncompared to the prior study.\n\nVASCULAR: There is no 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 abdominal wall stoma as described above.  Midline\nsurgical changes are noted after prior laparotomy, which are shifted to the\nright compared to the prior study, to due increased width of the parastomal\nhernia.",
            "output": "1. Findings concerning for a rectovaginal and recto-enteric fistula.  Rectal\ncontrast fills the vaginal vault as well as overlying small bowel as described\nabove.  No free contrast within the peritoneum or free air.\n2. New parastomal hernia containing a loop of transverse colon without\nevidence of obstruction.\n3. 3 mm nonobstructing right renal stone.\n4. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: Trace left pleural effusion and bibasilar atelectasis. Normal\nheart size with coronary 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 or\nextrahepatic biliary dilatation.  The gallbladder contains hyperdense material\ncompatible with stones and is decompressed.\n\nPANCREAS: Complex heterogeneous collection compatible with walled off necrosis\nreplacing the entire pancreas and extending into the peripancreatic tissues\ncontaining areas of hypodense and hyperdense fluid, the latter of which is\nlikely related to hemorrhage as seen on prior MRI, with interdigitating areas\nof fat is smaller and currently measures 22.2 x 9.4 cm, previously 25.1 x 14.5\ncm.  Interval development of locules of gas throughout the collection may be\ndue to the presence of a newly placed Axios stent position between the\nposterior wall of the stomach and the pancreatic and peripancreatic\ncollection. Within the stent there is intermediate density material throughout\nthe entire lumen with only tiny foci of gas noted along the edge of the stent\nlumen.  Persistent substantial fat stranding and edema within the surrounding\nmesentery.  Small amount of fluid tracks along the retroperitoneum and\nmesentery inferiorly.\n\nSPLEEN: Persistent splenomegaly measuring up to 20 cm 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: Thickened and edematous stomach wall compatible with\nreactive gastritis.  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.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\nThe splenic vein remains occluded.  Multiple collaterals are noted in the\nanterior abdomen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Large fat containing ventral hernia in the lower abdomen with\nincreased skin thickening and edema compare to ___ is concerning for\nsuperimposed inflammation and cellulitis.",
            "output": "1. Extensive pancreatic and peripancreatic complex fluid collection compatible\nwith walled-off necrosis from hemorrhagic pancreatitis is slightly smaller in\nsize compared to MRI from ___.  New locules of gas throughout the\ncollection is likely secondary to the presence of a new Axios stent between\nthe stomach and the collection, however infection of this collection cannot be\nexcluded on this exam.\n2. Axios stent appears in expected position.  Much of the stent lumen is\nfilled with intermediate density material.\n3. Continued occlusion of the splenic vein with multiple anterior abdominal\nvenous collaterals..\n4. Large anterior ventral hernia with worsening skin thickening and edema is\nconcerning for superimposed inflammation and cellulitis.  Correlate\nclinically.\n5. Cholelithiasis.\n6. Marked splenomegaly, 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. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains hyperdense material\ncompatible with gallstones or sludge without evidence of wall thickening or\npericholecystic fluid.\n\nPANCREAS: There is redemonstration of a complex heterogeneous collection\ncontaining predominantly hypodense Fluid replacing the entire pancreas and\nextending into the peripancreatic tissues measuring approximately 22.7 x 8.0\ncm, previously measuring 22.2 x 9.4 cm on prior study dated ___\n(02:29).  There is redemonstration of locules of gas throughout the\ncollection.  Overall, the collection appears more organized with a more\ndiscrete wall compared to prior study.  An Axios stent is again seen between\nthe posterior wall of the stomach and the pancreatic collection.  There is\nredemonstration of extensive stranding and edema within the adjacent\nmesentery, unchanged.\n\nSPLEEN: The spleen is enlarged measuring 18.7 cm, unchanged.  No focal lesions\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. \nThere are subcentimeter hypodensities in the bilateral kidney's, too small too\ncharacterize but compatible with simple cysts.  There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach again demonstrates wall thickening and edema,\nlikely reactive secondary to the adjacent inflammatory changes.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\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 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.  There is redemonstration of\nocclusion of the splenic vein with multiple venous collaterals.  Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of a large fat containing ventral\nhernia in the lower abdomen with a hernia neck measuring 6.1 cm, unchanged\nfrom prior study.  There is redemonstration of mild skin thickening overlying\nthe hernia, slightly decreased from prior study.",
            "output": "1. Redemonstration of a complex, heterogeneous pancreatic and peripancreatic\nfluid collection measuring up 22.7 cm, compatible with walled-off necrosis and\nslightly more organized with a more discrete wall compared prior CT dated ___.  Axios stent is again seen in stable position.\n2. Again seen splenic vein occlusion.\n3. Large ventral abdominal wall hernia, unchanged.\n4. Cholelithiasis.\n5. Splenomegaly measuring 18.7 cm."
        },
        {
            "input": "LOWER CHEST: Trace left pleural effusion.  Mild bibasilar atelectasis.  The\nheart is normal size with heavy atherosclerotic calcification of the coronary\narteries.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is an unchanged streak like calcification at the right hepatic dome\n(series 3, image 20).  No significant intrahepatic ductal dilatation.  No\ndilatation of the common bile duct.  Periportal nodes measure up to 0.8 cm in\nthe short axis (series 601, image 38).  The portal vein is patent.  The\ngallbladder contains stones as seen previously, no signs of acute\ncholecystitis.\n\nPANCREAS: Interval drainage and substantial improvement in previously\ndemonstrated diffuse walled-off pancreatic and peripancreatic necrosis.  The\npancreas remains mildly edematous and heterogeneous, however the underlying\nparenchyma is poorly assessed secondary to absence of arterial phase study. \nPeripancreatic stranding is markedly improved.\n\nA cyst gastrostomy tube is demonstrated, with a AXIOS stent located within the\nupper stomach.  The cyst-gastrostomy catheter terminates in the collection\nalong the splenic hilum.  There is marked interval decrease in size of a well\norganized, thick-walled collection containing foci of air in the splenic hilum\nspanning the length catheter measuring 8.2 x 4.2 cm, previously part of the\nlarger collection which spanned 22.7 x 7.9 cm (series 3, image 35).  Along the\nanterior neck of the pancreas there is  a partially organized collection with\na fluid component measuring 5.8 x 3.3 cm, also markedly decreased in size\n(series 3, image 36; series 601, image 35).\n\nSPLEEN: There is splenomegaly up to 19.5 cm, similar to the prior study.  No\nfocal lesions are identified.  Similar perisplenic stranding along 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Increased visualization of the stomach wall compared to the\nprior study with some areas of persistent thickening and edema.  There is\nill-defined thickening along the greater curvature of the stomach with\nsubstantial improvement status post fluid drainage (series 3, image 19). \nAdditional stranding and thickening is demonstrated near the pylorus.  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 largely decompressed.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES/MESENTERY: Numerous reactive nodes are demonstrated throughout the\nmesentery, measuring up to 1.2 cm in the short axis (series 3, image 46). \nFindings are stable compared to the prior study.  Periportal nodes as\ndescribed above.  There are numerous prominent periaortic nodes also likely\nreactive measuring to 1.1 cm in the short axis (series 3, image 46).  There is\npersistent stranding of the mesentery with trace fluid within the left\npericolic gutter.  A focal area of mesenteric thickening near the proximal ___\nmeasures 9.6 x 2.0 cm, previously 8.1 x 2.5 cm without evidence of organized\nfluid collection.\n\nVASCULAR: Small caliber arteries are incompletely assessed due to phase. \nPreviously demonstrated occlusion of the splenic vein is unchanged, with\nnumerous collaterals seen at the splenic hilum similar to the prior study. \nThe IMV is attenuated as it approaches the confluence, which is similar to\nprior.  The SMV is patent.\n\nThere is no abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Large ventral abdominal wall hernia containing fat with a hernia\nneck measuring 5.1 cm in the transverse dimension is unchanged compared to the\nprior study.  Thickening along the subcutaneous tissues at the anterior and\ninferior aspects of the hernia is also unchanged.",
            "output": "1. Significant improvement in the previously demonstrated large walled-off\npancreatic and peripancreatic necrotic collection status post cyst\ngastrostomy.  The cyst gastrostomy within the upper stomach terminates in the\nperisplenic collection which now measures 8.2 x 4.2 cm, previously spanning up\nto 22.7 x 7.9 cm.\n2. Mesenteric thickening and stranding along the anterior pancreatic neck an\nunderlying fluid collection measuring 5.8 x 3.3 cm, also substantially\nimproved from the prior study.\n3. Unchanged chronic splenic venous occlusion with multiple collateral vessels\nat the splenic hilum.  Stable splenomegaly.  Attenuation of the IMV just\nproximal to the portal confluence also appear similar compared to prior.\n4. Severe atherosclerosis of the coronary arteries.  Consider routine followup\nwith cardiology when deemed clinically appropriate.\n5. Cholelithiasis without secondary signs cholecystitis.\n6. Large ventral wall hernia containing fat is stable."
        },
        {
            "input": "LOWER CHEST: The heart is normal in size.  There is no pericardial effusion or\nwall thickening.  There are dense triple coronary arteries calcification.  The\npartially visualized pulmonary arteries are patent.  There are bibasilar\nlinear atelectasis.  There is trace left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Prominent right hepatic lobe, similar to prior.  Linear\ncalcification in the hepatic dome, unchanged from previous study.  There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There are multiple calcified stones\nvisualized in the gall bladder with no evidence of cholecystitis.\n\nPANCREAS: Diffuse edema and soft tissue stranding of the pancreas, slightly\nimproved from previous study.  There is minimal, spotted residual enhancement\nof the pancreatic.\nInterval removal of the axios stent and resolution of the collection in the\npancreatic tail.\n\nThere is a 2.4 x 3.2 x 3.2 cm rim enhancing fluid collection at the pancreatic\nbody (series 4, image 37) interval decreased in size from previous study\n(previously measuring 3.5 x 1.6 x 3.7 cm).\n\nInterval removal of the Axios stent and exchange of the pigtail catheter. \nThere is a new stent has its distal tip in a 7.8 x 9.1 cm thick/fluid\ncollection, slightly decreased since prior.  The proximal tip is in the\nstomach.\n\nSPLEEN: The spleen is significantly enlarged measuring 18 cm craniocaudally.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: There is redemonstration of perigastric fat stranding likely\nsecondary to cystogastrostomy procedure.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is grossly unremarkable.\n\nLYMPH NODES: There are prominent periaortic lymph nodes likely reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is redemonstration of splenic vein occlusion with multiple\ncollateral vessels visualized\n\nBONES: There is mild multilevel degenerative changes of the thoracolumbar\nspine.\n\nSOFT TISSUES: There is redemonstration of a large fat containing ventral\nhernia with a mouth measuring 6.2 cm.  There is re-demonstrated of soft tissue\nstranding anterior and inferior to the hernia, unchanged from previous study.",
            "output": "1. Interval decrease of peripancreatic fluid collections as described above. \nNo new collection. Removal of cyst-gastrostomy stent and exchange of looped\nstent.\n2. Stable chronic splenic vein occlusion with splenomegaly.\n3. Large ventral fat containing hernia."
        },
        {
            "input": "LOWER CHEST: There is a stable appearance to waxing and waning bibasilar\nground-glass opacification pattern better characterized on same day CT chest. \nThere is moderate consider atherosclerosis of the coronary arteries.  There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple millimetric well-circumscribed hypodensities of the right\nhepatic lobe too small to characterize on CT however statistically likely\nbiliary hamartomas or 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 diffuse punctate foci\nof calcifications than likely sequela prior pancreatitis/chronic pancreatitis.\nNo 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. \nInterpolar region of the left kidneys a 20 mm well-circumscribed lesion that\ndemonstrates an attenuation of 14 Hounsfield units consistent with a simple\nrenal cyst, (series 12, image 27).  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. Diverticulosis of the sigmoid colon is noted,\nwithout evidence 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 is mildly enlarged with a few foci of\ncalcification.  The seminal vesicles are unremarkable.\n\nLYMPH NODES: The stable 8 mm right aortocaval lymph node is again\ndemonstrated, (series 5, image 75).  The right and left external iliac lymph\nnodes measure 3 mm, (series 5, image 107) and 5 mm, (series 5, image 103). \nThere is no retroperitoneal or mesenteric lymphadenopathy.  There is no pelvic\nor 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, multilevel degenerative changes are seen at there lower thoracic and\nlumbar spine including vacuum phenomena, intervertebral space narrowing,\nendplate sclerosis and osteophytosis.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No evidence of metastasis within the abdomen or pelvis.\n2. Stable conspicuous retroperitoneal lymph nodes which do not meet CT\ncriteria for lymphadenopathy.\n3. Small hiatal hernia.\n4. Mild prostatomegaly.\n5. Please refer to same-day CT chest for description of thoracic findings."
        },
        {
            "input": "GASTROINTESTINAL: The visualized small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  The visualized colon demonstrates\ndiverticulosis, particularly in the descending and sigmoid colon, without\nevidence of acute diverticulitis.  There is a large impacted stool ball seen\nat the level of the rectum with surrounding rectal wall thickening, compatible\nwith stercoral colitis.  Additionally, inflammation and edema seen at the\nlevel of the rectum can be concerning for phlegmonous changes versus early\ndeveloping abscess (series 2: Image 39).  A small tract seen from the right\nrectal wall to the surface of the right buttock is concerning for perianal\nfistula (series 2: Image 43-45).  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 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 at the lumbosacral spine.\n\nSOFT TISSUES: Incidental note is made of a small umbilical fat containing\nhernia.",
            "output": "1. There is a large impacted school wall seen at the level of the rectum with\nsurrounding rectal wall thickening, compatible with stercoral colitis. \nAdditionally, inflammation and edema at the level of the rectum is concerning\nfor phlegmonous changes versus early developing abscess.\n2. A small tract is seen from the right rectal wall to surface of the right\nbuttock, concerning for perianal fistula.\n\nNOTIFICATION:   The findings were discussed with ___ , M.D. by ___\n___, M.D. on the telephone on ___ at 11:13 am, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: Re-demonstrated are bilateral scarring and fibrotic changes on a\nbackground of emphysema.  There is mild pleural thickening along the left\nmedial lung base, similar to prior.  Partially visualized are multiple large,\nheterogeneous hilar and paraesophageal/mediastinal lymph nodes.  These measure\nup to 4.2 x 6.3 cm (02:11) in the left paraesophageal region and up to 3.3 x\n2.8 cm in the right hilar region (2:2), similar to ___.  A 1.0 cm\nsolid, spiculated nodule in the right lower lobe appears similar to ___ (2:6).\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 pancreatic\nductal dilatation.  There is a 5 mm hypoattenuated lesion in the pancreatic\nbody (02:27), which is incompletely characterized, but 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. \nA 2.3 cm simple cyst in the right interpolar kidney is unchanged.  There is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is collapsed.  No bowel obstruction is seen. \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 adnexa are within normal limits.\n\nLYMPH NODES: There is bulky lymphadenopathy in the gastrohepatic region\nmeasuring up to 2.4 x 4.0 cm (02:22), similar to ___.  There is no\nretroperitoneal lymphadenopathy.  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. \nRe-demonstrated are moderate to severe multilevel degenerative changes.  There\nis similar grade 1 anterolisthesis of L3 on L4, L4 on L5 and retrolisthesis of\nL5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal or intrapelvic pathology.\n2. The primary, spiculated right lower lobe lung nodule appears similar in\nsize compared to ___.\n3. Re-demonstrated is bulky mediastinal, hilar and gastrohepatic\nlymphadenopathy, grossly similar in size and extent to ___, however,\ndifficult to accurately assess since the last study with noncontrast enhanced\nand some lymph nodes may be increased in size.\n4. 5 mm hypoattenuating lesion in the pancreatic body is incompletely\ncharacterized, but may represent a side branch IPMN.  MRCP may be considered\nfor further evaluation if clinically indicated.\n5. No evidence of bowel obstruction."
        },
        {
            "input": "LOWER CHEST: Patchy areas of subsegmental atelectasis are noted at the lung\nbases bilaterally.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken and nodular, compatible with cirrhosis.  No\nfocal lesions are identified, although this study is not tailored for\nevaluation of hepatocellular carcinoma.  There is no intrahepatic biliary\ndilation.  Gallbladder wall thickening is most likely due to third spacing. \nMultiple gallstones were better seen on the prior MRCP.\n\nPANCREAS: The pancreas is diffusely atrophic.  Scattered parenchymal\ncalcifications are compatible with a sequela of chronic pancreatitis.  Main\npancreatic duct is dilated at the neck and proximal body measuring up to 7 mm,\nwhich appears to narrow abruptly at the level of the pancreatic head where\nthere is a 17 mm intraductal stone (03:59).  Lobulated cystic lesion at the\npancreatic head measures up to 22 x 18 mm, and is likely similar in size\n(03:59).\n\nSPLEEN: Spleen is enlarged, measuring up to 15.9 cm.  Scattered subcentimeter\nhypodense foci along the inferior margin of the spleen are nonspecific\n(___:74).\n\nADRENALS: The right and left adrenal glands 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\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits.  There\nis large volume ascites.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.  No pelvic\nsidewall or inguinal lymphadenopathy.\n\nVASCULAR: Abdominal aorta is not aneurysmal.  Celiac artery is patent.  The\nright hepatic artery is replaced to the SMA.  Left gastric artery arises\ndirectly from the aorta.  SMA and bilateral renal arteries are patent.  Portal\nvenous system appears patent.  Prominent esophageal, paraesophageal, and\nperisplenic varices are compatible with a sequela of portal hypertension.\n\nPELVIS: Urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Subcentimeter enhancing lesion in the fundus likely\nrepresents a fibroid (3:147), with probable other calcified fibroids.  No\nadnexal masses are identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Main pancreatic duct dilation terminates abruptly at the pancreatic head\nwhere there is a 17 mm intraductal stone.\n2. 22 mm lesion at the pancreatic head is likely similar in size to the prior\nstudy.\n3. Cirrhotic liver, with sequela of portal hypertension including large volume\nascites, mild splenomegaly, esophageal and paraesophageal varices."
        },
        {
            "input": "Upper images show peripheral of pulmonary parenchyma parenchymal abnormality\nin the right middle lobe, slightly decreased in prominence compared to the\n___ chest CT. No pleural effusion is seen. The patient is status post\nright mastectomy.  Coronary calcifications are visible.\n\nA 6 mm hypodensity is identified in the right lobe of the liver posteriorly\n(3; 22) with no new hypodensities identified.  This is unchanged compared to\nprior studies.  No abnormalities seen in the spleen, pancreas, or gallbladder.\nOvoid enlargement of the left adrenal gland is unchanged in size and has\npreviously shown to have features of an adenoma on magnetic resonance imaging.\nThe right adrenal gland remains normal in appearance.\n\nThe kidneys are normal in size and no calcifications are identified. A 2.5 cm\nsimple cyst is seen arising from the cortex of the left kidney laterally with\nan intrarenal cyst seen immediately adjacent to this, both better\ncharacterized on previous contrast-enhanced studies but not increased in size\ntoday.\n\nOrally administered contrast opacifies stomach and small bowel and\nsliding-type hiatal hernia in is seen. A small diverticulum is seen arising\nfrom the second portion of the duodenum. No intestinal obstruction or\nmesenteric mass or inflammatory change in is identified.  No retroperitoneal\nadenopathy is seen. Some calcified atherosclerotic plaque is seen in the\nabdominal aorta, especially infrarenal y and in the lower thoracic aorta\nanteriorly.\n\nIn the pelvis, the mostly empty urinary bladder is normal in appearance.\nCalcifications in the dome of the uterus have the appearance characteristic of\nfibroid calcification. The ovaries are not definitely seen. No free fluid is\nidentified.\n\nThoracic and lumbar vertebral bodies ovoid diffusely demineralized but\nmaintained in height and no focal suspicious osteolytic or osteoblastic lesion\nis seen. Mild lumbar levoscoliosis is present. intervertebral disc spaces are\nnarrowed, especially L4-5 and L5-S1.",
            "output": "1.  Stable to slightly improved appearance of pulmonary pulmonary parenchymal\nprocess at right middle lobe peripherally compared to ___ chest CT. \nNote incomplete evaluation.\n\n2.   Atherosclerosis including coronary artery plaque.\n\n3.  Demineralized bones with no suspicious focal lesion.\n\n4. Other unchanged findings include a simple left renal cysts, hiatal hernia,\nstable left adrenal mass previously shown to be adenoma, fibroid\ncalcifications and tiny focal hepatic hypodensity."
        },
        {
            "input": "LOWER CHEST: A 5 mm right lower lobe pulmonary nodule is unchanged since ___ (series 2, image 9).\n\nABDOMEN:\n\nHEPATOBILIARY: Focal hypoattenuation in segment IV could reflect a ciliated\nhepatic foregut cyst or focal fat deposition, unchanged since ___ (series\n2, image 15).  No new hepatic lesions identified.  The portal veins are\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: 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. \nHypoattenuating renal lesions are too small to completely characterize, but\nstatistically likely reflect simple cysts.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are unremarkable.  The appendix is not visualized, though 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: The uterus is unremarkable for patient age.  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: The abdominal and pelvic wall is unremarkable.",
            "output": "No acute abdominopelvic pathology."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and 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 are multiple prominent right inguinal lymph nodes measuring\nup to 0.9 cm (series 302:33) likely reactive.  There is a prominent right\nexternal iliac chain lymph node measuring 1.2 cm (series 302:30)\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is ill-defined stranding of the subcutaneous tissue of the\nright inguinal region.  There is no drainable fluid collection.",
            "output": "There is soft tissue stranding within the subcutaneous tissues of the right\ngroin, at the site of known cellulitis-without an associated rim enhancing\nfluid collection to suggest presence of an abscess.  There are enlarged right\ninguinal and right external iliac chain lymph nodes that are likely reactive."
        },
        {
            "input": "Kidneys and ureters:\n\nRight kidney: The patient is status post right PCNL.  Again seen is a right\nnephroureteral stent in appropriate position.  There are multiple (at least 5)\nresidual stone fragments in the right renal pelvis as well as the upper and\nlower pole calices, measuring up to 0.8 cm (___).  There is mild right\nhydronephrosis.  There is a 5.8 x 3.8 cm fluid collection in the lower pole of\nthe right kidney with surrounding fat stranding (___).  This may represent a\nseroma or exophytic cyst.  There is hyperdense material in the superior pole\ncalyx, likely representing residual contrast material.  There are a few\nlocules of air in the renal pelvis, likely related to recent procedure.  No\nstone fragments are identified along the course of the stent.  There is soft\ntissue stranding surrounding the ureter throughout its course.\n\nLeft kidney: There is a 8.9 x 7.7 cm exophytic simple cyst in the lower pole\nof the left kidney (___).  No left hydronephrosis or nephroureterolithiasis.\n\nLung bases: There is right basilar consolidation, likely representing\naspiration pneumonitis. There is mild peribronchiolar thickening in the left\nlower lobe. Partially imaged cardiomegaly.\n\nAbdomen: There are a few subcentimeter hepatic hypodensities, incompletely\ncharacterized on this non-contrast study. The largest measures 0.9 cm in\nsegment VII (___). There is a prominent splenic artery calcification in the\nsplenic hilum.  There is fat stranding surrounding the adrenals without\ndiscrete nodules.  Otherwise, the unenhanced appearance of the liver, spleen,\ngallbladder and pancreas is normal. The abdominal aorta appears normal in\ncourse and caliber.Minimal atherosclerotic disease of the aorta and its\nbranches.  There is no lymphadenopathy. Small hiatal hernia.  The stomach and\nduodenum otherwise appear normal.\n\nPelvis: Loops of small and large bowel show no signs of ileus or obstruction.\nSigmoid diverticulosis.  The appendix is normal. The urinary bladder is\ndecompressed, limiting evaluation.  No distal ureteral stone is seen. \nUnremarkable uterus and ovaries.  No free fluid.\nBones: Unremarkable.",
            "output": "1. Persistent mild right hydronephrosis with a nephroureteral stent in\nappropriate position.  There are multiple (at least 5) non-obstructing\nresidual stone fragments in the renal pelvis and upper pole calyces, measuring\nup to 0.8 cm.\n2. There is a right 5.8 x 3.8 cm perinephric fluid collection, likely a post\nsurgical seroma or exophytic cyst.\n3. Right lower lobe lung parencymal consolidation, concerning for aspiration\npneumonitis."
        },
        {
            "input": "LOWER CHEST: There has been interval development of a small to moderate right\npleural effusion and small left pleural effusion with associated compressive\natelectasis.  Additional patchy diffuse ground-glass airspace opacities\ninvolving the visible portions of the lungs.\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 minimally distended. \nThere is mural thickening/edema involving the fundus.  A few tiny layering\nstones are visualized.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no focal\nperipancreatic stranding.\n\nSPLEEN: Stable splenomegaly.  No focal splenic lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left kidney is slightly larger than right and demonstrates mild\nheterogeneous enhancement with slightly asymmetric perinephric stranding\nconsistent with pyelonephritis.  No perinephric abscess is identified.  There\nis no evidence of focal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Mild diffuse stranding of the mesentery with a small amount\nof free fluid in the paracolic gutters.  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 top\nnormal in caliber without associated periappendiceal stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: There is mild asymmetric enlargement of the left ovary\nwithout discrete mass 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: Mild diffuse body wall edema.",
            "output": "1. Mild asymmetric enlargement of the left kidney with faint heterogeneous\nattenuation and asymmetric perinephric stranding consistent with the diagnosis\nof pyelonephritis.  No perinephric abscess identified.\n2. Mural thickening/edema involving the fundus of the gall bladder with a few\nlayering stones.  This most likely is reactive to patient's underlying liver\ndisease and unlikely to be secondary to cholecystitis given lack of gall\nbladder distension and previous negative hepatobiliary scan.  Correlate with\nany right upper quadrant symptoms and laboratory values.\n3. There has been interval development of right greater than left pleural\neffusions, mild ascites, and body wall edema suggestive of third spacing.\n4. Mild enlargement of the left ovary without discrete masses presumably\nphysiologic.  Correlate with any pelvic pain and consider further evaluation\nwith pelvic ultrasound.\n5. Stable degree of splenomegaly.\n\nRECOMMENDATION(S):  Recommendations as above."
        },
        {
            "input": "CT ABDOMEN: The visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nThe liver is normal without focal liver lesion identified. There is no intra\nor extrahepatic bile duct dilation. The gallbladder, spleen, pancreas and\nbilateral adrenal glands are normal.  The kidneys enhance symmetrically and\nexcrete contrast promptly without hydronephrosis. Hypodensities in the left\nkidney are seen, one at the upper pole, which is too small to characterize,\nthough minimally larger than on ___. A 2.2 simple cyst in the left\nrenal upper pole is also larger.\n\nThe small and large bowel are normal in course and caliber without\nobstruction.  Incidentally noted is a duodenal diverticulum (4:32) The\nappendix is visualized and is normal (6:17). There is no free fluid and no\nfree air. The abdominal aorta is of normal caliber with mild atherosclerotic\ncalcifications along its course.  No pathologically enlarged mesenteric or\nretroperitoneal lymph nodes are identified.\n\nCT PELVIS: The rectum is normal.  Diverticula are seen throughout the sigmoid\ncolon without inflammatory changes.  The bladder and prostate are\nunremarkable.  There is no free fluid and no pelvic or inguinal\nlymphadenopathy.\n\nBONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.\nMild degenerative change is seen in the femoroacetabular joints bilaterally,\nsimilar to ___.",
            "output": "1.  No acute intraabdominal abnormality.  Normal appendix.\n\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 a 9 mm hypodensity in segment ___ (02:20) that is 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Evaluation of the deep pelvis\nis significantly limited due to streak artifact from bilateral total hip\narthroplasties.  Within this limitation, circumferential thickening of the\nrectum extending to the rectosigmoid junction and spanning approximately 4 cm\nis identified, compatible with the patient's known history of rectal cancer\n(601:41, 2:67).  This causes significant narrowing of the lumen.  There is\nextensive perirectal stranding, which is incompletely assessed due to streak\nartifact.\n\nThere is upstream extensive colonic stool burden with distension of\nessentially the entire colon.  Nondilated, fluid-filled loops of small bowel\nis likely related to the at least partial obstruction at the rectum.  Small\nbowel is normally enhancing.\n\nPELVIS: The bladder is not well seen due to streak artifact.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is not seen due to streak artifact.\n\nLYMPH NODES: Deep pelvic lymph nodes are not well assessed due to streak\nartifact from bilateral total hip arthroplasties.  For they are seen, there is\nan 8 mm right pelvic sidewall node (2:63).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted.\n\nBONES: Bilateral total hip arthroplasties are in place.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.",
            "output": "1. Significantly limited assessment of the pelvis due to extensive streak\nartifact from bilateral total hip arthroplasties.\n2. Circumferential thickening approximately 4 cm of the rectum to the\nrectosigmoid junction with significant luminal narrowing is consistent with\nthe patient's known rectal cancer.  While deep pelvic lymph nodes are\nincompletely assessed, a right pelvic sidewall lymph node does measure up to 8\nmm.  Additionally, there is significant perirectal stranding.\n3. The rectal tumor does cause at least partial obstruction, with significant\nstool burden and borderline dilation of the colon.\n4. 9 mm hypodensity in the right hepatic lobe may reflect a cyst, or\nhemangioma, although given the patient's history of cancer, continued\nattention is warranted on follow-up examinations.  Alternatively MR may be\nhelpful.  Lesion is too small to characterize, although metastatic disease is\nless likely than a benign lesion.  No other findings concerning for distant\nmetastases are seen 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 redemonstration of a 0.8 cm hypodensity within hepatic segments ___\nnear the confluence of the right anterior and posterior portal veins (series\n2, image 58).  No interval change in size.  No new lesions are demonstrated. \nA perihepatic surgical clip along the posterior hepatic edge (series 2, image\n74) is unchanged.  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 ductal\ndilatation.  There is a 5 mm hypodensity within the pancreatic body (series 2,\nimage 62), which likely represents invaginated fat.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Evaluation of the\ndeep pelvis is substantially limited due to overlying beam hardening artifact\nfrom the bilateral total hip arthroplasties. There is redemonstration of a\nfocal area of rectal wall thickening approximately 5 cm in keeping with the\npatient's history of rectal carcinoma.  The remainder of the visualized colon\nis within normal limits.\n\nPELVIS: The bladder and prostate are largely obscured by overlying beam\nhardening artifact.  No free fluid in the pelvis.\n\nLYMPH NODES: Previously identified FDG avid right pelvic sidewall lymph node\nis not visualized.  A seperate right pelvic sidewall lymph node measuring 6 mm\n(series 2, image 98) is smaller compared to the prior CT and MR and was not\n___ FDG avid.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes throughout the lumbar spine are\ndemonstrated without acute or suspicious osseous abnormality.  Bilateral total\nhip arthroplasties are again noted, without focal complication where\nvisualized.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Full assessment of the pelvis is limited due to extensive overlying beam\nhardening artifact from the bilateral total hip arthroplasties.\n2. Within the limits of the study, there is overall similar appearing\ncircumferential thickening of the rectum in keeping with the patient's known\nhistory of rectal carcinoma.\n3. Adjacent structures are incompletely evaluated.  Please note that pelvic\nMRI would be more sensitive for evaluating local disease.\n4. A previously identified FDG avid right pelvic sidewall lymph node is not\nvisualized.  A seperate right pelvic sidewall lymph node is smaller compared\nto the prior CT and MR and was not ___ FDG avid.\n5. No evidence of distant metastases within the abdomen or pelvis.\n6. A 8 mm right hepatic lobe hypodensity is stable favoring a benign etiology.\n7. Please see separate report of the same-day CT chest for full description of\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain noted is a 0.8 cm hypodense lesion in the right lobe of the liver on\nseries 2, ___ 57.  This is stable in size and most consistent with a cyst or\nhamartoma.  No new lesions are seen.  There is a surgical clip along the\nposterior aspect of the liver on series 2 ___ 72.  This is unchanged.  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 solid renal lesions or hydronephrosis.  There is a 0.7\ncm hypodense lesion in the upper pole of the right kidney on series 2 ___ 58. \nThis is stable in size and although too small to characterize most consistent\nwith a cyst.  A second subcentimeter hypodense lesion in the upper pole of the\nleft kidney is seen on series 2 ___ 56 this is stable as well.  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: Evaluation of the pelvis is limited by artifact from bilateral hip\nprosthesis.  4The urinary bladder and distal ureters 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of metastatic disease in the abdomen and pelvis.  Please note\nthat the evaluation of the pelvis is limited by streak artifact from bilateral\nhip prosthesis\n2. Stable subcentimeter hypodense lesion in the liver most consistent with a\ncyst or biliary hamartoma\n3. Stable bilateral subcentimeter renal cysts\n4. Please refer to separate report from chest CT for description of the\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Improved consolidation in the right lower lobe compared to prior\nstudy suggestive of resolving aspiration episode, now with only linear\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 filled with biliary sludge with no associated\ninflammatory/infectious signs.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 suspicious\nrenal lesions 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.  A nasogastric tube has its tip in the\ngastric body.  The stomach is otherwise unremarkable.\nPatient is status post low anterior resection of the rectum with a left lower\nquadrant end colostomy.  A catheter was inserted through the colostomy,\nthrough which contrast material was injected, and is noted to fill the entire\ncolon with no suggestion of leak.\nThere is a surgical mesh noted in the posterior pelvis (3:104), relatively\nunchanged from prior.  There is a tethered segment of proximal ileum anterior\nto this mesh, a suggested transition point for the moderate upstream dilation\nof ileal and jejunal segments, unchanged from prior study.  The deep pelvis\nabove the anus is not well assessed because of streak artifact from the hip\nprostheses.  Stranding and several fiducials are seen in this area.  There has\nbeen removal of the left lateral approach surgical drain.\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 not visualized due\nto streak artifacts from the bilateral hip prosthesis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nStatus post bilateral iliac lymphadenectomy.  There is a hematoma noted in the\nright hemipelvis (3:105) measuring approximately 6 x 4 x 10 cm (AP x TV x CC)\nwith fluid fluid levels..\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. \nBilateral hip arthroplasty.\n\nSOFT TISSUES: Mild amount of subcutaneous emphysema noted in the lower\nabdominal wall, likely related to the recent surgical procedure (3:21).",
            "output": "1. Relatively unchanged appearance of moderately dilated small bowel loops\nwith a suggestive transition point in the proximal ileum, immediately anterior\nto the pelvic surgical in this patient post lower anterior rectum resection\nand left lower"
        },
        {
            "input": "LOWER CHEST: Previously noted airspace opacification in the right lower lobe,\nlikely representing an episode of aspiration appears improved compared to\nprior.  Minimal ground-glass opacity in the right middle lobe is nonspecific\nhowever could also be seen in the setting of aspiration, but in the\ndifferential diagnosis consider infection.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  Mild increase in density of the medullary pyramids suggesting\nan element of medullary nephrocalcinosis.  A punctate one-two mm ___\nplaque is noted in relation to the lower pole of the left kidney.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach.  Residual oral\ncontrast is seen in the stomach.  There is diffuse dilation of small bowel\nloops up to a point in the posterior pelvis immediately anterior to the mesh\n(series 3, image 110) suggesting high-grade small bowel obstruction with\nminimal contrast seen in collapsed bowel loops distal to this (series 3, image\n116).  Non opacification of the distal ileum.  There is a catheter present in\nthe end colostomy in the left lower quadrant.  The patient is status post low\nanterior rectal resection.  There is a mesh in situ in the pelvis.\n\nPELVIS: Again seen is a hematoma in relation to the right pelvic sidewall\nextending posterosuperiorly along the retroperitoneum measuring 42 mm in\ndiameter, being slightly increased in size compared to prior.  Catheter\npresent in the bladder.\n\nREPRODUCTIVE ORGANS: The morning obscures the pelvis.\n\nLYMPH NODES: Pelvic lymph nodes are suboptimally assessed in the absence of\ncontrast and beam hardening artifact.\n\nVASCULAR: 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 hip prosthesis in situ which partially obscures imaging of the\npelvis.\n\nSOFT TISSUES: Postsurgical changes involving the lower anterior abdominal wall\nis again noted.",
            "output": "1. Diffuse dilation of small bowel loops up to a point in the pelvis just\nanterior to the mesh where there is high-grade small-bowel obstruction with\ncontrast seen trickling past this point.  This is approximately 20-30 cm\nproximal to the ileocolic junction.\n2. Patient is status post low anterior resection with mesh in situ in the\npelvis.\n3. Right pelvic and retroperitoneal hematoma is minimally increased in size\ncompare"
        },
        {
            "input": "CHEST:\n\nThe 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 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. The right kidney\ncontains a simple cyst measuring 2cm x 1.8cm. The left kidney also has a small\nsimple cyst measuring 3.5mm x 2.5mm. There is no evidence of hydronephrosis.\n\nThe stomach is grossly unremarkable in appearance.  A tiny fat-containing\numbilical hernia is noted. The small and large bowel are normal in caliber and\nwithout evidence of wall thickening.  Surgical clips are present on the cecum\nand the appendix is not visualized, likely due to prior appendectomy.  No\ncolonic diverticula are seen on this examination. There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum. The aorta and iliac branches are normal in course and\ncaliber. The celiac trunk and SMA are grossly patent.\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 or fat stranding is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  There is bilateral spondylolysis\nat L5 with Grade 2 anterolisthesis of L5 on S1.",
            "output": "No acute intra-abdominal process 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 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.  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 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.  Redemonstration of NuvaRing within the upper 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nOf note, there is a transitional vertebra at the lumbosacral junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute 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 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 mild\nstool burden; the colon and rectum are within normal limits. 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 and bilateral adnexae are within normal\nlimits.  There is a NuvaRing visualized within the 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.  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 findings to account for left lower quadrant abdominal pain."
        },
        {
            "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: Segmental biliary ductal dilatation noted in hepatic segment VI\nis unchanged.  Portal hepatic shunt noted hepatic segment VIII. Small\nsubcapsular fluid collection in segment II is unchanged.  The gallbladder is\nsurgically absent.\n\nPANCREAS: Postsurgical changes are again seen post Whipple.  Soft tissue\ndensity in the resection bed measures 2.1 x 3.8 cm, not significantly changed\nwhen compared to the prior examination.  There is a 10 x 15 mm cystic lesion\nin the tail the pancreas, unchanged.  Soft tissue in the resection bed\ncompresses and narrows the main portal vein at its confluence.  The splenic\nvein is not visualized throughout the entirety of its course, suggestive of\nocclusion by the tumor.  Similarly, the splenic artery appears proximally\noccluded by the tumor, with distal collateral reconstitution of the splenic\nvasculature.  Tumor surrounds and narrows the proper hepatic artery, extending\nto the bifurcation of the hepatic arteries.\n\nSPLEEN: Heterogeneous hypoenhancement, peripherally in the spleen is likely\nrelated to decreased perfusion in the setting of splenic arterial and venous\ncompromise.  Splenomesenteric collaterals 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, or hydronephrosis.  2.2 cm cyst noted in the\nlower pole of the left kidney.  Additional bilateral subcentimeter\nhypoattenuating renal lesions are too small to characterize, most likely\nrepresenting simple cysts.  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.\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 and the seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Fluid noted in the right inguinal canal.",
            "output": "1.  Re-demonstration of local disease recurrence in the resection bed, with\nunchanged involvement of the portal confluence, hepatic arteries, splenic\nartery and vein.  Locally recurrent tumor is unchanged in size.\n2.  Segmental biliary ductal dilatation in segment 6, concerning for\ncholangitis, as on the prior examination."
        },
        {
            "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 2.4 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: Biliary stent\nis present which appears patent.\n\nArterial evaluation\n\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nVariant anatomy: none\n\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):\nMinimal narrowing 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): Mild\nnarrowing of the distal SMV\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: Multiple mildly enlarged portal lymph nodes, largest\nmeasuring 9 mm short axis (04:123), unchanged\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nABDOMEN:\n\nHEPATOBILIARY: There are few scattered patchy areas of hyper enhancement seen\nperipherally in the liver particularly in segments 4A and 4B.  Common bile\nduct stent is present with expected pneumobilia.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is contains\nstones, without evidence of cholecystitis.\n\nPANCREAS: Again seen is a pancreatic head mass, not significantly changed in\nsize measuring 2.4 x 1.7 cm.  Fiducial markers are noted within the mass. \nThere is persistent pancreatic atrophy and upstream pancreatic ductal\ndilatation measuring up to 10 mm.  Please see table above for further staging\ndetails.\n\nSPLEEN: The spleen shows normal size 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 left lower pole renal cysts, as well as other scattered\ntiny renal hypodensities, too small to accurately characterize but also likely\ncysts.  The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones 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. Diverticulosis without evidence of diverticulitis.\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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is trace free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged prostate measuring up to the 5.9 cm in\ntransverse dimension.  The seminal vesicles also appear prominent but no\nevidence of focal lesions.\n\nBONES: There 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 are few scattered patchy areas of hyper enhancement seen peripherally\nin the liver particularly in segments 4A and 4B.  This likely represents\nperfusional differences, however cannot exclude early cholangitis.\n2. No significant change in size of pancreatic head mass measuring up to 2.4\ncm causing diffuse upstream pancreatic ductal dilatation and parenchymal\natrophy.\n3. There is persistent involvement and mild narrowing of the distal SMV\nextending to the portal confluence.\n4. Mildly enlarged portal lymph nodes which are not significantly changed.\n\nNOTIFICATION:  The findings in the liver were discussed with Dr. ___.\nby ___, M.D. on the telephone on ___ at 3:45 ___, 10 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: The liver demonstrates homogenous attenuation throughout. \nThere are multiple hypodensities of the liver some too small to characterize\non CT.  The largest well-circumscribed hypodensity is located in segment V and\nmeasures 32 x 29 mm demonstrating a density of 14 Hounsfield units consistent\nwith a hepatic cyst, unchanged when compared to most recent prior chest CT\ndated ___.  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: There multiple well-circumscribed hypodensities throughout the\nbilateral kidneys some too small to fully characterize on CT.  The largest\nperipelvic cyst in the right kidney measures up to 26 mm, (series 3, image\n69).  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: There is a small hiatus 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.  There is moderate\nfecal loading of the colon.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly.  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.\nBONES: 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 definite 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 redemonstration of multiple hypodense lesions throughout the liver,\nseveral too small to characterize, with the largest located in segment 5\nmeasuring 3.0 x 3.3 cm, previously measuring 2.9 x 3.2 cm and compatible with\na hepatic cyst.  There are no new suspicious 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is redemonstration of a right midpole renal cyst measuring 2.5 cm\n(2:60), previously measuring 2.6 cm.  There is no evidence of 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. There\nis sigmoid diverticulosis without evidence of diverticulitis.  Otherwise, 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: There is mild prostatomegaly, unchanged.\n\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 mild dilation of the bilateral common iliac\narteries measuring 1.7 cm bilaterally, unchanged from prior study (601:35 and\n601:33).\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. No evidence of metastatic disease in the abdomen and pelvis.\n2. Please refer to same day report of CT chest for description of the 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. \nAgain seen are multiple hypodense lesions scattered throughout the liver\nmeasuring up to 3.1 x 2.9 cm, compatible with a hepatic cyst.  There are no\nnew 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. \nAgain seen is a 2.6 cm simple cyst at the midpole of the right kidney.  There\nis no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate size 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 or 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 measures 5.2 cm in long axis.  The\nvisualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric 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 old right-sided rib fractures.  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. There is no evidence of metastatic disease within the abdomen/pelvis.\n2. Please refer to dedicated CT chest for further characterization."
        },
        {
            "input": "LOWER CHEST: Redemonstration a small right pleural effusion.  Redemonstration\nof cardiomegaly, similar to ___ CTA chest.  Redemonstration of\nextensive subpleural cysts, likely secondary to fibrosis.  Several scattered\ncalcified granulomas are seen in the lung bases, for example, 2:13 and 2:15.\n\nABDOMEN:\n\nHEPATOBILIARY: There is small volume perihepatic and perisplenic ascites, new\nsince ___ but similar to CTA chest ___.  Again seen are\nmultiple hypodense lesions scattered throughout the liver measuring up to 3.3\ncm, incompletely evaluated on this noncontrast exam, but may represent hepatic\ncysts.  Within limits of a noncontrast exam, there are no new hepatic 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  Redemonstration of a\n2.6 cm simple cyst in the midpole of the right kidney (2:29), stable since\n___.  There is no suspicious renal lesions, within the limitations\nof an unenhanced scan.   There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall\nthickness. Diverticulosis of the descending and sigmoid colon is noted,\nwithout evidence of wall thickening or fat stranding. The appendix is normal.\n\nPELVIS: There is small volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, stable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Redemonstration of chronic right-sided rib fractures.  There is no\nevidence worrisome osseous lesions or acute fractures.\n\nSOFT TISSUES: There are bilateral ascites-containing indirect inguinal\nhernias.  These appear to communicate with small anterior, fluid-filled\nperitoneal outpouchings lateral to the inferior epigastric vessels (2:77, 78),\nlikely representing small direct inguinal hernias.",
            "output": "1. Small volume ascites within the abdomen and pelvis, similar to CTA chest ___ but new since ___.\n2. Within limitations of a noncontrast enhanced exam, no evidence of\nmetastatic disease within the abdomen and pelvis.\n3. Stable prostatomegaly."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.   There is moderate calcified\natherosclerotic disease with no evidence of significant stenosis of the celiac\naxis, SMA, or ___.  There is no evidence of occlusion of the abdominal aorta,\nceliac axis, or ___.  There is no active extravasation within the bowel. \nConventional celiac branching is noted.\n\nLOWER CHEST: There is moderate bibasilar atelectasis.  There is no pleural or\npericardial effusion.  Mild calcification of the aortic annulus and left\nanterior descending coronary artery is noted.  Heart size is normal.\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 has been 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. \nSubcentimeter hypoattenuating foci in the kidneys bilaterally (series 3:243)\nare too small to characterize but statistically likely represent simple cysts.\nThere is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass.  The\nincluded and excluded stomach appear unremarkable and there are no anastomotic\ncomplications.  Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is colonic diverticulosis without evidence\nof diverticulitis.  Colon and rectum are otherwise unremarkable.  No colonic\nor rectal wall thickening is present.  Appendix contains air, has normal\ncaliber without evidence of fat stranding.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Foley is noted in the bladder which is decompressed.  The bladder is\notherwise unremarkable.  There is no free fluid in pelvis.  There is no pelvic\nor inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  No adnexal abnormality\ndetected.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is multilevel degenerative changes of the lumbar spine, most severe at\nL2-L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No source for GI bleeding identified.  No evidence of active extravasation.\n2. Colonic diverticulosis without diverticulitis.\n3. Moderate background atherosclerotic disease of the abdominal aorta. No\nevidence of occlusion or significant stenosis of the abdominal aorta, celiac\naxis, SMA, or ___.\n4. Status post Roux-en-Y gastric bypass without evidence of 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 suspicious focal lesion.  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 a 7 mm\nhypoattenuating cystic lesion in the pancreatic head, which likely represents\na small side chain IPMN (series 7, image 31).  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is a 7.1 x 3.4 x 5.4 cm\nheterogeneously enhancing centrally necrotic mass arising from the mid to\ndistal transverse colon, extending superiorly to abut the greater curvature of\nthe stomach.  There is wall thickening of the adjacent transverse colon.  The\nremainder of the colon appears normal.  No evidence of bowel obstruction.\n\nThere has been interval improvement in the pericolonic fat stranding along the\ndescending colon and sigmoid that was seen on the prior study, consistent with\nresolved diverticulitis.  There is colonic diverticulosis without\ndiverticulitis.  The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.  There is omental fat\nstranding without discrete mass or nodularity.  There is an 8 mm portacaval\nlymph node (series 7, image 22) and a 7 mm periportal lymph node, not\npathologically enlarged by CT size criteria.  There are multiple prominent\nretroperitoneal lymph nodes, also not pathologically enlarged by CT size\ncriteria.  These include a 5 mm left periaortic and 6 mm aortocaval lymph node\n(series 7, image 36).\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  The celiac axis, SMA, ___ and renal arteries are patent. \nThere is atherosclerotic calcification at the ostium of the left renal artery.\nThe hepatic and portal veins are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing inguinal hernias bilaterally.  Surgical\nclips are seen in the bilateral spermatic cords consistent with vasectomy. \nThere is a right-sided hydrocele.  The abdominal and pelvic wall is otherwise\nwithin normal limits.",
            "output": "1. There is a 7.1 cm ill-defined heterogenous mass arising from the mid to\ndistal transverse colon extending superiorly to abut the greater curvature of\nthe colon, similar in appearance compared to the prior study from ___.  There is associated thickening of the transverse colonic wall without\nevidence of obstruction.  These findings are consistent with primary colonic\ncarcinoma.\n2. No abdominal or pelvic lymphadenopathy.\n3. No evidence of metastatic disease in the abdomen or pelvis.\n4. Interval resolution of sigmoid diverticulitis.\n5. There is a 7 mm cystic lesion in the head of the pancreas, which likely\nrepresents a small side chain IPMN.  An MRCP is recommended for further\ncharacterization.  See recommendations below for further details.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):   For management of pancreatic cyst(s) between 6-15 mm in\npatients less than ___ years at presentation, recommend annual non-contrast\nMRCP follow-up for ___ years, then every other year up to a total of ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 12:10 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\n___ 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.  However there are\nat least 2 hypoattenuating cystic lesions within the pancreatic head and\nuncinate process measuring up to 7 mm, (series 4, images 120 and 126),\nunchanged from prior.  The aforementioned findings likely represent small 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 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. The patient is\nstatus post left colectomy with expected postsurgical changes.  Few  scattered\ndiverticulosis of the ascending colon without wall thickening or adjacent 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 demonstrates a few coarse calcifications\nwhich are of no clinical significance.  The seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Redemonstration of an 8 mm portocaval, (series 4 image 105) and 7\nmm periportal lymph nodes (series 4 image 106).  Redemonstration of multiple\nsubcentimeter retroperitoneal lymph nodes which include a 7 mm left periaortic\nlymph node, (series 4, image 130) and 6 mm aortocaval lymph node, (series 4,\nimage 129).  There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild calcified\natherosclerotic disease is noted.  The main portal vein, superior mesenteric\nand splenic veins are widely 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.  The\nright scrotum demonstrates post vasectomy changes.",
            "output": "1. Status post left colectomy with expected postsurgical changes.\n2. No evidence of recurrent or metastatic disease.\n3. Multiple cystic lesions in the pancreatic head and uncinate process measure\nup to 7 mm and likely represent side-branch IPMNs.\n4. Please refer to a same-day report of the CT chest for a detailed\ndescription of thoracic findings.\n\nRECOMMENDATION(S):   For management of pancreatic cyst(s) between 6-15 mm in\npatients less than ___ 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.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains contrast from recent CT scan of the\nprior day.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 suspicious\nrenal 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. Status post left colectomy with\nexpected post surgical changes.  The appendix contains mutiple appendicoliths\nand measures 11 mm with surrounding inflammatory changes (series 3, images\n66-79).  This is worse in comparison to the prior examination of ___\n\nPELVIS: The urinary bladder is unremarkable.  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.  Findings consistent with worsening acute appendicitis in comparison to the\nprior examination of ___ with increased caliber of the appendix now\nmeasuring 11 mm and increased surrounding inflammatory changes.  No free air\nor abscess.\n2.  Status post left hemicolectomy.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 12:50 am, 1 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  Subcentimeter cystic lesions in the pancreatic\nhead and uncinate process measuring up to 6 mm (2:146) are unchanged and\nlikely represent small side branch IPMNs.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is top-normal in size with normal attenuation throughout,\nand 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. \nSubcentimeter hypodensities bilaterally are too small to characterize, but\nstatistically likely represent simple cysts.  There is no evidence of solid\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.  Postsurgical\nchanges related to left hemicolectomy are again noted.  The remaining colon\nand rectum are within normal limits aside from a few scattered diverticula. \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: As before, there are coarse calcifications within the\nprostate gland.  The seminal vesicles are grossly normal.\n\nLYMPH NODES: Subcentimeter retroperitoneal lymph nodes measuring up to 7 mm in\nthe left periaortic station (2:171) are unchanged and not pathologically\nenlarged by 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. \nRedemonstrated is transitional anatomy with lumbarization of S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post left hemicolectomy without evidence of local recurrence or\nmetastatic disease in the abdomen or pelvis.\n2. Multiple cystic lesions in the pancreatic head and uncinate process\nmeasuring up to 6 mm are unchanged and likely represent side branch IPMNs.\n3. Please refer to dedicated chest CT performed on the same date for\ndescription of intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are notable for minimal\natelectasis/chronic scarring of the dependent lung bases bilaterally as well\nas mild right lower lobe cylindrical bronchiectasis.  Moderate cardiomegaly is\nnoted.  No pericardial effusion.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Minimal intrahepatic biliary dilation\nwith persistent 1 cm dilation of the common bile duct which tapers smoothly to\nthe ampulla (2:33) without visualization of an obstructing mass, similar in\nappearance when compared to the ___ MR. ___ appearing\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: Calcified residual spleen compatible with autosplenectomy.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRedemonstrated within the upper pole of the right kidney is a 2.6 cm simple\ncyst.  The 1.7 cm cyst within the interpolar left kidney with 24 Hounsfield\nunits likely represents a simple cyst.  There are 2-3 mm hyperdense foci\nwithin the bilateral lower poles may represent nonobstructing renal stones\n(2:38).  There is no evidence of solid 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: Bilateral total hip arthroplasty hardware obscures visualization of\nthe midline pelvic structures.  Within these limitations, the urinary bladder\nand distal ureters are grossly unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is normal appearance.  There is a 1.2 x 0.9 cm\ncoarse calcification within the right adnexa (2:58) which may represent a\nburnt out dermoid 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. \nStatus post bilateral total hip arthroplasties.\n\nSOFT TISSUES: Diastasis recti with a (5 cm-)  wide neck midline Richter hernia\ncontaining the anterior wall of short segment of transverse colon (2:42).  No\nevidence of bowel obstruction.",
            "output": "1. No acute findings within the abdomen and pelvis.\n2. 5 cm wide necked midline Richter hernia containing the anterior wall of a\nshort segment of transverse colon without evidence of obstruction or\nstrangulation.\n3. Persistent dilatation of the common bile duct to 10 mm with distal smooth\ntapering at the ampulla without evidence of obstructing mass, similar in\nappearance to the ___ MRCP.\n4. Moderate cardiomegaly.\n5. Calcified shrunken spleen compatible with auto splenectomy.\n6. Probable nonobstructing bilateral renal calculi."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis and some minimal pleural thickening are\nunchanged.  There is also right greater than left basilar bronchiectasis. \nThere is no evidence of pleural or pericardial effusion.  There is mild\ncardiomegaly.\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 is small and calcified consistent with auto 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. \nA 2.5 cm right renal simple cyst is unchanged.  Previously demonstrated foci\nnear the bilateral inferior renal pole collecting systems (series 2, image 37,\n39) are consistent with nonobstructing stones.  There is no evidence of solid\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 not visualized.\n\nPELVIS: Bilateral total hip arthroplasty obscures the midline pelvis.  Within\nthese limitations: The urinary bladder is grossly unremarkable.  No large\nvolume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A coarse calcification in the adnexa on the right\nmeasures 1.1 cm and is unchanged compared to the prior study.  The visualized\nuterus is grossly unremarkable.  No abnormality within the visualized left\nadnexa.\n\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: Status post bilateral total hip arthroplasty.  No acute fracture or\nsuspicious osseous lesions.\n\nSOFT TISSUES: Small Richter hernia containing a partial loop of transverse\ncolon without evidence of obstruction.",
            "output": "1. No acute abdominopelvic findings.\n2. Redemonstration of a midline Richter hernia containing the anterior wall of\na short segment of the transverse colon, without obstruction.\n3. Mild-moderate cardiomegaly.\n4. Probable millimetric nonobstructing renal calculi within the bilateral\ninferior renal poles, unchanged from the prior study."
        },
        {
            "input": "LOWER CHEST: There are pulmonary nodules at the bilateral lung bases measuring\nup to 4 mm (Series 3, images 5, 9, 13), which are stable from ___.  Heart\nis normal in size, without a pericardial effusion.  Coronary calcifications. \nSevere aortic valve calcifications.  There is a stent in the left anterior\ndescending artery.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver 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. \nPortal venous system 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: Spleen is normal in size and attenuation throughout.  There is a 5 mm\nhypodense lesion, stable from ___, and may represent a small cyst or\nhemangioma.\n\nADRENALS: The 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 is no nephrolithiasis on the right.  There is a 5 mm\nstone in the lower pole of the left kidney (06:35).  There is likely an\nadditional punctate stone adjacent to it (06:36).  Bilateral renal cysts\nmeasure up to 3.9 cm in the right kidney, and 2.1 cm in the left kidney. \nThere 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 right hemicolectomy.  Other than diverticulosis, the remainder of the\ncolon and rectum 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: There is an ill-defined hypodensity in the prostate gland\n(9:81), unchanged from ___, and may represent a sequela of prior 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.  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. Non-obstructing left lower pole renal stones, measuring up to 5 mm.\n2. Diverticulosis.\n3. ___ year stability of bibasilar pulmonary nodules measuring up to 4 mm.\n4. Severe aortic valve calcifications."
        },
        {
            "input": "LOWER CHEST: A 4 mm pulmonary nodule is seen in the right lower lobe (303; 8).\nThere are increased subpleural reticular markings, similar to prior, and\nsuggestive of chronic lung disease.  There is no evidence of pleural or\npericardial effusion.  Coronary artery and mitral annular 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 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 cortical renal cysts are noted.  There is no hydronephrosis.  A 3 mm\nnonobstructing renal stone is seen in the upper pole of the right kidney.  2\nnonobstructing stones are seen in the left kidney measuring up to 8 mm.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Patient is status post right\nhemicolectomy the coloenteric anastomosis appears intact.  There is\ndiverticulosis of the colon without wall thickening or surrounding fat\nstranding to suggest acute diverticulitis.  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 contains calcifications.  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: Degenerative changes are seen in the lumbar spine, most extensive at\nL5-S1.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. Nonobstructing bilateral renal calculi measuring up to 8 mm.\n2. No hydronephrosis.\n3. Stable 4 mm right lower lobe pulmonary nodule."
        },
        {
            "input": "LOWER CHEST: There are multiple bilateral pulmonary nodules, some of which are\nnew from prior, including 2 5 mm pleural based nodules at the left lung base\n(2:16, 18).  There is a partially imaged spiculated nodule in the right lower\nlobe, with the imaged portion measuring 1.2 x 0.7 cm (2:1).  There is no\npleural or pericardial effusion.  Coronary artery calcifications are notable.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  Bilateral renal\ncysts are again seen.  There are bilateral calculi, the largest on the right\nmeasuring 3 mm in the upper pole (2:43) and the largest on the left measuring\n2 mm in the lower pole (601:81).  There is mild left hydronephrosis proximal\nto an obstructing 7 mm stone in the proximal left ureter (2:65).  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 right\nhemicolectomy.  There is diverticulosis 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 to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are redemonstrated\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias and a\nventral hernia with 2.8 cm neck containing a loop of nonobstructed bowel.",
            "output": "1. Obstructing 7 mm stone in the proximal left ureter with associated mild\nleft hydronephrosis.\n2. Multiple new pulmonary nodules measuring up to 5 mm, as well as a partially\nimaged spiculated nodule in the right lower lobe new from prior study. \nNonurgent chest CT is recommended for further evaluation.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 1:40 pm, 4\nminutes after discovery of the findings."
        },
        {
            "input": "Pelvis: The bladder is unremarkable.  Limited views of the proximal bowel are\ngrossly normal.  There is a 4.7 x 3.0 cm cyst adjacent to the left ovary has a\nwell as a 3.3 x 2.4 cm cyst adjacent to the right ovary.  The uterus is\nnormal.  There is rectal wall thickening and adjacent perirectal fat stranding\nas well as a perianal fistula with surgical material seen posteriorly that\nappears to communicate with the skin surface.  No focal fluid collection is\nidentified.  Small locules of gas are seen adjacent the perianal cleft, on the\nright.  Additionally there is small focus of gas projecting in the lower\nanterior pelvic subcutaneous tissue, which on sagittal imaging (5b;.  Images \n46 and 28) appear to be within pannus fold rather than definitively within\nsubcutaneous tissue.  Correlate with direct visualization to exclude\ninflammation.\n\nOsseous Structures: No suspicious lytic or sclerotic lesions are identified.",
            "output": "-Rectal wall thickening as well as perirectal fat stranding suggestive of\nacute inflammation.\n-Additionally, significant perianal disease with a posterior perianal fistula\ncommunicating with the skin surface with surgical material seen within it,\npossibly better evaluated on MRI.\n-Small locules of gas seen along the perianal cleft are noted. Recommend\ncorrelation with recent instrumentation.  Small focus of gas projecting in the\nlower anterior pelvic subcutaneous tissue, which on sagittal imaging (5b;. \nImages 46 and 28) appear to be within pannus fold rather than definitively\nwithin subcutaneous tissue.  Correlate with direct visualization to exclude\ninflammation\n-Bilateral ovarian cysts as described above.\n\nNOTIFICATION:  Updated findings were communicated to Dr. ___\ntelephone on ___ 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 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 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. 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: Postpartum 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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Fat containing umbilical hernia.  There is also a superior\nmidline hernia with soft tissue inflammation raising the possibility of\nstrangulation.  A tubular structure enters the hernia sac (02:40).  The\ntubular structure does not connect a bowel and probably represents peritoneal\nreflection.",
            "output": "Midline supraumbilical hernia containing fat and peritoneal reflections with\nassociated edema raising the possibility of strangulation.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:25 am."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nPatient is status post abdominal aortic stent placement since the prior exam.\nThe stent spans from the abdominal aorta just above the renal arteries to the\nbilateral proximal common iliac arteries. The excluded portion of the aneurysm\nsac is thrombosed without evidence of endoleak. The largest diameter of the\naneurysm sac is 5.3 x 5.2 cm, stable from ___.  The aortic sac volume is\n92 cm3.  The celiac axis, SMA, bilateral renal arteries, and ___ are grossly\npatent. Atherosclerotic mural calcifications are seen throughout the aorta and\nits major branches. The hepatic arterial anatomy is traditional.\n\nABDOMEN:\n\nThe visualized lung bases are clear. There is no evidence of pericardial\neffusion.\n\nThe liver is normal in appearance.  The calcification in the liver segment 4B\nand the calcification at the superior surface of the left liver lobe are\nunchanged.  The portal venous system is patent. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains 1\ncalcified gallstone. Pancreas, spleen, and bilateral adrenal glands are\nnormal.  The kidneys enhance symmetrically.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening. There are few\nscattered diverticula in the sigmoid colon.  There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum.\nLarge ventral hernia contains bowel loops without signs of strangulation. \nThere is a smaller ventral hernia located superiorly which contains fat and\nfluid.  Bilateral inguinal hernia contains fat.\n\nPELVIS:\n\nThe bladder is grossly unremarkable. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  There is anterolisthesis of L4 on\nL5.  No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  Patient is status post abdominal aortic stent placement since the prior\nexam on ___. The aorta biiliac stent is in appropriate position without\nevidence of endoleak. The 5.3 x 5.2 cm aneurysm sac is stable.\n\n2.  Large ventral hernia containing bowel loops without evidence of\nstrangulation, similar to prior."
        },
        {
            "input": "LOWER CHEST: Mild dependent bibasilar atelectasis.  Trace bilateral pleural\neffusions.\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.  Mild prominence of the main pancreatic duct measures up to 2\nmm.  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. \nFew subcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, though likely compatible with simple cysts.  There is no\nevidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  A few fluid-filled loops of\nsmall bowel demonstrate wall hyperenhancement, likely consistent with\nenteritis.  The colon appears largely decompressed, and demonstrates diffuse\nbowel wall thickening, edema, and hyperenhancement, consistent with colitis. \nFew scattered diverticula are noted at the sigmoid colon.  The appendix is\nnormal.  The ventriculoperitoneal shunt catheter is seen coursing along the\nright chest wall and coiling within the mid abdomen.\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 grossly within\nnormal limits.\n\nLYMPH NODES: Few mildly prominent retroperitoneal and mesenteric lymph nodes\nare not pathologically enlarged by CT size criteria, likely reactive.  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. \nSmall sclerotic focus within the left-sided pars interarticularis of L4,\nlikely compatible with bone island.  Mild degenerative change of the lumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  The\nventriculoperitoneal shunt catheter is seen coursing along the right chest\nwall and coiling within the mid abdomen.",
            "output": "1. Findings consistent with pan colitis.  No evidence of bowel obstruction.\n2. Few fluid filled loops of small bowel with wall hyperenhancement,\ncompatible with enteritis.\n3. Trace bilateral pleural effusions."
        },
        {
            "input": "LOWER CHEST: Minimal bibasal atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Chronic mild dilation of the intrahepatic bile ducts and CBD,\nmay relate to prior cholecystectomy and age group.  Liver is otherwise\nunremarkable.\n\nPANCREAS: Mild-to-moderate atrophy of the body, 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is diffuse colonic, sigmoid and rectal wall thickening\nwith mucosal enhancement and pericolonic stranding consistent with pancolitis,\nfilled with watery stool.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid within the pelvis, either physiologic or related to the\nshunt.  No organized fluid collections.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is scattered prominent non pathologically enlarged\nmesenteric nodes which are likely reactive.  There is no retroperitoneal\nlymphadenopathy..  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a tubular nonocclusive hypodense filling defect within the\nleft common femoral vein (2:85, 601:13) which likely represents a deep venous\nthrombosis.  Mild to moderate atherosclerotic disease is noted.  Celiac trunk,\nsuperior and inferior mesenteric arteries and veins remain patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNo sacroiliitis.\n\nSOFT TISSUES: A ventriculoperitoneal shunt catheter tip ends within the left\npelvic sidewall.",
            "output": "1. There is recurrent/persistent pan proctocolitis, most likely infectious\n(for example C difficile) versus inflammatory in the acute setting.  Given\ndiffuse involvement, an ischemic process is less likely.\n2. Nonocclusive hypodense filling defect within the left common femoral vein\nlikely representing deep venous thrombosis."
        },
        {
            "input": "LOWER CHEST: There are trace bilateral pleural effusions with associated\nrelaxation atelectasis.  Bronchial wall thickening in the left lower lobe with\nmore prominent ground-glass opacities is concerning for a component of\naspiration/aspiration pneumonia.\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 solid renal lesions or hydronephrosis.  Several\nsubcentimeter hypodensities are again seen bilaterally, too small to\ncharacterize but likely representing cyst.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Previously seen small bowel\nwall hyperenhancement is resolved.  Previous pancolonic wall thickening is\nmuch improved, though there remains mild wall thickening throughout the rectum\nand much of the colon.  Part of the ascending colon have resolved the previous\nwall thickening.  Previous hyperenhancement of the colon is also much\nimproved.\n\nPELVIS: A 1.4 cm urinary bladder stone is noted.  Otherwise the bladder and\ndistal ureters are unremarkable.  Trace pelvic free fluid is noted.\n\nREPRODUCTIVE ORGANS: Fluid is seen within the vagina/cervical canal.  Query\nhistory of cervical stenosis.\n\nLYMPH NODES: Scattered mesenteric and pelvic lymph nodes are again seen to be\nprominent, but not pathologically enlarged by CT size criteria but likely\nreactive.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Previously seen filling defect in the left common femoral\nvein is not visualized.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are demonstrated.\n\nSOFT TISSUES: The ventriculoperitoneal shunt appears grossly unremarkable.",
            "output": "1. Compared to the prior study from ___, there has been marked\ninterval improvement of previous proctocolitis.  There is mild residual wall\nthickening in much of the colon and rectum without hyperenhancement.  While\nthis may represent residual changes from previous inflammation, given the\nlapse of time between the prior study, cannot exclude a recurrent/developing\nnew proctocolitis, and clinical correlation is recommended.\n2. Bronchial wall thickening with ground-glass opacities in the left lower\nlobe is concerning for aspiration/aspiration pneumonia.\n3. Trace bilateral pleural effusions.\n4. Fluid in the vaginal/cervical canal."
        },
        {
            "input": "LOWER CHEST: Multiple pulmonary nodules consistent with metastatic lesions are\nseen in the partially visualized lung bases.  There has been interval growth\nof all of these lesions.  The largest lesion is in the medial right lower lobe\nmeasuring 1.5 x 1.5 cm, previously 1.2 x 1.1 cm.\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: Severe atrophy of the pancreas with scattered coarse calcifications\nin the area of the pancreatic head is likely related to chronic pancreatitis,\nunchanged from the prior study.  Correlate clinically for signs of pancreatic\ninsufficiency.\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 1.3 cm simple cyst in the anterior interpolar region of the right kidney is\nunchanged.  There is no evidence of hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\nGASTROINTESTINAL:  Evaluation is limited due to the lack of administered\nenteric contrast.  However, despite this limitation, there are multiple\nmetastatic lesions along the stomach and small bowel (EGD proven).  There are\nmultiple levels of small bowel intussusception with resultant mild/partial\nSBO.  There is a gastric body mass (300b:19).  The stomach is otherwise\nunremarkable.  Multiple areas of focal wall thickening scattered throughout\nthe small bowel are compatible with metastatic deposits (02:34, 35, 36, 53,\n64, 77, et al.) including the lesion previously seen in the second portion the\nduodenum, which appears more prominent than on the prior study (02:40). \nAdditionally, multiple nodules are noted in the upper abdomen abutting the\nduodenum, likely additional metastatic deposits (02:40).  Multiple areas of\nsmall bowel intussusception are seen, likely with metastatic deposits serving\nas lead points (02:40, 48, 59, 74).  The longest such segment measures 5.3 cm\n(300b:24).  While transient intussusception can be a normal finding, dilated\nand fluid-filled loops of small bowel upstream from these foci suggest partial\nor early complete small bowel obstruction.  The colon is relatively\ndecompressed, limiting evaluation for wall thickening, although metastatic\ndeposits are suspected (02:41, 46).  The appendix is not definitively\nidentified but there are no secondary signs in the right lower quadrant to\nsuggest acute appendicitis.  No definite mesenteric adenopathy is identified. \nA soft tissue density nodule is seen in the intraperitoneal fat in the right\nlower quadrant (02:40), similar in appearance to the previous study.\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 urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.  A gas containing thick-walled mass in the\nleft lower quadrant measures 2.9 x 2.4 cm, slightly smaller than on the prior\nstudy.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nNo definite osseous metastases are identified in the visualized thoracolumbar\nspine.  Multilevel degenerative changes are similar to the prior study with\nexuberant anterior osteophyte formation and Schmorl's nodes at the junction of\nL2-L3.\n\nA plaque-like soft tissue density lesion in the superficial subcutaneous\ntissues of the left lower quadrant measures 9.0 x 5.6 x 1.2 cm, increased\ncompared to the prior study, at which time it measured 7.8 x 5.5 x 1.5 cm.  A\nnodule in the right flank has also increased size, now measuring 7.5 mm\ncompared with 5.6 mm prior study.  A 2.1 x 0.7 cm nodule within the proximal\nleft buttock may be new from prior study (2:100).  A small fat containing\numbilical hernia is incidentally noted.",
            "output": "1. Multiple areas of small bowel intussusception causing partial or early\ncomplete small bowel obstruction, likely with metastatic lesions serving as\nlead points.\n2. Interval increase in size of multiple pulmonary, small bowel, and soft\ntissue metastatic deposits.\n\nPlease note, any future cross-sectional studies of the abdomen and pelvis\nshould include enteric contrast for better delineation of metastatic 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 CT findings to explain the patient's abdominal pain."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar atelectasis is seen.  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 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,.  8 mm\nhypodensity at the inferior aspect of the spleen may represent a cyst. \nAdjacent splenule is also 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 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. 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: An intrauterine device is visualized within the uterus. \nThere are multiple bilateral ovarian follicles and ovarian enlargement.\n\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 pathology.  Normal appendix.\n2. Multiple bilateral ovarian follicles and ovarian enlargement compatible\nwith patient's history of egg retrieval, however CT is not as sensitive as\npelvic ultrasound for ovarian pathology. There is no free fluid.\n3. An intrauterine device is visualized within the uterus.\n\nRECOMMENDATION(S):   Recommend pelvic ultrasound if clinical concern persists."
        },
        {
            "input": "CHEST:  There are calcified granulomas in the bilateral bases. The visualized\nportion of the heart and pericardium are normal.  There is no pericardial\neffusion.\n\nABDOMEN:  Assessment of abdominal viscera is limited without intravenous\ncontrast. Allowing for this limitation, the liver is normal in size without\nfocal lesions. There is no intra or extrahepatic biliary ductal dilatation.\nThe gallbladder is decompressed, and does not contain radiopaque gallstones.\n\nThe spleen, adrenal glands, and pancreas are unremarkable.\n\nThe kidneys are normal in size. There is mild fullness of the right-sided\ncollecting system. In the upper pole of the left kidney there is a 1.7 x 1.2 x\n1.8 cm hyperdense nodule. In the lower pole of the right kidney there is a\npunctate calcification (601b:34).There are no perinephric abnormalities seen.\n\nThe distal esophagus is normal appearing with no hiatal hernia.  The stomach\ncontains a large amount of gastric contents. The small bowel is not adequately\nassessed.  The proximal jejunum may be dilated, however this is not well\nassessed. The large bowel is loaded with stool, without evidence of\nobstruction or wall thickening. The appendix is not definitely identified.\nThere is no intraperitoneal free air or free fluid.\n\nThere is no aneurysmal dilatation of the abdominal aorta.\n\nPELVIS:  The bladder is under distended, but grossly normal. The rectum and\nsigmoid are are distended with stool and gas. There is no pelvic free fluid.\nThere are no pathologically enlarged pelvic sidewall or inguinal lymph nodes\nby CT size criteria.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: There are no concerning lytic or\nsclerotic lesions seen. No hernias are identified.",
            "output": "1.  The stomach is distended with a large amount of gastric contents. The\nsmall bowel is not adequately assessed. The proximal jejunum may be dilated,\nhowever this is not well assessed. The large bowel is loaded with stool,\nwithout evidence of high grade obstruction or wall thickening. The appendix is\nnot definitely identified. There is no intraperitoneal free air or free fluid.\n\n2. Hyperdense lesion in the upper pole of the left kidney. Consider\nnon-emergent renal ultrasound for additional evaluation.\n\n3.  Punctate calcification in the lower pole of the right kidney."
        },
        {
            "input": "LOWER CHEST: There is mild atelectasis in the bilateral costophrenic angles. \nThere is a tiny calcified granuloma in the posterior right costophrenic angle.\nA 2 mm subpleural nodule in the left costophrenic angle (series 4, image 33)\nis stable compared to CT of the chest from ___.  There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post left hepatectomy.  No focal lesions\nare seen within the right hepatic lobe.  The patient is status post\nhepaticojejunostomy, with associated tiny locules of pneumobilia.  There is no\nbiliary ductal dilatation.  There is a new enhancing nodule measuring 1.6 x\n0.9 cm (series 601 image 53; 604, image 58) within the remnant common bile\nduct.  The common bile duct is dilated, measuring up to 12 mm in caliber.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  A 9 mm hypodensity in the\npancreatic tail is consistent with focal fat.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right 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 cortical hypodensities in both kidneys, too\nsmall to characterize, but unchanged from prior and statistically likely\ncysts.  There is a nonobstructing 3 mm stone in the interpolar region the\nright kidney (series 2, image 35).  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 prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: Lymph nodes in the porta hepatis and aortocaval stations measure\nup to 0.6 cm in the short axis (series 5, image 35), and are unchanged from\nthe prior study.  There is no mesenteric lymphadenopathy.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Mild narrowing of the celiac artery origin and the proximal\nSMA secondary to noncalcified plaque is unchanged from prior.  There is focal\nectasia of the infrarenal abdominal aorta, measuring up to 2.5 cm in diameter.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Small fat containing\nbilateral inguinal hernias.",
            "output": "1. Dilatation of the remnant common bile duct containing a new enhancing\nnodule measuring 1.6 x 0.9 cm, concerning for tumor recurrence.\n2. Status post left hepatectomy.  No suspicious right hepatic lesions.\n3. 3 mm nonobstructing right renal stone.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 19:27 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: There is mild atelectasis at the right lung base.  Visualized\nlung fields are within normal limits.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Surgical clips are seen, status post left hepatic lobectomy,\nRoux-en-Y hepaticojejunostomy, cholecystectomy, and excision of extrahepatic\nbiliary tree.  In the region of the left hepatic duct at the surgical margin\nof the hepaticojejunostomy, there is a 3.4 x 1.3 cm fluid collection, likely\npostoperative.  The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary 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 a 3\nmm punctate calcification in the right kidney which may represent a\nnonobstructing calculus.  There are 2 subcentimeter, hypoattenuating,\nnonenhancing lesions in the interpolar region of the right kidney, too small\nto characterize.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post Roux-en-Y hepaticojejunostomy.   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.  Mural thrombus mildly narrows the SMA.  Mural thrombus is also\nnoted in the distal abdominal aorta.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias.  The\nabdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. 3.4 x 1.3 cm pocket of fluid at the surgical margin of the\nhepaticojejunostomy in the region of the left hepatic duct, likely\npostoperative.\n2. Mural thrombus mildly narrows the SMA.  Mural thrombus is also noted in the\ndistal abdominal aorta.\n3. Bilateral fat containing inguinal hernias."
        },
        {
            "input": "Imaged bowel loops appear normal.  The appendix is partially visualized and\nappears normal.  No free air or free fluid is seen.  The urinary bladder is\nmostly decompressed.  The prostate and seminal vesicles appear normal.  No\npelvic free fluid.  No pelvic sidewall or inguinal adenopathy.  No\nsubcutaneous gas.  The scrotum is better assessed on same-day scrotal\nultrasound.  No inguinal hernia.\n\nBones: No worrisome lytic or blastic osseous lesion.  No fracture.",
            "output": "No acute findings."
        },
        {
            "input": "CHEST:  Lung base are clear. There is no pericardial pleural effusion. Heart\nsize is normal, patient has pacemaker with leads ending right atrium, right\nventricle and left ventricle. Coronary artery calcifications are severe,\npatient has stenting of LCx.  Please refer to separate report of concurrent CT\nchest for detailed description of the thoracic findings.\n\nABDOMEN:  The liver demonstrates homogenous attenuation throughout. Smaller\nthan 3 mm segment 3 hypodense lesion is unchanged since ___ and\nlikely a simple cysts.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\n2.1 x 2.9 cm hypodense lesion is at the pancreatic head, encasing the SMV,\nwhich is narrowed.  The main pancreatic duct is moderately dilated up to 5 mm\nwith atrophy of the pancreatic body. Fat stranding surrounding the pancreatic\nhead, the second portion of the duodenum and the SMA is suspicious for local\ninvasion. There is a 2.1 x 3.6 cm duodenal diverticulum.\n\nSpleen and adrenals  are unremarkable.\n\nCortical renal thinning. There is no evidence of stones or hydronephrosis.\nBilateral kidney cysts are unchanged since ___, the largest in the\nlower pole of the left kidney measuring up to 1.9 cm (06:50). Small and large\nbowel loops are unremarkable. Right inguinal hernia contains small bowel\nloops, there is no sign of obstruction.\n\nThere is no evidence of retroperitoneal and mesenteric lymphadenopathy. The\nabdominal aorta demonstrates moderate atherosclerosis, involving the abdominal\naorta and the origin of the visceral branches.\n\nPELVIS:  The urinary bladder and distal ureters are unremarkable.  Patient has\nhad total prostatectomy. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid or air in the abdomen.\n\nBONES AND SOFT TISSUES:  L1 and L4 vertebral bodies, and left and right iliac\nwings and right sacra-iliac joint osteoblastic lesions are related to known\nhistory of prostate cancer (series 3: Images 60, 82,87, 88, 99). Patient has\nleft femoral prosthesis.",
            "output": "1. 2.1 x 2.9 cm hypodense  pancreatic head lesion encases and narrows the SMV.\nPeripancreatic head fat stranding involving the second portion of the duodenum\nand the SMA is suspicious for local invasion. No evidence of distant\nmetastases. There is moderate pancreatic duct dilatation measuring up to 5 mm\nand pancreatic atrophy.\n2. 3 mm segment III hypodense liver lesion is likely a small liver cyst\n3. Bilateral kidney cysts largest left kidney up to 2 cm.\n4. Patient has had prostatectomy for prostate cancer. Multiple osteoblastic\nlesions are compatible with prostatic metastases."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\nAt the lower pole of the left kidney, there is a 2 mm calcification which\nrepresents a non obstructing renal stone. Previously visualized left ureteral\ncalculus is not seen. No other stones are identified along the left kidney or\nureter.\nThe evaluation is limited by the lack of intravenous contrast and low-dose\ntechnique. The liver, gallbladder, pancreas, spleen, and bilateral adrenal\nglands are normal. The visualized large and small bowel are normal in caliber.\nThe appendix is normal. There is no intra-abdominal free air or free fluid. No\nmesenteric or retroperitoneal lymphadenopathy seen. Fat containing umbilical\nhernia is noted.\n\nPELVIS: The bladder, uterus, and adnexae are unremarkable. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nVESSELS: The aorta is normal in caliber.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Previously seen left upper ureterall stone is not seen. 2 mm nonobstructive\nrenal calculus at the lower pole of left kidney."
        },
        {
            "input": "Please see the dedicated CT chest report from the same date for the thoracic\nfindings.\n\nLIVER: Again seen are several rounded hypodensities within the liver,\nmeasuring up to 2.9 cm in segment II, unchanged since the last scan and\npreviously described as cysts on MR (___). There is no new liver lesion, or\nintra- or extrahepatic biliary dilatation. Mild pneumobilia is expected status\npost Whipple procedure in ___, and is largely unchanged. The portal vein is\npatent.The gallbladder is surgically absent.\n\nSPLEEN: Patient is status post splenectomy.\n\nPANCREAS: Patient is status post complete pancreatectomy in ___,\naccording to the ___ medical record note from ___.\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: Again seen are multiple bilateral millimetric renal hypodensities,\ntoo small to characterize on CT, however previously described a cyst on MR. \n___ left renal cortical thinning is unchanged. The right kidney has an\nextrarenal pelvis. The bilateral kidneys are otherwise without suspicious\nlesion.\n\nGI:Patient is status post Whipple procedure, with an unremarkable\ngastroenteric anastomosis and no evidence of small bowel obstruction. There is\ncolonic diverticulosis without evidence of diverticulitis.  There is a small\nfat containing umbilical hernia.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.Again seen is a small fat containing left\ninguinal hernia.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.  There is\nunchanged grade 2 anterolisthesis of L4 on L5 with vacuum phenomenon and\nbilateral pars defects.",
            "output": "1. Compared with the prior CT scan from approximately 2 weeks ago, there has\nbeen no interval change. No evidence of intra-abdominal or intrapelvic fluid\ncollections or new lesions."
        },
        {
            "input": "LOWER CHEST: The partially assessed lung bases are clear. There is no pleural\nor pericardial effusion. Please see separately submitted report of Chest CT\nfor full description of the lungs.\n\nLIVER: The liver enhances homogeneously without intrahepatic biliary duct\ndilation. Multiple hypodensities in segment II, segment ___, segment VII and\nsegment VIII were previously described as cysts on MR, and are unchanged from\nmultiple prior studies.  No suspicious liver lesion is identified. Mild\npneumobilia is expected postoperatively and unchanged compared with the prior\nstudy. The portal and hepatic veins are patent. The gallbaldder is surgically\nabsent.\n\nSPLEEN: The spleen is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure with complete\npancreatectomy with no evidence of disease recurrence in the surgical bed. \nSurgical clips are in unchanged position.\n\nADRENALS: Slight thickening of the head of the left adrenal gland is unchanged\nfrom multiple prior studies, likely representing a small adenoma. The right\nadrenal gland is unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly.  Bilateral extrarenal pelvises are noted. Numerous bilateral\nmillimetric renal hypodensities are unchanged from the prior study, and were\npreviously characterized as cysts by MR. ___ is no suspicious renal lesion\nhydronephrosis.\n\nGI: Patient is status post Whipple procedure with an unremarkable\ngastroenteric anastomosis and no evidence of obstruction. There is a moderate\nhiatal hernial. The stomach is moderately distended without obvious\nintraluminal mass or wall thickening. The remaining small and large bowel are\nwithin normal limits, without wall thickening or evidence of obstruction. A\nnormal appendix is visualized. There is extensive colonic diverticulosis\nwithout evidence of diverticulitis.  A small fat containing umbilical hernia\nis noted.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with extensive\natherosclerotic calcifications.  A nonobstructing noncalcified atherosclerotic\nplaque is noted in the SMA (2:64), unchanged from prior exams. There is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS:  A small fat-containing left inguinal hernia is noted. The urinary\nbladder appears normal. No pelvic wall or inguinal lymph node enlargement by\nCT size criteria is seen. There is no pelvic free fluid.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES:  Severe degenerative changes of the lumbar spine are\nunchanged, with grade I/II anterolisthesis of L4 on L5 and associated vacuum\nphenomenon, bilateral L5 pars defects, and partial sacralization of L5. No\nfocal lesion suspicious for malignancy present.",
            "output": "1. No evidence of local recurrence or metastatic disease within the abdomen or\npelvis.\n2. Severe degenerative changes of the lumbar spine."
        },
        {
            "input": "ABDOMEN:\n\nCentrilobular and paraseptal emphysema is identified at the lung bases.\nPreviously identified tiny hypodense density in segment 4A of the liver is\nunchanged, likely related to focal fatty deposition (3:71). No suspicious\nfocal hepatic lesions are identified. The portal veins and hepatic veins are\npatent. Increased perihepatic ascites is noted, with scalloping of the hepatic\ncontour (3:80). The ascites appears loculated, with no significant free fluid\nin the paracolic gutters. Small amount of perisplenic free fluid is\nidentified. There is increased greater omental stranding (3:98) with\nlow-density attenuation. Small amount of mesenteric fluid is identified\n(3:97). The gallbladder, adrenal glands, and pancreas are unremarkable. Both\nkidneys demonstrate symmetric enhancement all. Bilateral mild to moderate\nhydronephrosis and proximal hydroureter is identified, with mild interval\nworsening on the right. The stomach is unremarkable. Caliber of small and\nlarge bowel is within normal limits. A lobulated outpouching at the first\nportion of the duodenum (3:88), may relate to a duodenum diverticulum. No\nmesenteric or retroperitoneal lymphadenopathy. Soft tissue structures are\nunremarkable.\n\nPELVIS:\n\nA large right inguinal hernia is again identified containing loops of small\nbowel, with increased fluid in the hernia sac, without evidence of\nobstruction. Mild to moderate sigmoid diverticulosis is again noted, with no\nevidence of diverticulitis. Small amount of free fluid is again identified\nwithin the pelvis. The urinary bladder is unremarkable. Prostate gland is not\nenlarged. No inguinal or pelvic lymphadenopathy.\n\nOSSEOUS STRUCTURES:\n\nBones are grossly osteopenic. Compression fractures of L2 and L5 vertebral\nbodies are again noted, relatively unchanged compared to the prior study. No\nnew lytic or blastic lesions are identified.",
            "output": "1. Bilateral mild to moderate hydronephrosis and proximal hydroureter, with\nmild interval worsening on the right.\n2. Increased perihepatic fluid, concerning for malignant ascites. Small amount\nof perisplenic, mesenteric and pelvic free fluid.\n3. Increased greater omental stranding, suggestive of omental metastases\n4. Large right inguinal hernia containing loops of small bowel, with increased\nfluid in the hernia sac, without evidence of obstruction.\n5. Mild to moderate sigmoid diverticulosis, with no evidence of\ndiverticulitis.\n6. No mesenteric or retroperitoneal lymphadenopathy.\n7. Stable compression fractures of L2 and L5 vertebral bodies."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or 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 grossly 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.\n\nSOFT TISSUES: Status post umbilical hernia repair with a small to moderate fat\ncontaining umbilical hernia noted inferior to the mesh, overall unchanged in\nappearance since ___.",
            "output": "1. No acute abdominopelvic pathology.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. Status post umbilical hernia repair with a small to moderate fat containing\numbilical hernia noted inferior to the mesh, overall unchanged in appearance\nsince ___."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  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 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, with multiple\nhypodensities in the superior aspect of the spleen measuring up to 1.3 cm\nwhich may represent cysts versus 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. \nA 1.2 cm left upper pole renal cyst is demonstrated.  There is no evidence of\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Proximal small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon and rectum are within normal limits. Extensive phlegmonous changes with\nsoft tissue stranding and fluid are demonstrated surrounding a dilated\nthick-walled an inflamed appendix.  And appendicular is is seen within the\nproximal aspect of the appendix (601:24) with discontinuity of the appendiceal\nwall (601:26) compatible with perforated appendicitis.  No drainable\ncollections are identified.  Note is made of terminal ileal wall thickening\nadjacent to the appendiceal inflammation consistent with reactive ileitis.  No\nbowel obstruction.\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: 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 small umbilical hernia containing fat is noted.",
            "output": "Perforated appendicitis with extensive phlegmonous changes in the right lower\nquadrant and small amount of fluid.  No drainable fluid collections\nidentified.  Terminal ileitis is likely reactive to the adjacent appendiceal\ninflammation."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Haziness adjacent to the\nproximal SMA persists and is separate from the pancreatic mass (2:126),\nunchanged from prior.\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 patent hypodensities are re-demonstrated which most likely represent\nhepatic cysts.  Additionally in segment VII there is an indeterminate\nhypodensity measuring 5 mm (2:108) corresponding to findings on MRCP of ___.  There is mild central intrahepatic biliary dilatation and\npneumobilia with a CBD stent in place.  The gallbladder is within normal\nlimits, without stones or gallbladder wall thickening.  Trace free fluid is\nvisualized throughout the abdomen primarily perihepatic in nature.\n\nPANCREAS: There is re-demonstration of a ill-defined pancreatic head/uncinate\nprocess mass that measures 2.0 x 1.9 cm (2:137), previously measuring 2.9 x\n2.5 cm.  Mass causes upstream pancreatic ductal dilatation measuring up to 8\nmm (02:131).  Contact with the SMV greater than 180 degree remains unchanged\nfrom prior.  Multiple peripancreatic and porta hepatis nodes are\nre-demonstrated measuring up to 1.3 cm (2:123).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  An accessory spleen is re-demonstrated.\n\nADRENALS: The 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 cysts are re-demonstrated and similar\nin appearance to prior studies.  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. There\nis no evidence of mesenteric 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: Multilevel degenerative changes visualized throughout the imaged\nportion of the thoracolumbar spine without evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Diffuse edema is visualized throughout the imaged soft tissues.",
            "output": "1. Re-demonstrated ill-defined pancreas head/uncinate process mass with\ndecreased size and stable SMV involvement and resultant main pancreatic ductal\ndilatation.\n2. Interval increase in size of peripancreatic/porta hepatis nodes.  Trace\nperihepatic ascites.\n3. New segment VII 5 mm indeterminate hypodensity correlates with finding on\nMRCP of ___.\n4. Unchanged haziness adjacent to the proximal SMA which appears separate from\nthe region of pancreatic mass.\n5. Please refer to same-day CT chest for characterization of intrathoracic\nfindings"
        },
        {
            "input": "VASCULAR:\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 separate chest CT done the same day for thoracic\nfindings.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nUnchanged scattered hepatic cysts/biliary hamartomas, the largest at the\nhepatic dome measuring 2 cm.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Hypoattenuating and ill\ndefined mass\nSize (maximal axial dimension in cm): 3 cm (series 601, image 52).\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent.  There is a 8 mm dilatation of the main pancreatic duct with marked\natrophy of the pancreatic parenchyma.\nBiliary tree abrupt cutoff with or without upstream dilatation: There is a CBD\nstent in place with secondary aerobilia as well as air in the gallbladder.\n\nArterial evaluation\nSMA involvement: Absent.  The hazy fat stranding that previously abutted the\nSMA no longer makes a contact with it and has generally improved in the root\nof the mesentery.\n\nCeliac Axis involvement: The soft tissue and hazy attenuate around the celiac\nand common hepatic artery appears similar and possibly slightly more\nconspicuous along the right aspect of the celiac artery.\nSolid soft-tissue contact: <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: present\nSolid soft-tissue contact:  <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: none\n\nVenous evaluation\nMPV involvement: present (series 601, image 54)\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 increased hazy attenuation/stranding contact: <=180\u00b0 and improved\nfrom prior.\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\nExtension to first draining vein:  Present on opposite wall\nThrombus within vein: absent; type of thrombus:  None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: Small amount of ascites in the pelvis.\nSuspicious lymph nodes: 11 x 13 mm common hepatic node is similar.  Multiple\nsmall nodes around the common hepatic and celiac artery remains suspicious.\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nSPLEEN: Mild splenomegaly measuring 13.9 cm\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unremarkable besides scattered unchanged cortical\nhypodensities too small to be characterized.  A 13 mm right interpolar cyst is\nunchanged.\n\nGASTROINTESTINAL: Uncomplicated colonic diverticulosis.  No small bowel\nobstruction.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  No pelvic\nlymphadenopathy. The prostate and seminal vesicles are grossly unremarkable.\n\nBONES: No concerning bone lesions.  T11 vertebral body hemangioma is\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Pancreatic head mass with overall similar appearance.  Decrease in haziness\naround the SMA and SMV but persistent soft tissue, haziness and small lymph\nnodes around the celiac and common hepatic artery.\n2. 11 mm common hepatic artery remains concerning for node involvement.\n3. No distant metastasis in the abdomen or pelvis.\n4. Please refer to separate chest CT done the same day for thoracic findings."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits.  Again seen are well-circumscribed\nhepatic cysts, unchanged from prior, the largest arising from the right\nhepatic dome measuring 1.8 x 1.4 cm (series 4, image 81, 91, 98, 115).  No new\nor concerning hepatic lesion is detected.  There is mild periportal edema\n(series 4, image 97).  There is no intra or extrahepatic bile duct dilation. \nThere is mild pneumobilia, resulting from a patent CBD stent, which appears\nappropriately positioned.  No radiopaque ductal stones are detected.\n\nThe pancreas is moderately atrophic, with the pancreatic duct dilated to 9 mm,\ntapering rapidly at the 2 head, where there is a ill-defined 2.3 x 1.7 cm mass\n(series 4, image 115), similar in appearance to the ___\nexamination.  Again seen is fluid-density extending from this lesion, encasing\nthe distal CBD, and extending superiorly to encase the celiac trunk and common\nhepatic artery (series 4, image 103, 102).  A prominent common hepatic node is\nunchanged, measuring 7 mm (series 4, image 103).  There is also stranding\nextending medially to encase the proximal SMA (series 4, image 110, 107). \nThis configuration remains stable in comparison to the ___ study.\n\nThe spleen is mildly enlarged, measuring 13.4 cm.  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 hypodensities along the lower pole of the right\nkidney and upper pole of the left kidney likely reflect tiny cysts (series 4,\nimage 105, 134).  Arising from the posterior interpolar aspect of the right\nkidney is a well-circumscribed 2.1 cm lesion demonstrating intermediate\ndensity (31 Hounsfield units), demonstrating interval enlargement from 1.3 cm\non the ___ examination (series 4, image 111).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.\n\nThere is no new mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe bladder is decompressed, and appears normal.  The prostate is normal in\nsize.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  Mild stranding along the proximal\n___ is stable since the prior examination, and remains nonspecific (series 4,\nimage 140).\n\nThere are no osseous lesions concerning for malignancy or infection.  Moderate\nL4/5 and L5/S1 disc loss with extensive endplate sclerosis appears stable\nsince the prior study.  There is no acute fracture.",
            "output": "1. Unchanged appearance of an ill-defined 2.3 x 1.7 cm pancreatic head mass,\nwith stranding extending to encase the distal CBD, celiac trunk, common\nhepatic artery, and proximal SMA.\n2. Unchanged 7 mm common hepatic node.  No new adenopathy.\n3. Interval enlargement of a intermediate-density right interpolar lesion\nsince the ___ examination, now measuring 21 mm.  This is likely a\nenlarging hemorrhagic cyst rather than a solid lesion given the rapid change\nin size since the prior recent study.  If further confirmation is desired,\nultrasound could be performed as an initial assessment.  Otherwise, this can\nbe followed on subsequent surveillance studies.\n4. Mild splenomegaly.\n5. No distal abdominopelvic metastasis.\n6. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver parenchyma is heterogeneous, likely reflecting variable steatosis. \nAgain seen are multiple well-circumscribed hypodense lesions throughout the\nliver, unchanged from the prior examination, the largest within segment 4\nmeasuring 1.7 cm, most compatible with cysts or biliary hamartomas.  An\nill-defined 9 mm focus of hyperenhancement within segment 6 is not definitely\nseen on prior examinations (series 3, image 108), and is nonspecific, given\nbackground heterogeneity of the parenchyma.\n\nAgain seen is a 2.2 x 1.7 cm pancreatic head mass, unchanged in comparison to\nthe ___ examination (series 3, image 113).  There are new fiducials\nalong the anterior aspect (series 3, image 118, 117).  Moderate upstream\npancreatic duct dilation, measuring up to 7 mm, is unchanged (series 3, image\n107).  Moderate pancreatic body and tail atrophy is also stable.  Stranding\nand soft tissue density extending from the mass superiorly encases the celiac\ntrunk (series 3, image 101), common hepatic artery and GDA (series 3, image\n102, 105), and proximal proper hepatic artery (series 3, image 102).  The\nstranding also contacts the right hepatic artery proximally (series 3, image\n100).  There is minimal stranding surrounding the proximal SMA, unchanged from\nprior (series 3, image 106).  There is contact against the main portal vein\nand SMV, without narrowing.\n\nThe spleen is top-normal in size.  No focal splenic lesions are detected.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  Bilateral well-circumscribed hypodense lesions, most\ncompatible with cysts, are unchanged from prior.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nremain normal in caliber.  There is mild colonic diverticulosis.  Mild sigmoid\nwall thickening and stranding, with slightly increased trace pelvic fluid\n(series 3, image 183, 177), are suggestive of mild colitis.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches remain patent and normal in caliber.  Accessory bilateral renal\narteries are again seen.\n\nThere is no new mesenteric, retroperitoneal, or intrapelvic lymphadenopathy.\n\nModerate thoracolumbar spondylosis appears similar in comparison to the prior\nexamination.  There is no acute fracture.  There are no osseous lesions\nconcerning for malignancy or infection.",
            "output": "1. Unchanged appearance of a pancreatic head mass, with soft tissue/stranding\nencasing the celiac, common hepatic, proper hepatic, gastroduodenal, and\nproximal right hepatic arteries.  Minimal stranding contacting the SMA is\nunchanged.  There is continued contact of the main portal vein and upper SMV,\nwithout attenuation.\n2. Ill-defined subcentimeter hyperenhancing focus within segment 6 is\nnonspecific, but warrants subsequent surveillance studies.  If tumor markers\nare concerning for progression, MRI could be considered further assess this\narea.  Otherwise this area can be reassessed on followup surveillance.\n3. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Accessory bilateral renal\narteries are again seen.\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. \nAgain seen are multiple well-circumscribed hypodense lesions throughout the\nliver, unchanged from the prior examination, the largest within segment IV\nmeasuring 2.0 cm, most compatible with cysts.  The previously described\nhyperenhancing segment VI lesion, only seen on the most recent study, is no\nlonger visualized.  No new focal lesions.  Mild pneumobilia, predominantly\nwithin the left hepatic lobe and gallbladder, is again seen and in keeping\nwith CBD stent.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is unremarkable.\n\nPANCREAS: Again seen is a pancreatic head mass increased in size measuring 3.0\nx 2.7 cm (3:110), previously 2.2 x 1.7 cm, and with increased central\nhypodensity.  Fiducials are again seen along the anterior aspect of the mass. \nUpstream pancreatic ductal dilatation measuring up to 7 mm (3:104) is\nunchanged.  Moderate atrophy of the pancreatic body and tail appears similar.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 3.0 x 2.7 cm, previously 0.2 x 1.7\nLocation (head right of SMV, body left of SMV): head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent, unchanged upstream pancreatic ductal dilatation measuring 7 mm.\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\n\n___ involvement: present\nIncreased hazy attenuation/stranding contact: <=180\u00b0\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: present\n\nCeliac Axis involvement: present with extension to and encasement of the GDA\nwhich is severely attenuated midway along its course (03:105-106).\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: present\nIncreased hazy attenuation/stranding contact:  >180\u00b0\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: present\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):\nabsent\n\n___ involvement: present\nDegree of solid soft-tissue 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: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  An accessory spleen is again seen.\n\nADRENALS: There is mild thickening of the bilateral adrenal glands without\nfocal nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple cysts within the bilateral kidneys measure up to 1.9 cm.  Few other\nsubcentimeter hypodensities throughout the bilateral kidneys are too small to\ncharacterize but statistically likely represent simple cysts as well.  There\nis no evidence of stones or hydronephrosis. There are no urothelial lesions in\nthe kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is apparent mucosal\nhyperenhancement within the gastric antrum and first portion of duodenum. \nElsewhere, small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening or fat stranding. The appendix is not visualized. \nNo secondary signs of appendicitis are 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 prostate and seminal vesicles are grossly\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nwell-defined subcentimeter lucency in the right iliac bone (3:148) is\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval increase in central hypoattenuation and size of pancreatic head\nmass measuring up to 3.0 cm, previously up to 2.2 cm.  Overall, extensive\nvascular involvement including portions of the celiac axis, superior\nmesenteric artery and vein, and main portal vein, appears similar to the prior\nstudy.\n2. Apparent mucosal hyperenhancement within the gastric antrum/first portion\nof the duodenum is more conspicuous than the previous studies.  It is unclear\nwhether this conspicuity is related to differences in contrast timing or\nrepresents evidence of tumor extension.\n3. Diverticulosis without acute diverticulitis.\n4. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "The visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\n\nABDOMEN:\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 is surgically absent. The pancreas,\nspleen, and bilateral adrenal glands are normal. The kidneys enhance\nsymmetrically and excrete contrast promptly. Within the midportion of the\nright kidney there is a 1.8 x 1.5 cm hypodensity, likely a cyst. Multiple\nadditional bilateral renal hypodensities are too small to characterize but\nlikely cysts.\n\nThe stomach is grossly unremarkable in appearance. The small bowel is normal\nin caliber and without evidence of wall thickening. The appendix is normal in\ndiameter. Diffuse colonic diverticulosis is noted. Additionally, there is a\nfocal region of sigmoid colon containing multiple diverticuli with wall\nthickening and adjacent fat stranding (2:70), suggestive of diverticulitis.\nMultiple adjacent foci of air may represent microperforations versus\nintraluminal gas. There is no drainable fluid collection or frank\npneumoperitoneum. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. The aorta and iliac branches are normal in course and caliber. The\nceliac trunk and SMA are grossly patent.\n\nPELVIS:  The bladder, sigmoid colon, and rectum are grossly unremarkable.\nThere is no pelvic side-wall or inguinal lymphadenopathy by CT size criteria. \nTrace free pelvic fluid is noted.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Uncomplicated acute sigmoid diverticulitis.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___\ntelephone at 18:05 on ___, 2 min after discovery."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder is surgically absent and the biliary tree is normal. The pancreas\nis normal, without focal lesion or duct dilation. The spleen is normal in\nsize, without focal lesion. The adrenal glands are normal. The kidneys enhance\nnormally and excrete contrast briskly. There are no solid renal lesions or\nhydronephrosis.  There is a 1.6 cm simple cyst in the right kidney and several\ntiny bilateral hypodensities which are too small to characterize. The small\nbowel and large bowel are normal in caliber, without wall thickening.  The\nprevious episode of sigmoid diverticulitis has resolved.  There is moderate\ndiverticulosis without evidence of acute diverticulitis.  A normal appendix is\nseen.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening. The rectum is unremarkable.\nThere is no pelvic mass. There is no free fluid. There is no pelvic or\ninguinal lymphadenopathy. The uterus is normal in size and enhancement. No\nadnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection.",
            "output": "Previous episode of diverticulitis has resolved.  There is no acute\ninflammatory process evident in the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is variant arterial anatomy.  The\nfirst branch of the abdominal aorta gives off the left gastric as well as a\ndiaphragmatic artery.  The next branch is the splenic artery.  There is a\nreplaced common hepatic from the SMA. There is mild 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 is shrunken and nodular.  There are multiple small\ngranulomas in the liver.  There are a few punctate hyperdensities in the right\nand left lobe of the liver measuring 5 mm too small for accurate\ncharacterization, series 3ab image 34.  Wall thickening of the gallbladder is\nnonspecific in the setting of ascites.  There is moderate to large large\nvolume 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: There is splenomegaly measuring 15.2 cm.  Splenic granulomas are\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. \nPunctate hypodensities in the kidneys bilaterally likely represent cysts\nhowever are too small for accurate characterization.  There is no evidence of\nstones, suspicious 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.  There is mild diverticulosis of the descending\nand sigmoid colon.  Appendix contains air, has normal caliber without evidence\nof fat stranding.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is moderate fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a umbilical hernia containing fat and ascites.  There\nare additionally bilateral inguinal hernias right greater the left, the right\nhernia containing ascites.",
            "output": "1. Cirrhotic liver with ascites and splenomegaly.  No suspicious focal liver\nlesions.  Hypodense lesions in the liver measure up to 5 mm are too small for\naccurate characterization at this time.\n2. Replaced common hepatic artery arising from the SMA.\n3. Please see dedicated chest CT report for further evaluation of 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: 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\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 mildly enlarged with normal attenuation throughout. \nPossible chronic thin subcapsular fluid collection, perhaps an old hematoma. \nMultiple coarse splenic calcifications are likely granulomas, as seen on the\nprior 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. \nSubcentimeter renal hypodensities are small to characterize by CT, but are\nstatistically likely cysts.  There is no hydronephrosis, or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  A surgical clip\ndenotes site of recent polypectomy (5:79) in the cecum.  A metallic marker is\nidentified in the region of the sigmoid colon (5:113).  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 unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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.  Surgical clip denotes the site of recent cecal polypectomy.\n\n2.  No intrabdominal or intrapelvic lymphadenopathy.  No other intraperitoneal\nmasses detected.\n\n3.  Please refer to the dedicated CT chest report of the same date for the\nintrathoraic findings."
        },
        {
            "input": "LOWER CHEST: New low-density small right pleural effusion.  No left pleural\neffusion.  Overlying right lower lobe atelectasis.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken with nodular borders, compatible with\nknown cirrhosis and not significant changed in extent from the prior study.  A\npreviously described cystic lesion near the gallbladder fossa is not\ndemonstrated on the current exam.  Multiple hypodense lesions throughout both\nhepatic lobes measure up to 0.9 cm in the hepatic dome, and are unchanged in\nsize from ___.  The TIPS is patent.\nThe gallbladder is distended, with a dependent stone measuring 7 mm.  There is\nfocal thickening along the lateral wall which may be adenomyomatosis (series\n2, image 6).  No pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is peripancreatic fluid\ndemonstrated, which is new from prior and low density (series 2, image 26). \nMultiple peripancreatic lymph nodes are prominent, including a para-aortic\nnode measuring 0.6 cm in the short axis (series 2 image 33).\n\nSPLEEN: The spleen is enlarged at 15.1 cm, with 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 with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Bilateral\nhypodensities within the renal cortex which are too small to characterize by\nCT are unchanged from prior and likely benign cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Embolization coils are seen\nconsistent with embolized varices.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon is within\nnormal limits. The appendix is normal.  There is mild thickening of the\nrectum, may be secondary to portal hypertension and collateral.  There is\ndiffuse anasarca\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume ascites.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Numerous periaortic lymph nodes are prominent, which is increased\nfrom the prior study.  There is also diffuse stranding of the retroperitoneal\nfat, nonspecific in appearance.\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 abdominopelvic walls within normal limits.  Note is made of\nleft sided gynecomastia.",
            "output": "1. Interval development of para-aortic lymphadenopathy with retroperitoneal\nedema and trace peripancreatic fluid.  There is small-volume ascites. \nFindings could be part of the diffuse anasarca, however cannot exclude early\npancreatitis.  Aortitis is considered much less likely given the relatively\nnormal appearance of the aortic lumen.  Recommend correlation with physical\nexam and laboratory findings.\n2. Equivocal gallbladder wall thickening with a dependent stone and mild wall\nedema without significant pericholecystic fluid or stranding.  If clinical\nconcern for acute cholecystitis persists, a HIDA may be considered.\n3. Redemonstration of cirrhotic liver morphology with a patent TIPS. \nSplenomegaly to 15.1 cm.\n4. Focal rectal thickening without adjacent fat stranding, given the patient's\nliver disease this could be related to portal hypertension and varices. \nProctitis due to an infectious or inflammatory process is considered less\nlikely.\n5. Flattened vena cava is worrisome for dehydration."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions with associated relaxation\natelectasis.  5 mm subpleural nodular density in the right lower lobe likely\nrepresents atelectasis (series 303, image 6).  There is mild cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular and shrunken consistent with history of\ncirrhosis.  There multiple hypoattenuating cystic lesions throughout the\nliver, not significantly changed compared to the prior MR of the liver ___.  Hyperenhancing focus seen in segment 6 the arterial phase is\nlikely a perfusion related abnormality.  There are no suspicious lesions\nmeeting OPTN criteria for HCC.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nsurrounding inflammation.  There is adenomyomatosis of the gallbladder fundus.\n\nA TIPS stent is seen adjoining the right portal vein and the right hepatic\nvein.  The stent 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: There is splenomegaly (14.3 cm in craniocaudal dimension).  The spleen\nis normal in attenuation throughout 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 solid renal lesions.  There multiple subcentimeter\nhypoattenuating cystic lesions too small to characterize but likely\nrepresenting benign renal cyst.  There is no perinephric abnormality.  There\nis no hydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and enhancement. The colon and rectum are within normal limits.\nThe appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.  Coarse calcification of the prostate gland, similar to prior.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.  There multiple prominent\nperiportal and peripancreatic lymph nodes, likely secondary to portal\nhypertension and are not pathologically enlarged by CT size criteria..\n\nVASCULAR: Coil embolization material is seen in multiple perigastric varices. \nMultiple small gastric and esophageal varices are present.  There is evidence\nof portal hypertension including splenorenal shunting.  No significant\natherosclerotic disease is noted. There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is evidence of gynecomastia.  There is a relative paucity\nof subcutaneous fat.",
            "output": "1. No suspicious lesions in the kidney meeting OPTN criteria for\nhepatocellular carcinoma.  There are multiple hypoattenuating cystic lesions\nseen throughout the liver, similar to those seen on recent MRI of the liver.\n2. Hepatic cirrhosis with evidence of portal hypertension including\nsplenomegaly, splenorenal shunting, perigastric and small esophageal varices.\n3. Stable positioning of the TIPS stent, which is patent.\n4. Cholelithiasis without evidence of cholecystitis.  There is focal\nadenomyomatosis of the gallbladder fundus."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  5 mm left lower lobe lung nodule\n(3; 46), unchanged since ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  . \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Normal.\n\nADRENALS: The right and left adrenal glands 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 focal renal lesions.  There is no evidence of\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.   Status post LAR in ___ was\nunremarkable anastomosis.  Interval left lower quadrant ileostomy takedown\nwith development of a small nonobstructive bowel containing parastomal hernia.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\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. \nSubcentimeter right inguinal lymph nodes, likely reactive.  Surgical clips in\nthe left inguinal canal.\n\nVASCULAR: Interval resolution of portal vein thrombosis.  There is no\nabdominal aortic aneurysm.  No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Previously noted presacral collection has resolved.",
            "output": "1. No locally recurrent or metastatic rectal cancer in the abdomen/pelvis.\n2. 5 mm left pulmonary nodule, stable for 20 months.  Attention on follow-up."
        },
        {
            "input": "LOWER CHEST: Please refer to the chest CT done the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSmall 7 mm lesion at the periphery of segment 8 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.\n\nADRENALS: The right and 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 12 x 10 mm hypodense lesion in the inferior aspect of left the\nkidney with indeterminate density (65 ___ unit).  There is a 8 mm cyst\nin the inferior aspect of the right kidney.  There is no perinephric\nabnormality.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is not well-distended which limit the evaluation\nof this organ.  This is to be correlated to an endoscopy if clinically\npertinent.  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: 2 cm anterior fundic fibroid and 1 calcified measuring 11\nmm in the posterior fundus.\n\nLYMPH NODES: There is no retroperitoneal or 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 in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "-No acute intra-abdominal process.\n-Indeterminate 1.2 cm left renal lesion not seen on the ultrasound done the ___ to be further characterized by MRI.\n-\n\nRECOMMENDATION(S):  Abdominal MRI to characterize left renal lesion."
        },
        {
            "input": "LOWER CHEST: Bibasilar opacities could reflect a combination of atelectasis\nand/or aspiration.  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 mild intrahepatic biliary dilation.  There is\ncholedocholithiasis with a stone in the distal CBD (601:28).  The the CBD\nmeasures up to 14 mm.  There is cholelithiasis without gallbladder wall\nthickening or pericholecystic stranding to suggest acute cholecystitis.\n\nPANCREAS: Pancreatic parenchyma is atrophic, but demonstrates normal\nattenuation.  No ductal dilation or focal lesions are seen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The adrenal glands are mildly thickened bilaterally.\n\nURINARY: The kidneys are of normal and symmetric size.  There are multiple\nbilateral renal cysts.  A lesion in the right interpolar region measuring\napproximately 13 mm demonstrates hyperdensity, but is overall incompletely\ncharacterized (02:20).  A fat containing 2.4 cm left inferior pole partially\nexophytic lesion is most consistent with an angiomyolipoma.  There is no\nhydronephrosis.  The right upper polar urothelium/renal pelvis appears\nthickened with a soft tissue density (02:22).  There are bilateral\nnonobstructing renal calculi.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber and wall thickness throughout.  There is colonic\ndiverticulosis without evidence of diverticulitis.  The appendix 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 is not seen, likely 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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel lumbar spine degenerative changes are noted.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.  Nonspecific\ncalcification in the right breast.  There is a right abdominal wall lipoma\n(02:25).",
            "output": "1. Choledocholithiasis with a stone in the distal common bile duct, and\ndilation of the CBD and intrahepatic bile ducts.  Cholangitis cannot be\nexcluded, correlate with laboratories.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Bilateral incompletely characterized renal lesions, including in the right\nrenal pelvis and interpolar region.  Non urgent, outpatient renal ultrasound\nis recommended for further characterization.\n4. Diverticulosis without evidence of diverticulitis.\n5. Atelectasis versus aspiration at the lung bases."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 mildly decreased attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is severely enlarged measuring up to 17.5 cm, unchanged\nfrom prior study.  No focal lesions 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: The stomach is unremarkable.  Previously noted subtle\nstranding around the second through fourth portion the duodenum appears\nlargely resolved.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.   Again noted is fat stranding surrounding the duodenum and extending\ntowards the colon such as on series 2 ___ 42 ___ 48 and on coronal images on\nseries 601 ___ 35.  This is unchanged from prior study of ___.\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.  A\nbone island is again seen in the sacrum, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  stable fat stranding surrounding the duodenum and extending towards the\nascending colon.  Differential diagnosis includes duodenitis or pancreatitis.\n2.  Stable splenomegaly.  No evidence for infarcts"
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nLIVER:  The liver is normal in size and attenuation.  There is moderate intra\nand extrahepatic biliary ductal dilatation, which is increased from the prior\nexamination done in ___. The common bile duct measures 1.2 cm. Again\ndemonstrated is chronic thrombosis of the main portal vein extending into the\nSMV with extensive intra-abdominal varices similar in appearance to ___\nand better characterized on ___ MRI. No focal hepatic lesions are\nidentified.\n\nGALLBLADDER: The patient is status post cholecystectomy with clips seen in the\ngallbladder fossa.\n\nSPLEEN: The patient is status post splenectomy. A 2 cm regenerated or\naccessory spleen is again demonstrated and unchanged in size (series 2, image\n17).\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:  Subcentimeter hypodensities are seen throughout both kidneys but are\ntoo small to characterize. The kidneys are otherwise normal with no suspicious\nrenal lesions identified. There is no evidence of hydronephrosis in either\nkidney.\n\nBOWEL: The stomach is unremarkable.  The small bowel appears normal with no\nevidence of obstruction.  The large bowel is normal in caliber.  There is\nmoderate stool seen throughout the descending and sigmoid colon.  There is no\nfree air or free fluid seen in the abdomen or pelvis.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: The rectum and sigmoid colon appear within normal limits. The bladder\nis unremarkable. There is no pelvic sidewall lymphadenopathy.  A moderate\nright hydrocele is again demonstrated and similar in size to the prior exam.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. Moderate to significant intrahepatic biliary ductal dilatation, increased\nfrom the prior CT on ___.\n2. Chronic thrombosis of the portal vein with extension into the superior\nmesenteric vein is again demonstrated. Extensive intra-abdominal varices are\nstable from the prior exam.\n3. No intra-abdominal/intrapelvic fluid collection identified. No\nintraperitoneal free air."
        },
        {
            "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: 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 stable moderate intrahepatic and\nextrahepatic biliary dilatation.  A prior common bile duct stent has been\nintervally removed.  A TIPS is seen in appropriate configuration.  Again seen,\nis nonocclusive peripheral thrombus of the main portal vein between the ___\nstent and the TIPS (09:40, 11:29).  However, there has been interval\nhepatopetal propagation of the clot, now with greater overall burden in the\nmain portal vein and interval extension into the inferior tip of the TIPS\n(___).  An ___ stent is in similar configuration appears patent. The\ngallbladder is is resected.\n\nPANCREAS: Hypodensity in the pancreatic tail is stable from prior, likely\nrepresenting small side-branch IPMN (09:35).  The pancreas has normal\nattenuation throughout, without evidence of new 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.\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.  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. Interval increase in main portal vein nonocclusive thrombus burden with\ninterval propagation of clot into the inferior portion of the TIPS.  Patent\nSMV stent.\n2. Persistent moderate intrahepatic and extrahepatic biliary dilatation with\ninterval removal of biliary 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. \nMillimetric arterially hyperenhancing foci in the left lobe is unchanged\ncompared to at least ___ and demonstrates persistent enhancement on\nportal venous and delayed phase images without evidence of washout, likely\nrepresenting either perfusional difference or flash filling hemangioma\n(301:15).  Otherwise, no concerning liver lesions are identified.  Moderate\nintrahepatic and extrahepatic biliary ductal dilatation is not substantially\nchanged.  The common bile duct measures up to 1.0 cm, previously 0.9 cm\n(603:46).  The gallbladder is surgically absent.  Patient is status post TIPS,\nin appropriate configuration.  Nonocclusive peripheral thrombus within the\nmain portal vein between the ___ stent and the TIPS does not appear\nsignificantly changed, with stable extension of clot material into the\ninferior tip of the TIPS compared to ___ (303:40, 603:50, 47, 45). \nCompared to prior exam, new hypodensity seen within the ___ stent with\npossible post stent distal extension raises question of early nonocclusive\nthrombus versus endothelial proliferation versus flow related artifact\n___, 61, 70).\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout. \nRedemonstration of a 1.0 x 0.6 cm pancreatic tail hypodensity, which is\nunchanged compared to at least ___ (303:44).  The main pancreatic\nduct is not dilated.  There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.  A 1.9 x 2.0 cm accessory spleen\nremains in left upper quadrant (303:38).\n\nADRENALS: The 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 mm nonobstructive right interpolar renal calculus is seen (02:28).  Tiny\nbilateral renal cortical hypodensities are too small to fully characterize. \nThere is no evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The visualized small large\nbowel loops demonstrate normal caliber and enhancement.  No evidence of bowel\nobstruction.  Appendix is not visualized.  A dropped surgical clip is\ndemonstrated in the right lower quadrant (603:42).\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.  A right hydrocele is\npartially 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.  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. As compared to exam dated ___, there is new hypodensity seen within\nthe SMV stent with possible post stent extension raising the question of early\nthe nonocclusive thrombus versus endothelial proliferation versus flow related\nartifact.  Repeat CT abdomen with delayed portal venous phase can be\nconsidered.\n2. Patent TIPS with stable appearance of nonocclusive thrombus burden within\nthe main portal vein and inferior portion of the TIPS.\n3. Persistent moderate intrahepatic and extrahepatic biliary ductal\ndilatation, unchanged compared to prior exam.\n4. Stable appearance of a 1.0 cm pancreatic tail hypodensity compared to at\nleast ___, likely a side branch IPMN.\n5. Punctate nonobstructive right renal stone.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:20 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "VASCULAR:\n\nPatient is status post TIPS with resultant metallic streak artifact slightly\nlimiting evaluation for thrombus.  Allowing for this, the TIPS stent appears\npatent without the filling defects.  There is persistent narrowing of the\nportal vein and SMV confluence between the stents (303:45), likely due to\nrecanalization of prior thrombus.\n\nSMV stent is re-demonstrated with unchanged nonocclusive intraluminal\nthrombus.\n\nCavernous transformation and other portosystemic collaterals, including\nparaesophageal, perigastric, mesenteric, pericolic, and perirectal varices are\nre-demonstrated.\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 liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is stable mild intrahepatic biliary\nductal dilatation, likely secondary to cholecystectomy.  The gallbladder is is\nresected.  There is no ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without pancreatic\nductal dilatation.  A 1.1 cm hypoattenuating lesion within the pancreatic tail\nis stable compared to prior and slightly increased in size since the MRCP of\n___ when it measured 0.7 cm, likely a side-branch IPMN.  There is\nno peripancreatic stranding.\n\nSPLEEN: Status post splenectomy.  Splenosis nodule is re-demonstrated in the\nsplenectomy bed.\n\nADRENALS: The bilateral adrenal glands are unremarkable.\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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Apparent mild circumferential bladder wall thickening is likely due to\nunderdistention and/or chronic urinary outflow obstruction.  The distal\nureters are unremarkable. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.  A dropped surgical\nclip, likely from cholecystectomy, is seen in the inferior pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and contains coarse\ncalcifications.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent TIPS without evidence of thrombus.  Persistent nonocclusive thrombus\nwithin the SMV stent,similar in extent to the prior exam.\n2. 1.1 cm hypoattenuating pancreatic tail lesion, likely a side-branch IPMN,\nstable compared to prior but slightly increased in size since ___\nwhen it measured 0.7 cm."
        },
        {
            "input": "LOWER CHEST: Small nonhemorrhagic right and traced left pleural effusions. \nBibasilar atelectasis.  There is also linear atelectasis within the right\nmiddle lobe and lingula.  No pericardial effusion.\n\nABDOMEN:\nThere is a moderate amount of nonhemorrhagic ascites throughout the abdomen\nand pelvis.\n\nHEPATOBILIARY: 7 mm arterially hyperenhancing lesion within the left lobe of\nthe liver with persistent enhancement on the portal venous phase, likely a\nhemangioma (series 10, image 26).  No other suspicious liver lesions.  Mild\nintra and extrahepatic biliary dilatation is unchanged compared to prior\nwithout focal obstructing lesions visualized.  Status post cholecystectomy.\n\nPatient is status post TIPS, which appears mostly patent.  However, there is a\nsmall amount of nearly occlusive thrombus in the proximal TIPS, which is\nsimilar compared to the CT dated ___, but is not seen on the\nrecent portal venogram dated ___ (series 10, image 48).  In addition,\nthere is new near complete thrombosis within the SMV stent compared to the\nrecent portal venogram, which appears completely occlusive in areas (series\n10, image 67).  The distal mesenteric branches appear patent.  There is also a\nsmall amount of nonocclusive thrombus within the main portal vein proximal to\nthe TIPS, which is also new.  Extensive cavernous transformation surrounding\nthe main portal vein and tips, which has progressed since the CT dated ___.\n\nPANCREAS: 10 mm hypodense lesion within the pancreatic tail is unchanged\ncompared to prior, likely a side branch IPMN (series 10, image 44). \nOtherwise, the pancreas has normal attenuation throughout, without main\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: Status post splenectomy.  Small accessory spleen superiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple punctate nonobstructing stones are seen within the right\nkidney (for example series 4, image 36).  Subcentimeter hyperdense lesion\nwithin the interpolar region of the left kidney, likely a\nhemorrhagic/proteinaceous cyst (series 4, image 36).  Multiple additional\nsubcentimeter hypodensities within the right kidney are too small to\ncharacterize, but likely represent cysts.  Otherwise, the kidneys are of\nnormal and symmetric size with normal nephrogram.  There is no evidence of\nenhancing renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Evaluation for intraluminal bleeding is limited due to\npre-existing oral contrast within the distal colon.  Within these limitations,\nthere is no evidence of active extravasation.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Moderate circumferential thickening and submucosal edema\naffecting the ascending colon, which likely reflects portal colopathy, however\ninfectious or inflammatory colitis cannot be excluded.  The distal colon and\nrectum are within normal limits.\n\nPELVIS: Small focus of air within the bladder lumen is likely due to recent\ncatheterization.  Otherwise, the urinary bladder and distal ureters are\nunremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: No mesenteric lymphadenopathy.  Numerous small lymph nodes and\ndilated retroperitoneal lymphatics are similar compared to prior (for example\nseries 10, image 86).  There is no new retroperitoneal lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease 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 and pelvic wall is within normal limits.",
            "output": "1. Evaluation for intraluminal bleeding is limited due to pre-existing oral\ncontrast within the distal colon.  Within these limitations, no evidence of\nactive extravasation.\n2. New near complete occlusion of the SMV stent due to thrombosis.  Near\ncomplete occlusion at the proximal TIPS.  Distal TIPS appears patent. \nNonocclusive thrombus within the main portal vein with increased cavernous\ntransformation.\n3. Circumferential thickening and submucosal edema affecting ascending colon,\nlikely due to portable colopathy, however an underlying infectious or\ninflammatory colitis cannot be entirely excluded.\n4. Unchanged 10 mm hypodense lesion within the pancreatic tail, likely a side\nbranch IPMN.\n5. Unchanged mild intra and extrahepatic biliary dilatation.\n6. Moderate volume ascites.  Small right and trace left nonhemorrhagic pleural\neffusions.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:38 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nStatus post TIPS placement with mild adjacent metallic streak artifact\nsomewhat limiting evaluation for thrombus.  There appears to be some mild\nintraluminal irregularity within the TIPS stent, possibly artifactual, however\nresidual nonocclusive thrombus (as seen on most recent prior CT abdomen exam)\nis not excluded.  There is no evidence of occlusive thrombus within the TIPS\nstent.  Again seen is a ___ stent with nonocclusive intraluminal thrombus,\ndecreased in extent compared to the prior study.  Extensive cavernous\ntransformation is seen surrounding the main portal vein and TIPS, similar to\nthe most recent prior exam.\n\nStable congestion of the mesentery, likely due to portal hypertension.\n\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 mild intra and extrahepatic biliary\nductal dilatation, unchanged compared to prior exam.  No focal lesions are\nidentified.  The gallbladder is is resected.\n\nPANCREAS: The pancreas has normal attenuation throughout.  A 9 mm\nhypoattenuating focus in the pancreatic tail, likely reflects a side branch\nIPMN and is unchanged compared to prior exam (03:37).  No peripancreatic\nstranding.\n\nSPLEEN: Status post splenectomy.  A small splenule remains in the post\nresection bed.\n\nADRENALS: The right and left adrenal glands 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.\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 mildly 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 TIPS placement with moderate metallic streak artifact limiting\nevaluation for thrombus.  Within this limitation, no obvious evidence of\ncompletely occlusive thrombus.  Evaluation for stenosis and flow velocities\nbetter depicted on same day liver Doppler ultrasound.\n2. Status post SMA stenting with persistent incompletely occlusive\nintraluminal thrombus, decreased in extent compared to ___.\n3. Extensive upper abdominal cavernous transformation, similar to prior exam.\n4. 9 mm hypoattenuating pancreatic tail lesion, possibly a side branch IPMN. \nThis may be further evaluated with dedicated abdominal MRI on a non urgent\nbasis."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis, left greater than right.  No\nlarge pleural effusion or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is trace predominantly central\nintrahepatic biliary ductal dilatation which appears unchanged compared to at\nleast ___.  There is no evidence of extrahepatic biliary ductal\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 is\nwithin normal limits.  The appendix is normal.  There has been interval\nremoval of the Mallinckrodt drain.  ___ is seen within the intersphincteric\nspace.  Known perianal fistula was better evaluated on recent MRI pelvis\nperformed ___.  A right-sided trans sphincteric tract is seen\nleading to an area of soft tissue density with areas of more low attenuating\ndensity and small intraluminal foci of air within the right ischial anal fossa\nand gluteal fold, this measures approximately 2.7 x 3.0 x 4.2 cm (2:89,\n602:28).  This appears similar in size compared to recent MRI performed ___ and was previously characterized as an inflammatory tract. \nThere is a possible tract communicating with the skin surface in the right\nmedial gluteal fold, similar to recent MRI (2:93).  Additionally, a\ncurvilinear area of soft tissue density in the left intersphincteric space is\nunchanged and compatible with phlegmonous changes (602:37).\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.  A small\n1.1 x 1.2 cm left adnexal cyst is likely physiologic (601:31).\n\nLYMPH NODES: Mildly prominent retroperitoneal lymph nodes are not\npathologically enlarged by CT size criteria.  No mesenteric lymphadenopathy. \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: Right issue anal and gluteal fold soft tissue abnormality as\ndescribed above.  Otherwise, the abdominal and pelvic wall is within normal\nlimits.",
            "output": "1. Redemonstration of a known multicomponent perianal fistula which was better\ncharacterized on recent MR pelvis performed ___.  There has been\ninterval removal of the Mallinckrodt drain.  A ___ is seen in appropriate\nposition.\n2. A soft tissue density with multiple small pockets of air within the right\nischioanal fossa and gluteal fold measures up to 4.2 cm and appears unchanged\ncompared to prior MRI where was characterized as an inflammatory tract. \nFindings are compatible with phlegmonous changes.  No drainable abscess is\nseen.\n3. Additional curvilinear area of soft tissue density in the left interval\nsphincteric space is also compatible with phlegmonous changes and is unchanged\nsince ___.\n4. Mildly prominent retroperitoneal lymph nodes are not pathologically\nenlarged by CT size criteria.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:39 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. \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. There is a small enhancing\nlesion in the jejunum measuring 7 mm, this could represent a polyp or small\ncarcinoid lesion, recommend correlation with MR enterography.  Note is made of\nfecalization of terminal ileal contents, which may reflect delayed transit or\na competent ileocecal valve.  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 and bilateral adnexae are within normal limits\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.  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 enhancing lesion in the jejunum measuring 7 mm, this could represent\na polyp or small carcinoid lesion, recommend correlation with MR enterography.\n2. Moderate colonic fecal burden with fecalization of contents at the distal\nileum, which may reflect slow transit of material or a patent ileocecal valve.\n\nRECOMMENDATION(S):  Correlation with MR enterography.\n\nNOTIFICATION:  The updated findings were emailed to the the QA nurses by\n___, M.D., to notify the primary care physician."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen: Intrahepatic and extrahepatic biliary ductal dilation is unchanged\nfrom prior exam in this patient status post prior cholecystectomy.  No focal\nliver lesions are seen.  The main portal vein is patent.  The spleen is\nunremarkable.  There is a small hiatal hernia.  Adrenal glands are normal. \nPancreas appears normal.  The stomach is unremarkable though decompressed.  A\nperiampullary duodenum diverticulum is noted otherwise duodenum is normal. \nThe abdominal aorta is moderately calcified though normal in caliber with\nwidely patent major branches.  No retroperitoneal lymphadenopathy is seen.  No\nfree air or free fluid.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction.  No secondary signs of appendicitis.  There is moderate fecal\nloading of the colon.  Diverticulosis is noted without definite signs of\ndiverticulitis.  The sigmoid colon is under distended which limits evaluation\nfor subtle bowel wall thickening.  No overt signs of colitis or\ndiverticulitis.  The urinary bladder wall appears mildly thickened and\nhyperemic, correlate for infection.  Uterus is surgically absent.  No adnexal\nmasses are seen.  No inguinal lymphadenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.    Severe\ndegenerative disease at L5-S1 noted with near complete loss of disc space and\nvacuum disc phenomenon.",
            "output": "1.  Mild thickening of the urinary bladder, correlate for infection.\n2.  Colonic diverticulosis without convincing signs of diverticulitis. \nDecompressed sigmoid colon limits evaluation for subtle bowel wall edema.\n3.  No secondary signs of appendicitis.\n4.  Intrahepatic and extrahepatic biliary ductal dilation is unchanged, likely\ndue to prior cholecystectomy though clinical correlation is advised for\nsigns/symptoms of cholangitis."
        },
        {
            "input": "The study is limited by motion.\n\nLOWER CHEST:  There is bibasilar dependent atelectasis.  Pleural effusions. \nHeart size is top normal, without pericardial effusion.  Calcifications are\nnoted in the coronary arteries and aortic valve.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 1 cm simple cyst in segment ___ (2a: 17).  The liver\notherwise 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:  The right kidney is atrophic.  There is severe hydronephrosis on the\nright.  The right ureter is also severely dilated along its entire course,\nmeasuring up to 2.8 cm, both findings appearing chronic.  The distal right\nureter, particularly at the ureterovesicular junction is difficult to\nvisualize due to extensive streak artifact from right hip arthroplasty.  There\nis a 1.9 cm simple cortical cyst arising from the lower pole of the right\nkidney.  Left kidney is normal in size, without evidence of focal lesions on\nthis non-enhanced study.  No nephrolithiasis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is scattered colonic\ndiverticulosis, without evidence of acute diverticulitis.  The colon and\nrectum are otherwise unremarkable.  Normal appendix.  No ascites.\n\nPELVIS: The bladder is well distended.  There is in unusual concave\nconfiguration of the right lateral bladder wall at the level of the\nureterovesicular junction, with suggestion of possible wall thickening\n(2a:59), although further evaluation is severely limited by artifact.  This\nmay reflect postoperative change from prior ureteral implantation, although\nunderlying neoplasm cannot be excluded.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus contains scattered 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.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Status post right total hip arthroplasty.  Multilevel\ndegenerative changes are noted throughout the lumbar spine, including the\njoint arthropathy at L5-S1 bilaterally.  There is grade 1 anterolisthesis of\nL4 on L5, and grade 1 anterolisthesis of L5 on S1.  There is a small fat\ncontaining umbilical hernia.  Abdominal and pelvic wall is otherwise within\nnormal limits.",
            "output": "1. No sequela of trauma within the abdomen or pelvis.  No free fluid.\n2. Severe right hydroureteronephrosis with unusual configuration of the right\nlateral bladder wall near the UVJ appears chronic and could reflect\npostoperative change from prior ureteral reimplantation.  However, mural\nthickening of the bladder wall is present and neoplasm cannot be excluded if\ncorrelative history does not exist.  This could be further evaluated with\ncystoscopy.\n3. Colonic diverticulosis, without evidence of acute diverticulitis.\n\nNOTIFICATION:  Updated findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 9:59 AM, 60 minutes after discovery of\nthe findings."
        },
        {
            "input": "The study is limited by beam hardening artifact due to right hip prosthesis.\n\nPELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains coarse calcifications and the\nseminal vesicles are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR:  Moderate atherosclerotic disease is noted with calcified and\nnoncalcified plaque.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right total hip prosthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Again\nseen is a large mixed density right gluteal collection measuring 14.9 x 12.4 x\n15.4 cm, not significantly changed in size or appearance from prior.",
            "output": "14.9 x 12.4 x 15.4 cm mixed density fluid collection within the right gluteal\nmuscles, suggestive of intramuscular hematoma.  Superimposed infection cannot\nbe excluded on the basis of this study.  If palpable abnormality does not\nresolve clinically, follow-up imaging will be necessary."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nbladder is distended.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted with areas of noncalcified\nplaque.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right total hip arthroplasty.\n\nSOFT TISSUES: There is a 18 x 9 x 20 cm (AP x TV x CC) rim enhancing fluid\ncollection with heterogeneous internal content in the right gluteal\nmusculature.  This lesion corresponds to the previously characterized\nhemorrhagic sarcoma.  The exact size is difficult to compare to prior MRI of\nthe pelvis from ___ due to differences in patient positioning,\nhowever, the longest dimension is about the same.  There has been interval\nremoval of the draining catheter.",
            "output": "1. 18 x 9 x 20 cm rim enhancing fluid collection in the right gluteal\nmusculature with complex internal content, corresponding to the previously\ncharacterized hemorrhagic sarcoma.  The exact size is difficult to compare due\nto patient positioning but grossly similar to MR dated ___ in the\nlongest dimension."
        },
        {
            "input": "Lower Chest: There is minimal basilar atelectasis.  No consolidations.  Trace\nbilateral pleural effusion.  Coronary artery calcifications.\n\nAbdomen and Pelvis:\n\nHepatobiliary: Diffuse fatty liver, as seen on prior.  No focal hepatic\nlesions.  Cholecystectomy.  Normal bile ducts.  Patent hepatic, portal veins\n\nSpleen: Normal\n\nAdrenals: Normal\n\nKidneys, Bladder, Ureters: No hydronephrosis.  No focal renal lesions normal\nbladder.\n\nPancreas: Atrophic pancreas.\n\nGastrointestinal: Moderate soft GI hiatal hernia, as seen on prior. \nPreviously seen small volume fluid within the hernia sac has nearly resolved. \nNormal appendix.  Normal loops of colon, small bowel, no obstruction.  No free\nair.  Previously seen free pelvic fluid has resolved.\n\nLymph Nodes: No adenopathy\n\nPelvis: No free fluid\n\nReproductive Organs: No abnormality\n\nVascular: Mild atherosclerotic calcifications.  Visualized vessels are patent,\nalthough, many are suboptimally opacified secondary to suboptimal contrast\nbolus technique.\n\nSoft Tissues: Anterior abdominal wall, subcutaneous edema has significantly\nworsened compared to prior, associated skin thickening, may be from edema if\npatient has been position prone, clinically correlate to exclude inflammatory\nor infectious process.  Small focus of air in the left anterior abdominal wall\nis likely injection site.  Previously seen bilateral flank edema has mildly\nimproved.  No organized fluid collections\n\nBones: Degenerative changes spine.  Bilateral L5 pars interarticularis defect,\ngrade 1 L5-S1 anterolisthesis.  Multilevel degenerative changes, with\ndegenerative disc disease in lumbar spine, S shaped thoracolumbar curve. \nDegenerative changes sacroiliac joints, hips",
            "output": "There is no gallbladder fossa or pericholecystic fluid collection or abscess. \nPreviously seen pelvic fluid has resolved.\nPredominant anterior abdominal wall symmetric subcutaneous edema, stranding,\nmay be from fluid overload if patient has been prone,, clinically correlate to\nexclude inflammatory or infectious process.  No drainable fluid collection, no\nhematoma.  Small focus of air left anterior abdominal wall, presumably\ninjection site, just underneath skin surface."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Low\nattenuation throughout the liver parenchyma suggests steatosis.  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 has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 large 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 identified.\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 grossly 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 no evidence of worrisome osseous lesions or acute fracture. \nBilateral L5 spondylolysis is noted with grade 2 anterolisthesis of L5 on S1. \nMid lumbar dextroscoliosis and lower thoracic levoscoliosis is noted.\n\nSOFT TISSUES: Moderate fat containing umbilical hernia is noted.",
            "output": "1. No acute intra-abdominal process, no findings to explain symptoms.\n2. Large hiatal hernia.\n3. Moderate fat containing umbilical hernia."
        },
        {
            "input": "CHEST: Imaged lung bases demonstrate small bilateral pleural effusions with\nadjacent compressive atelectasis.  Partially imaged consolidation in the right\nmiddle lobe may represent atelectasis or focus of developing infection.  Heart\nsize is normal with no pericardial effusion.\n\nABDOMEN: The liver is hypo attenuating compared to the spleen, consistent with\nhepatic steatosis. There is no focal hepatic lesion. The gallbladder is\nsurgically absent. The pancreas is normal in bulk an attenuation. Spleen is\nnormal in size and attenuation. The adrenal glands are morphologically normal\nbilaterally. The kidneys enhance and excrete contrast symmetrically.\n\nThe stomach and majority of the small bowel is mildly dilated and fluid\nfilled. There is haziness of the mesentery and a right anterior abdominal\nwall, likely from recent surgery and colostomy takedown.\n\nSmall amount of the simple free fluid is noted along the pericolic gutters,\nlayering dependently in the pelvis. Locules of air in the left lower quadrant\nare likely from recent surgery. There are no pathologically enlarged\nmesenteric or retroperitoneal lymph nodes.\n\nPELVIS:  The patient is status post subtotal colectomy with an ileosigmoid\nanastomosis, which appears patent. Rectal contrast reaches loops of ileum,\nwell beyond the anastomosis, with no evidence of extravasation. Free fluid in\nthe pelvis is simple in density in keeping with recent postoperative status.\nThe urinary bladder is decompressed and contains a Foley catheter. There are\nno pathologically enlarged pelvic sidewall or inguinal lymph nodes.\n\nVESSELS:  The aorta is normal in caliber with mild calcium burden.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Small bilateral pleural effusion with adjacent atelectasis. Focal area of\nconsolidation in the right middle lobe likely represents atelectasis, however\ndeveloping or superimposed infection cannot be excluded.\n2.  Intra-abdominal free air and simple free fluid in keeping with recent\npostoperative status.\n3.  Patent ileo-sigmoid anastomosis with no evidence of extravasation of\nrectal contrast.\n4.  Postsurgical changes in the right mid abdomen and midline of the abdomen\nin keeping with colostomy takedown and longitudinal midline incision.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 6:32 ___, 5 minutes after discovery of the findings."
        },
        {
            "input": "PELVIS:  The partially visualized small bowel is unremarkable.  Diverticulosis\nof the visualized sigmoid, descending, and ascending colon without evidence of\ndiverticulitis.  9 mm hypodensity in the inferior most portion of the liver is\nincompletely evaluated but likely represents a hepatic cyst (2:1).  The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and heterogeneous, with dominant\nfibroid measuring 3.5 x 3.5 cm (401:106).\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: Bilateral sclerosis of the sacral ala, also seen on concurrent CT\nlumbar spine, is consistent with patient's known history of sacral\ninsufficiency fractures (400:87).  There is severe degenerative changes of the\nright hip joint (02:45-54), including joint space narrowing, marginal\nsclerosis, and varix dense of subchondral cyst formation.  There are also\nproliferative changes including spurring at the right hip.  There are moderate\ndegenerative changes of the left hip with joint space narrowing, mild marginal\nsclerosis, and spurring of the femoral head..  Sclerotic changes of the\nbilateral pubic rami, likely related to recent history of bilateral pubic rami\nfractures (2:74, 75).  Degenerative changes in the parasymphyseal region may\nreflect an age-indeterminate fracture (3: 61, 400:47).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Evidence of bilateral sacral insufficiency fractures with adjacent\nsclerosis.\n2. Sclerotic changes of the bilateral pubic rami, likely related to prior\nhistory of fracture.\n3. Degenerative changes in the parasymphyseal region may reflect an\nage-indeterminate fracture.\n4. Severe degenerative changes of the right hip joint and moderate\ndegenerative changes of the left hip joint.\n5. Enlarged heterogeneous uterus, with a dominant fibroid measuring 2.5 cm. \nThe uterus is not optimally assessed on this study, consider nonurgent\noutpatient pelvic ultrasound as clinically indicated.\n6. Diffuse colonic diverticulosis of the partially imaged sigmoid, descending,\nand ascending colons without evidence of acute diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\nThere is diffuse mild thickening of aortic wall.  Prominent retroperitoneal\nsoft tissue is identified surrounding the aorta and its branches.  Arteries\narising from the aorta including celiac artery, SMA, bilateral renal arteries,\nand ___ demonstrate thickened walls proximally.  The aorta is not lifted off\nof the vertebral bodies.\n\nLOWER CHEST: Mild ___ opacities in bilateral lung bases may reflect\nsmall airway disease.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMillimetric hypodensity in the upper pole of left kidney is too small to be\nfully characterized.  There is no hydronephrosis.  The ureters are not\ndilated, although suboptimally visualized given the phase of contrast timing. \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. There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: Prominent retroperitoneal soft tissue as described above.\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 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. Prominent retroperitoneal soft tissue is identified anterior and lateral to\nthe aorta.  The wall of the aorta and the proximal segments of its branches\nappear thickened.  Differential considerations include large vessel\nvasculitis, retroperitoneal fibrosis or less likely lymphoma given the lack of\nanterior aortic displacement."
        },
        {
            "input": "LOWER CHEST: There is minimal dependent atelectasis in the visualized lung\nbases.  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 is within normal limits.\n\nPANCREAS: There is moderate diffuse 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops are normal\nin caliber.  The rectum is distended with stool, with associated\ncircumferential wall thickening with surrounding fat stranding.  This may be\ndue to stercoral colitis or collateral inflammation from cystitis.  The colon\nis unremarkable.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is collapsed, with wall thickening and mild\nsurrounding fat stranding, likely cystitis.  A suprapubic catheter is in\nappropriate position.  The distal ureters are unremarkable.  Multiple surgical\nclips are seen in the lower pelvis.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate has been 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: There is no suspicious osseous lesion.  A moderate compression\ndeformity of the T12 vertebral body is unchanged compared to CT of the\nabdomen/pelvis from ___.  A mild-to-moderate compression deformity\nof the T10 vertebral body is also likely chronic, but not covered on the prior\nstudy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Collapsed urinary bladder, with wall thickening and mild surrounding fat\nstranding, likely cystitis.  Suprapubic catheter is in appropriate position. \nClinical correlation with urinalysis is recommended.\n2. Rectum is distended with stool, with associated circumferential wall\nthickening with surrounding fat stranding, which may represent stercoral\ncolitis or collateral inflammation from cystitis.\n3. Moderate compression deformity of the T12 vertebral body, unchanged\ncompared to CT of the abdomen/pelvis from ___.  Mild-to-moderate\ncompression deformity of the T10 vertebral body is also likely chronic, but\nnot covered on 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.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRe-demonstrated are multiple subcentimeter hypodensities scattered throughout\nthe liver, unchanged from prior exam.  As before, these remain 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: As before, the right kidney is atrophic with multiple small cysts. \nThe left kidney is normal in size.  Multiple subcentimeter hypodensities are\ntoo small to characterize, but statistically likely represent simple 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. 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 mixed solid and cystic omental implant is similar in\nsize, currently measuring 12.1 x 6.1 cm, previously 11.4 x 6.6 cm (2:84).  A\nsecond mixed solid and cystic lesion in the right hemipelvis has increased in\nsize, currently measuring 5.0 x 3.4 cm, previously 3.8 x 2.7 cm (2:93).  More\ninferiorly, a hypoattenuating lesion in the right hemipelvis has also\nincreased in size, currently measuring 4.6 x 5.0 cm, previously 4.8 x 3.7 cm\n(2:96).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  An infrarenal IVC filter is in unchanged position.  There is\npersistent extension of thrombus in the right common iliac vein extending to\nthe inferior vena cava.  The tumor thrombus again appears to extend to the\ninfrahepatic IVC above the level of the IVC filter.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMarked multilevel degenerative changes are again noted in the lumbar spine.  A\nlarge Schmorl's node appears unchanged in the superior endplate of the L2\nvertebral body.  Grade 1 anterolisthesis of L4 on L5 appears unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No significant change in appearance of the dominant mixed solid and cystic\nomental implant in the anterior mid abdomen.\n2. Interval increase in size in the additional smaller omental implants in the\nright hemipelvis.\n3. Stable tumoral extension/thrombosis of the right common iliac vein\nextending to the inferior vena cava with an IVC filter in place.  As before,\nthe tumor thrombus appears to extend above the level of the IVC filter into\nthe intrahepatic IVC.\n4. No new foci of metastatic disease are identified.\n5. Please refer to dedicated CT chest performed on same date 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.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSmall punctate low-density lesion in hepatic segment 2 is unchanged from prior\nexam and too small to characterize.  Several additional sub-5mm subtle low\ndensity peripheral foci in the liver are unchanged over multiple studies over\nthe last year, indeterminate.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contracted.  Small cleft\nalong the right hepatic lobe capsule (series 2, image 56) is similar over many\nyears but perhaps slightly more conspicuous, might be post-treatment.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 interval increased right-sided hydronephrosis in the\npreviously seen diminutive and atrophic kidney.  Subcentimeter low-density\nlesion in the right midpole is again seen, unchanged and too small to\ncharacterize.  The left kidney is normal.  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 is under distended.\n\nREPRODUCTIVE ORGANS: Patient is status post supracervical hysterectomy. \nMetastatic solid and cystic omental implants and pelvic masses include:\n- Similar appearing cystic lesion in mid anterior pelvis measuring 6.2 x 7.4\ncm in axial dimension and 10.6 cm on craniocaudal dimension, previously 6.1 x\n8.9 cm on axial dimension 10.2 craniocaudal dimension,\n- Enlarged lobulated hyperdense lesion superior and to the right of this\nmeasuring 5.5 x 5.1 cm in axial dimension and 4.8 on craniocaudal dimension,\npreviously 4.9 x 3.4 on axial dimension and 4.7 cm craniocaudal dimension,\n- Enlarged solid lesion in the posterior right pelvis measuring 4.6 x 6.5 cm\non axial dimension and 7.1 cm craniocaudal dimension previously 4.6 x 5.4 cm\non axial dimension and 6.1 cm craniocaudal dimension\n\nLYMPH NODES: There is no additional retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is IVC filter in place, unchanged.  Again seen is thrombosis\nin IVC just below the IVC filter with the vein more distended than before, and\nan enlarged anterior lobulation measuring 2.7 cm (previously 2.3 cm);\nintravascular tumor should be considered as the thrombosed vessels have\nheterogeneous attenuation.  Multiple venous collaterals pathways noted.  Left\ncommon femoral system collateralizes via the paravertebral veins; right common\nfemoral system collateralizes via anterior abdominal wall vasculature.  There\nis no aortic aneurysms\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4-5 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval slight increase in extent of cystic and solid metastatic omental\nimplants pelvic masses.\n2. Status post IVC filter with thrombosed IVC, more distended than before. \nIntravascular tumor should be considered; MR could be considered to evaluate\nfor tumoral enhancement within the thrombosed component, if clinically\nrelevant.\n3. Recurrence of severe right hydronephrosis in the previously seen atrophic\nand diminutive right kidney.\n4. Low density foci in the liver unchanged over several studies.\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 19:22 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 pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. One\nhypoattenuating lesion (image 49, series 2) might have increased in size\nmeasuring 4.3 mm today (2.8 mm previously).  There is a left liver lobe lesion\nmeasuring 3.6 mm compared with 4.6 mm previously.  Multiple liver lesions are\nalso smaller today including one located just inferiorly to the middle hepatic\nvein which is not seen anymore.  A subcapsular lesion remains stable (series\n2, image 54) at 4 mm.  There is subcapsular ascites anteriorly to the right\nlobe of the liver, which is new but measures only 12 mm.  2 adjoining stable\nsupradiaphragmatic nodule in the right lung base likely subcapsular liver\nlesions with largest measuring 2.2 cm.\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 right kidney is severely atrophic.  The previously noted\nhydronephrosis of the right kidney has resolved in the interval.  There is a\nsubcentimeter cyst in the midpole of the right kidney.  No significant lesion\nor hydronephrosis involving the left kidney.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The hepatic\nflexures and distal ascending colon demonstrates mild wall thickening. The\nappendix 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 patient is status post supracervical hysterectomy.\n\nMetastatic solid and cystic omental implants and pelvic masses include:\n\n-A decreasing cystic lesion measuring 7.4 x 5.0 x 8.4 cm (7.4 x 6.2 x 10.5 cm\npreviously).\n\n-A decreasing lobulated hyperdense lesion arising superiorly and to the right\nfrom the above-mentioned cystic lesion, measuring 5.6 x 4.4 x 4 cm (5.5 x 5.1\nx 4.7 cm previously).\n\n-In the posterior right pelvis, there is a stable mostly solid lesion with\nnecrotic components measuring 6.6 x 4.5 x 6.7 cm (6.5 x 4.6 x 6.7 cm).  The\ninferior part of this lesion extends toward the right internal obturator\nmuscle and the right pelvic sidewall.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an IVC filter, the size of the IVC has decreased from 42 mm\npreviously to 31 mm today.  The IVC and the proximal common iliac veins\ncontain a thrombus that has decreased when compared with prior study, the\nthrombus is nonspecific, could be bland or due to endoluminal metastatic\ndeposit.  There is redemonstration of multiple collateral venous pathways.\n\nThere is no abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: There is mixed sclerotic and lytic lesion involving the pubic\nsymphysis, and both anterior pubic bones, as well as both sacral ala, which\ncould be due to prior radiation changes or to metastatic disease.  There are\nsome irregularities of the anterosuperior and anteroinferior cortices\nbilaterally, for which we cannot exclude subtle fractures.\n\nThere is an 11 mm sclerotic focus involving L 4 which remains stable when\ncompared with prior study.\n\n There is a Schmorl nodules involving L2.  There is degenerative bony changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 2 pelvic lesions are mildly decreasing in size with a third one in the deep\nposterior and lower pelvis is stable.\n2. Multiple liver lesions, most of the meters stable or smaller.  A 4.3 mm\nlesion is more conspicuous on today's examination, and could have minimally\nenlarged.\n3. Right colonic wall thickening, which may be due to infectious or\ninflammatory process such as colitis, more likely than circumferential\nimplants.\n4. Pelvic sclerotic lesions, either due to radiation therapy changes or due to\nmetastatic deposit.\n5. Stable L4 sclerotic focus."
        },
        {
            "input": "LOWER 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 macronodular contour in the right\nhepatic lobe and homogenous attenuation throughout.  Hypodensities in the left\nand right hepatic lobes measuring less than 5 mm are too small to\ncharacterize, but appear similar to the previous study (2: 43, 47, 56). \nOtherwise, there is no evidence of focal lesions. Mild central intrahepatic\nbiliary ductal dilatation.  The gallbladder is within normal limits.d\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 atrophic.  Otherwise, the kidneys demonstrate normal\nnephrograms.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 visualized.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.  Several cystic and heterogeneous masses demonstrated in the pelvis. \nFor example, a cystic masses now measuring 5.0 x 4.7 cm, previously 7.4 x 5.0\ncm (2:83), and 5.8 x 4.3 cm, previously 5.8 x 4.0 cm (2:79) are noted.  A\ncomplex cystic and solid mass now measures approximately 7.2 x 6.3 x 4.0 cm,\npreviously 7.6 x 6.4 x 4.1 cm (2:94).\n\nREPRODUCTIVE ORGANS: Patient status post subtotal hysterectomy with bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  An infrarenal IVC filter is similarly positioned.  Again\ndemonstrated is extensive thrombosis extending from the hepatic veins\nconfluence to the distal common iliac veins bilaterally.  Venous collaterals\nare seen arising from the external iliac veins.\n\nBONES: Heterogeneous sclerotic and lytic appearance of the sacral ala and\npubic rami bilaterally, but most notable on the left, may reflect\npostradiation changes, overall similar to the prior study.  Cortical\nirregularity of the right sacral ala are also similar to the most recent study\n(2:83).  Cm sclerotic focus in the vertebral body of L4 is largely unchanged\n(2:72).  Lumbar levoconvex scoliosis and multilevel degenerative changes of\nthe lumbar spine with a grade 1 anterolisthesis of L4 over L5 and grade 1\nretrolisthesis of L5 over S1 are again noted.  Schmorl's node in the superior\nendplate of L2 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Overall, similar to minimally decreased size of cystic and complex pelvic\nmasses.\n2.  Redemonstration of subcentimeter hepatic hypodensities, too small to\ncharacterize, overall similar to the prior study.\n3.  Largely unchanged thrombosis involving the IVC and common iliac veins."
        },
        {
            "input": "LOWER CHEST: Redemonstrated subpleural soft tissue nodules in the right lung\nbase measuring approximately 2.9 and 1.5 cm respectively.  The a 1 cm nodule\nin the left lung base is unchanged from prior.  Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Few\nsubcentimeter hypodensities throughout the liver are unchanged from prior. \nHypodense indentation of the posterior aspect of the right hepatic lobe is\nmore prominent on current study and may represent a peritoneal implant (2:50).\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: There is new severe right hydroureteronephrosis from the mid right\nureter secondary to extrinsic compression by the pelvic mass (601:26, 2:81). \nRight renal atrophy is chronic.  There is no left hydronephrosis or solid\nlesions.   There is no perinephric abnormality.\n\nGASTROINTESTINAL: A gastric tube is in place.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Few air-fluid\nlevels are seen in loops of the small bowel without transition point likely\nsecondary to ileus.  The colon and rectum are within normal limits.\n\nPELVIS: 6.5 x 4.3 by 4.1 cm right obturator mass is slightly increased from\nprior, previously 4.6 x 3.9 by 4.3 cm. 6.6 x 2.6 x 6.2 cm 6.2 Cm right pelvic\nwall mass is similar to prior, previously measuring 7.1 x 2.5 x 6.4 cm. The\nurinary bladder is unremarkable.  There is small amount of free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: 11.8 x 5.7 x 7.2 cm mass in the mid/right pelvis\nconsistent with known endometrial stromal tumor demonstrates increase in size,\nparticularly of the superior component, measuring up to 8.4 cm, previously 6.3\ncm (2:87).  In size from prior previously measuring.  A hypodense 4 x 5.2 cm\nmass in the right lower quadrant, posterior to the abdominal wall, appears\nslightly laterally shifted from prior, previously more midline, is of unclear\norigin but could represent a peritoneal implant.\n\nLYMPH NODES: Centrally necrotic lymph nodes in the retroperitoneum have\ndecreased in size from prior study, for instance the right common iliac\nadenopathy measure 1.2 cm previously 4.8 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Expanded and thrombosed IVC with a filter in place appears less\ndilated than on prior study measuring up to 4.1 cm in diameter, previously 4.8\ncm.\n\nBONES: Similar sclerotic appearance of the sacrum, likely secondary to poor\nradiation changes, without evidence of acute fracture.  Stable sclerotic focus\nin the L4 vertebral body.  Similar appearance of the superior endplate of L2\nwith a small nodule versus mild superior endplate compression.\n\nSOFT TISSUES: There is mild anasarca.",
            "output": "1. New right severe hydroureteronephrosis due to external compression by\nenlarging pelvic mass.\n2. Interval increase in size of the known right hemipelvic mass corresponding\nto the known endometrial stromal tumor, now measuring up to 11.8 cm.  Slight\ninterval increase in size of the right obturator mass also noted compared to\nthe prior exam.\n3. Interval decrease in size of the retroperitoneal adenopathy and thrombosed\nand expanded IVC with IVC filter.\n4. Redemonstrated are similar appearing peritoneal and pleural implants.\n5.  Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION:\nThe findings were discussed with ___, m.D. by ___\n___, M.D. on the telephone on ___ at 7:02 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Unchanged subpleural soft tissue nodules in the right lung base\nmeasuring 2.4 and 1.7 cm respectively.  New foci of gas in the smaller nodule\ninterval necrosis.  Unchanged since ___ nodular opacity in the left\nlung base with atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hypodensities are again seen.  There are no new suspicious liver\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 left kidney is normal in size and nephrogram.  Atrophic right\nkidney is again seen.  There is no hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Moderate-sized hiatal hernia, otherwise unremarkable\nstomach.  Multiple fluid-filled and dilated loops of small bowel are\ndemonstrated compatible with a small-bowel obstruction with a transition point\nin the right pelvis due to a dominant right pelvic mass (02:57).  Abnormal\nloop of small bowel spanning approximately 8 cm, immediately proximal to the\nsite of obstruction, has edematous and thickened wall (02:49-57), which may be\ndue to ischemia.  The appendix is not seen.  Diverticulosis of the colon is\nnoted, without evidence of wall thickening or fat stranding. Rectum is\nunremarkable.\n\nThere is small amount of ascites.  No free air.\n\nPELVIS: Again noted are several masses in the lower abdomen and pelvis.  An\novoid 5.1 x 3.4 cm cystic appearing mass in the right mid lower abdomen is\nslightly smaller, previously measuring 4 x 5.8 cm, while a 5.4 x 3.7 cm cystic\nappearing mass in the right mid pelvis adjacent to the bladder has changed\norientation and previously measured 4.7 x 5 cm.  An approximately 9.4 x 5.6 x\n8.5 cm obliquely and vertically oriented heterogeneous dominant mass in the\nright pelvis has substantially increased in size, previously measuring 6.4 x\n4.1 by 6.7 cm.  The right pelvic wall mass has increased in size and measures\n7.1 x 2.5 x 6.4 cm, previously measured 6.4 x 2.1 x 5.9 cm. There is small\namount of fluid and fat stranding in the mesorectum.  The urinary bladder is\ncompressed by 1 of the pelvic masses but appears otherwise normal.  Distal\nureters are not well seen.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  The vaginal cuff is\nnot well seen.\n\nLYMPH NODES: No definitive retroperitoneal or abdominal adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There are multiple\ncollaterals in the abdomen and retroperitoneum likely from chronic IVC\nocclusion.  Further expansion of the thrombosed common iliac veins and IVC,\nexpanding the IVC filter has occurred with IVC thrombus again seen extending\nsuperior to the filter to the intrahepatic IVC, as on prior.  There is an\nexpanded thrombus in the right common femoral vein, new from prior.\n\nMild atherosclerotic disease is noted.\n\nBONES: Mottled appearance of the sacrum is likely secondary to radiation\nchanges.  Unchanged sclerotic focus in the L4 vertebral body.  Stable mild\ngrade 1 anterolisthesis of L4 on L5.  No new bone lesions in the osseous\nstructures of the abdomen or pelvis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. High-grade small-bowel obstruction secondary to obstruction by an enlarging\ndominant right pelvic mass.\n2. An 8 cm long segment of distal small bowel immediately proximal to the site\nof obstruction appears edematous and thickened, with small volume of new\nascites, which is concerning for ischemia.  Lactate level correlation is\nrecommended.\n3. Interval progression of expansile thrombus within the common iliac veins\nand IVC as well as new right common femoral vein thrombus.\n4. Progressed metastatic disease in the pelvis demonstrated by enlargement of\nthe right pelvic masses.\n5. Redemonstration of right lower lobe metastatic lesions, one of them\nexhibiting interval necrosis."
        },
        {
            "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 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\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: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus.  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: Multilevel degenerative changes of the lumbar spine with a grade 1\nanterolisthesis of L5 over S1.  There is no acute fracture.\n\nSOFT TISSUES: There is abdominal diastasis.  Otherwise, the abdominal and\npelvic wall is within normal limits.",
            "output": "1. No finding to explain the patient's symptoms.\n2. Gallstones."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac trunk and its\nbranches are patent.  The SMA is patent.  The portal venous system is patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is mildly hypoattenuating consistent with mild fatty\nliver.  There is no evidence of focal lesions.  Patient is status post ERCP\nwith sphincterotomy and biliary stent placement.  Pneumobilia and contrast\nmaterial in the gallbladder are as expected.  Markedly dilated intrahepatic\nand extrahepatic biliary duct are noted, as on prior ultrasound.  The\ngallbladder is filled with contrast material.\n\nPANCREAS: There is diffuse pancreatic parenchymal atrophy with residual\ntissues in the uncinate process (series 5, image 23 and series 3, image 50). \nThere is a 0.8 cm intraductal stone in the head/uncinate region adjacent to\nthe ampulla (series 3, image 44 and series 5, image 25) resulting in marked\ndilatation of the upstream pancreatic duct.  Numerous calcifications\nthroughout the pancreas are also noted.  These findings likely represent\nsequela of chronic 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. \nThere is no stones or hydronephrosis.  A 0.9 cm simple cyst in the right\ninterpolar region is noted.  There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is circumferential thickening of the first and second\nportion of the duodenum extending to and likely involving the ampulla of Vater\n(series 3, image 46-53) concerning for malignancy as on recent ERCP.  Multiple\ncollections adjacent to the duodenum (series 3, image 49) and adjacent to the\npancreas (Series 3, image 45) could represent fluid collection from prior\npancreatitis or prior perforated duodenum.  There is no bowel obstruction. \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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is moderate fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not well visualized.\n\nBONES: There 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 thickening of the first and second portion of the duodenum\nextending to the ampulla concerning for malignancy as on recent ERCP.\n2. Atrophic pancreas with numerous pancreatic calcification and a large\nobstructing stone in the ampulla resulting in upstream pancreatic ductal\ndilatation, likely representing sequela of pancreatitis.  It is unclear if\nchronic pancreatitis and stone formation may be associated with obstruction\nrelated to the duodenal mass described above.  Soft tissue prominence at the\nregion of the uncinate likely represents some preserved pancreatic parenchyma.\n3. Multiple collection adjacent to the pancreas and duodenum likely due to\nprior pancreatitis or old duodenal perforation.\n4. Moderate free fluid in the pelvis."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.  There is a 1.5 cm subcutaneous\nhypodensity in the left posterior-lateral lower chest wall (series 3, image\n27) that is likely a sebaceous cyst.\nNo pleural effusions.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously.  The portal vein\nand its branches are patent.  Hepatic veins are patent.\nThe gallbladder is under distended with no radiopaque calculi within it or\npericholecystic inflammation.\nPANCREAS: There is homogeneous enhancement of the pancreatic parenchyma\nwithout main duct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: There is a 9 mm calculus within the right renal pelvis (2:68). \nPost-contrast images demonstrate mild enhancement of the right renal pelvic\nurothelium, there is of ever no hydronephrosis.  No additional renal or\nureteric calculi seen on either side.\nGASTROINTESTINAL: There is no bowel obstruction.  Normal appendix containing\nair noted in the right lower quadrant.  The patient is post partial\ngastrectomy.  Small hiatus hernia noted.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis.  No\nmesenteric lymphadenopathy seen..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears unremarkable.  The uterus and\nadnexae are not visualized.  There is no free fluid in the pelvis..\n\nBONES AND SOFT TISSUES:\nDegenerative disc disease is most prominent at L4-5 level.  No worrisome\nosseous lesions identified.",
            "output": "1. A single 9 mm calculus located within the right renal pelvis with mild\nenhancement of the right renal pelvic urothelium, likely secondary to\ninflammation from presence of the stone.  No hydronephrosis, enhancing renal\nmasses, filling defects within the opacified portions of the rest of the\ncollecting system and ureters on either side noted.\n2. No other acute process noted in the rest of the abdomen or pelvis."
        },
        {
            "input": "CHEST:   There is mild bibasilar atelectasis.\nABDOMEN:  The liver is normal without evidence of focal lesions or\nintrahepatic biliary ductal dilatation. The spleen is homogeneous and normal\nin size. The pancreas is normal without evidence of focal lesions or\npancreatic duct dilatation. The adrenal glands bilaterally are normal. The\nkidneys bilaterally normal without evidence of focal solid or cystic lesions\nconcerning for malignancy. There is no evidence of hydronephrosis.\n\nThe gallbladder is normal.\n\nThe stomach, duodenum, and small bowel are normal without evidence of wall\nthickening or obstruction. There is no retroperitoneal or mesenteric\nlymphadenopathy. No intra-abdominal free air or free fluid is identified.  The\ncolon is normal. The appendix is visualized and is normal.\nPELVIS:  The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is trace free fluid in\nthe pelvis.  Uterus is better assessed on the same day pelvic ultrasound.\nBONES AND SOFT TISSUES:  There is no evidence of worrisome lesions.",
            "output": "No acute intra-abdominal abnormalities."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen: The liver, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber.  No lymphadenopathy, free air or free fluid is seen.  The stomach\nand duodenum appear normal.\n\nPelvis:  Loops of small bowel demonstrate no signs of ileus or obstruction.\nThe appendix is fluid-filled with mucosal hyperemia and diameter measuring up\nto 8 mm. No significant fat stranding though overall findings are concerning\nfor early acute appendicitis.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "Findings concerning for early acute appendicitis.\n\nNOTIFICATION:  Findings discussed in person with Dr. ___."
        },
        {
            "input": "The bones are diffusely osteopenic.\n\nRedemonstrated is an intertrochanteric fracture through the right femur with\nmild medial angulation and comminution of the greater and lesser trochanters.\nThere is a fat-fluid level and a hematocrit level in the adjacent greater\ntrochanteric bursa. Heterogeneous appearance of the adductor muscles on the\nright likely relates to hemorrhage. A group of stippled or arcs-and-rings\ncalcifications in the medullary cavity of the right greater trochanter\nmeasuring approximately 1.5 x 2.4 cm (2:81), dating back to at least ___, likely represents an enchondroma.\n\nMild degenerative changes are present in bilateral hips. No additional\nfracture is identified. There is no sacroiliac or pubic symphysis diastases.\nIncidental note made of small focus of hydroxyapatite edges to the left\ngreater trochanter. Note is made of focal soft tissue density in both proximal\nfemurs.\n\nAt least moderate degenerative changes are present in the imaged portion of\nthe lumbar spine including vacuum disc phenomenon, disc bulges, ligamentum\nflavum thickening and facet arthropathy.  Grade 1 anterolisthesis of L4 on L5\nis noted.\n\nAtherosclerotic calcifications are noted along the abdominal aorta and its\nbranches. The prostate is enlarged. A small fat containing right inguinal\nhernia is unchanged. There is no pelvic free fluid or lymphadenopathy.\nAnterior abdominal musculature appear atrophic.",
            "output": "1. Intertrochanteric fracture through the right femur with mild medial\nangulation and comminution of the greater and lesser trochanters as described\nabove.  Surrounding hemorrhage noted.\n\n2. Probable enchondroma in the right greater trochanter dating back to ___. \nAllowing for the fracture, no osteolytic component is identified to suggest an\naggressive chondroid lesion."
        },
        {
            "input": "LUNG BASES:  Streaky opacities at the left greater than right lung bases\nlikely represent subsegmental atelectasis in the setting of a chronically\nelevated left hemidiaphragm.  Otherwise, the partially imaged lung bases are\nclear.  There is a trace left pleural effusion.  There is no pericardial\neffusion.  Coronary artery and aortic and mitral valve calcifications are\nnoted.  There is no hiatus hernia.\n\nCT ABDOMEN:\nThere is normal homogeneous attenuation of the liver without obvious focal\nlesion.  There is no obvious intrahepatic biliary ductal dilation.  Evaluation\nof the portal vein is limited in the absence of IV contrast.  The patient is\nstatus post Whipple procedure, with a generally unchanged postoperative\nappearance in the upper abdomen.  There has been mild interval atrophy of the\nremaining portion of pancreas.  The anastomosis with the biliary limb appears\nintact.  Punctate calcifications in the spleen may represent vascular\ncalcifications.  The adrenal glands are unremarkable.  The kidneys display a\nnormal noncontrast appearance.  There is no evidence of hydronephrosis.\n\nThe stomach and GJ anastomosis are unremarkable.  The biliary limb is not\ndilated, and appears generally unremarkable.  The JJ anastomosis is not\nclearly visualized, however there is no evidence of small bowel obstruction or\nsmall bowel wall thickening.  The ascending, transverse, and the majority the\ndescending colon are unremarkable.  The rectosigmoid colon is redundant.  In\nthe left hemiabdomen, there is a markedly dilated, stool-filled sigmoid colon\nwhich descends in the mid abdomen measuring up to 7.5 cm.  Multiple\nhyperdensities within the colonic lumen likely represent ingested pills. \nThere is circumferential wall thickening and mild surrounding inflammatory\nchange of the involved sigmoid colon extending into the rectum with fecal\nimpaction.  Findings are compatible with stercoral colitis.\n\nThere is moderate to severe atherosclerotic calcification of the abdominal\naorta, most prominent in the infrarenal abdominal aorta and proximal common\niliac arteries.  There is no evidence of aneurysm or dilation.\n\nMildly prominent mesenteric and retroperitoneal lymph nodes are likely\nreactive in nature (for example, see series 2, image 44).  There is no free\nintraperitoneal air or fluid.\n\nCT PELVIS:\nA Foley catheter balloon is seen inflated within the bladder lumen, which is\nonly mildly distended and grossly unremarkable.  The prostate is enlarged. \nThere is no pelvic sidewall, iliac chain, or inguinal lymphadenopathy.  There\nis no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is a small fat containing right inguinal hernia, unchanged since ___.  A broad- necked abdominal wall laxity measuring 2.7 cm across is noted\nin the midline abdomen (series 2, image 35).  Multiple lower, predominantly\nleft-sided subcentimeter soft tissue nodules measure up to 9 mm (for example\nsee series 2, image 60) may represent injection granulomas.  A right femoral\nintramedullary rod and fixation screw are new since prior CT, and appear\ngenerally unremarkable without evidence of loosening or other hardware related\ncomplication.  There is severe multilevel thoracolumbar spine degenerative\nchange.  Grade 1 L4-5 anterolisthesis is unchanged since ___.  Compression\ndeformities involving the L1, L2, and L3 vertebral bodies, with\npost-vertebroplasty changes in the L2 and L3 vertebral bodies, are unchanged\nin appearance since CT from ___.  There is no evidence of concerning\nfocal lytic or sclerotic osseous lesion.",
            "output": "1. Markedly dilated, fecally impacted, sigmoid colon and rectum, with wall\nthickening and surrounding mild inflammatory change, compatible with stercoral\ncolitis.  No free intraperitoneal air or fluid.\n2. Status post Whipple procedure.\n3. Generally unchanged severe thoracolumbar spine degenerative change, with\nchronic compression deformities of the L1-L3 vertebral bodies.\n4. Unchanged fat containing right inguinal hernia.\n5. Bibasilar left greater than right atelectasis.  Trace left pleural\neffusion."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions with multifocal confluent\nconsolidations.  Please refer to separate report of CT chest performed on the\nsame ___ for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is an 8 mm hypodensity within segment III of the liver, too small to\nfurther characterize, but likely represents a hepatic cyst.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis slightly distended with evidence of sludge, but there is no surrounding fat\nstranding 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: Bilateral native kidneys are atrophic.  Left renal parenchymal\nstones.  There is a 2.2 cm hypodense indeterminate lesion within the lower\npole of the right native kidney (series 2, image 65).  Recommend further\ncharacterization with renal ultrasound.\n\nPatient is status post 2 renal transplants with the transplanted kidneys in\nthe right lower quadrant.  The more superior kidney transplant demonstrates\nregion of hypodensity within the midpole, concerning for infarction or\npyelonephritis (series 2, image 80).  Recommend clinical correlation.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel appears collapsed.\nThe colon and rectum are within normal limits. The appendix is normal.  Rectal\ntube is in place.\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 no 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 2.2 cm hypodense indeterminate lesion within the lower pole of the right\nnative kidney.  Recommend further characterization with renal ultrasound.\n2. The more superior kidney transplant demonstrates region of hypodensity\nwithin the midpole, concerning for infarction or pyelonephritis.  Recommend\nclinical correlation.\n3. The gall bladder is distended with evidence of sludge, but without signs of\ncholecystitis.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  Recommend renal ultrasound.\n\nNOTIFICATION:  The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 4:28 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "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, SMA, and ___\nare all widely patent.  The hepatic arterial anatomy is conventional.  Two\nrenal arteries supply the left kidney and two renal arteries supply the right\nkidney, all of which are widely patent.  Multiple embolization coils are\nvisualized in the mid to lower pole of the right kidney abutting the large\nright renal pelvis stone, described below.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 simple renal cysts are demonstrated in the right kidney as well as\nmultiple subcentimeter cortical renal hypodensities, which are too small to\ncharacterize though likely also represent renal cysts.  Multiple embolization\ncoils are visualized in the lower to mid pole of the right kidney which are\nreported to of previously migrated into the collecting system.  The\nsuperior-most aspect of these coils abuts a large nonobstructing 2.3 cm right\nrenal pelvic stone (08:40).  Incidental note is made of focal fat density\nadjacent to the embolization coils medially (07:37).  No left-sided renal\ncalculi.  There are no urothelial lesions in the kidneys or ureters. There is\nno 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 within normal limits.  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: The prostate and seminal vesicles are normal.\n\nBONES: There 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 non-obstructing 2.3 cm right renal stone.  Additional right renal\nembolization coils are noted.\n2. Two renal arteries supply each kidney, bilaterally, all of which are patent\nwithout focal irregularity."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 appears symmetric in size.  Embolization coils are\nre-demonstrated in the lower to midpole of the right kidney.  There is\nredemonstration a large right staghorn calculus which measures 3.4 x 2.0 x 2.6\ncm, previously 2.8 x 1.7 x 1.8 cm.  Multiple additional stones are noted\nwithin the right kidney.  Mild focal dilation of the proximal right ureter is\nunchanged.  No stones are noted within the left kidney.\n\nThe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of solid 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.\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": "Interval increase in size of large right staghorn calculus which measures 3.4\nx 2.0 x 2.6 cm, previously 2.8 x 1.7 x 1.8 cm.  Multiple additional stones are\nalso noted within the right kidney. Mild focal dilation of the proximal right\nureter without identifiable cause is 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 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: Again seen is a heterogenous left adrenal lesion measuring 3.9 x 3.3\nx 3.6 cm, (series 4, image 52), (series 9, image 50) and previously measured\n4.0 x 3.2 cm in the axial plane.  The right adrenal is of normal size and\nshape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nRedemonstrated, in the interpolar region of the right kidney is a\nwell-circumscribed hypodensity measures 2.1 x 2.0 x 2.4 cm consistent with a\nsimple renal cyst, (series 4, image 65), (series 9 image 27).  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: Stable postsurgical changes following hysterectomy and\nbilateral salpingo-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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPunctate foci of the left and right iliac bones, (series 4, image 91, 93),\nleft femoral head, (series 4, image 109) are stable since CT and pelvis ___ and likely represent bone islands.\n\nSOFT TISSUES: 23 mm irregular hyperdensity in the right lateral abdominal wall\nmay represent sequela of injection.",
            "output": "1. Stable postsurgical changes following hysterectomy and bilateral\nsalpingo-oophorectomy.  No evidence of local recent disease recurrence.\n2. No evidence of intra-abdominal or intrapelvic metastatic disease.\n3. Unchanged indeterminate left adrenal mass when compared to CT dated ___.  If there is no prior imaging to better characterize the left\nadrenal mass ,a follow-up adrenal MR may be considered.\n4. Please refer to same-day CT chest for description of thoracic findings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal vein\nis patent. The gallbladder is normal without radiopaque stones. There is no\nintra or extrahepatic biliary duct dilation.\n\nThe spleen is normal in appearance. An accessory spleen is noted. The adrenal\nglands and pancreas are unremarkable.\n\nThe kidneys demonstrate symmetric nephrograms and excretion of contrast. There\nis no evidence of hydronephrosis.  No focal renal lesions are seen.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is\ndistended and debris filled.  The small bowel is normal in caliber. Fecalized\nloops of terminal ileum in the right lower quadrant are nonspecific but may be\nsecondary to slow transit in the setting of constipation. There is\ndiverticulosis of the sigmoid colon without evidence of diverticulitis. The\ndescending colon is under distended making the evaluation of colitis\ndifficult. The remainder of the colon is unremarkable. The appendix is well\nvisualized and normal (series 601b: 35).\n\nThere is no intra-abdominal free fluid or free air. There is no\nretroperitoneal or mesenteric adenopathy. There are no abdominal wall hernia\nis.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No acute intra-abdominal process.\n2. Diverticulosis without evidence of diverticulitis.\n3. No evidence of abdominal lymphadenopathy."
        },
        {
            "input": "Study is degraded by motion.\n\nLOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: With limitations of the motion artifact there are no liver\nlesions, and the liver demonstrates homogenous 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Air-fluid level in the stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Apparent thickening of the ascending colon without significant fat\nstranding is likely due to decompression.  Large amount of stool in the rectum\nand sigmoid.  The appendix is normal.  No evidence of diverticulitis.\n\nPELVIS: The urinary bladder is unremarkable.  Distal ureters are not\nvisualized.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate unremarkable.\n\nLYMPH NODES: No abdominal or pelvic adenopathy 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. \nNo apparent hip dysplasia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Motion degraded study.  Allowing for this, no findings to account for reported\nsymptoms."
        },
        {
            "input": "VASCULAR: Please refer to separate cardiac CT report for details of vascular\nfindings.\n\nCHEST: Please refer to separate cardiac CT report for details of intrathoracic\nfindings.\n\nABDOMEN:\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 is somewhat atrophic and fatty replaced.  No focal\npancreatic lesions, evidence of main duct dilatation, or peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 and scarring is seen involving the upper and\ninterpolar region of the right kidney, as well as the upper pole of the left\nkidney, which may represent sequela of prior infectious or inflammatory\nprocess.  Otherwise the kidneys have an unremarkable appearance.  No evidence\nof hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is diverticulosis, without evidence of wall\nthickening or fat stranding.  Appendix contains air, has normal caliber\nwithout evidence 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. The prostate is enlarged and the seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.  Soft tissue\nstranding and gas in the subcutaneous fat of the anterior abdomen is\ncompatible with sequela of recent injection.",
            "output": "1. No acute or concerning process in the abdomen or pelvis.\n2. Please refer to separate cardiac CT report for details of vascular and\nintrathoracic findings."
        },
        {
            "input": "PELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume intermediate density fluid within the pelvis, similar in extent\nto prior CT.\n\nNote is made fecal incontinence.  Intrapelvic bowel loops are unremarkable.\n\nThere is no pelvic sidewall or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: Visualized prostate is unremarkable.  There is marked\nscrotal wall edema, as seen on ultrasound.  Foci of air tracking along the\nscrotal skin is most likely secondary to soft tissue folds.  No subcutaneous\ngas is seen tracking superiorly.\n\nVASCULAR: There is severe atherosclerosis of the descending abdominal aorta\nand iliac vessels.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is multilevel degenerative change of the lower lumbar spine. \nDegenerative changes are also noted about the bilateral, left greater than\nright hips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Scrotal wall thickening and edema.  Apparent air tracking along the scrotal\nskin is due to air trapped between the scrotum and the adjacent thighs.  There\nis no free air within the scrotal wall or within the scrotum itself.\n2. Pelvic ascites, similar in extent compared to prior CT, however now higher\ndensity, with a dependent 8 mm calcific density within the fluid, nonspecific.\n3. Severe atherosclerotic calcification involving the visualized portion of\nthe abdominal aorta and bilateral common iliac vessels and their branches.\n\nNOTIFICATION:  Updated findings impression 1.  discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 10:10 am, 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. \nCompared to ___, there has been interval increase in size and\nnumber of multiple hypodense lesions throughout the liver.  For example the\nlargest lesion in segment 3 measures up to 1.4 cm, previously 4 mm (02:14). \nThe largest lesion in the right hepatic lobe measures up to 1.2 cm, previously\n0.7 cm (02:12).  2 subcentimeter hypodensities in the hepatic dome (2:7) as\nwell as 2 subcentimeter hypodensities in the inferior aspect of the liver (2:\n25, 26) are new.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout.  As before, there is\na 0.8 x 0.7 cm hypodensity in the pancreatic head (02:24).  This lesion has\nbeen characterized as a probable side branch IPMN on a prior MR exam.  The\npancreatic duct is top-normal in size, similar to prior.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  As before,\npunctate granulomas are seen throughout the spleen, suggesting prior\ngranulomatous disease.\n\nADRENALS: There is similar, mild bilateral thickening of the adrenal glands\nwithout focal lesions.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of suspicious focal renal lesions or hydronephrosis. \nSubcentimeter hypodensities bilaterally are too small to characterize, but\nstatistically likely represent simple cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Similar to prior,\nthere is asymmetric thickening of the right rectal wall measuring 4.3 x 4.0 cm\nwith mild haziness of the adjacent fat, likely the known rectal mass. \nAlthough this is better appreciated on the recent rectal MRI this appears\nsimilar compared 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 not visualized.  There is no large adnexal\nmass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no inguinal lymphadenopathy.  There is a mildly prominent rectal nodes\nmeasuring up to 4 mm (02:55).\n\nVASCULAR: The aorta is tortuous, however, there is no abdominal aortic\naneurysm.  Extensive atherosclerotic disease is noted.\n\nBONES: The previously described left iliac bone lesion is visualized the\ncurrent study.  The bones are diffusely demineralized.  Multilevel\ndegenerative changes are moderate, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Asymmetric thickening in the right rectal wall is better appreciated on the\nrecent rectal MRI, is consistent with known rectal mass.\n2. Interval increase in size and number of multiple hypodensities scattered\nthroughout the liver, compared with ___, consistent with progression\nof metastatic disease.\n3. Unchanged 0.8 x 0.7 cm hypodensity in the pancreatic head, characterized a\nside branch IPMN on recent MRI.\n4. Previously described left iliac bone lesion is poorly visualized on the\ncurrent study.\n5. Unchanged bilateral adrenal thickening without focal lesions."
        },
        {
            "input": "CHEST:  Limited assessment on lung bases demonstrates bibasilar atelectasis. \nNo pleural effusion. The visualized heart is normal in size without\npericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones. The portal vein, SMV, and splenic vein are\npatent.\n\nThe spleen is normal. A 0.8 cm accessory spleen is noted. The pancreas\nenhances homogenously and is without focal lesions, peripancreatic fat\nstranding, or focal fluid collection. The adrenal glands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  Multiple\nsubcentimeter renal hypodensities are again noted some to small to\ncharacterize. Largest measures 2.3 x 2.2 cm (02:29) within the interpolar\nregion of the right kidney and is consistent with a simple cyst. A 1.8 x 1.5\ncm (02:24) left parapelvic cyst noted. No hydronephrosis or hydroureter\nidentified.  No renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. Wall edema is seen within the cecal base and\nterminal ileum, likely due to secondary inflammation. Mild wall thickening of\nthe distal ileum which measures approximately 2.3 cm in maximal width is\nsimilar to the prior exam, likely due to prior radiation treatment. Small\namount of adjacent mesenteric free fluid identified noted.  The small bowel is\notherwise normal in caliber without wall thickening.  No pneumatosis. \nRemainder of the large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. Colonic diverticulosis is present without\nevidence of acute diverticulitis. The appendix is dilated and fluid-filled\nwith a large 1.3 cm appendicolith at the base. Maximal diameter of appendix\nmeasures 1.9 cm (02:51).  Along the mid appendix there is loss of mucosal\nenhancement (601 b: 25) without extraluminal air suggestive of necrosis. No\nfocal fluid collection.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  Small amount of atherosclerotic\ncalcification noted. The iliac arteries are normal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo abdominal wall hernia or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "Acute appendicitis with evidence of necrosis and obstructing appendicolith. \nNo definite evidence of perforation or focal fluid collection. Secondary\ninflammation of the cecal base and terminal ileum.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:22 ___, 5 minutes after discovery\nof the updated findings."
        },
        {
            "input": "Partially imaged lung bases are notable for slightly increased bibasilar\natelectasis and small bilateral pleural effusions. Large simple fluid\ncollection surrounding the distal esophagus, posterior to the heart measuring\n15.1 x 9.4 cm (trv x ap) is unchanged.\n\nCT abdomen: Evaluation of intra-abdominal organs is limited by lack of\nintravenous contrast. Noncontrast enhanced appearance of the liver, spleen,\npancreas, adrenal glands, and bilateral kidneys is unremarkable. The\ngallbladder contains a punctate radiodensity which could represent a small\nstone but is otherwise unremarkable. Intravenous contrast from an earlier\nstudy is seen in the renal collecting systems. There is no hydronephrosis.\n\nSurgical material is seen along the distal esophagus and fundus of the\nstomach. Increased fat stranding in this region and particularly along the\nlesser curvature of the stomach may relate to recent surgery. Nondilated\npartially fluid-filled loops of small bowel are normal in course and caliber.\nThere is no obstruction. Oral contrast from a prior study is seen throughout\nthe colon, notable for sigmoid diverticulosis but no diverticulitis.\nEvaluation of the cecum and the lower abdomen is limited by extensive streak\nartifact caused by dense oral contrast in the cecum. There is no drainable\nintra-abdominal fluid collection. There is no free air. Scattered small\nmesenteric and retroperitoneal lymph nodes do not meet size criteria for\nlymphadenopathy. Abdominal aorta is of normal caliber throughout. An inferior\nvena cava filter is noted.\n\nCT pelvis: Bladder is decompressed around a Foley catheter. Seminal vesicles\nand prostate gland are unremarkable. There is no pelvic free fluid or\nlymphadenopathy. A small fat containing left inguinal hernia is noted.\n\nBone window: No concerning lytic or sclerotic osseous lesion is identified.",
            "output": "1. Stable postoperative changes in the lower esophagus and proximal stomach\nwith unchanged appearance of a large paraesophageal fluid collection, thought\nto represent a seroma.\n\n2.  No evidence of hematoma or large fluid collection in the abdomen or\npelvis."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions, similar to the prior\nexam on ___.  Minimal adjacent bibasilar atelectasis. \nSuggestion of ___ opacities in the right lung base may be infectious\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 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: Interval placement of a percutaneous nephrostomy tube on the right,\nwith decrease in extent of right-sided hydronephrosis.  Large calculus in a\nupper pole minor calyx extending into the major calyx is unchanged, compatible\nwith a partial staghorn calculus (02:26).  Ureteral stones in the right mid\nand distal ureter are in similar position (series 2, images 53, 66).  The\nfluid collection adjacent to the renal pelvis/proximal right ureter measures\n4.6 x 2.3 cm, similar to the prior exam.  Increased perinephric fat stranding\non the right is likely postprocedural.  Small locule of air in the renal\npelvis, probably post-instrumentational (02:35).\n\nSeverely atrophic left kidney, without evidence of nephrolithiasis on the\nleft.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Residual oral contrast is seen\nthroughout the colon from a prior examination.  Extensive colonic\ndiverticulosis.  Normal caliber appendix.  There is no ascites.\n\nPELVIS: Urinary bladder is largely collapsed around a Foley catheter.  There\nis 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.  Heavy atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nIntertrochanteric screw and intramedullary rod partially imaged in the\nproximal right femur.  Osseous structures are diffusely demineralized.  Mild\ncompression deformities at L1 and L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Improved hydronephrosis status post right PCN placement.\n2. Similar position of two right ureteral stones, the larger measuring up to\n0.8 cm.  Unchanged right upper pole partial staghorn calculus.\n3. Fluid collection adjacent to the right proximal ureter measuring\napproximately 4.6 x 2.3 cm is overall similar.  Increased right perinephric\nfat stranding may be postprocedural.\n4. Small bilateral pleural effusions, similar.\n5. Suggestion of right lung base ___ opacities, likely infectious. \nClinical correlation and follow-up 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 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.  The dorsal pancreatic duct\nappears to drain directly into the duodenum, separate from the common bile\nduct (series 3, image 26), suggestive of pancreas divisum.  There is no\nperipancreatic 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.  The left\nadrenal gland appears minimally thickened, suggestive of adrenal hyperplasia\n(series 3, image 17).\n\nURINARY: The kidneys are of 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.  Within\nthe upper pole of left kidney, there is a hypoenhancing 1.1 cm rounded lesion\n(series 3, image 16).  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 uterus and right adnexae are within normal limits. \nThere is a 1.4 cm hypoenhancing rounded structure within the left adnexa\n(series 3, image 57), incompletely evaluated on current exam.\n\nLYMPH NODES: There is no retroperitoneal or 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. No findings in the imaged abdomen pelvis to explain patient's left upper\nquadrant pain.\n2. 1.4 cm hypoenhancing left adnexal structure, incompletely evaluated on\ncurrent exam.\n3. 1.1 cm hypoenhancing lesion within the upper pole left kidney.\n4. Minimally thickened left adrenal gland, suggestive of adrenal hyperplasia.\n5. Incidental finding of pancreatic divisum.\n\nRECOMMENDATION(S):  1.  Consider pelvic ultrasound for further evaluation left\nadnexal structure.\n2.  Consider renal MR in ___ year for further evaluation of left renal lesion.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:12 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "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: Mild atelectasis within the lingula.  No focal consolidations. \nNo pleural or pericardial effusions.\n\nABDOMEN:\nLarge volume loculated ascites throughout the abdomen and pelvis with\nassociated nodular peritoneal thickening and enhancement, which has increased\ncompared to prior, compatible with malignant ascites.  There are extensive\nperitoneal and omental implants.  The largest implant along the left pericolic\ngutter measures approximately 15.0 cm in anteroposterior diameter, which has\nincreased compared to the CT dated ___ (series 5, image 91).  An\nimplant within the lower right pericolic gutter also appears more bulky\ncompared to prior (series 5, image 133).\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 lower pole of the left kidney\nis unchanged compared to prior, too small to characterize, but likely a cyst\n(series 5, image 68).  Otherwise, the kidneys are of normal and symmetric size\nwith normal nephrogram. There is no evidence of stones, new focal renal\nlesions, or hydronephrosis. There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Other than mass effect from the large necrotic pelvic mass,\nthe small bowel loops demonstrate normal caliber, wall thickness and\nenhancement throughout. Colon and rectum are within normal limits.  Appendix\nis not visualized.\n\nRETROPERITONEUM: A large necrotic aortocaval lymph node measures approximately\n3.5 x 2.1 cm.\n\nPELVIS: There is mass effect on the bladder from the large necrotic pelvic\nmass.  Otherwise, the urinary bladder and distal ureters are unremarkable. \nThere is no inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The large necrotic pelvic mass has increased in size\nmeasuring 17.0 cm in maximum axial ___, and measuring 18.4 cm in the\nsagittal plane.  There is also significant mass effect on pelvic small and\nlarge bowel loops.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are 2 small left lower ventral hernias containing fluid\n(series 5, image 126, 135).",
            "output": "1. No evidence of bowel ischemia.\n2. Large necrotic pelvic mass has increased in size, now measuring up to 18.4\ncm. Persistent mass effect upon the bladder and pelvic bowel loops.\n3. Malignant ascites with nodular peritoneal and thickening and\nperitoneal/omental implants, also increased compared to the prior examination."
        },
        {
            "input": "LOWER CHEST: 5 mm nodule in the right lower lobe is unchanged compared to ___\n(series 2; image 3), benign.  Otherwise there is no concerning nodularity or\nfocal consolidation in the visualized 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 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal glands are mildly thickening without focal lesion.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a high density lesion off the inferior pole of the right kidney,\nwhich has increased in size compared to ___, measuring 3.5 cm, previously 2.4\ncm.  Otherwise, 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. There are multiple\ncolonic diverticula without surrounding inflammation to suggest\ndiverticulitis.  Appendix is surgically absent.\n\nPELVIS: Again seen is somewhat large incidental right pelvic sidewall lipoma,\nwith mass effect on the bladder and right adnexa, unchanged.  The urinary\nbladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.  There are\nmultiple borderline inguinal lymph nodes, none of which meet CT size criteria\nfor enlargement.\n\nVASCULAR: There is no 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 abnormality.\n2. Cholelithiasis without cholecystitis.\n3. High density lesion of the inferior pole of the right kidney has increased\nin size compared to ___, measuring 3.5 cm, previously 2.4 cm.  Finding most\nlikely represents hemorrhagic cyst.  Non-urgent renal ultrasound could be\npursued for further evaluation.\n4. Stable 5 mm nodule in the right lower lobe, benign.\n5. Stable right pelvic sidewall lipoma.\n\nRECOMMENDATION(S):  Non urgent right renal ultrasound for further assessment\nof high density lesion, which is increasing in size."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Lung bases, visualized pleural\nspaces, and lower mediastinal structures otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  There is a small\nhypoattenuating focus at the dome of the liver measuring approximately 10 mm\nin diameter (series 2, image 14).  It is too small to appropriately\ncharacterize on CT.  No focal parenchymal lesions identified otherwise. \nNormal gallbladder.  No intrahepatic or extrahepatic bile duct 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: There is a tiny 10 mm left adrenal nodule (series 2, image 19),\nindeterminate.  Right adrenal gland normal.\n\nURINARY: Normal symmetric perfusion of the renal parenchyma.  Bilateral renal\ncortical cysts.  The largest cyst on the right measures 4.7 cm in diameter\n(series 2, image 23).  The largest cyst on the left measures 5.0 cm in\ndiameter (series 2, image 23).  No nephrolithiasis.  No hydronephrosis.\n\nGASTROINTESTINAL: Stomach normal.  Uncomplicated moderate to severe\ntransverse, descending, and sigmoid diverticulosis.  Diffuse engorgement of\nthe vasa recta around the sigmoid.  Several additional scattered uncomplicated\ndiverticula in the right hemicolon.  Normal small bowel.\n\nPELVIS: Mild circumferential thickening of the bladder wall, potentially on a\nbackground of underdistention.  Urinary bladder otherwise normal.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Tortuous iliac arteries.\n\nBONES: No acute or focal destructive osseous lesions.  Multilevel degenerative\nfacet arthropathy throughout the visualized spine.  Grade 1 anterolisthesis of\nL5 on S1, present on a background of bilateral pars defects.  Chronic anterior\nwedging and mild height loss within the T11 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nPERITONEUM: No intra-abdominal free air or free fluid.",
            "output": "1. No acute abdominal pathology is identified.\n2. Patient has uncomplicated moderate to severe colonic diverticulosis.  No\nevidence of acute diverticulitis on today's study.  No alternative explanation\nfor acute pain."
        },
        {
            "input": "LOWER 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. A stone is seen within the gallbladder\nwithout wall edema or pericholecystic fluid.\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 1.6 cm exophytic cyst is seen in the right renal\nlower pole, hyperdense on noncontrast study from ___, likely due\nto hemorrhagic or proteinaceous contents. Tiny hypodensities in the left\nkidney are too small to characterize, statistically likely representing cysts.\nThere appears to be a filling defect in the right renal pelvis (12:26, 28)\nwith expansion of the right renal pelvis compared to ___ and new\nurothelial enhancement (12:29).\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Diverticula are seen throughout the colon without\ninflammatory changes..\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 not aneurysmally dilated with focal ectasia\nto 2.4 cm in the infrarenal portion with moderate atherosclerotic\ncalcifications along its course. The main portal vein, splenic vein and SMV\nare patent. Incidentally noted is a retro aortic left renal vein.\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 uterus is atrophic. A 4.8 x 3.3 cm right adnexal cystic lesion was\n4.2 x 3.5 cm on ___, essentially unchanged. No left adnexal\nabnormality is identified.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Lucencies in the L4, L2, T11 and T8 vertebral bodies with stippled\ncalcifications likely represent hemangiomas. Abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1.  No evidence of metastatic disease in the abdomen or pelvis.\n2. Right renal pelvic filling defect and expansion and new urothelial\nenhancement. Correlation with urine cytology and direct visualization is\nrecommended.\n3.  Cholelithiasis without evidence of acute cholecystitis.\n4. Stable 4.8cm right adnexal cystic lesion. Pelvic ultrasound may be helpful\nfor further evaluation.\n5.  CT chest reported separately.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 17:57 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "CHEST:\n\nA saline, left breast prosthesis is noted. For full description of\nintrathoracic findings, please see the separate dedicated chest CT report\ndictated by the cardiothoracic imaging section.\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.  A 9 mm, exophytic hypodensity extending from the\ninterpolar region of the right kidney is too small to characterize, but\nunchanged from the prior examination and likely a cyst.\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\nair-filled and normal in appearance. Colonic diverticulosis is present without\nevidence of diverticulitis. There is no retroperitoneal lymphadenopathy by CT\nsize criteria. There is no free abdominal fluid or pneumoperitoneum. The aorta\nand iliac branches are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\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.\n\nOSSEOUS STRUCTURES:  Grade 1 anterolisthesis of L4 on L5 is noted, stable from\nthe prior examination and likely degenerative in nature. No focal lytic or\nsclerotic lesion concerning for malignancy.",
            "output": "1. No evidence of metastatic disease within the abdomen or pelvis by CT\nexamination. For description of intrathoracic findings, please see the\nseparate chest CT report.\n2. Colonic diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis. The lung bases are otherwise\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma is coarsened and heterogeneous. Hepatic\ncontours are nodular, in keeping with the patient's history of cirrhosis. An\narterially enhancing lesion is seen in the caudate lobe, just between the\nportal vein and the IVC. This demonstrates washout on delayed phase images,\nand is consistent with hepatocellular carcinoma.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder contains a\nnumber of gallstones. There is pericholecystic fluid, likely due to underlying\nhepatic dysfunction. No definite wall thickening is identified.\n\nPANCREAS: There is no definite evidence of focal pancreatic lesion. There is\nno pancreatic ductal dilatation.  There is mild fatty infiltration.  There is\nno peripancreatic stranding.\n\nSPLEEN: The spleen is markedly enlarged, measuring 20 cm. The splenic artery\npseudo aneurysm is again noted, measuring up to 4.4 cm (06:36).  In addition,\na likely true 1.8 cm fusiform aneurysm is seen of the splenic artery near the\nsplenic hilum.  (06:48, 10:65).  A small splenule is noted, measuring 1.2 cm\n(06:57).  There is heterogeneous attenuation of the spleen at the splenic dome\n(8:69).  This may be related to hypoperfusion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nArterially enhancing solid lesions are seen in the bilateral kidneys. The mass\non the right, measuring 2.0 x 1.9 cm is seen in the interpolar region (06:49).\nAnother arterially enhancing, though to a lesser extent, mass is seen in the\ninterpolar region of the left kidney, and measures 1.8 x 1.8 cm.  These are\nconcerning for renal cell carcinoma.\n\nGASTROINTESTINAL: The stomach is unremarkable aside from a moderate hiatal\nhernia. The visualized loops of small and large bowel demonstrate normal\ncaliber and wall thickness and enhancement.\n\nLYMPH NODES: There are a number of prominent mesenteric lymph nodes, likely\nrelated to hepatic dysfunction and ascites.  Vague retroperitoneal nodal\ntissue is also seen, difficult to measure, but roughly up to 1 cm in short\naxis.  These are all likely also reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is seen.  As mentioned previously, a pseudo aneurysm gantry aneurysm\nof the splenic artery are seen.  In addition, the caliber of the superior\nmesenteric vein is increased.  It measures up to 2.2 cm.  Perigastric and\nperisplenic venous 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. Arterially enhancing hepatic mass demonstrating washout (OPTN 5A) is\nconsistent with hepatocellular carcinoma.\n2. Bilateral, arterially enhancing renal masses are concerning for renal cell\ncarcinoma.\n3. Splenic arterial pseudo aneurysm and aneurysm."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Patient has undergone interval\nembolism of two splenic artery aneurysms with stent placement across a\nfusiform distal splenic artery aneurysm.  The splenic artery is patent.  There\nis no arterial or venous filling of the 4.3 x 3.5 cm aneurysm with a stent\ngraft across it (301:54).  Evaluation of the more distal aneurysm is limited\nin the setting of metallic artifact from embolization coil.\n\nCompared with ___, there is new thrombosis of the right and main\nportal vein to the confluence (301:46, 54).  The SMV distal to the confluence\nis patent.  There is nonocclusive thrombus in the distal splenic vein (301:59,\n70, 307b:45,46).  There are periesophageal, perigastric and perisplenic\nvarices.\n\nLOWER CHEST: There is a small left nonhemorrhagic pleural effusion and\nadjacent atelectasis.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken, coarsened and nodular, consistent with\ncirrhosis.  Again seen is a 2.4 x 1.9 cm arterially enhancing lesion in the\ncaudate lobe which demonstrates washout on delayed images, not significant\nchanged from prior, and consistent with hepatocellular carcinoma (5a:45).\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is contains stones, without evidence of gallbladder wall\nthickening or pericholecystic fluid.  There is a large nonhemorrhagic ascites,\nincreased from prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  The pancreatic duct is mildly prominent.  There is no\nperipancreatic stranding.\n\nSPLEEN:  The spleen is markedly enlarged, measuring up to 21 cm, similar to\nprior.  There are multiple new large areas of non enhancement of the splenic\nparenchyma, consistent with splenic infarct, related to recent embolizations\n(401b:57).  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. \nAgain seen are arterially enhancing lesions in the bilateral kidneys,\nmeasuring 2.2 x 2.0 cm in the right interpolar region, and 1.6 x 1.5 cm in the\nleft interpolar region, similar to prior, and again concerning for renal cell\ncarcinoma (103:71).  There is no evidence of stones or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL:  There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.  Appendix is not visualized.  Prominent\nmesenteric lymph nodes are not significantly changed from prior, and likely\nrelated to underlying liver disease.\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 moderate\nnonhemorrhagic ascites in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There 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 articular or venous filling of a 4.3 cm splenic artery aneurysm with a\nstent graft across it status post embolization.  Evaluation of the more distal\nsplenic artery aneurysm is limited in the setting of metallic artifact from\nembolization coil.  The splenic artery appears patent.\n2. Multiple large areas of non enhancement in the spleen, involving at least\n50% of the splenic parenchyma, consistent with splenic infarct related to\nrecent embolization.\n3. New thrombosis of the right and main portal vein to the confluence, and\nnonocclusive thrombus in the distal splenic vein.  The SMV distal to the\nconfluence is patent.\n4. Large nonhemorrhagic ascites is slightly increased from prior.\n5. New small left nonhemorrhagic pleural effusion and adjacent atelectasis.\n6. Cirrhosis with no significant change in a 2.4 cm arterially enhancing\nlesion in the caudate lobe which demonstrates washout, consistent with\nhepatocellular carcinoma.\n7. No significant change in bilateral enhancing renal lesions, again\nsuspicious for renal cell carcinoma.\n8. Cholelithiasis, with no evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: There is visualized small component of nonhemorrhagic left\npleural effusion, although it is incompletely imaged, with subpulmonic\ncomponent.  .  Mild right basilar atelectasis.  Stable cystic changes in the\ninferomedial right lower lobe stable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, compatible with known\ncirrhosis.  The arterially enhancing lesion in the caudate lobe is not well\nseen on the current phase.  There is mild intrahepatic biliary dilatation. \nThe gallbladder is distended with multiple stones, however the wall is not\nthickened.\n\nThe amount of intra- abdominal ascites has moderately increased since the\nprior study.  There are areas of linear peritoneal enhancement, consistent\nwith known diagnosis of peritonitis.  There are no loculated fluid collections\nin the abdomen or pelvis.\n\nRe- demonstration of thrombosis involving the right and main portal vein to\nthe confluence.  There is minimal flow along the periphery, posterior in upper\nmargin of the main portal vein, extends into 1 of the ___ tributaries, which\nis new since prior.  Dominant SMA contribution is patent, drains into the\nupper abdomen, gastric and paraesophageal varices.  Splenic vein was partially\nthrombosed on prior exam, is not visualized today, consistent with complete\nthrombosis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Pancreatic duct is mildly prominent, as before.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is enlarged up to 19 cm with multiple areas of infarction\ninvolving approximately 50% of the splenic volume, likely related to recent\nembolization.  There is no direct or indirect evidence of splenic abscess.\n\nOf note, there is no evidence of filling of the 4.2 x 3.6 cm splenic arterial\naneurysm, after interval embolism and stent graft placement (2 a: 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. \nPreviously described enhancing lesions in both kidneys, measuring 2.0 cm in\nthe right interpolar region and 1.6 cm in the left interpolar region, are\nunchanged in size and are concerning for renal cell carcinomas.  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 not directly\nvisualized.\n\nThere is no new circumscribed, extraluminal fluid collection.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A large\namount of nonhemorrhagic ascites extends into 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: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Please see above for further findings.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes lumbar spine, sacroiliac joints, hips pre.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Compared with the CT from ___, interval increase in the amount\nof nonhemorrhagic intra-abdominal ascites, with suggestion of peritoneal\nenhancement, consistent with peritonitis.  There are no loculated\nabdominopelvic fluid collections.\n\n2.  Stable splenic infarcts, without evidence of splenic abscess.\n\n3.  Persistent distention of the gallbladder, with multiple hyperdense stones.\nHowever, there is no gallbladder wall thickening or adjacent stranding.  It is\nsimilar in appearance to the ultrasound of ___.\n\n4.  Known arterially enhancing hepatic lesion is not well seen on the current\nstudy, due to contrast bolus timing.\n\n5.  Enhancing renal lesions, concerning for renal cell carcinoma, similar.\n\n6.  Persistent thrombosis in the right and main portal vein to the confluence.\nMain contribution of SMV distal to the confluence is patent, there is no\nthrombus extension within 1 of the SMV tributaries, and new complete occlusion\nof the splenic vein.  There few mildly distended small bowel loops, however,\nthere is no evidence of obstruction, and no bowel wall thickening to suggest\nischemia.  No pneumatosis.  ."
        },
        {
            "input": "LOWER CHEST: A trace right pleural effusion is new.  There is mild passive\nsubjacent atelectasis.  A 6 mm left lower lobe nodule is unchanged (303:14). \nA 3 mm right lower lobe nodule was not previously seen.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post left hepatic lobe resection.  Multifocal\narterial enhancing lesions with washout in pseudo capsule have significantly\nincreased from the prior study.  The largest confluent lesions centered in\nsegment ___ measures up to 8 x 13 x 13 cm, previously 8 x 6 x 9 cm (301:30). \nAn exophytic portion of the mass extends inferiorly, displacing the renal\nvessels inferiorly, and producing some degree of mass effect on right kidney\n(601:74).  Numerous additional lesions are present throughout the remaining\nliver, and all are new or increased in size.\n\nAdditionally, there is worsening moderate-to-severe biliary dilation,\nparticularly in segments 6 and 7 which appear obstructed by the dominant mass.\nThere is cholelithiasis without evidence of cholecystitis.\n\nThe main and right portal veins are markedly displaced and attenuated, but not\ndefinitely occluded until intrahepatic portions of the right posterior portal\nvein (for example 303:25).  Hepatic veins appear patent, although the\nintrahepatic IVC is compressed by the mass (303:33).\n\nModerate volume nonhemorrhagic ascites is increased.\n\nPANCREAS: A 9 mm cystic lesion in the pancreatic tail was not definitely seen\npreviously (301:53) there is borderline dilation of the main pancreatic duct,\nmeasuring up to 4 mm possibly secondary to mass effect by the large hepatic\nmass.\n\nSPLEEN: Multiple embolization coils are demonstrated near the splenic hilum. \nThere are multiple wedge-shaped hypodensities in the spleen, consistent with\ninfarcts, similar to prior.\n\nADRENALS: The adrenals are not well seen, due to streak artifact and mass\neffect by the hepatic mass.\n\nURINARY: As described above, the hepatic mass causes mass effect on the upper\npole of the right kidney.  Re-demonstrated is an arterially enhancing mass in\nthe anterior medulla of the right inferior pole measuring 1.4 cm, unchanged\nfrom prior (301:74).  The left kidney demonstrates normal enhancement.  There\nan arterially enhancing mass in the posterior cortex of left upper pole\nmeasuring 1.7 cm, also unchanged.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The lesser curvature of the stomach closely abuts the mass,\nbut there is a preserved fat plane.  Small bowel and colon are unremarkable.\n\nPELVIS: There is nodular thickening of the bladder wall.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal mass 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.  Extensive esophageal, and gastric varices are present.  Multiple\ncoils from prior splenic artery embolization are redemonstrated.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is diffuse osseous demineralization.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval massive increase in the size and number of diffuse, infiltrative\nhepatocellular carcinoma throughout the liver, with an exophytic component\ncompressing the upper pole of the right kidney. There is associated increase\nin biliary obstruction by the dominant mass, with severe biliary dilation\npredominantly in segments 6 and 7.\nModerate volume ascites and trace right pleural effusion\n2. Stable bilateral arterially enhancing renal masses, concerning for primary\nrenal neoplasm.\n3. New 3 mm right lower lobe pulmonary nodule and stable 6 mm left lower lobe\npulmonary 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal 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.\n\nADRENALS: Right and left adrenal glands 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.\n\nGASTROINTESTINAL: The colon is air-filled and demonstrates diffuse dilatation\nmeasuring up to 6.8 cm in the transverse colon.  There is narrowing of the\nsigmoid colon with adjacent to the bladder (2; 64) with more distal dilatation\nof the rectum is likely positional. Distinct transition point.  Small bowel is\nnormal in caliber.  The stomach is filled with debris but otherwise\nunremarkable.\n\nPELVIS: Massively extended bladder demonstrates diffuse wall thickening which\nis likely secondary to chronic outlet obstruction from severe prostatomegaly. \nProgressed when compared to prior.\n\nREPRODUCTIVE ORGANS: Severe prostatomegaly measuring 6 x 7 x 5 cm with an\nestimated volume of 150 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. \nMild multilevel degenerative changes of the lower thoracic and lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mildly dilated colon with air-fluid levels with narrowing of the sigmoid\ncolon secondary to an enlarged bladder.  No mass.  Differential considerations\ninclude relative external sigmoid compression secondary to bladder outlet\nobstruction versus ___ syndrome.\n2. Prostatomegaly (at least 150 cc) causing bladder outlet obstruction and\nbilateral moderate hydroureteronephrosis, progressed since the prior exam from\n___.\n\nRECOMMENDATION(S):  ."
        },
        {
            "input": "LOWER CHEST: New small to moderate right and small left nonhemorrhagic pleural\neffusions.  There is new poorly enhancing consolidation within the right lower\nlobe concerning for pneumonia.  Mild cardiomegaly is stable.  Small\npericardial effusion is new.  Tip of nasogastric tube terminates in the lower\nesophagus which is partially fluid-filled (2:3).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nsubcentimeter hypodensity near the hepatic dome (2:9) is incompletely\ncharacterized but unchanged.  There is no evidence of new focal lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is diffusely atrophic and not well seen due to colonic\ndistension.  Where seen, there is normal attenuation throughout, without\nevidence of focal lesions or pancreatic ductal dilatation.  There is no\ndefinite peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Interval\nincrease in small bowel dilatation measuring up to 4.0 cm, previously up to\n2.0 cm.  Marked interval increase in diffuse air-filled dilatation of the\ncolon measuring up to 10.9 cm in the sigmoid colon which was previously\ndecompressed about a distended urinary bladder.  However, the transverse colon\nmeasures 8.4 cm, previously 7.6 cm.  No distinct transition point is seen. \nThe appendix is not definitively visualized.\n\nPELVIS: The urinary bladder is decompressed about a Foley catheter.  The\ndistal ureters are not well seen.  There is no definite pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate is severely enlarged, 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.  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 interval increase in diffuse small and large bowel dilatation to the\nlevel of the anus, measuring up to 10.9 cm in the sigmoid colon and 4.0 cm in\nthe small bowel.  No definite transition point.  Findings are suggestive of\nworsening ileus.  No definite pneumatosis or pneumoperitoneum.\n2. Suboptimal positioning of nasogastric tube which terminates in the lower\nesophagus.  Advancement of at least 10 cm recommended.\n3. Interval decompression of the bladder with resolution of bilateral\nhydronephrosis.\n4. Right lower lobe pneumonia.\n5. New small to moderate right and small left nonhemorrhagic pleural\neffusions.\n6. New 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. \nSubcentimeter hypodensity in the left hepatic lobe is too small fully\ncharacterize (02:17).  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. \nProbable dromedary hump along the lateral border of the left kidney is\nincidentally noted.  A caliceal diverticulum is identified in the right\ninterpolar kidney.  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\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized uterus is unremarkable.  Multiple\nbilateral corpus luteal cysts are seen measuring up to 3.4 x 2.8 cm in the\nleft adnexa (601:35).  A 3.4 x 3.1 cm high attenuating cystic structure in the\nright adnexa may reflect a hemorrhagic cyst (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.  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 abdominopelvic process.\n2. Multiple adnexal cysts, some which demonstrate hyperdense components,\nlikely reflecting corpus luteal cysts versus hemorrhagic cysts.  This measures\nup to 3.4 cm in the right adnexa.  Recommend reassessment with pelvic\nultrasound in 6 weeks."
        },
        {
            "input": "LOWER CHEST:  Three pulmonary nodules are present the right lung (2:10, 2:9,\n2:5).  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypo attenuating with 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:  Most of the pamcreas has mild fatty replacement without evidence of\nductal dilation.  There is a ill defined soft tissue density in the pancreatic\ntail measuring approximately 4.3 x 3.0 cm which extends into the splenic hilum\n(2:28, 601b:41).  There is irregularity of the outer contour of this mass with\napparent invasion of adjacent fat.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 midpole of the\nright kidney is an oval hypodensity measuring 6 ___ which is unchanged in\nappearance from prior examination and likely consistent with a cyst.\n\nThere is interval slight increased fullness of the right collecting system\nsuggesting borderline hydronephrosis secondary to partial right ureteral\nobstruction as it traverses the phlegmon (02:46).  No calyceal blunting is\nseen.  There is no evidence of hydronephrosis in the left kidney.  There is no\nnephrolithiasis.  Slight perinephric haze is seen again which is unchanged\nfrom prior examination.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Unchanged from prior\nexamination in the right lower quadrant is a 6.8 x 6.0 cm phlegmon adjacent to\nthe appendix without distinct fluid collection (2:71).  The colon and rectum\nare within normal limits.  Again seen are diffuse hazy nodular irregularities\nwithin the omentum more prominent in the left upper quadrant (02:36, 02:43,\n02:50).\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: Multiple lucent bone lesions are present in the pelvis (601:58, 601:55,\n601:51).  In the L2 vertebral body is a lucent lesion consistent with a\nhemangioma.  Incidentally noted in the left femoral neck is a sclerotic focus\nconsistent with a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No drainable fluid collection.  Unchanged appearance of right lower\nquadrant phlegmon surrounding the appendix with adjacent nodules consistent\nwith acute appendicitis likely secondary to tumor.\n2. Borderline hydronephrosis of the right kidney suggesting partial right\nureteral obstruction as it traverses the phlegmon.\n3. Ill-defined soft tissue in the pancreatic tail, which extends into adjacent\nfat and the splenic hilum, concerning for pancreatic adenocarcinoma.  This may\nbe the primary tumor for the peritoneal disease including that involving the\nappendix.\n4. Unchanged hazy nodular omental irregularities consistent with peritoneal\ntumor.\n5. Several lucent bone lesions in the pelvis.  In light of malignancy, bone\nscan could be considered.\n6. Three pulmonary nodules in the right lung.\n7. Hepatic steatosis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 3:28 ___, 4 minutes after discovery of\nthe findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.   The abdominal aorta is tortuous with\nthe part stent is seen in the left renal artery. Calcium burden in the\nabdominal aorta and great abdominal arteries.  Patent stents is seen in both\nright and left renal arteries there is no narrowing at the origins of the\nceliac and SMA.  There is mild-to-moderate narrowing at the origin of the ___\nwhich is patent the aorta is mildly tortuous.  The iliac arteries are also\ntortuous.  There is no aneurysm in the iliac vessels or stenosis.\nThe right common iliac artery measures 8.6 mm and the left 9.1 mm in diameter.\nThe right common femoral artery measures 6.8 mm and the left 6.8 mm in\ndiameter\n\nLOWER CHEST: There are bilateral pleural effusions, larger on the of the left,\nand pericardial effusion.  Please refer to of the a gated CTA of the chest\ndone on the same date.\n\nABDOMEN:\n\nThere is moderate amount of ascites and mild anasarca edema throughout the\nabdomen 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 is is not seen.\n\nPANCREAS: The pancreas is atrophic.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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: No signs of a bowel obstruction.  Mild constipation.  The\nseveral sigmoid diverticula with no signs of diverticulitis.  There is no\nevidence of mesenteric 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: Uterus and adnexal regions appear within normal 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. No abdominal aortic aneurysm or occlusive vascular lesions.\n2. Patent bilateral renal artery stents"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  No definite focus of\ncontrast extravasation is identified to localize source of lower GI bleeding.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  A small\npericardial effusion is present.  A calcified granuloma is seen in the right\nlung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\n1.5 cm lesion is seen near the dome of the liver (12:25, 602a: 62),\ndemonstrating progressive, peripheral, nodular enhancement, possibly a\nhemangioma, though metastatic disease is not excluded in the setting of\nperitoneal disease.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is contracted along multiple calcified\ngallstones.  A stone is incidentally noted in the neck of 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.  An accessory spleen is noted, measuring 1.2 cm\n(12:45). A\n\nADRENALS: The 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 bilateral kidneys are most consistent with cysts.  A\nhyperdense lesion in the lower pole of the right kidney is incompletely\ncharacterized but may represent a hemorrhagic or proteinaceous cyst. Cortical\nirregularity in the lower pole of the right kidney is related to prior insult.\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.  There are innumerable colonic diverticula without\nevidence of acute diverticulitis.  As noted previously. No definite contrast\nextravasation is identified, to localize the source of lower GI bleeding.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable aside from a\nbladder diverticulum. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged and heterogeneous. The ovaries are\nnot identified. No adnexal masses are identified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are multiple peritoneal deposits, particularly in the\nright lower quadrant. The largest deposit measures up to 4.4 cm (8:110), and\nis amenable to percutaneous biopsy. Numerous other peritoneal deposits are\nnoted (6:497, 08:10 8, 112, 120, 12:  85, 98, 109).",
            "output": "1. Multiple peritoneal deposits consistent with metastatic disease.\n2. Abnormally enlarged, heterogeneous uterus with a poorly defined endometrium\nis concerning for primary malignancy.\n3. Multiple renal cysts, one of which is hyperdense, and may be hemorrhagic or\nproteinaceous.\n4. Indeterminate hepatic lesion which may be a hemangioma, though given\nperitoneal metastases, a metastatic lesion is not excluded.\n5. The source of lower GI bleeding is not identified."
        },
        {
            "input": "For intrathoracic findings, please refer to dictated CT thorax report.\n\nThere is an 11 mm hypodense lesion in the dome of the liver, which most likely\nrepresents a hepatic cyst or biliary hamartoma.  The spleen, and adrenal\nglands are unremarkable.  There is cholelithiasis.  There is no significant\nperipancreatic inflammation.\n\nBilateral kidneys are atrophic, left greater right without hydronephrosis with\nnumerous bilateral renal cysts, right greater left, the largest cyst measuring\nup to 3.7 cm in the interpolar right kidney.  The abdominal aorta demonstrates\natherosclerotic calcifications and is tortuous without aneurysm dilation.\n\nThere is no intra-abdominal free air or free fluid.\n\nThe included portions of the gastrointestinal tract demonstrates a small\nsliding-type hiatal hernia.  There is colonic diverticulosis without evidence\nof diverticulitis.  The appendix is visualized and appears normal.  There are\npostsurgical changes from prior left inguinal hernia repair.  There is a small\nfat containing right inguinal hernia.\n\nThe prostate is enlarged measuring 5.2 x 5.8 cm with indentation of the\nposterior bladder wall.\n\nNo acute fracture or suspicious osseous lesion is identified.  There are\nmoderate to severe multilevel degenerative changes of the spine.",
            "output": "1. No CT evidence of an acute intra-abdominal or intrapelvic process.  No\nabdominal or pelvic hematoma.\n2. Colonic diverticulosis without evidence of diverticulitis.\n3. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: In the left lower lobe there is a 0.1 cm solid nodule (series 2,\nimage 5).  Moderate bibasilar atelectasis.  Trace bilateral pleural effusions.\nNo pericardial effusion.\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.  The gallbladder is within normal limits.\n\nPANCREAS: Fatty atrophy of the pancreas without focal lesions or ductal\ndilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nProminent bilateral external iliac chain and inguinal lymph nodes are present\nthese measure up to 1.9 cm in the short axis on the right, possibly reactive.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Severe degenerative changes of the bilateral hips with chronic\ndeformity of the right femoral head.\n\nSOFT TISSUES: There is substantial thickening of the scrotum more predominant\non the right with a likely underlying small hydrocele.  No subcutaneous\nemphysema.  No enhancing collections.  Soft tissue tract is seen along the\nleft buttock and at the gluteal crease, extending to the left gluteus maximus\nmuscle, which should be correlated clinically.",
            "output": "1. Scrotal wall thickening with small hydrocele.  No subcutaneous gas to\nsuggest ___ gangrene.  No drainable collection.\n2. Enlarged bilateral inguinal and external iliac lymph nodes measuring up to\n1.9 cm in the short axis, likely reactive.\n3. 1.1 cm left lower lobe solid pulmonary nodule.  Please see ___\nrecommendations below.\n4. Possible mild hepatic steatosis.\n5. Severe osteoarthritis of the bilateral hips.\n6.  Soft tissue tract in the gluteal crease and left buttock extending to the\nleft gluteus muscle, please correlate clinically.\n\nRECOMMENDATION(S):  For incidentally detected single solid pulmonary nodule\nbigger than 8mm, a follow-up CT in 3 months, a PET-CT, or tissue sampling is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate to extensive calcium\nburden in the abdominal aorta and great abdominal arteries.  The visualized\nportions of the celiac artery, superior mesenteric artery, and inferior\nmesenteric artery are patent.\n\nLOWER CHEST: Evaluation of the lung bases shows bilateral pleural effusions\nand compressive atelectasis.  Underlying consolidation may also be present.  A\nmoderate pericardial effusion is present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered hypo enhancing foci are most likely perfusional in origin, as they\nwere not present on recent examination.  There is extensive portal venous gas\nextending into the superior mesenteric vein and its branches.  The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas is mildly atrophic.  There is no peripancreatic\nstanding.  No focal lesions 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 symmetric in size and demonstrate symmetric\nnephrogram.  Bilateral renal cortical scarring is noted.\n\nGASTROINTESTINAL: The majority of the mid and distal small bowel does not\ndemonstrate wall enhancement, involving the mid jejunum and the ileum,\nstarting at approximately image 3b:271.  These loops of small bowel\ndemonstrate pneumatosis.  Colonic pneumatosis is seen involving the cecum and\nascending colon as well as the descending and sigmoid colon.  The appendix is\nnot definitively identified.  There is no evidence of mesenteric\nlymphadenopathy.  Pelvic and abdominal free fluid is noted.  Free fluid\ncentered around the cecum and ascending colon is also noted (60___:53), which\nmay be suggestive of perforation.\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.  Pelvic free fluid is also\nseen.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nBONES: Multilevel degenerative changes are seen throughout the lower thoracic\nand lumbar spine, not significantly changed since the comparison exam.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive ischemic bowel involving the mid and distal small bowel and colon\nwith wall hypoenhancement, pneumatosis, and extensive portal venous gas. \nAbdominal and pelvic free fluid is noted, some of which appears to be centered\naround the cecum and ascending colon, which may represent perforation.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 5:00 ___, 1 minute after discovery of\nthe 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: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  There are lung nodules measuring up to 5 mm\nin the lower lobes (3A:  5, 8, 10).  A soft tissue nodule abuts a subsegmental\npulmonary vessel in the left lower quadrant (03:11).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  2\nhypodensities in the liver, measuring up to 2.0 cm are likely simple cysts. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains a layering dense high-density material, without\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 with normal nephrogram. \nMultiple bilateral hypodensities in the kidneys are likely simple cysts. \nThere is no evidence of stones 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. Colon are within normal limits.  High density\nmaterial within the colon present on noncontrast images are likely ingested\nmaterial.  A metallic stent is seen crossing the distal sigmoid colon and the\nrectum.  There is a pseudoaneurysm in the posterior wall rectum, abutting the\nrectal stent originating from the ___. The rectum demonstrates asymmetric\nthickening of the bowel wall with multiple enlarged lymph nodes measuring up\nto 1.0 cm in the mesorectal fat, compatible with patient's history of rectal\nmalignancy.  Appendix is not visualized.\n\nRETROPERITONEUM:  A para-aortic node measures up to 1.1 cm (2a:73).  Other\nmildly enlarged retroperitoneal lymph nodes are not pathologic by CT criteria.\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 and seminal vesicles 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. Pseudoaneurysm in the posterior wall rectum, abutting the rectal stent\noriginating from the ___.\n2. No evidence of active extravasation into the bowel lumen.\n3. Asymmetric thickening of the rectal wall with multiple enlarged lymph\nnodes, compatible with known history of rectal malignancy.\n4. Multiple lung nodules measuring up to 5 mm.  Given patient's history of\nmalignancy, short-term follow-up with dedicated CT is recommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 9:17 AM, 2 minutes after discovery of the\nfindings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  The previously identified\npseudoaneurysm arising off of the superior rectal is no longer present\nreplaced by coil pack.  There appears to be no evidence of active\nextravasation this area nor of bond embolized portions of the pseudoaneurysm. \nNeovascularity of the rectum is noted, compatible with the history of sigmoid\nadenocarcinoma.\n\nLOWER CHEST: Once again identified are lung nodules measuring up to 5 mm in\nthe left lower lobe (6, 13, 12, 8).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhypodensity in segment 6 of the liver is stable from the prior exam, likely\nrepresenting a cyst.  The gallbladder is within normal limits, without stones\nor 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, worrisome focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.  Multiple bilateral hypodensities in the\nkidneys are likely simple cysts.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is not visualized.  Multiple enlarged lymph nodes surrounding the\nrectum are noted, compatible with a history of adenocarcinoma.  A rectal stent\nis in place and unchanged from the prior exam.\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: Degenerative changes of the bone are noted.  There are no concerning\nosseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Previously identified pseudoaneurysm arising off of the ___ appears to be\nwell coiled with no perceivable remnants\n2. No evidence of active extravasation into the bowel lumen\n3. Neovascularity of the rectum, rectal stent and asymmetric thickening of the\nrectal wall with multiple enlarged lymph nodes are compatible with the known\nhistory of rectal malignancy\n4. Once again, multiple lung nodules measuring up to 5 mm.  Given patient's\nhistory of malignancy, short-term follow-up with dedicated CT is recommended\nif not performed already elsewhere."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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:  Stomach, duodenum, and proximal loops of small bowel are\nunremarkable.  No evidence of small bowel obstruction.  The terminal and\ndistal ileum are not well distended with oral contrast.  Despite the lack of\ndistention within the terminal ileum, there again appears to be and\napproximately 20 cm long segment of terminal and distal ileum demonstrating\nmucosal hyperemia and wall thickening (300b:45) consistent with active Crohn's\ndisease as seen on the prior MR. ___ the ileum more proximally are several\nshort segment focal areas of luminal narrowing, bowel wall thickening, mucosal\nhyperemia, adjacent fat stranding, and prominence of the vasa recta with\nintervening dilated fluid-filled loops of small bowel which also demonstrate\nmild mucosal hyperemia.  These findings are overall similar to the recent MR\nenterography dated ___.  No definite fistulous tract is\nidentified, and the previously described blind ending sinus tract within the\nproximal ileum is not well seen on the current exam.  No free air or free\nfluid within the peritoneal cavity.\n\nColon is unremarkable.  There is a 2.8 x 2.0 cm apparent rim enhancing\ncollection at the left anorectal junction (2:77) which appears to displace the\nanorectum to the right.\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": "1. Apparent 2.8 x 2.0 cm rim enhancing fluid collection at the right anorectal\njunction, suspicious for a perirectal abscess.  This is not well delineated on\nthe current CT, and dedicated MRI pelvis is recommended for further evaluation\nof perianal fistulous disease.\n2. Active Crohn's disease involving the distal and terminal ileum with several\nskip lesions is overall similar in appearance compared to ___. \nNo evidence of small bowel obstruction.  Previously described blind ending\nsinus tract within the ileum is not well visualized on the current CT.\n\nRECOMMENDATION(S):  Dedicated MRI pelvis for further assessment."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Follicles are\nseen 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.\n\nBONES: There 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 CT 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 attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 renal hypodensities, too small to fully\ncharacterize but statistically likely simple cysts.  There is no\nhydronephrosis.  Both kidneys enhance symmetrically and excrete contrast\nnormally.\n\nGASTROINTESTINAL:  Small hiatal hernia is noted.  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:  Uterus is enlarged and globular with multiple exophytic\nfibroids identified, the largest of which is peripherally calcified in the\nright uterus measuring 8.1 x 6.1 x 5.8 cm.  Pelvic varices and bilateral\ndilated gonadal veins are present.  Ovaries bilaterally 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.  No atherosclerotic disease\nis noted.\n\nBONES: Sclerosis about the iliac aspects of both sacroiliac joints, more\npronounced on the right, is consistent with osteitis condensans ilii.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. No acute abnormality identified within the abdomen or pelvis. \nSpecifically, the appendix is normal and there is no evidence of\ndiverticulitis.\n2. Dilated bilateral gonadal veins and pelvic varices may be seen with pelvic\ncongestion syndrome but can also be present in the normal population. \nClinical correlation is necessary.\n3. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Bilateral small pleural effusions have resolved.  Linear\natelectasis is seen in right lung base.\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.  Bilateral\nsubcentimeter low-density lesions in kidneys are unchanged too small\ncharacterize.  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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  The\npreviously seen a small volume of complex fluid has decreased.\n\nREPRODUCTIVE ORGANS: Again seen is an enlarged fibroid uterus, unchanged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Prominent gonadal veins are again seen similar to prior exam.  There\nis no abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: Sclerosis of bilateral sacroiliac joints greater on the right,\nunchanged.  There are bilateral L5 spondylolysis.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia. \nPreviously seen breast lesions is not included in this current exam.",
            "output": "1. Interval decrease in size of complex ascites.\n2. Interval resolution of bilateral pleural effusions.\n3. Small fat containing right inguinal hernia.\n4. Unchanged large fibroid uterus and prominent gonadal veins."
        },
        {
            "input": "LOWER CHEST: A 2 mm rounded density in the posterior left upper lobe is only\npartially imaged, and may represent a nodule (series 2, image 1). Correlation\nwith prior imaging is recommended.  There is bibasilar dependent atelectasis\nand areas of air trapping.  No pleural effusion.  Mild cardiomegaly, without a\npericardial effusion.  Multifocal coronary artery calcifications.  Thoracic\naorta is moderately calcified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits. \nPortal venous system 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 are simple cysts in the lower pole of the left kidney measuring up to\n1.5 cm.  Additional sub-cm hypodensity is too small to characterize (601b:34).\nNo hydronephrosis.  There 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.  A moderate amount of stool is noted in the rectal\nvault.  Appendix is surgically absent.  No ascites.  No pneumoperitoneum.\n\nPELVIS: Bladder is largely collapsed around a Foley catheter.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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. \nMultilevel degenerative changes, most pronounced in the thoracic spine where\nthere is loss of intervertebral disc space height and endplate sclerosis. \nThere is also marked loss of intervertebral disc space height at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal process identified to explain patient's symptoms.\n2. Small hiatal hernia.\n3. Partially imaged 2 mm density in the left upper ___ represent a\npulmonary nodule.  Correlation with prior imaging is recommended.  If no prior\nimaging is available for comparison, this could be re-evaluated with chest CT\nin ___ year if the patient is a smoker.  No additional follow-up is indicated in\nlow risk patients.\n4. Mild cardiomegaly.  Multifocal coronary artery calcifications.\n\nRECOMMENDATION(S):  Correlation with prior imaging to determine stability of a\npossible left upper lobe pulmonary nodule."
        },
        {
            "input": "VASCULAR:\n\nPreviously seen soft tissue mass inferior to the proximal SMV measures 3.1 x\n2.9 cm (3:132), grossly unchanged since ___.  The soft tissue lesion\ncontacts the right side of the SMA without SMA narrowing or contour\nirregularity.\n\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, ___, renal and\niliac arteries and their major branches are patent with no signs of occlusive\nor aneurysmal disease. The portal system including SMV, splenic and portal\nveins is patent. The renal veins are patent and demonstrate normal caliber.\nThere is moderate calcium burden in the abdominal aorta and great abdominal\narteries.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. External and internal biliary drains appear\nin similar position compared to prior.  Mild pneumobilia is again seen.  There\nis minimal residual intrahepatic biliary ductal dilatation. There has been\ninterval removal of a percutaneous biliary catheter and placement of 2\nmetallic stents within the common hepatic duct and traversing into the\njejunostomy. The gallbladder is resected.  Hepaticojejunostomy itself appears\nunremarkable.\n\nPANCREAS: The patient is status post Whipple procedure.  The\npancreaticojejunostomy is unremarkable.  The remaining pancreas is atrophic,\nwithout evidence of focal lesions. The pancreatic duct measures up to 4 mm in\ndiameter, which is similar to prior. 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, suspicious renal lesions, or hydronephrosis. \nMillimetric hypodensities in the kidneys bilaterally are too small to\ncharacterize, but appears similar to prior.  There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The gastrojejunostomy is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.  Appendix has normal caliber without\nevidence of fat stranding.\n\nRETROPERITONEUM: Cluster of pre aortic lymph nodes (601: 67) is similar to\nprior, with the largest measuring up to 1.1 cm.  There is a stable 1.0 cm\ngastrohepatic lymph node on 601b:63.  As noted previously, there is a stable\nlesion inferior to the proximal SMV within the mesentery.\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 enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nScattered bone islands are stable.\n\nSOFT TISSUES:  Small fat containing umbilical hernia.  Postsurgical changes in\nthe anterior abdominal wall.",
            "output": "1.  Previously seen soft tissue lesion inferior to the proximal SMV is similar\ncompared to prior.  No drainable fluid collections.\n2.  Retroperitoneal lymph nodes remain mildly enlarged.\n3.  Interval removal of biliary drainage catheters and placement of 2 metallic\nstents in the common bile duct.\n4.  Other findings as described above are similar to prior."
        },
        {
            "input": "LOWER 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 diffuse mild intrahepatic biliary\nduct dilatation, with a small amount of ___ seen in the right lobe,\nsignificantly decreased from prior.  Two common bile duct stents are present,\nextending to the jejunostomy.  Patient is status post cholecystectomy.\n\nPANCREAS:  Patient is status post Whipple.  A soft tissue mass inferior to the\nhead of the pancreas and adjacent to the SMA and SMV is not significantly\nchanged, measuring 3.3 x 2.8 cm.  The dilated pancreaticojejunostomy appears\nsimilar to prior.  Atrophy of the remainder the pancreas, with diffuse\ndilation of the main pancreatic duct is similar to prior.  Overall mass effect\nof the dilated pancreaticojejunostomy limb on the portal confluence and SMV is\nsimilar to prior.  Hazy appearance of the surrounding mesentery is similar to\nprior.\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 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 gastrojejunostomy.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThere is slight apparent thickening of the ascending colonic wall at the\nhepatic flexure, new compared with prior (604:37).  The rectum is within\nnormal limits.  Appendix contains air, has normal caliber without evidence of\nfat stranding (___:72).  Scattered subcentimeter mesenteric lymph nodes are\nnot significantly changed.\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 and the seminal vesicles are\nunremarkable.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is mild calcium\nburden in the abdominal aorta and great abdominal arteries. There is no\nevidence of arterial or venous intraluminal extravasation.\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 active intraluminal extravasation in the bowel.\n2. New slight irregular wall thickening of the ascending colon at the hepatic\nflexure, may represent a focal colitis, underlying lesion not excluded, but\nnone clearly seen previously.\n3. Intrahepatic biliary duct dilatation is similar to prior, however there has\nbeen significant decrease in ___ represent partial stent\nocclusion.\n4. No significant change in his soft tissue mass adjacent to the SMA and SMV.\n5. Persistent dilation of the pancreaticojejunostomy limb, with no significant\nchange in associated mass effect on the portal confluence and SMV."
        },
        {
            "input": "There is a new left and slightly larger however small right pleural effusion\nwith compressive atelectasis.\n\n\nThe tip of a percutaneous biliary drain is seen through the right biliary\nstent, which is new since the prior exam.  A left biliary stent is in\nunchanged position.\n\nPostsurgical changes are seen following Whipple with a 3.1 cm mixed solid and\ncystic mass centered at the resection bed, overall similar in appearance to\nthe recent prior exams.  The surrounding soft tissue with no vascular\ninvolvement is also unchanged.  Fiducials are seen in the postsurgical bed. \nThere is again dilatation of the main pancreatic duct measuring up to 7 mm.  A\ncystic lesion in the pancreatic tail is mildly decreased in size on today's\nexam, measuring up to 2 cm (5:61).\n\nThe pancreatic mass is seen involving the splenic vein and portal vein\nconfluence, with associated moderate to severe attenuation of the mid portal\nvein.  The distal SMV and proximal main portal veins are again noted to be\nthrombosed. There is persistent encasement of the SMA, which appears patent.\n\nMultiple small peripancreatic lymph nodes are unchanged.  Peritoneal\nthickening is again seen with septations along the hepatic margin.\n\nThere is mild central biliary dilatation, improved since ___. \nPneumobilia is noted in predominantly the left hepatic lobe.\n\nThe kidneys, adrenal glands and spleen are unremarkable.  Gallbladder has been\nresected. There is no intestinal obstruction.  Small hiatal hernia is again\nnoted.  A large amount of ascites is worse.\n\nNo enlarged pelvic lymph nodes.\n\nNo osseous abnormality.",
            "output": "1. Post Whipple, similar appearance of pancreatic malignancy with similar\nlocoregional extension and vascular involvement.\n2. The tip of a percutaneous biliary drain is seen within the right biliary\nstent, new since the prior exam.  A left biliary stent is unchanged since the\nprior study.  There is mild central biliary dilatation and pneumobilia in\npredominantly the left hepatic lobe, which is improved since ___.\n3. Interval increase in large amount of ascites and pleural effusions as\ndescribed."
        },
        {
            "input": "VASCULAR:\n\nPreviously seen soft tissue lesion at the site of previous SMV repair measures\napproximately 2.5 x 2.5 cm (3:134), compared to 2.1 x 2 cm on ___.  The soft tissue lesion contacts the right side of the SMA without SMA\nnarrowing or contour irregularity.  There is no abdominal aortic aneurysm. The\nceliac axis, SMA, ___, renal and iliac arteries and their major branches are\npatent with no signs of occlusive or aneurysmal disease. The portal system\nincluding SMV, splenic and portal veins is patent. The renal veins are patent\nand demonstrate normal caliber. There is moderate 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. External and internal biliary drains appear\nin similar position compared to prior.  Mild pneumobilia and mild intrahepatic\nbiliary dilatation are similar to ___. The gallbladder is is\nresected.  Hepaticojejunostomy is unremarkable.\n\nPANCREAS: The patient is status post Whipple procedure.  The\npancreaticojejunostomy is unremarkable.  The remaining pancreas has normal\nattenuation throughout, without evidence of focal lesions. The pancreatic duct\nmeasures up to 4 mm in diameter, which is similar to prior but without\nintraductal air which was seen on prior. 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, suspicious renal lesions, or hydronephrosis. \nMillimetric hypodensities in the kidneys bilaterally are too small to\ncharacterize, but appears similar to prior.  There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The gastrojejunostomy is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.  Appendix has normal caliber without\nevidence of fat stranding. 5 mm porta hepatis lymph node (3:134) is slightly\nlarger compared to prior.\n\nRETROPERITONEUM: Cluster of pre aortic lymph nodes (601:73) is similar to\nprior, with the largest measuring up to 1.1 cm.\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: There is no evidence of worrisome osseous lesions or acute fracture. \nScattered bone islands appear similar to ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Previously seen soft tissue lesion at the site of surgical SMV repair is\nlarger compared to prior.\n2. Other findings as described above are similar to prior."
        },
        {
            "input": "LOWER CHEST: 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 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 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. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace Fluid\nwithin the pelvis, likely within physiologic limits.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.  Re-demonstrated is a 1.9 cm Left ovarian/parovarian 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: An umbilical hernia containing fat is noted.",
            "output": "1. No evidence of acute abdominal or pelvic abnormality explain symptoms.\n2. Status post cholecystectomy."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. No atherosclerotic calcifications are\nseen.\n\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 2 perforators on the left.\n\nLEFT:\nBranching pattern: Type 2 (bifurcating)\nPerforators:\n2 mm, 22 mm to the left and at the level of the umbilicus, (series 10, image\n48 and series 12, image 33)\n1.9 mm, 59 mm to the left and just below the umbilicus, (series 10, image 49\nhand and series 12, image 26))\n\nRIGHT:\nBranching pattern: Type 2 (bifurcating)\nPerforators:\n2.7 mm, 23 mm to the right and 10 mm just below the umbilicus, (series 10,\nimage 49 and series 12, image 44)\n1.6 mm, 57 mm to the right and 10 mm just above the umbilicus, (series 10,\nimage 43 and series 12, image 51)\n\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 sigmoid diverticulosis.  The colon and\nrectum are otherwise unremarkable.  Appendix contains air, has normal caliber\nwithout evidence 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 except for 2\npunctate stones along anterior bladder wall.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal mass.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent bilateral inferior epigastric arteries as described in the body of\nthe report.\n2. No acute process within the abdomen pelvis."
        },
        {
            "input": "The liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent with clips in the gallbladder fossa. Mild prominence of the common bile\nduct measuring 0.6 cm (05:57) without calcified stone is expected post\ncholecystectomy. The portal vein, SMV, and splenic vein are patent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. A 1.8 x\n1.4 cm (05:56) hypodensity is seen within the upper pole of the right kidney\nand is consistent with a slightly hyperdense cyst likely related to\nhemorrhagic or proteinaceous contents, similar to ___ ___ PET. No\nadditional focal renal lesions. No hydronephrosis or hydroureter identified. \nNo renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. Colonic diverticulosis is present without\nevidence of acute diverticulitis. The appendix is normal without evidence of\nacute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. The\nceliac axis, SMA, and ___ are patent . The iliac arteries are normal in course\nand caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, or pneumoperitoneum. Small fat containing umbilical\nhernia is noted without evidence of strangulation.  Few locules of air within\nthe anterior left subcutaneous tissues most consistent with recent injection.\n\nPELVIS: The bladder is partially distended and within normal limits. No pelvic\nside-wall or inguinal lymph node enlargement by CT size criteria.  No free\npelvic fluid seen. The uterus and ovaries are within normal limits. A 3.7 x\n1.5 cm (5:85) hypodense fluid collection with minimal enhancement at edges is\nseen within the left gluteal region and demonstrates central hypodensity in\ncomparison to FDG PET from ___ likely representing evolving\nhematoma.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. Again seen is a lucent lesion\nwithin the postero left lateral aspect of the T12 vertebral body most\nconsistent with a hemangioma. No focal lytic or sclerotic lesion concerning\nfor malignancy.",
            "output": "1. 3.7 cm hypodense fluid collection with minimal enhancement at edges in the\nleft gluteal region likely represents evolving hematoma from recent bone\nmarrow biopsy.\n2. 1.8 cm mildly hyperdense right upper pole renal cyst likely related to\nhemorrhagic or proteinaceous contents, similar to ___ FDG PET.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 2:20 ___, 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 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\nextensive colonic diverticulosis without evidence of wall thickening or\npericolonic stranding to suggest diverticulitis.  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 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. \nThere are multilevel degenerative changes of the thoracolumbar spine, most\nprominent at L4-L5.  There is mild anterolisthesis at L4-L5, likely\ndegenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Surgical\nclips are incidentally noted in the Left inguinal region.  A metallic density\nis seen within the soft tissues of the anterior left lower quadrant (2:64).",
            "output": "1. No acute intra-abdominal or intrapelvic process to account for the\npatient's symptoms.\n2. Extensive colonic diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Patchy and linear bibasilar opacities, left greater right, likely\nrepresent atelectasis.  Extensive coronary artery calcifications.  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 moderate intrahepatic biliary ductal dilatation, stable. \nPatient is status post cholecystectomy.  There is stable dilatation of the\ncommon bile duct measuring up to 1.5 cm.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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.  Interval increase in\nsize of 4.2 cm simple cyst arising from the upper pole right kidney (02:24). \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 of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is not visualized.\n\nPELVIS: Apparent urinary bladder wall thickening is likely due to\nunderdistention.  The distal ureters are unremarkable.  There is no free fluid\nin 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: An infrarenal IVC filter is newly seen, grossly unremarkable.  There\nis no abdominal aortic aneurysm.  Moderate atherosclerotic disease is noted.\n\nBONES: Slight interval increase in moderate compression deformity involving\nthe T12 vertebra (602:45).  No bony retropulsion or perivertebral hematoma. \nNo worrisome osseous lesion is identified.  There is stable mild\nanterolisthesis of L5 on S1.\n\nSOFT TISSUES: Clips are again seen in the left inguinal region.  There is a\nfat containing ventral abdominal wall hernia.  Tip of a VP shunt catheter\nterminates in the mid abdomen.  No associated free fluid.",
            "output": "1. Slight interval increase in moderate T12 vertebral compression deformity. \nNo bony retropulsion.\n2. No intraperitoneal or retroperitoneal fluid collections to explain the\npatient's anemia.\n3. Stable moderate intrahepatic and extrahepatic biliary ductal dilatation\ncompare to ___."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.  An IVC filter is partially\nimaged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the visualized lumbosacral spine.\n\nSOFT TISSUES: A fat containing umbilical hernia is redemonstrated.",
            "output": "No acute fracture or traumatic injury in the pelvis."
        },
        {
            "input": "There is a tiny calcified granuloma in the right lower lobe, which is\nunchanged in size from the ___ study. The heart is normal in size and\nthere is no evidence of pericardial effusion.\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.  There is evidence of prior Whipple procedure. The\ngallbladder surgically absent. The remainder of the pancreas is unremarkable.\nThe pancreaticojejunostomy is visualized. Multiple mesenteric collaterals\nanterior to the pancreas are visualized. The spleen and bilateral adrenal\nglands are normal.  There are multiple, large right renal hypodensities, with\nattenuation less than 20 Hounsfield units and likely representing simple\ncysts.  For example, there is a 5.4 x 4.6 x 4.4 cm right renal hypodensity\n(4:34).  In the right upper pole, there is a 3.8 x 3.8 x 3.3 cm rounded\nhypodensity (4:25). In the right lower pole there is a 3.0 x 2.8 x 2.6 cm\nsimilar rounded hypodensity (4:42). There are multiple left kidney\nhypodensities, too small to characterize on this current study, but also\nlikely representing simple cysts.\n\nThe stomach is grossly unremarkable in appearance. The remaining small bowel\nand large bowel are normal in caliber and without evidence of wall thickening.\nThe appendix is visualized and within normal limits. Several small mesenteric\nlymph nodes are visualized, but not enlarged by CT size criteria. There is no\nretroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches contain mild\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\n\nPELVIS:\n\nThe bladder wall is thickened, though the bladder is not fully distended on\nthis exam. If there is a clinical indication, further evaluation could be\nperformed by ultrasound. The sigmoid colon and rectum are grossly\nunremarkable. There is no pelvic side-wall or inguinal lymphadenopathy by CT\nsize criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or blastic lesion\nconcerning for malignancy.",
            "output": "1.  No evidence of intra-abdominal or intrapelvic metastatic disease.\n2.  Thickened bladder wall, although the bladder itself is not fully distended\non this exam to determine whether this represents a real finding. If there is\na clinical suspicion, further evaluation could be performed by ultrasound."
        },
        {
            "input": "CT abdomen: The liver enhances homogeneously.  A sub cm hypodensity along the\nperiphery of the right hepatic lobe is unchanged and remains too small to\ncharacterize (2:64). There is no intra or extrahepatic biliary dilatation.\nPortal vein is patent. The gallbladder, spleen, pancreas and adrenal glands\nare within normal limits. The kidneys enhance and excrete symmetrically\nwithout focal lesions or hydronephrosis.\n\nStomach is decompressed. Contrast opacified loops of small bowel are normal in\ncaliber. Patient is status post right hemicolectomy. The remaining colon is\nunremarkable.\n\nAbdominal aorta is of normal caliber throughout and the origin of the celiac\naxis, SMA, bilateral renal arteries, and ___ are patent.  Mildly prominent\nmesenteric lymph nodes are noted. There is no retroperitoneal lymphadenopathy.\nDystrophic calcifications in the right lower quadrant and mild right\nperinephric stranding are unchanged. There is no intra-abdominal free air or\nfluid.\n\nCT pelvis: Partially distended bladder and terminal ureters are within normal\nlimits. Uterus and ovaries are not visualized. There is no pelvic\nlymphadenopathy or free fluid.\n\nBone window: Multilevel degenerative changes are present throughout the spine\nwithout concerning osteolytic or osteoblastic lesions.",
            "output": "1. No evidence of local recurrence or metastatic disease in the abdomen or\npelvis.\n2. Please refer to separately dictated CT chest report from the same day for\nfull 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. A 3\nmm hypodensity in segment VI is too small to characterize, but is unchanged\ncompared to multiple prior examinations.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and 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 right\nperinephric stranding is unchanged and likely postsurgical in nature.\n\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\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is unchanged grade 1 anterolisthesis of L4 and L5, with moderate\nto severe degenerative changes in the visualized lumbar spine.  No evidence of\nworrisome osteoblastic or osteolytic lesions.\n\nSOFT TISSUES: Dystrophic calcifications in the right lower quadrant and pelvic\nretroperitoneum, including dystrophic calcifications measuring up to 1.9 cm,\nare unchanged 5:93).  There is unchanged mild stranding along the posterior\nright peritoneum as well. No evidence of recurrent mass in the surgical bed.",
            "output": "1. No evidence of intra-abdominal or intrapelvic malignancy or metastatic\ndisease.\n2. Stable postsurgical changes in the right retroperitoneum, including mild\nstranding and dystrophic calcifications .\n3.  Please see dedicated CT chest report from the current date for the\nthoracic findings."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis without significant change with ___.  There is focal pleural thickening seen on 3.9 x 0.9 cm\ninvolving the paravertebral location (series 5, image 18).\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. \nCalcifications involving the inferior pole of the right kidney in keeping with\nscarring from previous inflammatory or infective changes.   There is an\nextrarenal pelvis on both the right and left kidneys, and the right ureter\ncannot be followed adequately distally, where a lesion measuring 8.5 x 6.4 cm\nis seen bordering the psoas on more than 2.5 cm and bordering the ureter at\nthis level.  There is no evidence of hydroureter on the right.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Status post right\nhemicolectomy and sigmoid resection.\n\nMultiple enhancing retroperitoneal and intraperitoneal masses are seen again\nstable to minimally enlarged from the immediate prior study of MRI of ___ as detailed below:\n\nA 1.8 cm subcapsular lesion adjacent to segment VII better outline on MRI than\non CT scan (series 5, image 19).\n\nA 5.6 x 4.1 cm (5.1 x 4.6 cm on previous MRI) soft tissue lesion (series 5,\nimage 22) in the left retroperitoneal space that displaces the inferior\nmesenteric vein, there is a second component (series 5, image 28) of this\nlesion slightly inferiorly which measures 36 x 31 mm (33 x 26 mm on previous\nMRI).\nA third component measuring 3.3 x 6.5 cm (series 5, image 22) not seen on MRI,\nlocated behind the head and uncinate process of the pancreas behind the second\nportion of the duodenum anteriorly to the vena cava and right renal vein,\nthere is a small linear soft tissue density connecting both components (series\n5, image 23).\n\nA 3.4 x 2.1 cm lesion in the anterior aspect of ___'s pouch (series 5,\nimage 26) stable with previous MR.\n\n___ the posterior aspect of ___'s pouch is a 29 x 23 mm lesion (image 26\nseries 5) stable with previous MRI.  This lesion is better seen on CT.\n\nA enhancing retroperitoneal mass bordering the anterior aspect of the right\npsoas, better seen on previous MRI, measuring approximately 29 mm (series 5,\nimage 41) considered stable.\n\n16 mm soft tissue mass (series 5, image 45), bordered by a 10 mm\ncalcifications (image 41), both located in the anterior aspect of the left\npsoas muscle, not adequately seen on previous MRIs or CTs.\n\nDominant right pelvic mass measuring up to 8.5 x 6.4 cm (8.2 x 6.1 on previous\nMRI) has minimally enlarged.  This is bordered by some fiducials.  Of note,\nthere is a oblong and elongated density arising from this dominant mass and\nextending inferiorly toward the bladder, we cannot distinguish the ureter from\nthis image until its last centimeters.  As mentioned above there is no\nhydronephrosis or hydroureter.\n\nIn the most lateral aspect of the obliques muscles on the right (series 5,\nimage 61) is a 15 mm soft tissue density containing some calcifications,\nremaining stable with previous MRI, where myositis or sequelae of prior\nradiation therapy was suggested.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus was surgically removed.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nStable 6 mm lymph node in the retroperitoneum (series 5, image 27).  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. \nDegenerative bony changes.\n\nSOFT TISSUES:\n\nRectus abdominal muscle diastasis.  Supra umbilical herniation containing\nsmall bowel loops measuring 44 mm wide.  No signs of bowel obstruction.",
            "output": "1. Multiple abdominopelvic masses, difficult to compare with MRI given\ndifferences in modality and technique, but overall appear stable to minimally\nenlarged.  Today, the CT scan demonstrates a right retroperitoneal lesion that\ncannot be seen by MRI (series 9, image 24), anteriorly to the vena cava.\n2. New lesion at the right lower chest lesion could be posterior thickening of\nthe pleura or be suspicious for new right pleural implant.  This can be\nre-assessed on follow up."
        },
        {
            "input": "LOWER 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 ill-defined area of hepatic hyperdensity measuring up to 2.1 x 1.8\ncm in the left hepatic lobe, which may reflect an area of fatty deposition\n(02:57).  This was not definitely seen on emanation.  No other hepatic lesions\nare identified.  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 redemonstration of calcifications at the inferior aspect of the right\nkidney compatible with scarring from prior insult.  There is associated high\nattenuating soft tissue perinephric nodularity measuring up to 1.5 cm, new\ncompared to prior examination (2:79).  Bilateral right greater than left\nextrarenal pelvises are again demonstrated.  The distal right ureter is not\nwell evaluated and is likely obscured by a right psoas lesion, described\nbelow.  There is no evidence of hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient is status\npost right colectomy and sigmoidectomy.  The remaining visualized colon\nappears within normal limits.\n\nAgain demonstrated are multiple mildly enhancing retroperitoneal and\nintraperitoneal masses described as follows:\n\n-There has been interval increase in size of a now 9.2 x 3.6 x 7.3 cm (TRV x\nAP x SI, 2:67, 601:23) low-attenuating mass centered within the right\nretroperitoneal space anterior to the IVC, along the plane of the renal vein. \nThis previously measured approximately 6.5 x 3.3 x 6.4 cm on ___.\n-A similar low-density mass centered within the left retroperitoneal space is\nslightly increased in size currently measuring 5.8 x 3.2 x 5.7 cm, previously\n5.6 x 3.1 x 5.4 cm (2:67, 601:28).\n-A 3.8 x 2.2 cm fat and soft tissue containing density within the left\nperiaortic space appears unchanged in size compared to prior examination\ncurrently measuring 3.5 x 3.1 cm, previously 3.6 x 3.1 cm (2:72).\n-A low attenuating mass within the inferior aspect of the liver is unchanged\nin size currently measuring 2.7 x 2.4 cm, previously 2.9 x 2.3 cm (2:69).\n-There has been interval resection of a large right lower quadrant mass which\nwas previously seen adjacent to the right psoas muscle.  There continues to be\nnodular soft tissue in this region seen on series 2, image 90 with a nodular\ncomponent abutting the anterior margin of the psoas measuring 12 x 31 mm. \nThere is soft tissue extending medial and inferiorly from this ___ psoas\nlesion with the medial component measuring 15 x 28 mm and the inferior\ncomponent measuring 22 x 48 mm on series 2, image 94.  Findings may reflect\nresidual or recurrent disease.\n-A heterogeneous left psoas soft tissue mass is minimally increased in size\ncurrently measuring 1.8 x 1.5 cm, previously 1.7 x 1.1 cm (2:88).\n-Along the lateral aspect of the right anterior oblique muscle there is a 1.1\ncm soft tissue density with macrocalcification, similar to slightly decreased\nin size compared to prior examination where it measured up to 1.5 cm (2:100). \nFindings may reflect myositis or sequelae of prior therapy.  Continued\nattention on follow-up imaging is recommended.\n-There has been interval resection of a mass in the right mid abdomen anterior\nto the right kidney and abutting the liver.  A tiny soft tissue nodule is seen\nat this site on series 2, image 76 measuring 7 x 8 mm, which may represent\nrecurrent or residual tumor.\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 abnormalities\nare 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: Patient is status post ventral herniography.  The abdominal and\npelvic wall is otherwise within normal limits.",
            "output": "1. Interval resection of 2 lesions in the right abdomen, with\nresidual/recurrent disease at these sites as described.\n2. Interval increase in size of multiple additional retroperitoneal masses\nmeasuring up 9.2 cm as compared to ___, suggesting tumor\nprogression.\n3. Subtle parenchymal hyperdensity within segment 4A of the liver, thought to\nreflect focal fat sparing, though attention on follow-up advised.\n4. Please refer to same day CT chest for description of the intrathoracic\nfindings."
        },
        {
            "input": "Lungs: Please see the report of the CT chest performed on the same ___ for\nmore details.\n\nLiver: The liver is homogeneous with a smooth contour. Tiny stable\nhypodensities are seen in the liver, too small to characterize, but likely\ncysts.\n\nThe previously described ill-defined area of hepatic hyperdensity is not\nconspicuous on today's examination. No suspicious liver lesion.\n\nStable hypodensity at the posterior aspect of the liver, measuring 2.9 cm x\n2.5 cm, series 5, image 66, likely representing a small amount of fluid.\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: Scarring is again seen at the lower aspect of the right kidney. There\nis no hydronephrosis.\n\nRedemonstration of masses in the right perirenal space, the largest\nposteriorly measuring 2.5 cm x 2.5 cm, previously 1.3 cm x 1.5 cm, series 5,\nimage 79, increased.  Another is seen more anterolateral to the right kidney,\nmeasuring 2.0 cm x 1.6 cm, previously 0.8 cm x 0.7 cm, also increased.\n\nRedemonstration of the mass abutting the anterior aspect of the right\niliopsoas muscle, measuring 2.4 cm x 4.6 cm, series 5, image 92, previously\n1.2 cm x 3.1 cm, at the expected location of the right mid ureter. There is\nextension to the left in the midline, image 89, measuring 2.0 cm x 3.8 cm,\npreviously 1.5 cm x 2.8 cm. Slightly above this, another soft tissue density\nhas increased, image 85, measuring 2.3 cm x 2.5 cm, previously 1.2 cm x 1.5\ncm.\n\nStable 1.5 cm x 1.6 cm calcified lesion at the anterior aspect of the left\niliopsoas muscle.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nGastrointestinal: Previous right hemicolectomy and sigmoid resection. There is\nno evidence of bowel dilatation or obstruction.\n\nThere is redemonstration of the stable low-density soft tissue masses in the\nretroperitoneal space, the largest of which is seen on the right, measuring\n4.2 cm x 9.3 cm, previously 3.5 cm x 9.2 cm, and is unchanged.\n\nVascular: There are minimal 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. Moderate\ndegenerative disc disease is seen in the lumbar spine.\n\nUnchanged right anterior oblique muscle soft tissue lesion. Stable right lower\nquadrant calcification measuring 1.9 cm.",
            "output": "1. Interval progression of disease as manifested by increase in size of the\nright perirenal space soft tissue masses and the masses near the right\niliopsoas muscle as detailed above.\n\n2. Stable dominant low-density masses in the retroperitoneum.\n\n3. Please see the report of the CT chest performed on the same day for details\non the chest."
        },
        {
            "input": "PELVIS: Contrast material is seen within the rectum and the sigmoid colon. \nThere is gradual caliber change from the distal descending colon into the\nsigmoid.  The sigmoid and the rectum are collapsed.  Incidental note is made\nhypodense appearance of the terminal ileal wall, and wall of multiple small\nbowel loops possibly related to distant or chronic ongoing inflammation.\nCompared to prior exam, the perirectal phlegmonous abscess has been drained\npreviously measuring 2.7 x 2.4 cm on ___, now 1.7 x 1.0 cm soft\ntissue density remaining around the catheter (03:34).  Adjacent mild stranding\nsimilar.  The urinary bladder and distal ureters are unremarkable. There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged prostate.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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.  Patient\nis status post left posterior approach pigtail catheter placement.  Minimal\nsubcutaneous emphysema at the left gluteal region is likely related to\ncatheter placement.",
            "output": "1. Interval perirectal abscess drainage, with percutaneous drain in place. \nThere is no communication with rectal lumen.\n2. Fatty attenuation of wall involving multiple loops of distal small bowel,\ncan be seen in the setting of prior infection or chronic, ongoing\ninflammation.\n\nNOTIFICATION:   The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 5:15 pm, 10 minutes\nafter discovery of the 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\nGENERAL: There is free air and fluid in the peritoneum. The largest fluid\ncollection is noted in the left paracolic gutter, which could represent fecal\nmatter.  Fluid is also noted in the upper abdomen and perihepatic region. No\nfree contrast is noted in the peritoneum. There is no focal area of bowel\nthickening, inflammation, or any other signs to help identify the site of\nperforation.  Moderate ascites is noted.\n\nHEPATOBILIARY:  The 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 ill-defined border\nand appears edematous. It is unclear if there is cholelithiasis.\nPANCREAS: Pancreas is atrophic.\nSPLEEN:  The spleen shows normal size and attenuation without evidence of\nfocal lesions.\nURINARY: There is a 31 mm simple renal cyst in the lower pole of the left\nkidney. The kidneys are of normal and symmetric size .  There is no evidence\nof stones or hydronephrosis.\nGASTROINTESTINAL:  Diverticulosis of distal colon is noted without evidence of\ndefinite diverticulitis. Small bowel loops demonstrate normal caliber\nthroughout.\nVASCULAR:  There is no abdominal aortic aneurysm.  There is atherosclerotic\nmural calcification of the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.\nREPRODUCTIVE ORGANS: Calcified fibroid is noted.\n\nBONES AND SOFT TISSUES:\n\nThere is diffuse demineralization and degenerative changes of the lumbar\nspine.",
            "output": "1.  Free fluid and air is identified in the peritoneum. The largest collection\nof fluid is in the left paracolic gutter is very complex, which may represent\nfecal matter in the peritoneum. No obvious source of perforation is\nidentified.\n\n2. Gallbladder has ill-defined border and appears edematous. It is unclear if\nthere is cholelithiasis. Ultrasound is recommended for further evaluation.\n\n3. Diverticulosis of the distal colon without evident diverticulitis.\n\n4. Incidentally noted is atrophic pancreas and a simple renal cyst at the\nlower pole of the left kidney.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 12:20 p.m., 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Please refer to the report from the concurrent CT chest for\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypoenhancing hepatic lesions are identified.  For example in hepatic\nsegment 3 is a 2.6 by 2.0 cm lesion.  Within the dome of the liver is a 1.9 by\n2.0 cm lesion.  More inferiorly within hepatic segment 8 is a 1.5 by 0.9 cm\nlesion.  And in hepatic segment 5 is a 0.8 x 0.7 cm 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: There is a wedge-shaped hypodensity within the upper aspect of the\nspleen, likely reflecting a splenic infarct.\n\nADRENALS: The right adrenal gland is normal in size and shape.  There is a 1.0\nx 1.0 cm nodule arising from the left adrenal gland (3:60).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal hypodensities are present, the largest within the\nright kidney measuring 6.0 x 3.9 cm.  These are incompletely characterized but\nlikely reflective of cysts. 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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There several enlarged retroperitoneal lymph nodes at the level\nof the kidneys.  A left para-aortic lymph node measures 1.6 x 1.8 cm (3:64). \nA lymph node more medially measures 1.4 x 1.1 cm.  An enlarged periportal\nlymph node measures 3.9 x 1.7 cm (3:64).  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate predominantly fatty\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions within the lumbar\nspine or visualized pelvis.  Multilevel degenerative changes are noted within\nthe lumbar spine.\n\nSOFT TISSUES: Small bilateral fat containing inguinal hernias.  Small\nlipomatous lesion within the left gluteus minimus (3:96)",
            "output": "1. Multiple hypoenhancing liver lesions are consistent with metastatic\ndisease.\n2. Enlarged retroperitoneal and periportal lymph nodes.\n3. Wedge-shaped hypodensity within the spleen likely reflects a splenic\ninfarct.\n4. Nonspecific nodule within the left adrenal gland measuring up to 1 cm.\n5. Moderate fatty atherosclerotic disease."
        },
        {
            "input": "Lower Thorax: There has been interval increase in the right-sided pleural\neffusion with adjacent compressive atelectasis. There is a hiatal hernia.\nThere is a small left pleural effusion. There are areas of bandlike\natelectasis throughout both lung bases. Cannot exclude infection spatially in\nthe right middle lobe. There is no cardiomegaly.\n\nPeritoneal Cavity: There has been an interval increase in intra-abdominal\nascites, which is now moderate to significant.  There is no free air.  There\nis diffuse significant anasarca that is also increased from previous.\n\nLiver: The liver is normal with no focal lesion.\n\nGallbladder and Biliary System: The gallbladder is absent.There is no\nsignificant intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: There are subcentimetric hypo enhancing lesions in both\nkidneys that are too small to characterize but may represent cysts.  There is\nno hydronephrosis bilaterally.\nThe adrenal glands are normal bilaterally.\n\nBowel: There is diffuse colonic mucosal enhancement and wall thickening\nconsistent with pancolitis.  Anastomotic sutures noted in the rectal region.\nThere is distension of the sigmoid and ascending colon up to 5.6 cm. There is\nno evidence of mechanical large bowel obstruction.  There is some fecalization\nof bowel contents within the distal ileum. There is no pneumatosis or portal\nvenous gas.  There are a few loops of thick-walled jejunum in the left upper\nquadrant, which is likely reactive to the significant surrounding ascites.\n\nPelvis:  There is a Foley catheter within a collapsed bladder. The uterus and\novaries have been removed.\n\nLymph Nodes: There is no significant mesenteric, pelvic or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: Evidence of L3/4 laminectomy noted. Patient has a history of dural\nrepair.  Fluid collection noted in the area of the laminectomy measuring 4.7 x\n3.6 cm and with an extension that lies subcutaneously. The subcutaneous\nposterior pocket measures 4.5 cm in the transverse dimension, 5.8 cm\nvertically and 1.6 cm in the AP diameter.",
            "output": "1. Diffuse colonic wall thickening in keeping with pancolitis, likely related\nto patient's known C. difficile colitis. There are areas of distention but no\nmechanical large bowel obstruction. Please note toxic megacolon cannot be\nexcluded on imaging.\n2. Bilateral pleural effusions, right greater than left.\n3.  Prior laminectomy at L3/4 with fluid pockets as described above with\nextension to the subcutaneous region of the back."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits. There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A small hypodense liver lesion in hepatic segment VII, with\nperipheral contrast puddling is likely a small hemangioma (2:13).  The liver\notherwise demonstrates homogenous attenuation throughout.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis 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. \nThere is no focal renal lesion or hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is moderate fecal loading. Colon and rectum\nare within normal limits. Appendix is not visualized, but there are no\nsecondary findings of appendicitis. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  A circumaortic left renal\nvein is identified.  There is no calcium burden in the abdominal aorta and\ngreat ab, without dominal 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.  A NuvaRing\nis identified in the vagina.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Nonacute CT of the abdomen and pelvis, without clear correlation for the\npatient's pain.\n2. Small probable hemangioma in hepatic segment VII.\n3. The appendix not directly visualized, but there are no secondary findings\nof appendicitis."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis with small pleural effusions, left\ngreater 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 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 small left lower pole renal cortical hypodensity is incompletely\ncharacterized but most likely a cyst.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach contains an NG-tube.  There has been passage of\noral contrast to the mid to distal small bowel with no convincing evidence of\nobstruction.  Distal small bowel loops are borderline dilated at 3.0 cm, but\nthe proximal small bowel is not dilated.  The large bowel is again diffusely\ndilated and now predominantly gas-filled, containing air-fluid levels. \nDistension of the distal sigmoid has slightly increased, now measuring 9.6 cm\nin transverse diameter, previously 8.7 cm.  The transverse colon measures 6.7\ncm, previously 6.1 cm.  There is no loss of haustral markings or significant\nmucosal edema.  There is no evidence of bowel wall pneumatosis,\npneumoperitoneum or ascites.  There are no intra-abdominal collections.\n\nPELVIS: The bladder and prostate are distorted by the distended rectum.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderately extensive\natherosclerotic disease is noted.\n\nBONES: Multiple circumscribed lucent lesion in lower thoracic and lumbar\nvertebral bodies correspond with hemangiomas on MRI from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits aside from\nbilateral flank edema.",
            "output": "Increasing diffuse distension of the colon with no specific findings of toxic\nmegacolon at this time.  However, the patient would be at risk of bowel\nischemia due to marked distension of the distal sigmoid.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:23 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Again seen is a small left pleural effusion with atelectasis in\nthe left lower lobe.  Stable atelectasis is also seen in the right lung base.\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: A percutaneous G tube remains in satisfactory position.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. When compared to the prior CT scan,\nthere has been slight interval diminution in the extent of cases distention of\nthe entire colon.  In particular there is far less gas distending the rectum\nand sigmoid colon on the current study.  The ascending transverse and\ndescending colons remain distended with gas.  No colonic wall thickening is\nnoted.  No air is seen within the wall of the colon.  The most proximal\nportion of the colon 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. \nCalcifications are again seen within an enlarged prostate gland.  Several\npelvic phleboliths 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. Slight interval decrease in the extent of diffuse gaseous distension of the\ncolon when compared to study from ___.  There is no CT evidence for\nany ischemic change in the colonic wall.  The small bowel is unremarkable."
        },
        {
            "input": "LOWER CHEST: 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.  Hepatic steatosis is similar to the prior\nstudy.  The gallbladder is within normal limits.\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\nis no perinephric abnormality.\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. The\nappendix is not definitively visualized, but there are no secondary signs in\nthe right lower quadrant to suggest acute appendicitis. There is no evidence\nof 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 trace free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  A wedge deformity of the T11\nvertebral body is unchanged from the prior study.  Abdominal and pelvic wall\nis within normal limits.  Dependent edema is noted within the posterior\nsubcutaneous soft tissues.",
            "output": "1. No acute intra-abdominal process, no findings to explain patient's\nsymptoms.\n2. Hepatic steatosis."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear aside from minimal basal\ndependent atelectasis.  The imaged portion of the heart is unremarkable. No\npleural or pericardial effusions seen.\n\nAbdomen: The liver enhances normally containing no concerning focal liver\nlesions.  Tiny hypodensity within segment 4A is likely focal fat deposition\nand appears unchanged.  Main portal vein is patent.  No biliary ductal\ndilation.  Gallbladder is surgically absent.  Tiny residual fluid collection\nin the left subdiaphragmatic space abutting the upper pole of the spleen is\nsignificantly decreased from prior.  The spleen appears normal.  Adrenals are\nnormal.  Kidneys enhance symmetrically.  No hydronephrosis or worrisome renal\nlesion.  The pancreas enhances normally.  The abdominal aorta is normal in\ncourse and caliber with mild atherosclerotic calcifications.  There is no\nretroperitoneal adenopathy.  The stomach and duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction.  No\nfree air or free fluid is seen.  The appendix is normal.  The colon contains a\nlarge fecal load is well as enteric contrast material.  Colonic diverticulosis\nis noted without evidence of acute diverticulitis.  The uterus is atrophic. \nNo adnexal masses are seen.  Urinary bladder is mostly decompressed.  No\npelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Degenerative\ndisc disease is most pronounced L4-5 and L5-S1.",
            "output": "1. No acute findings to account for pain.\n2. Tiny residual fluid collection in the left subdiaphragmatic space abutting\nthe spleen significantly decreased from prior.\n3. Large fecal load."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Coronary\ncalcifications 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 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 mild left ureterohydronephrosis and perinephric fat stranding and\ntrace of fluid in the perirenal space.  The left ureter is slightly dilated\nall the way to the ureterovesical junction, where a 4 mm stone is noted. \nThere is no evidence of suspicious focal renal lesions.  No right\nhydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is not well seen however there are no secondary signs of\ninflammation in the right lower quadrant.\n\nPELVIS:  Mild thickening of the left posterior aspect of the bladder, where\nthe for minimal obstructive stone is noted.  Another 2 mm nonobstructive stone\nis seen immediately proximal to the aforementioned.  Dilation of the distal\nleft ureter.  Normal distal right ureter.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal glands are unremarkable on CT.\n\nLYMPH NODES: No abdominal retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes in the lumbar spine.  No suspicious\nfocal lesions or acute fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Obstructive 4 mm renal calculus in the left ureterovesical junction causing\nmild left hydroureteronephrosis.  Small amount of perinephric fat stranding\nand fluid."
        },
        {
            "input": "Feeding tube terminates in the stomach.\n\nLOWER CHEST: Visualized lung fields demonstrate moderate dependent bilateral\nlower lobe atelectasis.  Trace bilateral pleural effusions.  Heart appears\nborderline in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Layering hyperdense material in the\ngallbladder suggests recent sludge formation.\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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is contrast opacification\nin the small bowel without evidence of high-grade small-bowel obstruction. \nThere is a loop of borderline dilated small bowel measuring up to 3.2 cm in\ndiameter in the left upper abdomen (2; 70).  In the pelvis, there is a loop of\ncollapsed small bowel with mild wall thickening or adjacent fat stranding\n(601; 62).  In the terminal ileum, there is additional loop of mildly\ncollapsed small bowel with possible wall thickening and adjacent fat stranding\n(601; 44).  Contrast is seen in the descending colon and proximal sigmoid\ncolon.  Within the proximal sigmoid colon, there is area of increased density\nalong the medial colonic which may represent mixing of contrast with\nintraluminal content (2; 107).  The appendix is normal (601; 76).\n\nPELVIS:  There is trace free fluid in the pelvis posterior to the uterus.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.  There is a small amount of\nmesenteric free fluid.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the lower lumbar spine is most notable at\nL3-L4 and L5-S1 with disc space narrowing, endplate osteophyte formation and\nvacuum phenomenon.  There is grade I anterolisthesis of L4 on L5 measuring 4\nmm, similar to prior.\n\nSOFT TISSUES: There is a small umbilical hernia containing fat.  Subcutaneous\nnodular densities in bilateral lower abdominal walls is consistent with\nsubcutaneous injections.\n\nIn the right anterior central breast, there is a 1.4 cm mass which is\nsuboptimally evaluated on CT.",
            "output": "1. No persistent evidence for small-bowel obstruction.  Borderline dilated\nsmall bowel loop is seen in the left upper quadrant measuring up"
        },
        {
            "input": "LOWER CHEST: The heart is mildly enlarged.  There is mild dependent bibasilar\natelectasis.  No pleural or pericardial effusion seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is unremarkable.  The gallbladder is distended, with\na focal area of wall thickening and hyperenhancement seen medially (02:29),\nabutting an area of prominent duodenal soft tissue.  There is moderate,\npredominantly central intrahepatic biliary dilatation.  The CBD is distended\nup to 1.2 cm (601:29), with focal tapering seen in the region of the duodenal\nobstruction.\n\nPANCREAS: The main pancreatic duct is mildly prominent at 3 mm.  The pancreas\nis otherwise unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Subcentimeter bilateral hypodensities are too small to characterize. \nThe kidneys are otherwise unremarkable.\n\nGASTROINTESTINAL: The stomach is distended with air and ingested contents. \nThere is focal postbulbar duodenal obstruction (2:31, 602:32) secondary to\nsoft tissue which measures approximately 3.1 x 2.8 x 4.0 cm.  There is no\nappreciable local fat stranding.  Small and large bowel loops distal to this\npoint are normal in caliber.  No ascites.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Atherosclerotic disease is\nmild to moderate.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 3.4 cm subcutaneous lipoma in the left flank (02:36).",
            "output": "1. Prominent soft tissue causes postbulbar duodenal obstruction.  Differential\nconsiderations include a neoplastic process.  An inflammatory process is\nconsidered less likely given lack of local fat stranding.  Recommend EUS with\nbiopsy.\n2. Moderate intrahepatic biliary dilatation and distention of the CBD up to\n1.2 cm is likely secondary to focal tapering of the CBD the region of the\naforementioned duodenal soft tissue.\n\nRECOMMENDATION(S):  EUS with biopsy for impression point 1.\n\nNOTIFICATION:  The updated findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 10:22 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:   Linear opacities at the lung bases are due to atelectasis. There is\nno pericardial or pleural effusion.\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:  The liver demonstrates homogenous attenuation throughout, with\nstable 6 mm hypodense lesion in segment 5 since ___, and likely the\nsmall cysts (series 4: Image 63). 3 mm calcified nodule in segment IV a is a\ngranuloma (04:50).  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions.\n\nThe adrenals glands are unremarkable bilaterally. The kidneys are of normal\nand symmetric size with normal nephrogram.  There is no evidence of stones,\nfocal renal lesions or hydronephrosis. Stomach, small and large bowel are\nunremarkable.\n\nThere is no evidence of retroperitoneal and mesenteric lymphadenopathy.\n\nThe abdominal aorta demonstrates mild atherosclerosis.\n\nPELVIS:  11 x 5 mm focal enhancement of the anterior wall of the urinary\nbladder warrants correlation with cytology and urology consult (4:97).  Distal\nureters are unremarkable.  There is no evidence of pelvic lymphadenopathy. \nBorderline sized inguinal lymph nodes, have still preserved benign features.\nInterval reduction of left inguinal hernia since ___, is 1.8 cm was 2.6\ncm.\n\nThere is no free fluid or air in the abdomen.\n\nBONES AND SOFT TISSUES:  Bone structures demonstrate extensive sclerotic\nlesions throughout the imaged portion of the abdomen pelvis, all larger since\nprior CT of ___.",
            "output": "1. Since ___ there has been a progression of extensive sclerotic lesions\nthroughout the imaged portion abdomen and pelvis.\n2. Focal enhancement of the anterior wall of the urinary bladder warrants\ncorrelation with cytology and urology consult.\n3. Stable 6 mm segment V liver cysts and a 3 mm calcified granuloma in segment\n___.\n4. No abdominal or pelvic lymphadenopathy.  Borderline sized inguinal lymph\nnodes have still preserved benign 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. \nUnchanged 11 mm peripheral arterial enhancing lesion in segment VI as well is\na 6 mm hypodensity in segment VII (series 5, image 67).  No new hepatic\nlesion.  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 unremarkable besides a tiny cortical hypodensity too\nsmall to be characterized.  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.\n\nPELVIS: The urinary bladder is not well distended.  The previously described\nanterior bladder wall thickening appears more conspicuous.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is a new 7.5 mm aorto-caval lymph node (series 5, image\n66).  No pelvic adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Patient known with multiple bone metastases that appears significantly\nless dense from prior CT.  The right pedicle of L1 appears more expansile\ncompared to prior CT, however no associated cortical destruction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New 7.5 mm aortocaval lymph node.  Although this lymph node does not meet\nCT criteria for a metastatic node, attention on follow-up is recommended.\n2. New expansile morphology of right L1 pedicle with no associated cortical\ndestruction.  While this may represent post treatment changes the expansile\nnature of the process is unusual and new metastatic disease cannot be entirely\nexcluded.  further characterization with dedicated MRI is recommended.\n3. Anterior bladder wall thickening appears more prominent on today's exam.\n\nRECOMMENDATION(S):  MRI to further characterize L1 vertebral body."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver is unremarkable.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY: The kidneys are unremarkable.\nGASTROINTESTINAL:  There is no bowel obstruction.  Scattered sigmoid colonic\ndiverticuli are noted without evidence of acute diverticulitis.  A normal\nair-filled appendix is identified in the right iliac fossa.\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is partially distended, unremarkable.  The uterus and adnexae are\nnot optimally evaluated on this exam.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  There is a small fat containing\numbilical hernia.  There is minimal soft tissue stranding within the umbilical\nhernia that may be the cause for patient's abdominal pain.",
            "output": "1. There is no evidence of acute appendicitis.  A normal air-filled appendix\nis identified in the right lower quadrant.\n2. There is a small fat containing umbilical hernia with mild soft tissue\nstranding within the hernia, that may possibly be the cause for patient's\numbilical pain.  No other acute intra-abdominal process is identified.\n3. Uterus and both adnexa are suboptimally evaluated on this exam, artifact\nrelated to patient body habitus and peristalsis from surrounding bowel loops\nobscures optimal visualization."
        },
        {
            "input": "GASTROINTESTINAL: Intrapelvic loops of bowel are unremarkable.  There is\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: Uterus is unremarkable.  A 2.3 cm right adnexal cystic\nlesion is noted.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nTract from previously removed femoral neck hardware are noted bilaterally. \nThere are mild degenerative changes of the right hip with subcondylar cystic\nchanges of the right acetabulum.\n\nSOFT TISSUES: Fat containing umbilical hernia is noted.",
            "output": "No acute fracture.  No large hip joint effusion."
        },
        {
            "input": "LOWER CHEST: A 5 mm nodule is seen in the right base. There is a 7 mm pleural\nbased ground-glass left lower lobe nodule. Imaged heart and pericardium are\nnormal. There is no pericardial or pleural effusion.\n\nABDOMEN: Assessment of intra-abdominal viscera is limited without intravenous\ncontrast.\n\nHEPATOBILIARY:  There is 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, without radiopaque\nstones 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: There is moderate left hydronephrosis and proximal left hydroureter.\nA 6 mm obstructing stone is seen in the proximal left ureter. An additional 4\nmm nonobstructing stone is seen the midpole the right kidney. Punctate\nnonobstructing stones are seen in the midpole of the left kidney is well. No\nconcerning mass lesions are seen. No evidence of right-sided hydronephrosis.\n\nGASTROINTESTINAL:  The distal esophagus is normal appearing with no hiatal\nhernia. The stomach is underdistended, but grossly normal. The unenhanced\nappearance of the small and large bowel is unremarkable. The appendix is well\nseen and normal appearing. There is mild sigmoid diverticulosis without\ndiverticulitis. There is no intra-abdominal free fluid or free air.\n\nRETROPERITONEUM:  Scattered prominent although not enlarged retroperitoneal or\nmesenteric lymph nodes are likely reactive.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS: The bladder is under distended, but grossly normal. There is a fibroid\nuterus. No adnexal mass lesions identified. No pelvic free fluid. No\npathologically enlarged pelvic sidewall or inguinal lymph nodes by CT size\ncriteria.\n\nBONES AND SOFT TISSUES: There is spondylolysis and grade 1 anterolisthesis of\nL4 on L5.  No concerning lytic or sclerotic lesions are seen.",
            "output": "1. Left proximal year old stone measuring 6 mm causing moderate left\nhydronephrosis.\n2. Additional nonobstructing stones within the kidneys.\n3. Right lower lobe nodule measuring 5 mm. If the patient is at high risk for\nmalignancy, recommend followup CT in 12 months for further evaluation.\n4. Hepatic steatosis.\n5. Fibroid uterus.\n6. Spondylolysis and grade 1 anterolisthesis of L4 on L5."
        },
        {
            "input": "CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously without focal lesion or intrahepatic biliary\ndilatation. The gallbladder is unremarkable and the portal vein is patent. The\npancreas, spleen and adrenal glands are unremarkable. The patient is status\npost left nephrectomy. The right kidney presents a normal nephrogram with\nexcretion of contrast. No focal lesions or hydronephrosis.\n\nThe proximal small bowel is distended and fluid filled measuring up to 3.6 cm.\nThere is a focal area of narrowing in the left lower quadrant (02:49) with a\nsecond transition point seen in the left upper quadrant (02:34) raising\nconcern for a closed loop obstruction the bowel distal to the second\nobstruction is completely decompressed. There is edema in the mesentery in the\nleft upper quadrant with a loop of bowel wall which is not enhancing to the\nsame degree as the remaining bowel.  There is no retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria. No free air.\n\n\nPELVIS:\n\nThe urinary bladder is unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy. There is a small amount of free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.",
            "output": "Small bowel obstruction with  transition points in the left abdomen. There is\nmesenteric edema in the left upper quadrant"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 adrenal is unremarkable.  The left adrenal is not seen.\n\nURINARY: The right kidney is unremarkable.  Patient is status post left total\nnephrectomy.  There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Multiple distended loops of\nfluid-filled small bowel with an acute transition point located in the mid\nabdomen with associated mesenteric edema and fluid.  Distal small bowel is\ndecompressed.  Diverticulosis of the sigmoid colon is noted, without evidence\nof wall thickening and fat stranding. The appendix is not definitively\nidentified.\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. \nDegenerative changes are noted in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. High grade small-bowel obstruction at the mid small bowel with an acute\ntransition point and distal decompressed bowel.  Adjacent mesenteric fluid is\nnoted.  Transition point is similar in location compared to remote prior exam\nfrom ___.\n2. Postsurgical changes status post left total nephrectomy.\n3. Diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Bandlike atelectasis of the left lung base. 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 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 unremarkable.  Patient status post left total\nnephrectomy.  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. Moderate stool\nburden throughout the colon.  Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening or fat stranding. 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: 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. \nModerate degenerative changes are noted at the lower lumbar spine, unchanged\nfrom prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic abnormality.\n2. Diverticulosis without evidence for diverticulitis.\n3. Status post left nephrectomy."
        },
        {
            "input": "LOWER CHEST: There is severe bronchiectasis and cystic bronchial wall\nthickening associated with multiple areas of consolidation, slightly\nprogressed compared to the prior CT chest examination of ___ and\nmost pronounced in the left upper lobe.  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, with focal fat in\nthe pancreatic head/uncinate (series 3, image 30).  Otherwise, no evidence of\na focal pancreatic lesion within limitations of an unenhanced scan.  There is\nno 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.  A 2.0 cm fluid\nattenuating structure in the right lower pole kidney is most compatible with a\nsimple renal cyst (series 3, image 42).  Otherwise, there is no suspicious\nrenal 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. Diverticulosis of the sigmoid\ncolon is noted without evidence of wall thickening or fat stranding.  There is\nmild pericolonic stranding along the cecum without evidence of colonic wall\nthickening or diverticula.  The appendix 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. \nThere is minimal retrolisthesis of L5 on S1.\n\nSOFT TISSUES: Status umbilical hernia repair with mesh placement.  No evidence\nof hernia recurrence.  Mild soft tissue thickening along the right umbilicus\nis likely related to surgery.  Diastasis recti is noted.",
            "output": "1. Postsurgical changes related to prior umbilical hernia repair with mesh\nplacement without evidence of hernia recurrence.\n2. Diastasis recti.\n3. Mild pericolonic stranding along the cecum without evidence of colonic wall\nthickening or diverticulitis.  Findings may reflect mild or resolving colitis.\n4. Severe bronchiectasis with multiple areas of consolidation, slightly\nprogressed compared to the prior CT chest performed ___. \nFollow-up and correlation with CT chest is recommended."
        },
        {
            "input": "GASTROINTESTINAL: Redemonstration of a dilated, hyperemic appendix, containing\na 1.1 cm appendicolith (series 601, image 22).  Marked surrounding phlegmonous\nchanges in the right lower quadrant surrounding the appendix (series 2, image\n19), spanning approximately 4.5 x 4.5 cm, without organized collection.  There\nis free fluid again seen tracking into the presacral region, with peritoneal\nenhancement, suggestive of peritonitis.  No organized fluid collections are\nidentified in the pelvis.\n\nPELVIS: The urinary bladder and distal ureters are within normal limits.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted, and normal in size.  No\nconcerning adnexal lesions are detected.\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 pelvic wall is within normal limits.",
            "output": "1. Evolving acute appendicitis with significant fat stranding and phlegmonous\nchanges around the appendix, without organized collection.\n2. Re-demonstration of free fluid in the presacral region with adjacent\nperitoneal enhancement, compatible with peritonitis.  No organized collections\nare seen in the pelvis."
        },
        {
            "input": "A nasogastric tube terminates in the stomach.  A right femoral arterial\ncatheter terminates in the right external iliac artery.  A right iliac venous\ncatheter terminates in the right common femoral vein.\n\nMinor streaky opacities at each lung base suggest atelectasis.\n\nIn the sixth segment of the left liver there is an indeterminate small liver\nlesion measuring 17 x 17 mm in axial ___ (305:17) with small\nloculations; this is not specific and not fully characterized.  Linear\nhypodensity in the dome of the left lobe left only appears on the postcontrast\nimages and is thought to represent an artifact.  The gallbladder appears\nnormal.  Pancreatic duct is slightly enlarged although doubtful in\nsignificance.  Very mild extrahepatic biliary ductal prominence is likely age\nrelated.  Spleen is normal in size.  Right adrenal shows slightly asymmetric\nenhancement but is mostly hyperenhancing.  The left shows an unusual pattern\nof asymmetric enhancement with less enhancement along the lateral limb than\nelsewhere raising possibility of partial ischemia/infarction.   There is low\nlevel heterogeneous enhancement of each markedly atrophic native kidney which\nis nonspecific and, this appearance can be expected with severe chronic kidney\ndisease.\n\nStomach appears normal.  Small bowel is unremarkable.  Sigmoid diverticulosis\nis mild.  Stool is mildly prominent throughout the colon.  Walls of the small\nand large bowel show enhancement throughout.\n\nThere are postsurgical changes in the right groin including scarring and fat\nnecrosis.\n\nThe bladder is mostly empty and difficult to assess.  Prostate is moderately\nenlarged with central hypertrophy.  Seminal vesicles are unremarkable.  There\nis no ascites or free air. Partly calcified portacaval node. No enlarged nodes\nby size criteria.\n\nFat stranding in the left anterior subcutaneous fat with trace air which can\nbe seen with no enlarged nodes by size criteria.\n\nSmall aneurysm of the distal right external iliac artery where it measures up\nto 16 mm in diameter.  Atrophic, narrowed bilateral renal arteries. \nIrregularity to the right common hepatic artery is likely due to\natherosclerotic disease.  Some jejunal mesenteric arterial branches show\ndistal underfilling although this is most likely due to technique.  Mesenteric\nvenous branches are patent.\n\nThere is moderately moderate narrowing of the L2-L3 interspace with\nirregularity which is quite possibly degenerative although post infectious\nappearance is possible.  There are no suspicious bone lesions.",
            "output": "1.  Distal mesenteric arterial branches are somewhat difficult to assess due\nto underfilling but bowel enhancement pattern appears normal.\n\n2.  Asymmetric enhancement of the left adrenal suggesting possibility of\npartial ischemia/infarct.\n\n3.  Indeterminate liver lesion.  Attempt to characterize with ultrasound may\nbe helpful versus multiphasic CT or preferably MR imaging."
        },
        {
            "input": "LOWER CHEST: Within the limitations of motion artifact, patchy densities in\nthe dependent portions of the lung bases are noted bilaterally, could reflect\natelectasis.  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.  A focus of dense material is noted within\nthe fundus of the collapse gallbladder, likely representing stones (02:31).\n\nPANCREAS: A multiloculated cystic structure associated with the head of the\npancreas measuring 2.8 x 2.0 x 3.4 cm is noted (02:34/601:22).  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Please note that paucity of intraperitoneal fat limits\nevaluation bowel loops. 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 is distended.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: A calcified fibroid is noted in the uterus.  Otherwise,\nthe uterus unremarkable.  No adnexal abnormality is are noted.\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes of the lumbar spine are noted.  There\nis also lumbar the dextroscoliosis.  There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous soft tissue stranding in skin thickening is noted\nposteriorly at the level of the ischial tuberosity bilaterally, worse on the\nright.  Although no skin defects are demonstrated, the findings are suspicious\nfor early decubitus ulcers.",
            "output": "1. Multiloculated cystic structure at the neck of the pancreas, incompletely\ncharacterized. MRCP is recommended for further characterization.\n2. No acute findings in the abdomen or pelvis.\n3. Posterior subcutaneous stranding at the level of the ischial tuberosities\nbilaterally, but worse on the right suspicious for early decubitus ulcers. \nPlease correlate clinically.\n\nRECOMMENDATION(S):  MRCP for further characterization of pancreatic cystic\nlesion."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 left lobe of the liver is too small to\ncharacterize by CT but likely represents a cyst or biliary hamartoma.  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. \nSubcentimeter hypodensity in the interpolar right kidney is too small to\ncharacterize by CT but likely represents 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.  There is mild\ndistension of distal ileal loops with mild fecalized components which could\nreflect an incompetent ileocecal valve or focal ileus, without evidence for\nbowel obstruction.  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 uterus is heterogeneous consistent with fibroid\nuterus.  There is a right lateral myomectomy defect.  There is a 1.4 cm ovoid\nring enhancing hypodense structure in the right adnexa, consistent with an\ninvoluting corpus luteum cyst.  There is small amount free-fluid in the pelvis\nlikely related to the corpus luteum cyst.  The endometrium is heterogeneously\nhyperdense and thickened to 19 mm.\n\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: Surgical changes from recent laparoscopic surgery are seen in\nthe umbilicus and ventral left lower abdomen.",
            "output": "1. Fibroid uterus with right lateral myomectomy defect.\n2. Right 1.4 cm involuting corpus luteum cyst with small volume free-fluid in\nthe pelvis.\n3. Heterogeneous and thickened endometrium.  Correlate with menses and if\nthere is continued clinical concern for an endometrial lesion, follow-up with\npelvic ultrasound may be obtained.\n4. Mildly distended distal ileal loops with fecalized internal contents may\nreflect an incompetent ileocecal valve versus mild focal ileus.  No evidence\nfor bowel obstruction.\n\nRECOMMENDATION(S):  Heterogeneous and thickened endometrium. Correlate with\nmenses and if there is continued clinical concern for an endometrial lesion,\nfollow-up with pelvic ultrasound may be obtained."
        },
        {
            "input": "There is bibasilar atelectasis versus scarring, the bases of the lungs are\notherwise clear. There is no pleural or pericardial effusion.\n\nLIVER: The liver enhances homogeneously without intrahepatic biliary duct\ndilation. There are several small rounded hypodensities scattered throughout\nthe liver, which are too small to fully characterize, but appear stable from\nthe prior exam of ___ and likely represent hepatic cysts. Additionally, there\nare several small hyperdensities that are too small to fully characterize,\nwhich were not seen on prior studies, but are likely transient hepatic\ndensities related to the timing of the contrast bolus on this current study\nperformed in artreial phase. The portal and hepatic veins are patent,\nincidental note is made of the common hepatic artery arising from the SMA, a\nnormal variant. The nondistended gallbladder is within normal limits, without\nwall thickening or pericholecystic fluid.  Note is made of numerous\nintraluminal calcified gallstones.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There are several nonobstructing renal stones bilaterally, stable\nsince at least ___. There are bilateral simple renal cysts, which are mildly\nenlarged when compared to ___. There is no hydronephrosis.\n\nGI:The stomach is distended with negative contrast and there is no obvious\nintraluminal mass or wall thickening.The small bowel is asymmetrically\ndistributed in the left hemiabdomen.  There is fatty infiltration of the walls\nof the distal ileum and much of the colon, compatible with chronic\ninflammatory changes consistent with a history of Crohn's disease and the\ndistal ileum proximal to the TI appears diffusely narrow.  There is no fat\nstranding to suggest an active flare.  There is colonic diverticulosis without\nevidence of diverticulitis.  There is a large, multiloculated, fat-containing\nhernia of the anterior abdominal wall.\n\nRETROPERITONEUM: The aorta is normal in caliber, with atherosclerotic\ncalcifications.  There is a penetrating atherosclerotic ulcer of both common\niliac arteries just distal to the bifurcation (4:76), without evidence of\ndissection or aneurysm formation and moderate focal narrowing of the right\ncommon ilaic artery beyond this.There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid. \nThere surgical clips noted bilaterally in the anterior pelvis, suggesting\nbilateral inguinal hernia repair with mesh.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.  There\nis a Tarlov cyst noted at the posterior superior sacrum as well as moderate to\nsevere degenerative changes at L4-5, with disc space narrowing, subchondral\ncyst formation, and facet arthropathy.",
            "output": "1. Changes of the colon and ileum consistent with chronic Crohn's disease, no\nevidence for acute flare or abscess.\n2. No evidence of malignancy.\n3. Nonobstructing nephrolithiasis and cholelithiasis.\n4. Focal hepatic hyerdensities likely to be transent aberrations in\nenhancement on this arterial phase 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 are a few sub-centimeter hypodensities scattered\nthroughout the liver (2:14, 36) that are too small to characterize, but\nstatistically likely represent cysts.  These are unchanged in appearance\ncompared to the prior CT performed on ___.  Liver is otherwise\nhomogeneous in attenuation throughout.  The gallbladder contains several\nintraluminal stones, but is not abnormally distended.  No pericholecystic\nfluid or 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.  Incidental note is made of an 8 mm splenule\n(2:28).\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 x 1.5\ncm simple cyst arising from the lower pole of the right kidney.  A 1.8 x 2.0\ncm exophytic simple cyst is also noted arising from the lower pole of the left\nkidney.  No other parenchymal lesions are identified within the limitations of\nthis non-contrast study.  There is no hydronephrosis.  There are numerous\nbilateral renal stones, measuring up to 8 mm in the right lower pole.  A\nconglomerate of stones in the left lower pole measures 1.4 x 1.7 cm.  No\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Again noted is an\nasymmetric distribution of the small bowel within the left abdomen and fatty\ninfiltration of the walls of the terminal ileum and a majority of the colon,\ncompatible with known history of Crohn's disease. No evidence of active\ninflammation.   Small bowel loops are normal in caliber and wall thickness\nthroughout.  There is descending and sigmoid colon diverticulosis, without\nevidence of diverticulitis.  No free fluid or free air within the peritoneal\ncavity.\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. \nThere are mild degenerative changes throughout the thoracolumbar spine,\nincluding a prominent anterior osteophyte at T8-T9 and loss of intervertebral\ndisc space height at L4-L5.\n\nSOFT TISSUES: There is a fat-containing umbilical and supra-umbilical hernia,\nunchanged appearance from ___.  Abdominal and pelvic wall is otherwise within\nnormal limits.",
            "output": "1. Bilateral non-obstructing nephrolithiasis, with a dominant conglomerate of\nstones in the left lower pole measuring 1.4 x 1.7 cm.\n2. Bilateral simple renal cysts.\n3. Findings consistent with chronic Crohn's disease, without evidence of acute\ninflammation.\n4. Cholelithiasis, without evidence of acute cholecystitis.\n5. Small hiatal hernia.\n6. Fat-containing umbilical and supra-umbilical hernias."
        },
        {
            "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. 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: Patient is status post distal pancreatectomy.  Abutting the area of\nthe suture line superiorly is ill-defined soft tissue density which surrounds\nthe common hepatic artery (604:33.  The remaining pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation. There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post interval splenectomy.  Small accessory spleen\nin the left upper quadrant is unchanged.\n\nADRENALS: Normal right adrenal gland.  Unchanged 1.6 x 0.7 cm medial limb\nnodule within the left adrenal gland, previously characterized on MRI from\n___ as 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. There\nare no urothelial lesions in the kidneys or ureters. 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\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed but unremarkable.  Distal ureters\nare unremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy.\nThere is no free fluid in the pelvis.\n\nVASCULAR: Interval development of ill-defined soft tissue density surrounding\nthe common hepatic artery measuring up to 14 mm in AP diameter thickness\n(301:34).  Additionally, minimal nonspecific soft tissue density is seen\nsurrounding the inferior mesenteric artery (301:81).  Mild narrowing at the\norigins of the celiac and SMA is demonstrated.  There is no abdominal aortic\naneurysm.  There is moderate calcium burden in the abdominal aorta and great\nabdominal arteries.  Portal vein and superior mesenteric vein are patent.\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. Interval development of ill-defined soft tissue density surrounding the\ncommon hepatic artery, worrisome for recurrent disease/perineural spread of\ndisease.\n2. Nonspecific minimal stranding about the inferior mesenteric artery.\n3. No distant metastatic disease identified within the abdomen or pelvis.\n4. Unchanged 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 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 mild\ncolonic diverticulosis, without evidence of wall thickening or 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: 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: There is a tiny fat containing umbilical hernia.  There is a\nsmall fat containing left inguinal hernia.",
            "output": "1. No acute intra-abdominal or intrapelvic pathology to explain the patient's\npain.\n2. Small left fat containing inguinal hernia.\n3. Mild colonic diverticulosis."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal.\n\nThere is an obstructing 2 mm stone at the left ureterovesicular junction\ncausing moderate left hydroureteronephrosis (4:80).  There is perinephric fat\nstranding and fluid around the left kidney, which features delayed excretion\nof contrast.  There may be a subtle slightly delayed nephrogram on the left as\ncompared to the right.  There is a peripheral hypodensity and cortical defect\nin the lower pole left kidney (601b:41).  There is a 19 mm simple cyst in the\nlower pole the right kidney, as well as several bilateral subcentimeter\nhypodensities which are too small to characterize. The right kidney enhances\nand excretes contrast normally.\n\nNo bowel obstruction or bowel wall thickening is seen.  The appendix is normal\n(4:62).  There is nonspecific mild haziness of the jejunal mesentery, i.e.\n\"misty mesentery\" (4:45).\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The sparsely calcified abdominal aorta\nis normal caliber, with patent main branches, including the SMA and ___.  The\nportal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable.There is no free fluid. There is no pelvic or inguinal\nlymphadenopathy. The prostate is minimally enlarged and the seminal vesicles\nare unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection.",
            "output": "1. 2 mm obstructing stone at the left ureterovesicular junction causing\nmoderate upstream left hydroureteronephrosis and left perinephric stranding.\n2. Cortical defect with adjacent hypodensity in the lower pole of the left\nkidney may represent sequella of prior insult but further characterization\nwith outpatient renal ultrasound is recommended upon resolution of acute\nprocess.\n\nNOTIFICATION:  The recommendation of followup renal ultrasound was\ncommunicated to Dr. ___ by Dr. ___ phone on ___ at 1:03 ___,\nafter attending review."
        },
        {
            "input": "LOWER CHEST: Diffuse ___ nodularity in the lingula and bilateral lower\nlobes and more focal consolidation in the right middle lobe concerning for\nmultifocal pneumonia.  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 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. \nBilateral nonobstructing renal stones measure up to 3 mm.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is normal.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not visualized. Calcified soft tissue\ndensity nodule in the left lower quadrant may reflect the sequela of prior\nepiploic appendagitis or a calcified lymph node (02:34).\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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multifocal pneumonia within the imaged lung bases.\n2. Bilateral nonobstructing renal stones measuring up to 3 mm.\n3. Extensive atherosclerotic calcifications.\n4. Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. No evidence of active contrast\nextravasation to suggest an acute GI bleed.  Multiple varices are seen along\nthe lesser curvature of the stomach, potentially representing candidates for\nthe cause of bleeding (06:50-58).  There is no significant calcium burden in\nthe abdominal aorta and great abdominal arteries.  Portal venous\ncollateralization noted compatible with portal venous hypertension.\n\nLOWER CHEST: There has been interval development of left greater than right\nlower lobe airspace disease suspicious for pneumonia.  No significant pleural\neffusion identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is again noted to have a nodular contour and\nheterogeneous attenuation compatible with steatosis.  No definite focal mass\nidentified.  There is hyperattenuating material noted within the gall bladder\non noncontrast imaging which could represent vicarious excretion of contrast\nfrom prior study or potentially sludge.  There is no significant\ngallbladder-wall distension, thickening, or focal surrounding inflammatory\nchange.\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 compatible with portal venous hypertension.  No focal\nsplenic 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Moderate to large volume ascites.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nExtensive colonic diverticulosis.  Colon and rectum are otherwise within\nnormal limits. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is no\nevidence of 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. Interval development of bilateral lower lobe airspace disease suspicious\nfor pneumonia may be secondary to aspiration given history of upper GI bleed. \nCorrelate clinically.\n2. CT findings compatible with cirrhosis and portal venous hypertension\nincluding splenomegaly and moderate to large volume ascites which is grossly\nstable from prior outside CT examination.  No definite etiology for upper GI\nbleed identified on this CT examination although there are large varices along\nthe lesser curvature of the stomach which may be candidates for the cause of\nbleeding.\n3. Hyperattenuating material within the gall bladder may represent vicarious\nexcretion of contrast from prior IV contrast administration or potentially\ncould represent hyperattenuating sludge.  No secondary inflammatory changes\nsuggest cholecystitis.  Correlate clinically.\n4. Additional chronic changes as above.\n\nRECOMMENDATION(S):  Recommendations as above."
        },
        {
            "input": "LOWER CHEST: Mild dependent bibasilar atelectasis and small amount of\natelectasis at the anterior right lung base.  Visualized lung fields are\notherwise within normal limits.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, 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 contains hyperdense material, likely compatible\nwith 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: Moderate splenomegaly measures up to 20.5 cm in greatest axial\ndimension.  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: 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 not visualized, however no secondary signs of inflammation in the\nright lower quadrant.  Large volume ascites within the abdomen and pelvis,\nincreased from prior study.\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 streak artifact emanating from embolization coils of\ngastroesophageal varices.\n\nBONES: There 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 hematoma identified within the abdomen or pelvis.\n2. Cirrhotic liver morphology with sequela of portal hypertension, including\nmoderate splenomegaly measuring up to 20.5 cm and large volume ascites within\nthe abdomen and pelvis, increased from prior study.\n3. Hyperdense material within the gallbladder likely represents vicarious\nexcretion of contrast from prior IV contrast-enhanced studies."
        },
        {
            "input": "LOWER CHEST: Moderate bibasilar atelectasis.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  Patent hepatic vasculature, detailed below. The liver\ndemonstrates a cirrhotic morphology and is heterogeneous with numerous tiny\nhypodense nodules.  No lesions meeting OPTN- 5 criteria for hepatocellular\ncarcinoma.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder demonstrates vicarious excretion of contrast\nwithout convincing evidence of cholecystitis.\n\nPANCREAS: There is new peripancreatic stranding and interstitial edema\ninvolving the pancreatic tail with hypoenhancement of the majority of the\npancreas which may represent early necrosis (301:85).  Peripancreatic\nstranding and small volume fluid extending along the left greater than right\nanterior pararenal space is relatively high density measuring approximately 50\nHounsfield units suggesting hemorrhagic pancreatitis.  No drainable fluid\ncollection.  Overall, ascites has decreased since prior scan.  Numerous\nembolization clips are noted in the upper abdomen near the stomach\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The lower esophageal mucosa is mildly hyperemic and\nedematous appearing.  The stomach is distended.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The partially\nvisualize colon and rectum are within normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There has been interval placement of a TIPS extending from the\njunction of the IVC and right/middle hepatic veins and coursing through the\ncaudate lobe into the main portal vein.  The TIPS, main, left/right portal\nveins, IVC, hepatic veins, portal confluence, splenic vein, and visualized SMV\nare patent. Patent aorta and celiac origin.  Evaluation of the left gastric\nand splenic arteries limited by streak artifact. Patent SMA.  Patent bilateral\nrenal arteries. Patent conventional hepatic arterial anatomy. Redemonstrated\nvarices.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent TIPS and hepatic vasculature.\n2. New acute interstitial pancreatitis with hypoenhancement of the majority of\nthe pancreas concerning for necrosis. Acute peripancreatic fluid collections\nwhich are hemorrhagic and small volume hemoperitoneum. No definite active\nextravasation or pseudoaneurysm although streak artifact limits assessment.\n3. Cirrhotic liver with interval TIPS placement and redemonstrated varices.\nOverall volume of ascites has slightly decreased. No biliary dilation.\n4. Hyperemic and mildly edematous distal esophageal mucosa.\n5. Moderate bibasilar atelectasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:24 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is a irregular fusiform abdominal aortic aneurysm starting just above\nthe origin of the renal arteries with luminal irregularity and eccentric\nthrombus.  The maximum ___ of the aneurysm are 6.2 x 6.1 cm, compared\nto 6.0 x 5.8 cm on the most recent prior study.  The sac volume is 421 cm3,\ncompared to 342 cm3 previously.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  Incidental note is made of a\nseparate origin of the left gastric artery from the aorta.  The celiac, SMA,\nrenal arteries, and ___ are patent.  There is a stent in the right common\niliac artery extending to the right common femoral artery.  Extensive\natherosclerotic disease is present in the left common iliac artery.\n\nLOWER CHEST:  Extensive emphysematous changes are present.  A spiculated mass\nin the right lower lobe measuring 6 mm stable in size and appearance since ___. There is no pleural or pericardial effusion. The visualized heart\nis normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A 7\nmm cyst is present in the left lobe of the liver.  No other focal hepatic\nlesions are present.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A 4 mm cystic lesion in the pancreatic head is\nsimilar to prior and likely represent 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: The right and left adrenal glands are normal in size and 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 3 mm\nnonobstructing calculus is seen in the upper pole of the right kidney.  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.  Mild sigmoid diverticulosis is present without\nevidence of diverticulitis.  Colon and rectum are otherwise within normal\nlimits.  Appendix is not visualized. 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: Reproductive organs are within normal 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. Mild increase in size of juxtarenal fusiform abdominal aortic aneurysm, as\ndescribed above.\n2. Stable appearance of 4 mm cystic lesion in the pancreatic head, most likely\nrepresenting a side branch IPMN.\n3. Stable appearance of 6 mm pulmonary nodule."
        },
        {
            "input": "CHEST: Imaged lung bases demonstrate a small left pleural effusion with\nadjacent atelectasis. There is mild atelectasis at the right lung base. The\nlungs are otherwise clear. The heart is normal in size with no pericardial\neffusion.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver and gallbladder are grossly normal. The\npancreas is normal in attenuation with no surrounding inflammation. The spleen\nand adrenal glands are unremarkable. The kidneys are normal in size with\nmultiple hypodense lesions bilaterally, likely representing cysts. There is no\nhydronephrosis.\n\nGastrostomy tube is noted in the dependent portion of the gastric body, with\nintraluminal contrast within the stomach, and no evidence of extraluminal\ncontrast extravasation. There is a large amount of free air within the\nabdomen, as well as air in the subcutaneous soft tissues of the left anterior\nabdominal wall, likely from recent gastrostomy tube placement. Oral contrast\nis seen within the large bowel, likely from prior cross-sectional imaging.\nSmall amount of simple free fluid is seen along the paracolic gutters\nbilaterally, layering dependently in the pelvis. There are no pathologically\nenlarged mesenteric or retroperitoneal lymph nodes.\n\nPELVIS: The urinary bladder is decompressed and contains a Foley catheter. The\nuterus and adnexae are unremarkable. There is a small amount of simple free\nfluid in the pelvis, but no pelvic sidewall or inguinal lymphadenopathy.\n\nVESSELS: The aorta demonstrates moderate atherosclerotic calcification without\naneurysmal dilatation.\n\nOSSEOUS STRUCTURES: Moderate degenerative changes of the lumbar spine with a\ngrade 1 anterolisthesis of L5 on S1 and moderate loss of height at the\nsuperior endplate of the L2 vertebral body, which is likely degenerative.",
            "output": "1.  Large amount of intra-abdominal free air, as well as free air tracking in\nthe left anterior abdominal wall, likely from recent gastrostomy tube\nplacement.\n2.  Gastrostomy tube appears to be in the dependent portion of the gastric\nbody, with no evidence of extraluminal contrast extravasation within the\nperitoneum.\n\nFindings were discussed with Dr. ___ in person by Dr. ___."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. \nNormal appendix.  The urinary bladder is decompressed and unremarkable\nunremarkable.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroid noted in the uterus.  No adnexal\nabnormality appreciated.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy by CT size\ncriteria.\n\nVASCULAR: No significant atherosclerotic disease is noted.\n\nBONES: Redemonstrated right acetabular fracture post fixation with a posterior\nacetabular lateral plate and interlocking screws and single screw extending\nfrom the right superior pubic ramus into the right iliac bone.  No evidence of\nhardware complication.  In the posterior acetabulum, the prior fracture\nappears well-healed.  The anterior acetabular fracture lucency persists, well\ncorticated, with no significant bridging callus (series 2, image 58). \nSimilarly, a fracture lucency involving the right inferior pubic ramus\npersists, well corticated with adjacent cystic changes suggesting microstress\nfrom motion, with minimal bone minimal bridging callus (series 2, image 75). \nChronic osseous changes involving the right iliac crest and ghost tracks from\nprior previously removed hardware.  There is no acute fracture.  Minimal\ndegenerative change involving the pubic symphysis.  No significant hip\ndegenerative change.  Moderate degenerative changes of the left sacroiliac\njoint include subchondral sclerosis, subchondral cystic change on both sides\nthe joint, and osteophytes.\n\nSOFT TISSUES: Postsurgical changes including scarring and trace edema are\nnoted in the right thigh.  A small fat containing right lumbar hernia is noted\nadjacent to the right iliac crest (series 301, image 16).",
            "output": "Sequela of chronic right acetabular fractures post fixation with well-healed\nchronic osseous deformity involving the posterior acetabulum but persistent\nfracture lucency and no significant bridging callus involving the anterior\nacetabulum and inferior pubic rami chronic fractures."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Focal calcification within the uterus is again seen.  No\nadnexal abnormalities are detected.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.  Scattered pelvic phleboliths\nare seen.\n\nBONES: Again demonstrated is right acetabular fixation hardware with lateral\nplate and interlocking screw device.  A single screw is again seen extending\nfrom the right superior pubic ramus into the right iliac bone.  The overall\nalignment is unchanged compared to the ___ examination.  No\nevidence of hardware related complication.  Multiple osteotomy sites are again\nseen involving the right iliac wing.  There is persistent visualization of the\nanterior acetabular fracture lucency, with anterior portion unfused and the\nposterior portion fused (series 15, image 75).  Chronic fracture deformity of\nthe inferior right pubic ramus demonstrates interval healing compared to the\n___ examination.  No new fractures are identified.  Right labral\ncalcifications are present.  Ghost tracks within the right acetabulum. \nPossible labral calcifications on the right.\n\nMild-to-moderate degenerative changes involving the bilateral SI joints\ninclude subchondral sclerosis, cystic change, and osteophytosis.  This is more\npronounced on the left compared to the right.  There is mild degenerative\nchanges involving the pubic symphysis.\n\nMild degenerative changes are seen involving the pubic symphysis.\n\nSOFT TISSUES: Postsurgical changes of the midline pelvis and lateral right\nthigh are again seen.  A small fat containing right lumbar hernia containing\nfat is again seen adjacent to the right iliac crest.",
            "output": "1. Redemonstration of right acetabular fixation hardware without evidence of\ninterval hardware related complication.\n2. Persistent visualization of the anterior acetabular fracture line with the\nanterior portion unfused and minimal bony incorporation within the posterior\naspect.  Possible labral calcifications on the right.\n3. Interval healing of a fracture deformity of the inferior right pubic ramus\ncompared to the ___ examination.\n4. No new fracture or dislocation.\n5. Mild-to-moderate degenerative changes of the bilateral SI joints, left\ngreater than right."
        },
        {
            "input": "LOWER 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 right hepatectomy after living\nliver donor transplant. The remaining liver parenchyma is normal. No focal\nliver lesion is identified. There is no bile duct dilation. The gallbladder is\nabsent.\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.\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.  Low-intermediate density surrounding the celiac\naxis (04:56) is likely post surgical. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Trace free fluid in the\npelvis is within the physiologic range. The patient is status post total\nabdominal hysterectomy. Ovarian follicles measure up to 3.5 cm on the right\nand 2.8 cm on the left, physiologic in a patient of this age.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Postsurgical changes are seen in the anterior abdominal wall.\nIncidentally noted is sacralization of the L5 vertebral body.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. CT chest reported separately."
        },
        {
            "input": "VASCULAR:\n\nThere is active extravasation left retroperitoneal hematoma appearing to arise\nfrom a branch of the left external iliac artery (302:41).  There is a right\nfemoral central venous catheter.  There is a right femoral arterial catheter\nextending to the thoracic cavity inferior to the aortic arch, representing an\nintra-aortic balloon pump.\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nCHEST: There is bibasilar atelectasis.  There are trace bilateral pleural\neffusions.  There is fat within the right ventricular endocardium reflecting\nknown recent myocardial infarction (02:28).  No focal consolidation.  No frank\npulmonary edema.  No thoracic lymphadenopathy.  There is a biopsy clip and a\nright breast lesion.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a left hepatic lobe 1.3 cm hypodensity likely represents a cyst or\nbiliary hamartoma (302:30).  Otherwise, there is no evidence of suspicious\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Vicarious excretion of contrast is noted in the gall bladder,\nlikely from prior cardiac catheterization.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 displaced anteriorly by the below described\nhematoma, and there is mild left perinephric stranding.  Both kidneys are of\nnormal and symmetric size with normal nephrogram. There is no evidence of\nstones, solid renal lesions, or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters.\n\nGASTROINTESTINAL: The stomach 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 visualized,\nhowever there are no secondary signs of acute appendicitis.\n\nRETROPERITONEUM: There is a 7.6 x 8.3 x 15 cm hematoma in the left\nretroperitoneal space with active extravasation likely arising from a branch\nof the left external iliac/common femoral artery (302:141).  There is an\nadditional area of contrast extravasation arising from the left common iliac\nartery best seen on the venous phase (304:126).\n\nThere 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 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. Large left retroperitoneal hematoma with active extravasation, arising from\nbranches of the left external iliac/common femoral artery and left common\niliac artery.\n2. Stranding in the left groin from recent intervention.\n3. Right femoral central venous catheter and right femoral arterial\nintra-aortic balloon pump.\n\nNOTIFICATION:\nThe findings were discussed with ___ MD on initial scan 1:30 am and with\n___, M.D. by ___, M.D. on the telephone on ___ at\n2:00 am, 2 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis, otherwise, visualized lung fields are\nwithin normal limits.  There is no evidence of pleural or pericardial\neffusion.  Calcifications are noted of the coronary arteries and aortic\nannulus.  Heart size is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.1\ncm hypodensity in the right lobe of the liver (series 2: Image 32), not\npreviously visualized but likely representing a biliary cyst or hamartoma. \nAdditional smaller hypodensities are too small to characterize but likely\nrepresent cysts or biliary hamartomas.  There is mild intrahepatic dilatation\ncentrally likely related to prior cholecystectomy.  No 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 a large simple cyst arising from the lower pole of the left renal\ncortex now measuring up to 9.6 cm (series 2: Image 31), previously 7.0 cm on\nmost recent prior dated ___.  Additional hypodensities in the\nkidneys are either too small to fully characterize are compatible with cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is mild swirling of the\nabdominal mesentery (series 2: Image 37 through 46) without evidence of\nobstruction or intestinal malrotation .  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not definitively visualized, however,\nthere 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: 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.  Moderate to severe\natherosclerotic disease is noted, worst in the infrarenal abdominal aorta.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the lumbar spine.  Grade 1 anterolisthesis of\nL5 on S1 is demonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute findings in the abdomen or pelvis to account for the patient's\nsymptoms."
        },
        {
            "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: 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 2.4 cm hemangioma noted in the dome of the\nliver.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is is resected.\n\nPANCREAS: There is edema and hypoenhancement of the uncinate process, head,\nand body of the pancreas, with a small amount of normally enhancing pancreatic\ntail, with associated ductal dilatation.  The duct rapidly tapers in the\ndistal body/proximal tail, concerning for underline stricture versus occult\nmass.  No discrete lesion is 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 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Small volume ascites noted.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral breast implants noted.",
            "output": "1. Hypoenhancement and edema in the uncinate process, head and body of the\npancreas, and small volume ascites, consistent with the given history of\npancreatitis.  No necrosis.\n2. Ductal dilatation in the pancreatic tail, with focal narrowing in the\ndistal body/proximal tail.  No discrete mass is identified.  This could\nrepresent a focal stricture, however, an underlying small lesion cannot be\nentirely excluded.\n3. Multi fibroid uterus."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Limited assessment of the lung bases are clear.  No pleural effusion\nor large pneumothorax. The visualized heart is normal in size without\npericardial effusion. Coronary artery calcifications are noted.\n\nABDOMEN:\n\nThe liver is homogeneous and grossly unremarkable. The gallbladder is\nsurgically absent.\n\nThe spleen is normal. The pancreas is homogeneous without peripancreatic fat\nstranding or focal fluid collection.  The adrenal glands are again noted to be\nthickened with calcification in the right adrenal gland, similar to previous\nexamination.\n\nThe native kidneys are slightly atrophic with small hypodensity in the upper\npole of the right kidney which is too small to characterize. No additional\nfocal renal lesions. No hydronephrosis or hydroureter identified. No renal or\nproximal ureter calculi.\n\nA small hiatal hernia is present. The stomach is grossly unremarkable in\nappearance. The small bowel is normal in caliber without wall thickening. The\nlarge bowel is normal in caliber without wall thickening, fat stranding, or\nfocal mass lesion.  The appendix is normal without evidence of acute\nappendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  Large\namount of atherosclerotic calcification noted. The iliac arteries are normal\nin course and caliber.  No retroperitoneal hematoma.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is largely distended. No pelvic side-wall or inguinal\nlymph node enlargement by CT size criteria. No free pelvic fluid seen. The\ntransplanted kidney is again seen within the right lower quadrant. A 2.6 x 2.0\ncm (02:49) hypodensity is seen within the upper pole of the right transplanted\nkidney is better characterized on ___ MR. ___ fat stranding seen\naround the transplanted kidney is decreased since previous examination. Uterus\nis notable for several calcified fibroids.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  No retroperitoneal hematoma.\n2.  Transplanted kidney in right lower quadrant with 2.6 cm hypodensity in the\nupper pole, better characterized on MR dated ___.  Interval\ndecrease in fat stranding surrounding transplanted kidney.\n3.  Distended bladder."
        },
        {
            "input": "LOWER CHEST:  Subtle right lower lobe consolidation may rib represent\npneumonia or aspiration.  There is also mild ground-glass opacity with septal\nthickening in the lung bases concerning for edema.  The heart is mildly\nenlarged.  Partially imaged is coronary artery calcification.\n\nABDOMEN:\n\nHEPATOBILIARY: The unenhanced appearance of the liver is normal.  Gallbladder\nis surgically absent.\n\nPANCREAS: Pancreas appears atrophic.\n\nSPLEEN: Spleen is normal.\n\nADRENALS: Thickening of the bilateral adrenal glands appear similar to prior. \nCalcifications are again noted within the right adrenal gland.\n\nURINARY: Native kidneys are somewhat atrophic with nonspecific perinephric\nstranding appearing similar to prior.  No kidney stone or hydronephrosis. \nThere is a right lower quadrant transplanted kidney.  A metallic density focus\nin the upper pole region of the transplanted kidney is consistent with a\nfiducial marker in this patient with reported RCC in the transplant kidney. \nNo transplant hydronephrosis.\n\nGASTROINTESTINAL:  Small hiatal hernia.  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 is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS:  Several calcified fibroids are seen within the uterus. \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.  Extensive 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. Pulmonary edema at the lung bases with focal consolidation in the right\nlower lobe concerning for aspiration or pneumonia.\n2. Known renal cell carcinoma in the transplant kidney, better assessed on\nprior MRI.\n3. Small hiatal hernia.\n4. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: There is a small right Bochdalek hernia (02:12) with adjacent\npatchy opacities, likely atelectasis.  There is a small hiatal hernia. \nVisualized lungs are otherwise within normal limits.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\nsubcentimeter hypodensity (02:12) is too small to characterize.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis 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 and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  A 2.3 cm simple\nparapelvic cyst is seen in the interpolar region of the right kidney.  There\nis a 1.1 cm exophytic hypodensity of indeterminate density ___ 30) arising\nfrom the interpolar region of the right kidney (02:36).  There is no\nsuspicious renal lesions within the limitations of an unenhanced scan.  A 3 mm\nnon-obstructing stone is seen in the interpolar region of the left kidney\n(02:32).  There is minimal pelvocaliceal dilatation without frank\nhydronephrosis.  The left ureter is mildly dilated and demonstrates extensive\nperiureteral stranding along its course.  A 3 mm stone is seen within the\ndistal left ureter (2:80).  Mild left perinephric stranding is nonspecific,\nbut in the setting of distal left ureteral stone, could suggest calyceal\nrupture.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is moderately\ndistended with fluid and ingested material.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is mild scattered colonic\ndiverticulosis without evidence of acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS: The urinary bladder is decompressed.  Apparent mild bladder wall\nthickening is likely due to underdistention.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The 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 no 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 mm distal left ureteral stone with mild left ureteral dilatation and\nminimal pelvicaliceal dilatation but no frank hydronephrosis.  3 mm\nnon-obstructing left renal calculus.\n2. Mild diverticulosis without evidence of acute diverticulitis.\n3. 1.1 cm exophytic hypodensity in the interpolar region of the right kidney\nlikely represents a cyst but is of indeterminate density.  Non-urgent\nultrasound is recommended for further evaluation.\n4. Prostatomegaly."
        },
        {
            "input": "LOWER CHEST: There is minimal basilar atelectasis.  There is stable rightward\nshift of the mediastinum.  There is a 0.9 cm pulmonary nodule in the right\nbase, stable dating back to ___, perhaps rounded atelectasis.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nVASCULAR: There is thrombosis at the origin (proximal 2.2 cm) of the superior\nmesenteric artery (02:23, 602:38), with some partial reconstitution distally\nlikely from early collateralization from the gastroduodenal artery, which\ndiminishes as the vessel courses below the level of the aortic bifurcation. \nThe clot extends into the aorta.  The celiac axis appears patent.  The\nremaining visualized major abdominal arteries appear patent.  There is no\nabdominal aortic aneurysm.  There is moderate vascular atherosclerotic\ncalcification.\n\nHEPATOBILIARY: Again seen are multiple unchanged hypodense hepatic lesions,\nwhich are too small to characterize.  Redemonstrated is an unchanged hepatic\ncalcification, likely representing a granuloma.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: The pancreas is normal attenuation throughout.  Again seen is a 1.5\ncm cystic lesion within the head of the pancreas, which is similar in size and\nappearance compared to the prior study accounting for differences in technique\n(02:33).  There is no peripancreatic stranding.\n\nSPLEEN: There is heterogeneous enhancement of the spleen which is concerning\nfor splenic infarct, though perfusion heterogeneity related to enhancement\nfrom the early phase of imaging may have this appearance.  No overt large\nsplenic artery filling defect.\n\nADRENALS: The right and left 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.  Again seen is a 2.2 cm cyst arising from the\nupper pole of the right kidney, unchanged compared to prior.  Additional\nsubcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, but remain unchanged.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  There is distension and\npatulous appearance of the stomach.  There are segments of hypo- or\nnonenhancing small bowel within the mid abdomen (for example 02:68, 601:35). \nThere is no evidence of intestinal pneumatosis, portal venous gas,\npneumoperitoneum, or large volume abdominal ascites to suggest advanced\nintestinal ischemia/infarction.  The patient is status post transverse\ncolectomy with stable appearance of the anastomotic site.  There is colonic\ndiverticulosis without evidence of bowel wall thickening or adjacent\nmesenteric fat stranding.  There is patulous appearance of the cecum and\nrectum, which was seen previously but appears slightly more exaggerated than\nthe prior study.  These findings may represent chronic changes or stercoral\ncolitis.  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 surgically absent.  There is no adnexal\nabnormality.  .\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  4\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is rectus diastasis with bilateral fat containing inguinal\nhernias, unchanged.",
            "output": "1. Occlusive thrombus at the origin of the mesenteric artery with extension of\nclot into the aorta.  There is heterogeneous reconstitution of the SMA\ndistally small collaterals arising from the gastroduodenal artery.  Distal SMA\nembolism cannot be excluded due to early contrast timing though smaller\nbranches are not seen to be filling.\n2. Segments of hypoenhancing and fluid filled small-bowel in the mid abdomen\nare concerning for ischemic changes.  Heterogeneous enhancement of the spleen\nmay represent splenic infarct, although heterogeneous filling due to early\nphase of contrast may have a similar appearance.\n3. Colonic diverticulosis without evidence of acute diverticulitis.\n4. Status post transverse colectomy.  Patulous cecum and rectum.  Gaseous\ndistended stomach.\n5. Stable 1.5 cm cystic lesion within the head of the pancreas, likely a side\nbranch IPMN.\n6. Stable 0.9 cm pulmonary nodule in the right lung base, advise continued\nattention on followup.\n\nNOTIFICATION:  The updated findings and impression were discussed with\n___, M.D. by ___, M.D. on the telephone on\n___ at 10:13 am."
        },
        {
            "input": "Study is motion degraded.\n\nLOWER CHEST: Visualized lung fields are within normal limits.  Subsegmental\natelectasis and trace pleural effusions are present at the bilateral lung\nbases.\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 multiple gallstones are seen\nclustered near the gallbladder neck, without wall thickening or wall edema. \nNo definite ductal stones are visualized.\n\nPANCREAS: There is mild fatty replacement of the pancreas, which is normal in\nattenuation throughout and without peripancreatic fat stranding or fluid\ncollection.\n\nSPLEEN: The spleen shows top normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is bilateral thickening of the adrenal glands without focal\nnodularity, possibly reflecting adrenal hyperplasia.\n\nURINARY: There is an 11 mm obstructing stone in the proximal left ureter near\nthe ureteropelvic junction, with resulting moderate left hydronephrosis. \nThere is a delayed nephrogram of the left kidney.  No focal areas of cortical\nhypoenhancement.  An additional 9 mm nonobstructing stone is noted in the\nlower pole of the left kidney.  There is some stranding in the retroperitoneum\nalong the course of the left ureter.  There is thickening of the perinephric\nbridging septations bilaterally, probably chronic, with additional stranding\nabout the left kidney which is likely acute.  Several subcentimeter\nhypodensities in the kidneys are too small to characterize by CT but likely\nrepresent cysts.  No evidence of solid renal lesions.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a heavy\nstool burden throughout much of the colon and rectum.  The appendix is not\ndefinitively visualized, however there are no secondary signs of acute\nappendicitis in the right lower quadrant.\n\nPELVIS: The thickened bladder wall is somewhat accentuated by minimal\ndistension, however within this limitation there is probably bladder wall\nthickening with some surrounding fat stranding.  Several bladder diverticula\nare noted.  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.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. An 11 mm obstructing stone near the left ureteropelvic junction, with\nresulting moderate hydronephrosis and delayed left nephrogram.  No focal areas\nof cortical hypoenhancement.\n2. Bladder wall thickening with stranding about the course of the left ureter\nare concerning for urinary tract infection, recommend correlation with\nurinalysis.\n3. Prostatomegaly.\n4. Heavy stool burden throughout much of the colon."
        },
        {
            "input": "LOWER CHEST: There is increased bibasilar atelectasis with persistent trace\nbilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: There is fatty atrophy of the pancreas.  There is no evidence of\nfocal lesion, within the limitations of an unenhanced scan.  There is a single\npunctate calcification in the medial pancreatic tail.  There is no pancreatic\nductal dilation or peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Diffuse bilateral adrenal thickening is similar to the prior\nexamination.\n\nURINARY: Patient is status-post left percutaneous nephrostomy tube.  The tip\nof the tube is located in a lower pole calyx, not the renal pelvis.  The\npreviously seen nonobstructing left lower pole calculus has migrated, now\nprobably located adjacent to the pre-existing stone at the left ureteropelvic\njunction, though it is not definitely separately identified from the\npre-existing UPJ stone.  Hydronephrosis has resolved.  Proximal left\nperiureteric fat stranding is improved.  Distal left periureteric fat\nstranding is similar.  Distal right periureteric fat stranding is new (series\n2, images 60-72).  The urinary bladder is trabeculated with numerous bladder\nwall diverticula.\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 not visualized.\n\nPELVIS: 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is minimal retrolisthesis of L2 on L3.  Endplate degenerative\nchanges are worst at L1-L2 and L2-L3.\n\nSOFT TISSUES: There is mild diffuse body wall edema.",
            "output": "1. A left percutaneous nephrostomy tube tip is located in a left lower pole\nrenal calyx rather than the renal pelvis.  However, hydronephrosis has\nresolved.\n2. A pre-existing nonobstructive left lower pole calculus has migrated,\nprobably now located adjacent to the pre-existing left ureteropelvic junction\nstone.\n3. New right distal periureteric fat stranding.  Consider infection. \nCorrelate with urinalysis.\n4. Severe prostatomegaly with evidence of chronic bladder outlet obstruction.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:38 pm, approximately\n15 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate mild bibasilar atelectasis. \nInterval resolution of bilateral trace pleural effusions.  Redemonstration of\na punctate calcification in the posterior left lower lobe, consistent with\nlikely granuloma.  Stable appearing coronary artery calcifications.  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 demonstrates cholelithiasis without secondary\nsigns of cholecystitis.\n\nPANCREAS: The pancreas demonstrates stable mild fatty atrophy 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.  There is a stable appearing punctate\ncalcification in the body of the pancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 tip of the\npercutaneous nephrostomy tube now forms a loop within the left renal pelvis\nwith the tip terminating in the inferior pole of the collecting system.  The\npreviously described renal calculi at the left UPJ are no longer seen within\nthe urinary tract.  There has been interval mild improvement of the\nperiureteral stranding on the left.  The distal right periureteral stranding\nhas resolved.  There is no suspicious renal lesions within the limitations of\nan unenhanced scan.  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.\n\nPELVIS: The bladder appears nodular with trabeculations and small diverticula.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is stably 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 multilevel degenerative changes lumbar spine with mild, stable\nretrolisthesis of L2 over L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The previously described calculi at the left UPJ are no longer seen within\nthe urinary tract, appearing to have passed.  The tip of the percutaneous\nnephrostomy tube no forms a loop within the left renal pelvis with the tip\nterminating in the inferior pole of the collecting system.\n2. Nodular bladder with trabeculation and small diverticula.\n3. Cholelithiasis without signs of cholecystitis.\n4. Interval resolution of bilateral trace pleural effusions.\n5. Stable mild 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 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. \nMultiple bilateral simple renal cysts are unchanged, the largest of which\nmeasures 7.4 cm in the lower pole of the left kidney.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. In the mid sigmoid colon, there is pericolonic fat\nstranding with an intramural abscess measuring 2.6 x 2.3 cm (601b:44 and\n2:63).  Findings likely reflect contained perforation of diverticulitis.  No\nother complications of acute diverticulitis identified. 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\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: Degenerative changes are seen in the lumbar spine.",
            "output": "Acute sigmoid diverticulitis with intramural abscess measuring 2.6 x 2.3 cm."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases demonstrates bilateral lower lobe\nground-glass opacities most consistent with atelectasis however superimposed\ninfection cannot be excluded in the appropriate clinical setting. No pleural\neffusion. The visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones. The portal vein, SMV, and splenic vein are\npatent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening.  Mild fat stranding and wall thickening is seen along a short\nportion of the distal descending colon with multiple adjacent diverticula\nconsistent with acute diverticulitis. No intramural abscess. No focal fluid\ncollection. No extraluminal air.  The large bowel is otherwise normal in\ncaliber without wall thickening, fat stranding, or focal mass lesion. Severe\nsigmoid and descending diverticulosis is present. The appendix is normal\nwithout evidence of acute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  Small amount of atherosclerotic\ncalcification noted. The iliac arteries are normal in course and caliber.\nRight internal iliac varix is present with a partially duplicated right common\niliac vein. (2: 76).\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. A 3 x 4 cm heterogeneous lesion within the left pelvis is consistent\nwith the left ovary. Right ovary not visualized.\n\nOSSEOUS STRUCTURES:  Mild retrolisthesis of L5 on S1 is noted. No focal lytic\nor sclerotic lesion concerning for malignancy.",
            "output": "1.  Acute diverticulitis involving a short portion of distal descending colon.\nNo intramural abscess. No focal fluid collection. No extraluminal air.\n2.  Bilateral lower lobe atelectasis. Clinical correlation is recommended to\nassess for superimposed infection.\n3.  Mild retrolisthesis of L5 on S1, is of indeterminate age."
        },
        {
            "input": "LUNG BASES: The partially imaged lung bases are clear.  There is no pleural or\npericardial effusion. There is no hiatus hernia.\n\nCT ABDOMEN:\nThe liver demonstrates a normal homogeneous noncontrast appearance without\napparent focal lesions. There is no obvious intrahepatic biliary ductal\ndilation. Lack of IV contrast precludes evaluation of the portal vein. The\ngallbladder is unremarkable. There is no splenomegaly.  The adrenal glands are\nunremarkable.  Suture material is seen in the upper abdomen near the\nesophageal hiatus reflective of recent surgery.  The left kidney is surgically\nabsent.  There is no evidence of abnormal fluid collection.  The right kidney\ndemonstrates a normal non-contrast appearance. There is no right\nhydronephrosis.\n\nThe stomach and duodenum are unremarkable. Nondilated small bowel loops are\nnormal in course and caliber without evidence of obstruction there is\nscattered colonic diverticulosis without evidence of active diverticulitis.\nThe appendix is not directly visualized, however there are no secondary signs\nof appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilatation.  Subtle haziness of the mesenteric fat near the origin of the\nceliac axis in the region of surgical suture is compatible with postsurgical\nchange (series 3, image 28).  There is no mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria. There is no free intraperitoneal air or\nfluid.\n\nCT PELVIS:\nThe imaged pelvic organs are unremarkable within the limitations of\nnoncontrast technique. The bladder is decompressed, and suboptimally\nevaluated.  A small trace free simple pelvic fluid may be physiologic in\nnature (series 3, image 68).  There is no pelvic sidewall, iliac chain, or\ninguinal lymphadenopathy.\n\nMUSCULOSKELETAL:\nOriented longitudinally along the anterior abdominal midline within the\nsubcutaneous fat is a 4.0 x 2.2 x 1.0 cm irregularly marginated fluid\ncollection without a clearly definable wall with minimal adjacent fat\nstranding. This likely represents postoperative seroma.  An additional small\npocket of subcutaneous gas along the left lateral anterior abdominal wall with\na subcutaneous fat is also likely postoperative.  No concerning focal lytic or\nsclerotic osseous lesions are seen.",
            "output": "1. No acute sequelae of trauma.\n2. Unremarkable left nephrectomy bed. Normal non-contrast appearance of the\nright kidney.\n3. 4.0 x 2.2 x 1.0 cm fluid collection along the anterior abdominal wall\nwithin the subcutaneous soft tissues, likely postoperative seroma.  Small\nfocus of gas in the left lateral abdominal wall subcutaneous fat, also likely\npostoperative.\n4. Small amount of free pelvic fluid, likely within normal physiologic range.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 1:41 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar dependent atelectasis is noted.  A few\nmicronodules are demonstrated (series 2, images 1, 3, 14).  Partially imaged\nICD leads are noted.  Otherwise, the heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Within the limitations of an unenhanced scan, the liver\ndemonstrates homogenous attenuation throughout.  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: There is diffuse fatty parenchymal replacement.  No focal lesions\nare demonstrated within the limitations of unenhanced scan.  No pancreatic\nductal dilatation is noted.  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 radio-opaque stones are noted.  A cortical defect in the posterior\naspect of the left lower pole may reflect sequela of previous\ninflammatory/infectious insult, or intervention.  An additional small cortical\ndefect is also noted in the right inferior pole.  Otherwise, there is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality to suggest infection.\n\nGASTROINTESTINAL: The esophagus is slightly patulous.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is extensive diverticular disease involving\nthe sigmoid colon without evidence of acute inflammation.  Otherwise, the\ncolon and image rectum are unremarkable.  The appendix is normal.\n\nPELVIS: The ischioanal fossa, perineum, anus, and surrounding soft tissues\nwere not imaged.  The urinary bladder and distal ureters are unremarkable. \nThere is no free 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 no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes in the thoracolumbar spine with 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 evidence of renal stone or acute process in the abdomen or pelvis.\n2. Extensive sigmoid diverticulosis without evidence of 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.  A 9\nmm hypodensity in segment II is unchanged since ___, likely representing a\ncyst or biliary hamartoma.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains a small gallstone\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without main\npancreatic ductal dilatation.  A 6 mm cyst in the pancreatic tail has been\nstable since ___, likely representing a side-branch IPMN (2:60).  There is no\nperipancreatic stranding or enlarged peripancreatic lymph 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.\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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate multilevel degenerative changes of the thoracolumbar spine,\nand mild anterolisthesis of L4 on L5, similar to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of lymphadenopathy in the abdomen and pelvis.\n2. Long-term stability of a 6 mm cystic lesion in the pancreatic tail,, most\nlikely representing a side-branch IPMN.\n3. Please refer to separate report of CT chest performed same day 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: 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.   The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  There is mild mucosal hyperemia of the sigmoid\ncolon and rectum which could represent mild proctocolitis.The remainder of the\ncolon is otherwise within normal limits.\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.  An\ninvoluting left corpus luteal 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.  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 hyperemia of the sigmoid colon and rectum could represent mild\nproctocolitis.  Correlation with clinical symptoms is suggested.\n2. No acute abnormality otherwise demonstrated.  Specifically, no CT findings\nto suggest cholecystitis.  Normal appendix."
        },
        {
            "input": "LOWER CHEST: Multiple lung nodules are partially imaged in the lower lobes,\nwhich are new or increased compared to ___.  Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered hypodensities throughout the liver measuring up to 10 mm are not\nsignificantly changed compared to the earliest available study performed ___ (02:47, 02:53, 02:57).  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 hypodensities throughout the kidneys bilaterally measure up to 11 mm,\ntoo small to characterize.  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: Patient is status post hysterectomy and bilateral\noophorectomy.  Again seen is soft tissue in the region of the left vaginal\ncuff that measures 4.5 x 2.8 cm, which is similar in size and appearance\ncompared to ___, and is likely postsurgical (2:106).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 abdominopelvic metastases.\n2. Stable appearance of 4.5 x 2.8 cm soft tissue along the left vaginal cuff,\nwhich is likely postsurgical.\n3. Multiple new or enlarged lung nodules, partially imaged.  Please refer to\nthe separate chest CT dictated on the same day for additional details on\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST:  Heart size is normal, and there is no pericardial effusion. \nCoronary artery calcifications are noted.  A 2 mm subpleural pulmonary nodule\nis seen at the right lung base (3:9) that is unchanged from ___,\nsuggesting a benign finding.  More inferiorly at series 3, image 18, an\nadditional 3 mm nodule is seen at the posterior right lower lobe (3:18), also\ndemonstrating over ___ year stability (5:114, prior study).  Trace\nnonhemorrhagic left pleural effusion with adjacent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are several cm hypodensities scattered throughout the liver (3:18, 24,\n26, 34) that are unchanged from ___ and likely represent benign findings such\nas cysts or hamartomas.  No abnormally enhancing liver masses are identified.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder 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: A small hiatal hernia is noted.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits. Appendix is not visualized. There is no\nevidence of mesenteric lymphadenopathy.\n\nPERITONEAL CAVITY:  There is large volume non-hemorrhagic ascites, which is\nnew from the prior CT in ___.  There has also been substantial\ninterval worsening of soft tissue nodularity along the peritoneal lining,\npredominantly on the right.  This extends from the level of the hepatic dome\nto the inferior pelvis, best appreciated on the coronal images, for example\nseries 601b, image 39.  There is also soft tissue nodularity along the left\nperitoneum that spans a craniocaudal dimension of 1.9 cm (601b:37).  A 1.5 x\n1.1 cm soft tissue nodule located in the posterior pelvis, medial to the left\ninternal iliac artery (3:72) was not definitely seen on the prior study likely\nalso represents a new deposit.\n\nRETROPERITONEUM: Several retroperitoneal lymph nodes, the largest of which\nmeasures 8 mm in the left para-aortic station (3:43) which is unchanged from\n___ (2:67, prior study).  None are pathologically enlarged by CT size\ncriteria.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nPELVIS: Urinary bladder is collapsed around a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy. Nonhemorrhagic free fluid\nwithin the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy for endometrial cancer.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nPatient is status post fixation of a prior intertrochanteric fracture on the\nleft, without evidence of perihardware lucency in the partially visualized\nintramedullary rod and gamma nail.  There is diffuse anasarca.",
            "output": "1.  Substantial worsening of peritoneal soft tissue nodularity, predominantly\non the right, compatible with diffuse peritoneal metastases.  New 1.5 x 1.1 cm\nsoft tissue nodule in the left posterior pelvis likely represents an\nadditional deposit.\n2.  New large volume non-hemorrhagic ascites, trace non-hemorrhage left\npleural effusion and diffuse anasarca.\n3.  Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Lower lung bases and pleural spaces are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  7 mm\nhypo attenuating lesion within segment 7 (series 4a, image 36), favored to\nrepresent a cyst/biliary hamartoma.  No solid liver lesions.   The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.\n\nNo intrahepatic ductal dilatation.  The common bile duct measures a maximal\ndimension of 11 mm in width, and tapers distally to a width of approximately 8\nmm, and at the ampulla it abruptly terminates.  No obvious extraluminal or\nintraluminal mass is identified at this level.  However there is a large\nduodenal diverticulum noted at the second/third portion of the duodenum, and\nis unsure if this is duodenal diverticulum could exert mass effect on the\nextrahepatic biliary tree.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\nNon pathologically enlarged perigastric and gastrohepatic lymph nodes are\nnoted, largest measuring up to 8 mm in short axis (series 4a image 17). \nMultiple non pathologically enlarged lymph nodes are seen within the jejunal\nmesentery.\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: Reproductive organs are within normal 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": "No intrahepatic ductal dilation. The common bile duct measures  11 mm in\nmaximum diameter  tapering to 8 mm, with abrupt cut off at the level of the\nampulla.  No obvious extra or intraluminal mass is identified at this level. \nA large duodenum diverticulum is noted in the periampullary portion of the\nduodenum which may be exerting mass effect on the CBD causing this appearance.\nHowever an associated periampullary lesion cannot be entirely excluded on this\nCT scan. Therefore further evaluation by an MRCP or ERCP may be considered.\nThe pancreas is normal in attenuation, with no mass lesion or ductal\ndilatation."
        },
        {
            "input": "CHEST:\nVisualized portions of the lung bases are clear bilaterally, and without\nevidence of suspicious mass lesions. No pleural effusion. The heart is normal\nin size and there is no pericardial effusion.\n\nABDOMEN:\nThere is a calcified lesion within the left anterior abdominal cavity,\nunchanged since prior exam. Surgical clips from previous distal gastrectomy\nare visualized. The remaining stomach appears normal. The small bowel, large\nbowel, and rectum are normal in caliber without focal wall thickening. There\nis moderate diverticulosis throughout the visualized colon but no evidence of\ndiverticulitis. Small focal areas of hypo-attenuation are seen within the\nperiphery of the liver, likely representing perfusion defects. No suspicious\nmasses are seen within the liver. No intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder shows no stones or wall edema. Portal veins are\npatent. Pancreas is atrophic. The spleen, bilateral adrenal glands and\nbilateral kidneys are normal. The aorta, SMA, and ___ are grossly patent.  No\nfree intra-abdominal fluid. There are several prominent mesenteric lymph\nnodes, with the largest one measuring up to 7.9 mm in diameter.\n\nPELVIS:\nThe bladder is unremarkable. An intrauterine device is seen within the uterus.\nNo free fluid within the pelvis. No inguinal lymphadenopathy by CT size\ncriteria.\n\nOSSEOUS STRUCTURES:\nVisualized portion of the vertebral column appears normal. Bone islands are\npresent in the right iliac bone, right femoral head, and left greater\ntrochanter. These are unchanged since CT on ___.",
            "output": "No evidence of local recurrence or distant metastases.\n\nNOTIFICATION:  Preliminary results were communicated by Dr. ___ to Dr. ___\n___ telephone on ___ at 4:13PM."
        },
        {
            "input": "LOWER CHEST: Large right and moderate left pleural effusions appear similar to\nminimally decreased compared to the ___ examination.  There is\nmild overlying compressive atelectasis.  There is now more diffuse left lower\nlobe opacities, likely reflecting pneumonia and/or aspiration.  Extensive\ncoronary artery calcifications are again noted.\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 layering sludge\nwithout evidence of wall edema or surrounding inflammation.\n\nPANCREAS: The pancreas demonstrates normal attenuation throughout.  A\npreviously described hypoattenuating pancreatic head/neck lesion it was better\nassessed on the prior examination of ___. 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: Again demonstrated are bilateral severely atrophic native kidneys\nwith cystic changes.  Failed right lower quadrant renal transplant is again\nseen.  Left lower quadrant transplant kidney is again seen without evidence of\nhydronephrosis or focal renal lesions.\n\nGASTROINTESTINAL: The stomach is largely distended.  The proximal small bowel\nloops are mildly fluid-filled and dilated up to 3.1 cm.  There is a focal\nshort segment of small bowel in the lower mid abdomen with imaging evidence of\npneumatosis, and associated free air in the adjacent mesentery (for example\nseries 5, image 74, series 7 image 10).  Findings are concerning for ischemia.\nThe colon is decompressed.  There is small to moderate volume free\nintraperitoneal air which may be related to recent surgery.  Small to moderate\nvolume abdominopelvic ascites.\n\nPELVIS: The urinary bladder is underdistended with high attenuating contrast\nmaterial.  Small to moderate free fluid is seen in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post total abdominal hysterectomy and bilateral\nsalpingo oophorectomy.\n\nLYMPH NODES: Small retroperitoneal lymph nodes are likely reactive and are not\npathologically enlarged by CT size criteria.  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.\n\nSOFT TISSUES: Moderate body wall anasarca.",
            "output": "1. Focal short-segment small bowel with pneumatosis and associated free air in\nthe adjacent mesentery is concerning for bowel ischemia.\n2. Small to moderate volume abdominopelvic ascites and free air, likely\nrelated to recent surgery.\n3. Large right and moderate left pleural effusions appear similar to slightly\ndecreased in size compared to the ___ examination.\n4. Diffuse left lower lobe opacities likely reflect pneumonia and/or\naspiration and are progressed compared to the most recent prior examination.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:17 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: Liver appears mildly congested.  There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains high density 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: Native kidneys are atrophic with cystic change in both kidneys. \nAtrophic renal transplant in the right lower quadrant.  Nonspecific stranding\nalong the right lower quadrant transplant ureter.  Left lower quadrant renal\ntransplant with some parenchymal thinning.  There is no evidence of solid\nrenal lesions or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Duodenal diverticulum noted. \nMural thickening affecting a loop of small bowel to the left of midline\n(601.24) measuring approximately 20 cm. Descending and sigmoid colon\ndiverticulosis without evidence of diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Moderate\nvolume free fluid around the liver and spleen with small volume free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There is an 11.4 x 10.5 x 10.5 cm heterogeneously\nenhancing pelvic mass felt likely to be arising from the left ovary and\ndisplacing the uterus with some central areas of relative ___.\n\nLYMPH NODES: Enlarged relatively low-density lymph node along the left ovarian\nvein measuring up to 14 mm in short axis.  Several prominent left para-aortic\nlymph nodes.  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: Anasarca noted.",
            "output": "1. A 11.4 x 10.5 x 10.5 cm heterogeneous pelvic mass slightly to the left of\nmidline - felt likely to be arising from the left ovary with low-density\nenlarged lymph node along the left ovarian vein.  This is new when compared to\nthe PET-CT from ___ and is suspicious for malignancy.\n2. Moderate volume ascites.\n3. Abnormally thickened small bowel loop to the left of midline measuring\napproximately 20 cm - differentials include serosal metastatic disease or\nfocal enteritis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pericardial effusion.  Trace bilateral pleural effusions are\npresent.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation 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 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 normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size 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 loops of\ndistended small bowel decompressed distally.  In the proximal ileum, there are\n2 separate regions of small bowl wall thickening with areas of normal bowel\nwall in between (2:50, 2:65).  The terminal ileum is decompressed but without\nevidence of bowel wall thickening (610:18).  The colon and rectum are within\nnormal 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 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": "1. Multiple loops of abnormally dilated small bowel with distal decompression\nconsistent with partial small bowel obstruction.\n2. Two separate areas of small bowel wall thickening not involving the\nterminal ileum which may represent Crohn's disease verses infectious etiology.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:23 ___, 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\nPartial visualization of a right-sided VP shunt catheter which terminates\nwithin the right upper quadrant.\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 mild to moderately distended\nwithout significant thickening or surrounding inflammation presumably related\nto fasting 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 grossly normal in size with normal nephrogram.  There\nis mild asymmetric cortical thinning involving the right greater than left\nkidney suggestive of scarring and/or chronic medical renal disease.  There is\na 2.8 cm simple cyst within the lower pole of the left kidney with multiple\nadditional tiny low attenuating lesions which are too small to adequately\ncharacterize but statistically represent additional benign cysts.  No definite\ncomplex cystic or solid mass is identified.  No significant no calculi or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Percutaneous gastrostomy tube\nis in place.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The rectum is mildly distended with fluid and\ndemonstrates mural thickening and surrounding inflammation consistent with\nproctitis.  The remaining large bowel is unremarkable.  No pneumatosis or free\nair.  No drainable fluid collection/abscess.  The appendix 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: Tortuous abdominal aorta without aneurysmal dilatation.  Moderate to\nsevere atherosclerotic disease is noted.\n\nBONES: Moderate degenerative change of the spine in the setting of scoliosis. \nNo fracture or suspicious osseous lesion.\n\nSOFT TISSUES: There is heterogeneous enlargement of the left obturator\ninternus and quadratus femoris.  The component along the pelvic sidewall\nmeasures approximately 9.5 x 3.3 x 9.6 cm (AP by transverse by craniocaudal)\nand the more superficial component posterior to the acetabulum measures 6.2 x\n3.1 x 5.6 cm (transverse by AP by craniocaudal).  There is no adjacent osseous\ndestruction or bony remodeling.  Incidental note is made of fat containing\nperiumbilical and bilateral inguinal hernias.  Soft tissue density at the\nattachment of the hamstring tendons bilaterally onto the ischial tuberosity\nlikely reflects calcific tendinopathy.",
            "output": "1. Fluid distension of the rectum which demonstrates mural thickening and\nsurrounding inflammation suggestive of proctitis.  Recommend correlation with\nphysical exam findings and consider follow-up proctoscopy to ensure no\nunderlying lesion.\n2. Heterogeneous enlargement of the left obturator internus and quadratus\nfemoris.  Differential includes myositis, hematoma, or less likely malignancy.\nContrast enhanced MRI of the left hip/pelvis may be useful for further\ncharacterization.\n\nRECOMMENDATION(S):  Recommendations as above."
        },
        {
            "input": "LOWER CHEST: The partially assessed lung bases are clear. There is no pleural\nor pericardial effusion.\n\nLIVER: The liver is without focal lesion or intrahepatic biliary duct\ndilation. The nondistended gallbladder is within normal limits, without wall\nthickening or pericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: A relatively normal-appearing kidney is present in the left renal\nfossa, apparently conjoined with a pelvic kidney with the appearance of\ncrossfused ectopia.  Two simple cysts arise from the left kidney. Assessment\nof variant renal anatomy is limited without the use of IV contrast.\n\nGI: The stomach is moderately distended without obvious intraluminal mass or\nwall thickening. The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction. The appendix is not definitively\nvisualized, but there is no fat stranding or free fluid in the right lower\nquadrant to suggest acute appendicitis. There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with extensive\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES:  There is diffuse osteopenia.  Multilevel degenerative\nchanges of the lumbar spine are noted, most severe at L4-L5 where there is\ndisk space narrowing, subchondral sclerosis, subchondral cyst formation,\nvacuum phenomenon, and grade 1 anterolisthesis of L4 on L5 severe compression\nfracture of the L2 vertebral body is age indeterminate. Mild retropulsion of\nthe posterior wall of the vertebral body causes at least moderate spinal canal\nstenosis. No focal lesion suspicious for malignancy present.",
            "output": "1. Limited assessment of the hepatobiliary tree without the use of IV\ncontrast. No gross mass or adjacent fat stranding.\n2. Age-indeterminate L2 compression fracture causing at least moderate spinal\ncanal stenosis.\n3. Apparent cross fused ectopia variant renal anatomy.\n4. Diffuse demineralization."
        },
        {
            "input": "LOWER CHEST: There is an 8 mm cyst in the right lung base.  No pleural\neffusion.  Heart is top-normal in size.  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 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: Adrenal glands are unremarkable in appearance.\n\nURINARY:  Left kidney contains a 1.7 cm simple cyst.  There is also an ectopic\nright kidney just inferior and fused to the left renal kidney, likely\nreflective of cross fused ectopia.  The inferior right kidney also contains 2\nsimple cysts, the larger of which measures 2.9 x 3.0 cm.  Evaluation is\nlimited in the absence of intravenous contrast.  No hydronephrosis or renal\ncalculi.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is scattered\ndiverticulosis, without evidence of acute diverticulitis.  Small amount of\nresidual oral contrast is seen throughout the descending and sigmoid colon,\nand rectum.  Appendix is not visualized, but there are no secondary signs of\nacute appendicitis.  No ascites.  No pneumoperitoneum\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES:  There is no acute fracture.  L2 compression fracture is unchanged from\n___.  Grade 1 anterolisthesis of L4 on L5 is also unchanged.  There\nis otherwise mild background degenerative changes.  No lytic or sclerotic\nlesion concerning for malignancy is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal process identified.\n2. Diverticulosis.\n3. Unchanged L2 compression fracture.\n4. Cross fused renal ectopia with several simple renal cysts, unchanged."
        },
        {
            "input": "LOWER CHEST: For full description of the lung please see chest CT report from\nthe same day.\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. \nThere is dilatation of the hepatic veins to 2.1 cm in the right hepatic vein\nconsidered consistent with hepatic venous congestion\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 subcentimeter hypodense\nlesion in the upper pole of the right kidney on series 3, ___ 64.  This is too\nsmall to characterize but stable in size and most consistent with a cyst. \nThere is a 1.9 cm cyst in the interpolar region of the left kidney on series 3\n___ 69.  This is stable in size.  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 a mildly enlarged lymph node in the left para-aortic\nregion on series 3 ___ 70 measuring 1.2 x 1.2 cm.  This is new from prior\nstudy.  There is a 1.9 x 1.2 cm lymph node adjacent to the IVC on series 3,\n___ 75.  There is a new a retrocaval lymph node on series 3 ___ 71 measuring\n2.4 x 1.2 cm.\n\nVASCULAR: There is a small infrarenal aortic aneurysm measuring 3.3 cm.  This\nis stable in size mild atherosclerotic disease is noted.\n\nBONES: There is a new 3.3 cm lytic lesion in the transverse process of L1\ninvolving the posterior elements on series 3, ___ 62.  This is new.  There is\na new mixed lytic/sclerotic lesion in the vertebral body of L2, L3 and L5. \nThere is a compression fracture of L3.  Then new mixed in sclerotic lesions\nthroughout the iliac wing bilaterally as well as the sacrum.  No laterally\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple new lytic or mixed lytic sclerotic lesions as described above\nconcerning for bone metastasis.  Please note that the most recent CT of the\nabdomen pelvis was done in ___.  The lytic lesion in the right\ntransverse process of L1 is amenable to biopsy\n2. New mild retroperitoneal lymphadenopathy concerning for metastatic disease\n3. Hepatic venous congestion raises concern for CHF\n4. Stable 3.3 cm infrarenal aortic aneurysm.\n\nRECOMMENDATION(S):  CT-guided biopsy of the transverse process of L1"
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis.  No pleural\neffusions.  A 2 mm granuloma is incidentally noted in the right lung base\n(2:2).  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple scattered hepatic lesions are noted.  The largest is a 2.2 x 1.4 cm\npredominate hypodense lesion with peripheral nodular enhancement in segment 6\n(02:30), compatible with a hemangioma.  Similarly, another 1.2 cm segment 6\nlesion (02:23) and a 0.9 cm segment 5 lesion (02:24) likely represent\nadditional hemangiomas.  Other sub-cm hypodensities are too small to\ncharacterize, but may represent cysts or hamartomas.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  Portal venous system 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.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon and\nrectum are within normal limits.  Normal appendix.  No ascites.  No\npneumoperitoneum.\n\nAnterior to the transverse colon, there is a heterogeneous focus of omental\nfat stranding that spans an area of approximately 8.8 x 3.6 cm (02:34).  This\nlikely represents omental infarction, rather than epiploic appendagitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Approximately 8.8 x 3.6 cm ill-defined focus of heterogeneous fat stranding\nanterior to the transverse colon, likely representing omental infarction. \nEpiploic appendagitis is felt to be less likely.\n2. Several hypodense lesions in the liver with peripheral nodular enhancement\ncompatible with hemangiomas the largest measuring 2.2 x 1.4 cm in segment 6."
        },
        {
            "input": "LOWER CHEST: There is bibasilar dependent atelectasis.  No pleural effusions. \nHeart size is normal, without a pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  Two\ncysts are noted in the right lobe of the liver, the larger in segment 7\nmeasuring 5.0 x 4.9 cm.  A smaller simple cyst measures 1.4 x 0.9 cm.  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: The kidneys are of normal and symmetric size.  A 1.4 x 1.2 cm\nhypodensity in the upper pole of the left kidney measures simple fluid\nattenuation, and consistent with a simple cyst (601b:35).  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.  Normal appendix.  No ascites.  No pneumoperitoneum.\n\nPELVIS: The urinary bladder is collapsed, limiting assessment for wall\nabnormalities.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland contains dystrophic calcifications, but is\notherwise 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:  No acute fracture.  There is a 0.9 cm intramedullary lesion in the\nleft posterior iliac bone with a central lucency and sclerotic borders,\noverall a nonaggressive appearance.  No other lytic or sclerotic lesions are\nidentified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal process identified.\n2. No nephrolithiasis.\n3. Incidentally noted 0.9 cm intramedullary lesion in the left posterior iliac\nbone, which has a nonaggressive appearance.  Recommend correlation with\nhistory of focal pain."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Small hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Slightly hypodense appearance of the hepatic parenchyma\nsuggests 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: Bilateral parapelvic renal cysts are noted.  No convincing evidence\nfor hydronephrosis or ureteral stone.  Ureters are normal in size.  No\nworrisome 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. Appendix is normal.  Colonic diverticulosis\nis present without diverticulitis.\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 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 changes in the lumbar spine most pronounced at L4-5 level.\nHypodense thickening of the left vaginal wall extending toward the left labia\nbest seen on series 2 image 90 measuring approximately 4.3 x 2.3 x 2.3 cm most\nsuggestive of a Bartholin's gland cyst.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No ureteral stone, hydronephrosis.  Bilateral parapelvic renal cysts\nincidentally noted.\n2. Normal appendix.\n3. Small hiatal hernia.\n4. Mild hepatic steatosis.\n5.  Cystic structure in the left vaginal wall in the region of the left labia\nmay represent a Bartholin gland cyst."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  The heart is\nenlarged.  Calcification within the left ventricle may have reflect\ncalcification of a papillary muscle.  Aortic annular, mitral annular, and\ncoronary artery calcifications are present.  There is 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 appears atrophic and fatty replaced.  No evidence of\npancreatic 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: 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:  Small hiatal hernia is seen.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThere is mild colonic wall thickening spanning from the hepatic flexure to the\nrectum, with trace surrounding fat stranding, most likely reflective of a mild\ncolitis.   The appendix 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.  Calcification within the\nuterus fundus may represent a calcified fibroid.  There is no evidence of\nadnexal 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Chronic appearing compression deformity of T12 is noted.  Moderate\ndegenerative changes are seen within the imaged thoracolumbar spine.  .\n\nSOFT TISSUES: Small umbilical hernia containing fat is noted.",
            "output": "1. Findings suggestive of a mild colitis involving from the hepatic flexure to\nthe rectum, which may be infectious or inflammatory in nature.\n2. Small hiatal hernia.\n3. Chronic appearing compression deformity of T12.\n\nNOTIFICATION:  Updated impression was discussed with Dr. ___ by Dr.\n___ telephone at 4:43pm on ___, 5 minutes after discovery."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The celiac axis,\nSMA, ___, and bilateral renal arteries are patent.\n\nLOWER CHEST: The heart is moderately enlarged.  There is contrast refluxing\ninto the IVC, suggesting a component of heart failure. There is mosaic pattern\nand ground-glass attenuation at the bilateral lung bases, likely representing\npulmonary edema.  There is a small right and trace left pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation, likely due to\nphase of imaging.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gall bladder wall is edematous, measuring up to 9 mm\nin thickness, consistent with volume overload/heart failure.\n\nPANCREAS: There is a 1.6 cm cystic lesion in the body of the pancreas.  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. \nHyperenhancement could represent a component of shock.\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 small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis colonic diverticulosis; colon and rectum are otherwise within normal\nlimits. There is no evidence of mesenteric lymphadenopathy.  There is a small\namount of ascites.\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 a small amount of\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is severe degenerative changes to the thoracolumbar spine.  T12\ncompression fracture is unchanged from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Moderate cardiomegaly.  Partially visualized right pleural effusion. \nReflux of contrast into the hepatic veins and IVC.  Findings suggest\nright-sided heart failure.  Presence of small volume ascites and gallbladder\nwall edema likely related.\n2. No evidence of mesenteric ischemia.\n3. Cystic lesion measuring 1.6 cm in the body of the pancreas.\n4.   Hyperenhancement of the adrenal glands may reflect shock, please\ncorrelate clinically\n\nRECOMMENDATION(S):  Nonemergent MRCP can be considered for further evaluation\nof the pancreatic cystic lesion."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac axis, SMA,, ___, and\nbilateral renal arteries are widely patent.  Of note there is a trifurcation\nof the celiac artery with the GDA rising as a single branch vessel.\n\nLOWER CHEST: There is bibasilar atelectasis.  A central venous catheter\nterminates in the right atrium..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneity throughout with a\ncongested appearance and periportal edema concerning for aggressive fluid\nresuscitation.  The gallbladder is unremarkable.  There is trace ascites\nsimilar in appearance to prior.\n\nPANCREAS: There is stable main pancreatic duct dilatation otherwise the\npancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: The bilateral native kidneys are enlarged with innumerable cysts\nconsistent with known polycystic kidney disease.  Within the right kidney\nthere are three embolization coils seen with indistinct branch vessels.  There\nare a few diminutive pseudoaneurysms within the right kidney (for example for:\n58, 4:62, and 4:67).  There is no evidence of active extravasation.  The right\nlower quadrant renal transplant is unremarkable aside for a few hypodense\nlesions too small to characterize, as on prior.\n\nGASTROINTESTINAL: There is no bowel obstruction.  The patient is status post\ntransverse colectomy and end colostomy with a patent stoma site.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The uterus and adnexa are unremarkable.  There is no free fluid in the\npelvis.\n\nBONES: There is no aggressive osseous lesions.",
            "output": "Polycystic kidneys, as on prior.  Diminutive right renal artery aneurysms\nwithout extravasation on current 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: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere appears to be a lipoma adjacent to the right gluteus medius muscle. \nDegenerative changes are seen along the inferior L4 endplate.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of solid renal lesions bilaterally.\n2. Enlarged, fibroid uterus."
        },
        {
            "input": "LOWER CHEST:  There is eventration of the right hemidiaphragm, accounting for\napparent right lung base opacity seen on the same day radiograph.  Trace\nbilateral pleural effusions.  Small bibasilar consolidations most likely\nrepresent atelectasis.  Heart size is mildly enlarged, without pericardial\neffusion.  Coronary artery calcifications are present.\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.  Stones are noted within the gallbladder, which is otherwise\nunremarkable.\n\nPANCREAS: Pancreas is atrophic, 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 spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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: 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.  No intraperitoneal 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: Prostate gland is enlarged.\n\nLYMPH NODES:  A few mesenteric lymph nodes are present that are not\npathologically enlarged by CT size criteria (601b:26).  No retroperitoneal\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous and heavily calcified, without\nevidence of aneurysmal dilation.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Levoconvex scoliosis of the lumbar spine.  Severe multilevel\ndegenerative changes are also noted.  Large right inguinal hernia is re-\ndemonstrated, containing predominantly fat.  However, there is now simple\nfluid in the hernia (3:110) that appears new from the prior CT performed in\n___.",
            "output": "1.  No acute intra-abdominal process.  Normal appendix.\n2.  Large right inguinal hernia contains fat and fluid.  Please correlate for\nfocal pain.\n3.  Cholelithiasis.\n4.  Small hiatal hernia.\n4.  Trace bilateral pleural effusions with adjacent atelectasis."
        },
        {
            "input": "LOWER CHEST: There is minimal 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 mild intrahepatic biliary\ndilatation.  No definite extrahepatic biliary dilatation.  The gallbladder is\ncontracted and contains numerous gallstones, but is otherwise unremarkable.\n\nPANCREAS: In the region of the head/proximal body, there is an ill-defined\nhypodense mass measuring 2.4 x 1.7 cm with ill-defined, soft tissue density\nwhich appears to extend through the retroperitoneum and encases the proximal\nSMA and celiac axis (601:32).  There is severe dilatation of the pancreatic\nduct within the pancreatic tail.  Additionally, there is thickening along the\nbilateral conal fascia, left greater right.\n\nSPLEEN: 0.7 cm hypodensity in the inferior spleen (02:22) is new and is\nworrisome for metastatic disease.  The spleen shows otherwise normal size and\nattenuation throughout.\n\nADRENALS: There is mild thickening of the bilateral adrenal glands without\nfocal nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.0 cm simple cyst in the upper pole of the left kidney.  There is\nno evidence of suspicious focal renal lesions 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 wall\nthickening about the mid descending colon could be artifactual due to\ndecompression.  There is pancolonic diverticulosis without evidence of\ndiverticulitis.  The appendix is normal.\n\nPELVIS: Apparent bladder wall thickening with few small diverticula is likely\nsecondary to chronic urinary bladder outlet obstruction.  The d distal ureters\nare unremarkable.  Trace simple free fluid within the pelvis is nonspecific.\n\nREPRODUCTIVE ORGANS: The prostate is markedly enlarged and contains numerous\nhyperdense nodules.\n\nLYMPH NODES: Scattered prominent subcentimeter mesenteric lymph nodes about\nthe root of the mesentery do not meet CT size criteria for pathologic\nenlargement and are possibly reactive.  Otherwise, there is no retroperitoneal\nor mesenteric lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Multiple opacified collaterals about the porta hepatis are\nsuggestive of cavernous transformation.  The SMV is occluded as it passes in\nclose relation to the pancreatic mass, but is reconstituted distally by\nmultiple venous collaterals.  There are extensive atherosclerotic\ncalcifications with a possible small splenic artery aneurysm about the\nanterior pancreatic tail (02:25) which is stable from prior.  There is no\nabdominal aortic aneurysm.  Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a large right inguinal hernia which contains\npredominantly fat and a small amount of fluid.",
            "output": "1. 2.4 cm ill-defined hypodensity in the pancreatic head/proximal body with\nupstream pancreatic ductal dilatation and mild intrahepatic biliary ductal\ndilatation is worrisome for pancreatic malignancy.  Retroperitoneal soft\ntissue density which encases the proximal celiac axis and SMA is worrisome for\nmalignant involvement as well.  Occlusion of the SMV in close relation to this\nmass is likely chronic given its reconstitution distally by multiple venous\ncollaterals.  A probable cavernous transformation of the portal vein is\nsuggestive of chronic portal vein thrombosis.\n2. New 0.7 cm hypodensity in the inferior spleen is worrisome for metastatic\ndisease.\n3. Asymmetric wall thickening about the mid descending colon could be\nartifactual due to bowel decompression.  Attention on follow-up studies\nrecommended.\n4. Fluid within a large right fat-containing right inguinal hernia is\nnonspecific.\n5. Trace simple free fluid within the pelvis is nonspecific as well.\n6. Diverticulosis without evidence of diverticulitis.\n7. Cholelithiasis without findings of acute cholecystitis.\n8. Findings of chronic urinary bladder outlet obstruction."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. There is no pericardial or pleural\neffusion..\n\nABDOMEN:\n\nThe liver contour for the somewhat irregular, consistent with patient's known\ncirrhosis. A 1.2 cm rounded hypodensity in segment 8 of the liver is unchanged\nfrom prior (04:20). The portal venous system is patent. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nand without gallstones.  There is mild to moderate simple ascites.\nGynecomastia is noted.\n\nThe spleen is borderline enlarged measuring 13 cm. The adrenal glands are\nunremarkable. The pancreas enhances homogenously and is without focal lesions.\n\nBilateral renal calculi are again noted. On the right, the largest stone is\nlocated in the renal pelvis and measures approximately 1.3 cm (04:36),\nunchanged.  On the left, the largest stone is seen within the renal pelvis and\nmeasures 1.2 cm (04:38). Multiple additional stones the left kidney are\nessentially unchanged from prior. There is no hydronephrosis. Again seen, is\nurothelial thickening and stranding within both renal pelvises extending to\nthe proximal ureters with a similar appearance to prior. There are no focal\nrenal lesions identified. There is no hydronephrosis. There is no evidence of\nrenal injury. There is no contrast excretion into the renal pelvises\nbilaterally at the time of acquisition.\n\nThere is a small hiatal hernia. The stomach is grossly unremarkable in\nappearance. The small and large bowel are normal in caliber and without\nevidence of wall thickening. The appendix is well-visualized and normal.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches contain calcifications and are normal in course and caliber. There is\nno retroperitoneal or mesenteric lymphadenopathy by CT size criteria. There is\nno free abdominal fluid or pneumoperitoneum.  There is a small fat containing\numbilical hernia.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Mild compression deformity with a Schmorl's node at L5 is\nunchanged. No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1. Multiple bilateral nonobstructing renal calculi, similar in appearance to\n___. Bilateral urothelial thickening and stranding involving the renal\npelvises also unchanged.\n2. No evidence of acute renal injury.\n3. Cirrhotic liver with mild to moderate volume simple ascites, similar to\n___."
        },
        {
            "input": "CHEST: Aside from mild bibasilar atelectasis, the visualized lung bases are\nclear.  The heart is normal in size with no pericardial effusion. There are\nscattered coronary artery calcifications.\n\nABDOMEN: Evaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver is slightly shrunken with a hypodensity in\nhepatic segment 5, statistically likely a cyst. There is no intrahepatic\nbiliary dilatation. The gallbladder is decompressed. The pancreas is atrophic,\nwith no surrounding stranding. The spleen is mildly enlarged, measuring 12 cm.\nThe adrenal glands are normal bilaterally.  The right kidney contains a 1.4 cm\ncalcification within the renal pelvis, and there is mild peripelvic fat\nstranding, which was present on the prior study from ___. No evidence of\nhydronephrosis. The left kidney contains several calcifications, the largest\nin the renal pelvis measuring to 1.3 cm. There is no dilatation of either\nureter.\nThe mesenteries hazy with diffuse stranding and a moderate amount of free\nfluid in the pericolic gutters bilaterally, as well as in the lesser sac.\nThere is a small hiatal hernia with a small amount of free abdominal ascites.\nThe small and large bowel are normal in caliber. There is no evidence of\nobstruction or colitis.\n\nPELVIS: The urinary bladder is normal appearing. The prostate and seminal\nvesicles are unremarkable. There is no free fluid in the pelvis, or pelvic or\ninguinal lymphadenopathy..  The and are unremarkable.\n\nVESSELS: The aorta demonstrates moderate atherosclerotic calcification without\naneurysmal dilatation.\n\nOSSEOUS STRUCTURES: There is mild endplate scalloping at the superior aspect\nof the L5 vertebral body, likely secondary to a Schmorl's node. No concerning\nosseous lesion is seen.  There is a chronic appearing wedge compression\ndeformity of the T8 vertebral body, unchanged since ___.",
            "output": "1.  Bilateral renal pelvic calculi, measuring 1.4 cm on the right in 1.3 cm on\nthe left. The right renal pelvis demonstrates mild surrounding stranding,\nunchanged since ___.  No hydronephrosis. Correlate clinically and with\nlab values for pyelonephritis.\n2. Slightly shrunken liver with moderate amount of intra-abdominal ascites,\ncompatible with known history of cirrhosis."
        },
        {
            "input": "The patient is status post right sided hip hemiarthroplasty.  There has been\ninterval relocation of the right hip with the femoral head prosthesis\narticulating appropriately with the acetabulum.  No evidence of hardware\nloosening or hardware fracture.  There is mild blunting of the posterior\nacetabular rim (series 3, image 56) and a tiny osseous fragment within the\nposterior hip joint space, likely a small fracture fragment.\n\nThere is a large heterogeneous intramuscular hematoma in the gluteus medius\nand piriformis muscles, which contains small foci of air.  The hematoma\nextends into the joint space and posterior to the greater trochanter.  There\nare faint linear high densities around the periphery of the hematoma, which\nmay represent small osseous fragments versus calcifications, for example: \nSeries 3, image 69, 73, 82, and 86.  The hematoma measures approximately 6.9\nby 10.1 x 14.3 cm (AP, transverse, and CC ___.  The edema extends into\nthe presacral space.\n\nThere is diffuse osseous demineralization.  Degenerative changes are seen at\nthe bilateral sacroiliac joints, pubic symphysis, and  visualized lumbosacral\nspine.\n\nSmall bony callus along the anterior aspect of S2-3 vertebral bodies, likely\nfrom old fracture.\n\nVascular calcifications are noted.\n\nThere is colonic diverticulosis.  There is a partially visualized loop of\nsmall bowel in the anterior midline abdomen on the last axial image that\ndemonstrates nonspecific wall thickening.",
            "output": "1.   Reduction of the right hip with large posterior intramuscular and\nintraarticular hematoma.  Mild blunting of the posterior acetabular rim with\ntiny osseous fragment in the posterior hip joint, likely small acetabular\nfracture.\n\n2. No evidence of hardware loosening or periprosthetic fracture of the right\nhip hemiarthroplasty.\n\n3.  Colonic diverticulosis.\n\n4. There is a partially visualized loop of small bowel in the anterior midline\nabdomen on the last axial image that demonstrates nonspecific wall thickening\n(incompletely evaluated)."
        },
        {
            "input": "LOWER CHEST: Mild pleural based linear/wedge-shaped opacities in the lateral\nright middle lobe are likely related to atelectasis.  No evidence of pleural\neffusion.  There is trace pericardial fluid.\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: A 3.0 x 1.6 cm left adrenal nodule is stable from ___\nin keeping with benign adenoma.  There is minimal chronic thickening of the\nanterior limb of the right adrenal in keeping with adenomatous change.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:\nThe stomach is unremarkable.  There are 2 duodenal diverticula arising from\nthe descending portion.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.\n\nThere is a 5.2 x 2.1 cm region of soft tissue density abutting the right\naspect of a segment of the sigmoid colon (5:66).  No diverticula are seen. \nNotably, similar soft tissue density has been present in the pelvis, though\nseparate from the sigmoid, on multiple prior examinations, including ___ (2:96).  Given history of bilateral oophorectomy from the OMR,\nthis could be a remnant of the gonadal vein or tube versus postsurgical\nscarring.  The remainder of the colon is unremarkable.\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 as per the OMR.\n\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": "Soft tissue density abutting the sigmoid colon on the right has been present\nin variable location on prior CT studies and likely represents a postsurgical\nremnant from previous bilateral TAH/BSO.  No colonic diverticula are seen and\nthere are no findings to indicate an acute inflammatory process.  Note that\nthis interpretation differs from the wet read report.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 14:44 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nAttempts were made to contact the referring physician by pager but were\nunsuccessful."
        },
        {
            "input": "LOWER CHEST: There is bibasilar dependent 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 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. \nNo hydronephrosis.  Scattered bilateral punctate hypodensities are\nnonspecific, but statistically likely represent cysts.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable in appearance.  There is mild\ngeneralized prominence of small bowel loops, measuring up to 2.9 cm (07:37)\nwithout a transition point, likely representing postoperative ileus.  Colonic\nloops are also slightly distended containing a large amount of fluid,\nmeasuring up to 7.5 cm (07:51).\n\nPatient is status post rectosigmoidectomy for incarcerated rectal prolapse,\nperformed on ___.  There is complete or near-complete disruption of the\nrectal anastomosis, with frank spillage of stool into the mesorectal fat and\nposteriorly/superiorly into the presacral space (series 10, images 40-43,\nseries 7, image 84, 88, 79).  The anal sphincter complex is not well\nvisualized.\n\nPELVIS: Bladder is largely collapsed around a Foley catheter.\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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. POD#4 after emergent rectosigmoidectomy with large disruption of the rectal\nanastomosis, resulting in frank spillage of fecal matter into the mesorectal\nfat and extending into the presacral space.\n2. Generalized small and large bowel ileus.  No high-grade obstruction.\n\nNOTIFICATION:  The findings were discussed with the resident or PA assisting\nDr. ___ in the operating room by ___, M.D. on the telephone on\n___ at 5:03 pm, 2 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Bibasilar consolidations likely represent atelectasis. There is\nno pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The most superior aspect of the hepatic dome is not captured on\nthe current study.  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\nsurgically absent.  Portal venous system 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. \nNo hydronephrosis.  Subcentimeter hypodensities are too small to characterize,\nbut statistically likely represent cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the body of the stomach.  There\nis fluid extending proximally to the distal esophagus.  Multiple small-bowel\nloops are diffusely dilated, measuring up to 3.3 cm (5:69).  There is no clear\ntransition point, and the right hemicolon is not collapsed.  Findings may\nrepresent an ileus.  There is no evidence of pneumatosis or pneumoperitoneum.\n\nPELVIS: There is a large presacral collection measuring up to 6.0 x 4.7 cm TV\nx AP (5:75), has enlarged from 3.3 x 2.2 cm on the prior exam.  The\npre-existing catheter terminates along the superior aspect of the collection. \nPartially distended bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Nodularity in the right anterior abdominal wall likely represent\nprior injection sites (05:57).",
            "output": "1. Interval enlargement in a now 6.0 x 4.7 cm presacral collection, with the\npre-existing catheter terminating along the superior aspect of the collection.\n2. Diffusely dilated small bowel loops measuring up to 3.3 cm, without an\nabrupt transition point or distal colonic collapse.  Findings are more\nsuggestive of an adynamic ileus, rather than a mechanical obstruction."
        },
        {
            "input": "presacral collection.",
            "output": "Successful CT-guided placement of an ___ pigtail catheter into the\ncollection. Samples were sent for microbiology evaluation.\n\nRECOMMENDATION(S):  Flush with 10 cc of normal saline every 8 hours."
        },
        {
            "input": "LOWER CHEST: There is bibasilar dependent atelectasis.  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. \nPortal venous system 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: Gastrostomy tube appears appropriately positioned.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Patient is status post sigmoid colectomy with end colostomy in\nthe left lower quadrant.  Residual colonic loops demonstrate normal caliber\nand wall thickness throughout. No pneumoperitoneum or ascites.\n\nPELVIS: Urinary bladder is largely collapsed.  Air within the bladder lumen is\nlikely due to recent instrumentation.  Interval placement of a right trans\ngluteal pigtail catheter, with decompression of previously noted fluid\ncollection.  There is no significant fluid abutting the pigtail catheter tip\nthough there is persistent presacral stranding in the deep 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": "Status post drainage of a collection in the posterior pelvis.  Residual fat\nstranding in the presacral region without residual 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 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 punctate\ncortical calcification in the left lower pole kidney.  A simple cyst measuring\nup to 1.7 cm is present in the right lower pole.  There is no evidence of\nsuspicious focal renal lesions within the limitations of an unenhanced scan. \nThere is no hydronephrosis.  There is no nephrolithiasis. There is perinephric\nstranding bilaterally.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  The colon and rectum are within\nnormal limits apart from a moderate stool burden..  The appendix is not\ndefinitely visualized.\n\nPELVIS: The bladder is collapsed around a Foley catheter there is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring up to 5.7 cm in\nmaximum transverse dimension.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes measuring up to 1.1 cm in\nshort axis in the left periaortic region (02:49) are nonspecific, but may be\nreactive.  There is no mesenteric lymphadenopathy.  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 2.5 x 1.7 cm lucent lesion in the right inferior pubic bone\n(2:91).  There are additional lucent lesions in the bilateral iliac bones\nmeasuring up to 8 mm (2:63, 64) there is also a heterogeneous, lucent lesion\nin the posterolateral left ninth rib (02:13).  Multilevel lucencies adjacent\nto the vertebral endplates in the L1, L4 on L5 vertebral bodies are also\nconcerning for metastatic disease.  The largest measures up to 1.9 cm in the\nanterior inferior aspect of L5 (2:63).  There are mild degenerative changes at\nthe lumbosacral junction.\n\nSOFT TISSUES: There is a fat containing right inguinal hernia.  Soft tissue\nstranding with locules of subcutaneous air in the anterior abdominal wall may\nbe related to previous subcutaneous injection.",
            "output": "1. No evidence of hydronephrosis.\n2. Mild prostatomegaly.\n3. Prominent retroperitoneal lymph nodes measuring up to 1.1 cm in the left\npara-aortic station are nonspecific.  Comparison with prior studies is\nrecommended.\n4. Multiple lucent lesions in the pelvis, spine and left ninth rib are\nsuspicious for metastatic disease, as above.\n5. Perinephric stranding bilaterally may be in keeping with known chronic\nkidney 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.  Few\nsubcentimeter hepatic hypodensities are too small to characterize, however\nlikely represent cysts.  There is a small hypodensity in the inferior left\nhepatic lobe measuring up to 3.1 cm which appears new compared with ___, however less prominent compared with CTA chest ___ which time\nit spans up to approximately 5.1 cm, is likely due to location of a liver\nretractor during recent surgery (02:58; 601:18).  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: Patient is status post distal pancreatectomy with a small amount of\nhypodensity at the distal aspect of the remaining pancreas, not significantly\nchanged compared with CTA chest ___ and likely representing\npostsurgical change (02:52).  The remainder of the pancreas has normal\nattenuation throughout, without evidence of focal lesions or pancreatic ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.  There is a left upper quadrant\npercutaneous drain in the surgical bed, unchanged in position.  There is\nminimal residual fluid under the left hemidiaphragm, with interval resolution\nof free air seen in the surgical bed on CTA chest ___.\n\nADRENALS: The right and 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 stone in the right lower pole.  There is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A enteric tube is looped in the stomach, the tip pointing\ntowards the gastric fundus.  Contrast administered through an enteric tube\nreaches the ascending colon with no evidence of leak outside of the bowel. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Mild diverticulosis of the colon is noted, without evidence of\nwall 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 is enlarged.  Fiducials are seen adjacent to\nthe 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 is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Surgical staples overlie the midline of the anterior abdominal\nwall.  There is a small left inguinal hernia containing fat.",
            "output": "1. Resolving postsurgical changes status post splenectomy and distal\npancreatectomy.\n2. Small hypodensity in the inferior left hepatic lobe is new compared with\npreoperative CT torso ___, however less conspicuous compared with\nCTA chest ___ and is likely due to location of a liver retractor\nduring recent surgery.\n3. Oral contrast administered through an enteric tube passed to the level of\nthe ascending colon without evidence of leak outside the bowel.\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.  The heart is\nmildly enlarged.  There is severe coronary and aortic valve calcification. \nThere is no evidence of left pleural or pericardial effusion.  Trace right\npleural effusion.\n\nABDOMEN: Respiratory motion obscures detailed evaluation of the abdominal\nstructures.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Prominence of the intrahepatic biliary\nducts is similar compared to remote prior.  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 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. \nThere is no evidence of focal renal lesions within the limitation of motion. \nNo hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Evaluation is limited by motion artifact.  Patient has\nileostomy.  Again seen is a very large right abdominal wall defect containing\nmultiple loops of small and large bowel.  Within this defect, there is a\nfocally dilated single loop of bowel, favored to represent large bowel when\ncompared to anatomy better demonstrated on prior CT.  Within this defect,\nthere are also decompressed small bowel loops.  There is again seen a large\nmount of fecal loading within the excluded rectosigmoid.\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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.",
            "output": "Evaluation is significantly limited by motion artifact and patient anatomy. \nWithin a very large right abdominal wall defect, there is a focally dilated\nsingle loop of bowel, favored to represent large bowel but difficult to\ndiscern.  Within this defect, there are also decompressed small bowel loops. \nIt is unclear whether these decompressed bowel loops are upstream or\ndownstream from the focally dilated bowel loop.  Given these findings, a\ndeveloping obstruction is difficult to exclude.  A repeat CT with enteric prep\ncould be considered for further evaluation and delineation of anatomy.\n\nRECOMMENDATION(S):  A repeat CT with enteric prep could be considered for\nfurther evaluation and delineation of anatomy."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There are trace\nbilateral pleural effusions with subjacent atelectasis.  There is no evidence\nof pericardial effusion.  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 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.  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, otherwise the stomach is\nunremarkable.  There is a right lower quadrant ileostomy.  There is a large\nright anterior abdominal wall defect with a parastomal hernia containing\nbowel.  Within this hernia there is a dilated loop of bowel which measures up\nto 8.3 cm thought to represent the cecum.  There is a transition point at the\ndistal end of the dilated loop near the neck of the hernia concerning for\nobstruction (601; 25). The very distal small bowel is also collapsed.  The\noral contrast has not reached the obstructed loop.  There is surrounding edema\nand overlying skin thickening (601; 37).  There is diverticulosis of the colon\nwithout evidence of acute diverticulitis.  The colocolonic anastomosis appears\nintact.  A large amount of stool is seen within the rectum.  The appendix is\nnot visualized.\n\nPELVIS: The urinary bladder is trabeculated, likely related to chronic bladder\noutlet obstruction.  The distal ureters are unremarkable.  There is no free\nfluid 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: Degenerative changes are seen in the lumbar spine.  A T11 compression\ndeformity is new compared to the study from ___ but appears chronic.\n\nSOFT TISSUES: Large right abdominal wall defect with a parastomal hernia, as\nabove.  A left anterior abdominal wall hernia also contains bowel which does\nnot appear obstructed.",
            "output": "1. Large right abdominal wall defect/parastomal hernia which contains a\ndistended loop of bowel, likely cecum, which measures up to 8.3 cm in diameter\nwith a transition point within the hernia.  The distal small bowel is not\ndilated.  There is surrounding edema and overlying skin thickening.\n2. Trace pleural effusion with subjacent atelectasis."
        },
        {
            "input": "There has been interval sigmoid colectomy. The sigmoid anastomosis appears\nintact.  There is no free intraperitoneal air demonstrated.  Small volume of\nfree fluid is seen in the upper and mid abdomen.  There is no evidence of\nbowel obstruction.\n\nNo focal hepatic lesion is demonstrated.  The gallbladder is distended.  No\ngallbladder wall thickening or pericholecystic inflammatory changes are\ndemonstrated. The common bile duct measures 13 mm.  The pancreas and adrenals\nare unremarkable.  Bilateral cortical renal cysts are again noted. There is no\nhydronephrosis involving either kidney. The bladder is unremarkable. Normal\nappearance of the prostate gland.\n\nThere is no abscess collection demonstrated. There is atheromatous\ncalcification involving the abdominal aorta and iliac arteries.  No adenopathy\nis demonstrated.  Postsurgical changes are noted in the anterior abdominal.\n\nThere is extensive patchy consolidation in the visualized right middle and\nright lower lobe, and lingula and left lower lung, with centrilobular nodules,\nground-glass, and more confluent areas of consolidation demonstrated. There\nare no pleural effusions. No osseous lesion is demonstrated.",
            "output": "1. Patchy bilateral lung consolidation (right greater than left) is in keeping\nwith pneumonia.\n2. Small volume of free fluid in the abdomen. There is no definite anastomotic\nleakage, or abdominal abscess collection demonstrated."
        },
        {
            "input": "Lungs and Heart: The lung bases are clear bilaterally. The visualized heart\nand pericardium are normal.\n\nLiver, Gallbladder: The liver is normal in size and attenuation. No focal\nhepatic lesions are identified. The hepatic and portal veins are patent. There\nis no intra or extrahepatic biliary duct dilatation. Again seen is\nadenomyomatosis of the gallbladder fundus. The gallbladder is otherwise\nnormal.\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. A small hypodense lesion in the\nhead of the pancreas is seen and is better characterized on recent MR from\n___.\n\nKidneys, Adrenals: The adrenal glands are normal bilaterally. Again seen is a\n1.3 cm cystic lesion in the lower pole of the right kidney, which is\nconsistent with a solid mass and was characterized on prior MR from ___.  There is no hydronephrosis.\n\nBowel: The small bowel is grossly normal. The patient is status post sigmoid\ncolectomy with surgical material seen in the pelvis. There is diverticulosis\nof the large bowel with no evidence of diverticulitis. There is no free air or\nfree fluid seen in the abdomen.\n\nVessels: There is moderate calcified atherosclerosis of the abdominal aorta.\nThe aorta is not aneurysmal in its major branches appear patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The bladder is normal. There is no pelvic sidewall lymphadenopathy. \nThe rectum is normal appearing. Again, surgical material is seen in the\npelvis.\n\nOsseous Structures: There are no suspicious lytic or blastic lesions seen in\nthe visualized osseous structures.",
            "output": "No acute intra-abdominal process. No free air or free fluid seen in the\nabdomen.\n\nA 1.3 cm solid renal mass is again seen."
        },
        {
            "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 nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\nAdenomyomatosis of the gallbladder fundus is again seen.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.  The hypodense lesion in the pancreatic head is better\ncharacterized on MR from ___.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no hydronephrosis. The 1.3 cystic lesion in the right\nkidney is unchanged, better characterized on MR from ___.\n\nGI:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The patient is status post sigmoid colectomy, with the\nexpected postsurgical changes and surgical material within the left lower\nquadrant and pelvis. The remaining small and large bowel is within normal\nlimits, without wall thickening or evidence of obstruction. Oral contrast\npasses to the level of the hepatic flexure.A normal, air-filled appendix is\nvisualized.\n\nRETROPERITONEUM: The aorta is normal in caliber, with moderate atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. No acute intra-abdominal abnormality to explain the patient's pain.\n2. Unchanged known 1.3 cm right renal mass."
        },
        {
            "input": "LOWER CHEST: Bilateral lower lobe atelectasis.  Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\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 has focal 1 cm fundal 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.  There is no\nperinephric abnormality.  2 right renal arteries.\n\nGASTROINTESTINAL: Gastrostomy tube in place.  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 collapsed on a Foley catheter.  Trace of\npresacral 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative lower lumbar spine with grade 1 retrolisthesis of L5 on\nS1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Small\nuncomplicated inguinal hernias.",
            "output": "1. No acute intra-abdominal process.  No signs of intra-abdominal infection.\n2. 10 mm focal thickening of the fundus of the gallbladder wall.\n3. Please refer to separate chest CT done the same day for thoracic findings.\n\nRECOMMENDATION(S):  Non emergent abdominal ultrasound to better characterize\nthe gallbladder focal thickening."
        },
        {
            "input": "LOWER CHEST: A 6 mm nodule seen in the right lower lobe (2:6).  The heart is\nenlarged.  Dense coronary artery calcifications are noted.  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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.  Evaluation for renal infarction is limited without intravenous\ncontrast.\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 or fat stranding. The\nappendix is not visualized.\n\nPELVIS: Evaluation the pelvis is limited by streak artifact from bilateral hip\narthroplasties.  Within this limitation the urinary bladder and distal ureters\nare unremarkable.  There is no large volume of free fluid in the pelvis. \nThere is no visualized pelvic adenopathy.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: A prominent pericaval lymph node measures 9 mm, unchanged\ncompared to prior.  There is no mesenteric lymphadenopathy.  There is no\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Bilateral hip\narthroplasties are noted.\n\nSOFT TISSUES: A supraumbilical and umbilical hernias containing fat are noted.",
            "output": "1. No acute intra-abdominal abnormality.  Evaluation for renal infarct is\nlimited without intravenous contrast.\n2. 6 mm pulmonary nodule, follow-up is recommended per the ___ criteria\nas detailed below.\n\nRECOMMENDATION(S):\n For incidentally detected nodules measuring 6 to 8mm in the setting of an\nincomplete chest CT, follow-up with a complete chest CT in 3 to 12 months is\nrecommended, depending on clinical risk.\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.  The heart is\nmildly enlarged.  There 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 no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach slightly distended with material.  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.   Moderate fecal load is demonstrated in the\ncolon.\n\nPELVIS: Evaluation through lower pelvis is limited due to streak artifact from\nbilateral hip arthroplasties.  The urinary bladder and distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No gross abnormality allowing for limitations due to\nstreak artifact.\n\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 patient is status post bilateral total hip arthroplasties without\nCT evidence of hardware complication.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is mild diastasis of the rectus muscles at the abdominal\nmidline.  Mild body wall edema is present.",
            "output": "No acute findings to account for pain.  Small incidental findings as stated\nabove.  Mild cardiomegaly."
        },
        {
            "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN AND 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 is within normal limits.\n\nPancreas: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSpleen: The spleen shows normal size and attenuation throughout, 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 with normal nephrogram.\nThere is no evidence of hydronephrosis.  Multiple bilateral hypodense nodules\nare noted in the kidneys, the largest measuring up to 2.1 cm in the left mid\nthird (05:43) with thin septations.  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 not visualized.  The rectum 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: There are 2 large defect in the peritoneum along the anterior\nmidline abdominal wall, the separate umbilicus 1 with insinuation of small\nenlarged bowel segments with a transverse gap of 10.8 cm, with 10.3 cm\nextension, in the infra umbilicus cap with insinuation of small-bowel loops\nwith a transverse gap of 6.7 cm, with 4.5 cm extension.  Please note there is\na small bowel loop transitioning from the supraumbilical hernia into the in\nfrom umbilical hernia that is significantly narrowed (08:46) with proximal and\ndistal dilation of the loop.  These feature is also noted in other too small\nbowel loops insinuating from within the pelvis into the infra umbilicus hernia\n(08:49 and 43).",
            "output": "1. Two large anterior abdominal wall hernias with insinuation of small and\nlarge bowel with no evidence of distress.  Please note that the infraumbilical\nhernia has a very narrow gap and is associated with narrowing of the\ninsinuating small-bowel loops with proximal and distal dilation.\n2. Minimally complex left renal cyst for which renal MRI is recommended for\nfurther assessment.\n3. No evidence of infection within 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.  A\nsubcentimeter hypodensity within the left hepatic lobe was previously\ncharacterized as a cyst on MRCP.   There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder appears decompressed. \nThickening of the gallbladder wall is felt to relate to related to third\nspacing.  Intra-abdominal ascites is small-to-moderate in volume.\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 peripheral wedge-shaped areas of hypodensity are seen within\nthe spleen, consistent with prior infarcts, and similar in appearance to\nrecent MRCP from ___.  Fluid surrounding the spleen measures\nsimple density.  There has been interval decrease in size of the spleen, which\nnow measures 12.2 cm, previously 15.3 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. \nA 1.8 x 1.7 cm cyst in the interpolar region of the right kidney is unchanged.\nThere is no evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Note is made of a small a\nduodenum diverticulum.  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 pelvic free fluid.\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.  A circumaortic left renal vein is incidentally noted (series 5,\nimage 72, 60).\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 mild\nanasarca.",
            "output": "1. Multiple splenic infarcts and appear similar to the MRCP from ___.  The spleen has slightly decreased in size over this interval.\n2. New mild simple abdominal ascites.\n3. Please see separate chest CT report for details of the intrathoracic\nfindings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 5:36 ___, approximately 120 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild atelectasis in the left lung base. Otherwise the visualized\nlung fields are clear.  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 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 hydronephrosis.  Bilateral renal cysts appear simple\nmeasuring 1.4 cm on the right and 1.9 cm on the left.  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 contain fluid compatible with reported history of diarrhea. The\nappendix 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: A left periaortic lymph node is borderline measuring 10 mm in\nshort axis (02:43) no mesenteric, pelvic, or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 inflammatory bowel disease or acute inflammation.\n2. Findings compatible with diarrhea.\n3. Borderline left periaortic lymph node, nonspecific."
        },
        {
            "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 large hiatal hernia.\n\nABDOMEN:  Evaluation of the intra-abdominal organs is limited without\nintravenous contrast. The unenhanced liver is unremarkable. Dilation of the\ncommon duct to 10 mm is within the range commonly seen after cholecystectomy\nas the gallbladder is surgically absent. The spleen is not enlarged and is\nunremarkable. The unenhanced pancreas and bilateral adrenal glands are\nunremarkable. There is no hydronephrosis or renal stone. A 2.2 cm simple cyst\nis seen in the right renal upper pole as noted on MRI ___.\n\nThe small and large bowel are normal in course and caliber without\nobstruction. The retrocecal appendix is visualized and is normal (601b: 43).\nThere is no free fluid and no free air. The abdominal aorta is normal in\ncaliber with moderate atherosclerotic calcifications along its course.  Tiny\natherosclerotic calcification is seen at the origin of the SMA, but further\nevaluation of the lumen is limited without intravenous contrast. No enlarged\nretroperitoneal or mesenteric lymph nodes are identified.\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 unenhanced uterus is grossly unremarkable. No adnexal abnormality\nis identified.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  Moderate degenerative change is seen in the thoracolumbar spine with\nminimal anterolisthesis of L4 on L5. Patient is status post median sternotomy.\nA tiny umbilical hernia contains fat..",
            "output": "1. No acute intra-abdominal abnormality. No evidence of malignancy in the\nabdomen or pelvis within the limits of this noncontrast examination.\n2. Large 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 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 hydronephrosis.  The previously noted 2 cm exophytic\nleft interpolar renal lesion has decreased in size measuring today 1.6 x 1.1\ncm (2.0 x 1.6 cm previously).  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a gastrostomy tube .  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 contains a 5 mm (series 2, image 119) calcified\nfocus bordering the right lateral wall, which seem to have been present\npreviously, but is now seen more distant from the bladder wall, and could be\nconcerning for a soft tissue lesion that only partly calcified.  This could be\nreassessed with ultrasound.  The distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Mesenteric nodes are much smaller than on prior study, for\ninstance a previously noted measuring 26 x 24 mm is not seen today.  Today,\nthe largest mesenteric lymph node measures 11 mm in its greatest dimension. \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 now sclerosis of L2, with pathological fracture involving its\nsuperior endplate.  There is also sclerosis of the intertrochanteric region of\nthe left femur, spanning on a distance of at least 34 x 29 mm while previously\nonly a small lytic focus measuring 11 mm was noted.\n\nSOFT TISSUES: The previously described subcutaneous soft tissue nodules are\nsmaller, for instance on the left flank a nodule measuring 20 x 16 mm now\nmeasures 11 x 8 mm.  The largest subcutaneous nodule measures 24 mm compared\nwith 32 mm previously (series 2, image 92).",
            "output": "1. Significant improvement of the metastatic disease presumed to be involving\nthe left kidney, the subcutaneous tissue, and the mesentery.\n2. Sclerotic changes involving L2 associated with a pathological fracture. \nDiffuse sclerosis involving the intertrochanteric region of the left femur,\nthese are likely due to treatment response.  Correlation with pain at these\nsites.\n3. Calcification bordering the right bladder wall, concerning for underlying\nsoft tissue lesion or metastasis, which could be reassessed with bladder\nultrasound.\n\nRECOMMENDATION(S):  Bladder ultrasound."
        },
        {
            "input": "LOWER CHEST: Please refer to concurrently performed CT chest for full report\nof the intrathoracic findings.\n\nABDOMEN:  A subtle 12 mm hypodensity is noted within segment 4 B on series 2,\nimage 25 which is new from prior and concerning for a site of metastatic\ndisease.  The spleen is unremarkable.  The pancreas, gallbladder and adrenals\nare normal.  There is a crescentic hyperdense left perinephric collection\nconsistent with a subcapsular hematoma which measures up to 16 mm in maximal\nthickness there is associated left perinephric stranding likely representing a\ncomponent of RP hematoma.  A tiny stone in the right kidney is noted without\nhydronephrosis or definite abnormality on this unenhanced exam.  The abdominal\naorta is normal in course and caliber.  No retroperitoneal lymphadenopathy. \nThe stomach and duodenum appear 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\nappendicitis.  The colon is normal.  Urinary bladder is decompressed a tiny\ncalcific density in the urinary bladder may represent a small stone.  No\npelvic free fluid.\n\n  A nodule seen adjacent to the liver on series 601, image 21 measures 14 x 20\nmm and is increased from prior concerning for a metastatic lesion.  Several\nsmall nodular lesions for instance on series 2, image 31 in the left upper\nabdomen measuring 10 x 7 mm, in the mid abdomen on series 2, image 37\nmeasuring 8 x 12 mm could represent sites of metastatic disease and attention\non follow-up is advised.\n\nBONES: A sclerotic lesion is again seen involving the L2 vertebral body which\nremains concerning for metastatic disease without evidence of pathologic\nfracture.\n\nSOFT TISSUES: There is a mass in the anterior abdominal wall measuring 2.5 x\n3.1 cm which is increased from prior and concerning for disease progression. \nAdditional smaller nodules in the anterior abdominal wall, for example on\nseries 2 image 12 on the left measuring up to 9 mm, series 2, image 15 in the\nanterior abdominal wall measuring 5 mm and series 2, image 33 in the left\nanterior abdominal wall measuring up to 8 mm appear increased from prior and\nare concerning for sites of metastasis.",
            "output": "1.  Left renal subcapsular hematoma with retroperitoneal component.\n2.  Evidence of disease progression with worsening burden of disease in the\nlungs, increased size of soft tissue nodules including nodules in the anterior\nbody wall, and new segment 4 liver hypodensity.  Please refer to separately\ndictated chest CT for further details.\n3.  Tiny calcific hyperdensity within the urinary bladder, please correlate\nfor possibility of recently passed stone.\n\nNOTIFICATION:  The findings were discussed by Dr. ___  with Dr. ___ on\n___ at 12:00 Pm, 1 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Small right pneumothorax and small right pleural effusion. \nNumerous pulmonary nodules bilaterally, the largest in the right middle lobe\nmeasuring up to 1 cm (series 2, image 2).  Irregular bilateral densities at\nthe lung bases, greater on the left compared to the right, appear slightly\nenlarged since the prior study.  Again noted is hyperdense curvilinear suture\nmaterial in the right lower lobe.  The imaged heart is unremarkable.  There is\nno pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Small hyperdense foci are again demonstrated in the posterior\nright hepatic lobe (series 2, image 23).  Otherwise, 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 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 right renal cortex is thickened and diffusely heterogeneous with\nhyperdense material (series 2, image 38/series 4, image 37), concerning for\nnecrosis with hemorrhage with a new right perirenal hematoma.  This associated\nwith perinephric stranding and trace fluid along the inferior pole of the\nright kidney.\nThe left kidney again demonstrates a crescentic hyperdensity along the lateral\ncortex, compatible with findings on prior ultrasound and CT, compatible with a\nperirenal hematoma (series 2, image 34/series 4, image 31).  There is also\nassociated perirenal stranding and trace fluid along the lower pole.\nThere is no hydronephrosis bilaterally.  There is contrast material, likely\nfrom the head MRI, within the left renal pelvis.\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.  Stranding\nextending from the perirenal space and inferiorly to the level of the pelvis,\ngreater on the left compared to the right.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent retroperitoneal and mesenteric lymph nodes, not meeting\nCT criteria for lymphadenopathy.    There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Redemonstration of pathologic fracture in the vertebral body of L2.\nSclerosis involving the intertrochanteric femurs, greater on the left compared\nto the right are noted.\n\nSOFT TISSUES: 2.8 cm subcutaneus round density along the anterior abdominal\nwall at the level of the pelvis appears slightly increased (series 2, image\n64).  There is associated stranding the abdominal and pelvic wall is within\nnormal limits.",
            "output": "1.  Diffuse right renal heterogeneity with hyperdense material, which is\nconcerning for possible hemorrhage and/or infarction with new perirenal\nhematoma.\n2.  Crescentic hyperdensity along the left kidney compatible with perirenal\nhematoma, as seen on prior CT and ultrasound and not significantly increased.\n3.  Small right pneumothorax with multiple nodules and bibasilar densities,\noverall similar to the prior study.\n4.  Redemonstration of pathologic fracture involving the vertebral body of L2.\n\nRECOMMENDATION(S):  Short term follow-up CT abdomen and pelvis for evaluation\nof interval changes in renal in hemorrhage/hematomas.\n\nNOTIFICATION:  A the findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:09 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Innumerable bilateral pulmonary nodules are grossly stable from\nyesterday but have progressed significantly from ___.  Right\npneumothorax is again noted, incompletely evaluated on this study but\nappearing slightly improved at the level of the lung base.  There is mild\nbibasal atelectasis.  Right lower lobe sutures are noted.  There are numerous\nsmall soft tissue nodules in the mediastinal fat, stable from yesterday but\nincreased from ___ in keeping with metastases.  Small right pleural\neffusion is stable.  No evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation.  A 1.9 cm lesion\nin segment 4B (05:27) is grossly similar to unenhanced CT from yesterday but\nwas not visible on enhanced CT from ___ suggesting rapid progression\nor hemorrhage.  A 1.8 cm lesion in segment 8 (05:17) was likely present on\nprior study though not well-defined, but was also not visible on ___. A punctate hypodensity in segment 2 (05:20) could be a new lesion versus\nartifact.  No biliary dilation.  The gallbladder is within normal limits.\n\nPANCREAS: 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 at 13.9 cm, unchanged from recent prior\nstudies.  The parenchyma enhances homogeneously with no evidence of focal\nlesion.\n\nADRENALS: Normal bilaterally.\n\nURINARY: Diffuse bilateral perinephric hematoma is grossly stable from CT\nyesterday.  There is stable mild pararenal/retroperitoneal stranding.  There\nare innumerable small subcentimeter cortical hypodensities bilaterally.  Some\nappear linear/wedge-shaped and may represent infarct, but many appear rounded,\nraising the possibility of rapidly progressive or hemorrhagic metastatic\ndisease.  There is no hydronephrosis or dominant intrarenal 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\nThere are numerous subcentimeter intraperitoneal nodules, increased in size\nand number from ___ (examples 5:37, 39, 61, 65).  Other nodules are\nstable.  These are likely metastases.  There is no ascites.\n\nPELVIS: There is slightly increased presacral hematoma, likely related to\nredistribution of retroperitoneal blood products.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Rounded mesenteric nodules measuring up to 1.0 cm (05:33) could\nrepresent lymph nodes or intraperitoneal metastases.  These have not changed\nsignificantly.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is no contrast\nextravasation to suggest active bleeding.\n\nBONES: L2 vertebral body metastasis with associated pathologic fracture is\nstable.  A 7 mm round lytic lesion in the left femoral intertrochanteric\nregion (07:41) is stable from ___ and demonstrates increased\nperipheral sclerosis, likely reflecting post treatment change.  No new osseous\nmetastases identified.\n\nSOFT TISSUES: A 2.7 x 2.3 cm soft tissue nodule in the right anterior\nabdominal wall (5:67) has increased from 2.4 x 1.7 cm on ___ and now\ncontains a central hypodense component, likely reflecting interval hemorrhage.\nMultiple additional smaller subcutaneous nodules throughout the abdominal and\npelvic wall are mostly stable.  A few new lesions are noted (examples 5: 48,\n50, 51).",
            "output": "1. Bilateral perinephric hematoma is stable from CT yesterday.\n2. Extensive new cortical hypoattenuating lesions compared with prior enhanced\nCT ___ are favored to predominantly represent rapidly progressive or\nhemorrhagic metastases.\n3. Short interval enlargement of pulmonary, mediastinal, intraperitoneal and\nsubcutaneous soft tissue nodules, as well as liver lesions, in keeping with\nmetastases.  The largest anterior subcutaneous nodule contains a hemorrhagic\ncomponent first seen ___.\n4. Right pneumothorax and pleural effusion again noted."
        },
        {
            "input": "LOWER 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\nslightly decreased in comparison to the spleen compatible with mild steatosis.\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: There is splenomegaly measuring up to 13.8 cm in greatest dimension on\ncoronal image, (series 7 image 22).  The spleen demonstrates homogeneous\nattenuation throughout, without evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The interpolar region of the left kidney is a 17 mm\nwell-circumscribed exophytic lesion demonstrates a density of 75 Hounsfield\nunits, (series 7 image 44).  The kidneys are of normal and symmetric size with\nnormal nephrogram.  There is no hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Stomach is partially distended with\noral contrast and 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 prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy.  There are few\nsubcentimeter mesenteric lymph nodes that do not meet CT criteria for\nlymphadenopathy, (series 4, image 96).  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\nfracture.Small L2 vertebral body hemangioma.\n\nSOFT TISSUES: There is scattered fat stranding at the anterior abdominal wall\nand soft tissues overlying the gluteal muscles which represent sequela prior\ninjection.  Hyperdensities within the soft tissues overlying the right gluteal\nmuscles represent gluteal injection granulomas, (series 4 image 105).",
            "output": "1. Solid-appearing left renal lesion may represent primary renal cell\ncarcinoma or metastasis (a hemorrhagic cyst is considered less likely given\nreported history of new hemorrhagic brain masses).  Further evaluation with\nMRI of the abdomen with and without intravenous contrast (renal protocol) is\nrecommended.\n2. Mild hepatic steatosis and splenomegaly.\n3. Multiple soft tissue nodules in the anterior abdomen and in the gluteal\nregions bilaterally could be sequela of injection granulomas or cellulitis. \nCorrelate with patient history.\n4. Please refer to same-day CT chest for detailed report of intrathoracic\nfindings.\n\nRECOMMENDATION(S):  MRI of the abdomen with and without intravenous contrast\n(renal protocol).\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:32 pm, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "Non-contrast scan is limited in detecting vascular and solid parenchymal organ\nabnormalities.\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 and\nis borderline fatty.  There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis again not visualized and appears surgically absent.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There are two small accessory spleens.\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: Multiple sub cm hypodensities in the kidneys bilaterally which likely\nrepresent renal cysts which are too small to characterize. There are\ninnumerable calcifications within the renal pelvis consistent with renal\nstones. The largest renal stone measures 7 mm.\n\nGASTROINTESTINAL:  The patient is status post gastric bypass. The small and\nlarge bowel are normal in course and caliber without obstruction. Colon and\nrectum are within normal limits. Appendix contains air, has normal caliber\nwithout 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:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\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. Uterus and adnexae grossly unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.  There is no\nevidence of hernia. There are multiple phleboliths within the pelvis.",
            "output": "1.  There is no evidence of hernia.  There are no pathologic findings on this\nexamination to explain the patient's symptoms.\n\n2.  There are multiple renal stones redemonstrated within the renal pelvis.\nThe largest measures 7 mm in diameter in the anterior portion of the midpole."
        },
        {
            "input": "LOWER 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. \nPortal venous system 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: Spleen is enlarged, measuring up to 20.9 cm (7b:40).  No focal splenic\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. \nNo hydronephrosis.  There is a subcentimeter hypodensity in the lower pole of\nthe right kidney (5:76), and additional subcentimeter hypodensity in the\ninterpolar region of the left kidney (5:73) that are 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.  Normal appendix.  No ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears small.  There is a 6.6 x 6.1 cm\npartially calcified and centrally hypodense mass along the posterior uterus,\nlikely representing a necrotic fibroid (5:111).  There is a hypodense right\nadnexal lesion that measures 1.6 x 1.5 cm (5:106), which appears stable from\n___, and likely represents a cyst.\n\nLYMPH NODES:  There is a portal caval node measuring up to 13 mm (5:60). \nSlightly more inferiorly, there is another enlarged peripancreatic lymph node\nmeasuring 2.5 x 2.0 cm (5:64).  There are multiple subcentimeter\nretroperitoneal lymph nodes, measuring up to 9 mm in the aortocaval station\n(5:70).  No pathologically enlarged mesenteric lymph nodes by CT size\ncriteria.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.  Left femoral popliteal bypass graft is partially imaged.\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. Enlarged portacaval and peripancreatic lymph nodes, consistent with\npatient's known lymphoma.  Multiple retroperitoneal lymph nodes are\nsubcentimeter in size, measuring up to 9 mm in the aortocaval station.  No\nenlarged pelvic sidewall or inguinal lymph nodes by CT size criteria.\n2. Marked splenomegaly.\n3. Partially necrotic and calcified fibroid measuring 6.6 x 6.1 cm.\n4. 1.6 x 1.5 cm hypodense right adnexal lesion likely an ovarian cyst, stable\nfrom ___.  Recommend follow-up with pelvic ultrasound in ___ year.\n\nRECOMMENDATION(S):  Pelvic ultrasound in ___ year for follow-up of the right\nadnexal lesion."
        },
        {
            "input": "LOWER CHEST: Left lower lobe opacity, likely atelectasis.  No pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is intrahepatic pneumobilia.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 a punctate calcification in the left kidney\ninterpolar region which likely represents non-obstructing stone  there is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Markedly distended stomach contains a enteric tube.  The\nsmall bowel is distended up to 4.4 cm from the duodenum to the mid ileum with\na transition point in the pelvis (2; 69) the distal ileum and large bowel are\ndecompressed.\n\nPELVIS: There is circumferential emphysema in the bladder wall.  No apparent\nfistula between the bowel and bladder.  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.  Moderate to extensive\natherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Sternotomy wires\nare partially visualized\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. High-grade small-bowel obstruction with transition point in the mid ileum\nin the pelvis.\n2. Circumferential emphysema in the bladder wall, in keeping with\nemphysematous cystitis.  No apparent fistula to the bowel.\n3. Extensive intrahepatic pneumobilia.  Correlation with patient's history of\nprior sphincterotomy recommend.\n4. Left lower lobe opacity, likely atelectasis.\n5. Punctate, nonobstructive left renal stone.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by\n___ and ___ m.D. in person on ___ at 3:45pm,\nat the time of discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Left lower lobe opacities read demonstrated may represent\natelectasis however superimposed pneumonia can not be 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 decreased pneumobilia compared to prior examination with air\nvisualized in the common bile duct.  The gallbladder is surgically absent.\n\nPANCREAS: Pancreatic body and tail is not visualized.  Calcifications are seen\nin the head of the atrophic pancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Redemonstrated\npunctate calcification in the mid pole of the left kidney likely represents a\nstone.  There is no hydronephrosis bilaterally hypodensity in the midpole of\nthe right kidney likely represents a cyst (series 2, image 41).\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Previously seen dilated loops of small bowel has resolved. \nSuture material in the bowel loops of the anterior mid abdomen are consistent\nwith recent small bowel resection.  There is mesenteric edema.  Viability the\nbowel wall can not be assessed due to lack of contrast enhancement.  There is\ndiverticulosis without diverticulitis.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter.  There is\nair in the bladder dome, decreased compared to prior.  Previously seen\nemphysematous bladder wall has resolved.  There is a small amount of 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen in the anterior abdominal wall.",
            "output": "1. Previously seen emphysematous bladder wall has resolved.  Residual air\nwithin the bladder dome.\n2. Status post small bowel resection with postsurgical changes identified. \nViability of bowel wall can not be assessed without contrast administration."
        },
        {
            "input": "LOWER 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.  A stone is seen within the gallbladder,\nwhich is not abnormally distended.  Gallbladder wall edema may be due to third\nspacing or possibly underlying liver disease.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN:  The superior most aspect of the spleen is not captured on the current\nstudy.  Visualized portions of spleen demonstrate homogeneous attenuation\nthroughout, 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 a 2.0 cm simple cyst arising from the upper pole of the right kidney.\nSeveral additional sub-centimeter hypodensities scattered throughout both\nkidneys are too small to characterize, but statistically likely also represent\ncysts.  No enhancing parenchymal masses, nephrolithiasis or hydronephrosis. \nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a moderately-sized hiatal hernia.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThere is an umbilical hernia containing a loop of small bowel (3B: 292).  The\nhernia neck measures 1.5 cm.  No evidence of bowel ischemia.\n\nThere is extensive colonic diverticulosis, without evidence of diverticulitis.\nPooling of contrast is seen within the descending colon (3a: 88), consistent\nwith a focus of extravasation.  No other foci concerning intraluminal\nextravasation.  No free air or free fluid within the peritoneal cavity.\n\nVASCULAR:  The celiac axis, superior mesenteric artery, bilateral renal\narteries and inferior mesenteric arteries are calcified at there are origins,\nbut remain patent.  Abdominal aorta is also heavily calcified.  The infrarenal\nabdominal aortic aneurysm is stable from ___, currently measuring 4.3\ncm in greatest transverse dimension (601b:62).  Bilateral iliac branches are\nheavily calcified, without aneurysmal dilation.  The bilateral superficial\nfemoral arteries are thrombosed shortly after their origins, also unchanged.\n\nRETROPERITONEUM:  There are scattered retroperitoneal lymph nodes, measuring\nup to 1 cm in short axis (3B: 241), likely reactive.  No mesenteric, pelvic\nsidewall or inguinal lymphadenopathy by CT size criteria.\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: Bladder is mildly enlarged and contains calcifications.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere multilevel degenerative changes are noted within the lumbar spine. \nThere is minimal retrolisthesis of L5 on S1.\n\nSOFT TISSUES: Umbilical hernia as described above.  Abdominal and pelvic wall\nis otherwise unremarkable.",
            "output": "1. Focus of active extravasation within a portion of descending colon, likely\na diverticular bleed.\n2. Background extensive diverticulosis, without evidence of acute\ndiverticulitis.\n3. Cholelithiasis, without evidence of acute cholecystitis.  Gallbladder wall\nedema may represent third spacing.\n4. Umbilical hernia containing a non-obstructed loop of small bowel through a\n1.5 cm defect.\n5. Moderately-sized hiatal hernia.\n6. Stable size of 4.3 cm infrarenal abdominal aortic aneurysm.\n7. Chronic thrombosis of the bilateral superficial femoral arteries."
        },
        {
            "input": "LOWER 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 some central periportal edema which\nmay represent fluid overload.  There is also mild intrahepatic biliary\ndilatation.  Extrahepatic biliary dilatation. The gallbladder is within normal\nlimits.\n\nPANCREAS: The patient is status post prior abdominal procedure with atrophy of\nthe remnant pancreas.  There is an unchanged coarse rounded hyperdensity at\nthe pancreatic tail likely representing calcifications from prior chronic\npancreatitis.  The pancreatic duct is demonstrated interval increase in size\nup to 6 mm, previously measured 2 mm on most recent prior dated ___. \nThe short interval pancreatic duct dilatation may be due to an underlying\nstricture.  There is no peripancreatic stranding.\n\nSPLEEN: The patient is status post splenic resection.\n\nADRENALS: The right 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 hypodensities of the bilateral kidneys,\nsome too small to characterize on CT but statistically likely renal cysts. \nThe largest left parapelvic cyst measures 27 mm, (series 5, image 76).  No\nevidence of hydronephrosis.  There is no perinephric abnormality. \nIncidentally noted is a 6 mm homogeneous the enhancing soft tissue nodule\nposterior to this stomach and anterior to superior pole of left kidney which\nlikely represents accessory splenic tissue, unchanged when compared to study\ndated ___.\n\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 a large stool burden in the colon. \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 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.  No evidence of metastatic disease in the abdomen or pelvis.\n2. Short interval dilatation of the main pancreatic duct is concerning for\npossible ampullary stricture.\n3. Stable postsurgical changes   with coarse calcification in the pancreatic\ntail, unchanged when compared to most recent prior.\n4. Please refer to same-day CT chest for detailed report of intrathoracic\nfindings.\n\nRECOMMENDATION(S):  Follow-up MRCP is recommended to determine the etiology of\nthe  interval main pancreatic duct dilatation.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:41 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "LOWER CHEST: There is a chronic consolidation at the right lung base with\nassociated bronchial wall thickening and endoluminal debris.  Moderate\ncentrilobular emphysema is also noted at the lung bases.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is evidence of the small peripherally enhancing lesion in segment ___\n(2:9) measuring approximately 9 mm.  This was not identified on prior exam. \nAdditional tiny subcentimeter hypodensity in segment five (02:17) is\nincompletely characterized though is new since last month's exam.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Pneumobilia is\nagain noted, as seen on remote prior exam.  The gallbladder is not visualized.\n\nPANCREAS: Per ___ medical record, patient is status post Whipple\nprocedure.  The duodenum is intact.  There is soft tissue in the region of the\npancreatic head, potentially related to postoperative changes, potentially a\npancreatiojejunostomy with what appears to be a bowel loop in the region of\nthe pancreatic head best seen on coronal image (601:26).  High-density\nmaterial in this region could be postoperative in nature.  If no history of\npancreaticojejunostomy, alternatively, this could represent an underlying\npancreatic head mass measuring approximately 3.4 x 2.8 cm (02:21).  There is\nan adjacent subcentimeter lymph node (02:26).  The remaining pancreatic\nparenchyma is atrophic with coarse calcification noted at the tail. \nPancreatic duct measures up to 4 mm on today's exam.\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. \nThere is no evidence of focal suspicious renal lesions or hydronephrosis. \nBilateral renal hypodensities are too small to characterize but likely cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a heterogeneous approximately 5.1 x 3.4 cm lesion\nalong the greater curvature of the stomach, along the undersurface of the\nliver (2:9).  It demonstrates heterogeneous attenuation with probable\nhyperenhancement.  It is uncertain if this is exophytic arriving from the\nliver or within the omentum or less likely stomach.  This structure is\nunchanged dating back to ___ though has enlarged since prior MRI in\n___ when it measured approximately 1.2 x 2.6 cm.   The stomach is otherwise\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon demonstrates moderate stool burden those\notherwise unremarkable.  The appendix is not identified.\n\nPELVIS: The urinary bladder is distended.  The distal ureters are\nunremarkable.  There is no free 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.  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 ill-defined relatively hypodense structure at the pancreatic head\nwith ___ of adjacent fat planes.  In light of patient's reported\npancreatic surgery, this could represent a pancreaticojejunostomy (as opposed\nto a Whipple procedure).  Please note that an underlying pancreatic head mass\nwould be possible, especially if patient has not had this procedure.  Given\nrelative ___ of adjacent fat planes, component of acute pancreatitis\ncould also be considered.\n2. Subcentimeter peripherally enhancing lesion in the liver which is new since\nlast month's exam.  This could represent a small abscess.  Additional\nhypodense lesion in segment five is incompletely characterized though is new\nsince last month's exam as well.  If the lesion at the pancreatic head turns\nout to be malignancy, metastatic disease in the liver would be an alternative\nexplanation.\n3. Heterogeneously enhancing lesion seen adjacent to the liver and stomach,\nthe exact origin of which is uncertain.  It could potentially represent an\nexophytic hepatic lesion.  This incompletely characterized lesion has shown\nslow interval growth since ___.\n4. Sequela of chronic pancreatitis.\n5. Chronic changes the right lung base medially.\n\nRECOMMENDATION(S):  MRCP with contrast is suggested to further evaluate the\nliver and pancreas, including the lesion which may be exophytic from the\nliver.\n\nNOTIFICATION:  Updated findings of impression points 1 and 2 and\nrecommendation were discussed by Dr. ___ with Dr. ___ at 10:45 on\n___."
        },
        {
            "input": "LOWER CHEST: Severe emphysema is again noted in the lower lungs with similar\npattern of chronic consolidation in the right lower lobe with associated\nbronchiectasis concerning for atypical infection.\n\nABDOMEN:\n\nHEPATOBILIARY: There are numerous hypodense liver lesions with subtle\nperipheral enhancement consistent with sites of known metastatic disease. \nThese appear increased in overall size and number when compared with CT dated\n___.  For example in the hepatic dome the dominant lesion measures\n16 mm, previously 9 mm (02:14).  The main portal vein is patent. No intra or\nextrahepatic biliary dilatation.  Gallbladder is not visualized. No\nperihepatic ascites.  No definite pneumobilia.\n\nPANCREAS: There is a 4.0 x 3.6 cm mass in the region of the pancreatic head,\ndifficult to accurately measure but appears marginally increased in size when\ncompared with recent prior MRCP (02:25).  Atrophic pancreatic parenchyma is\nnoted with calcifications in the pancreatic tail.  No definite main ductal\ndilatation is noted.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Scattered\ncortical hypodensities are too small to characterize.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is no small bowel obstruction.  Moderate colonic fecal\nburden.  Colon and rectum otherwise within normal limits.  The appendix is not\ndefinitively visualized due to a paucity of intra-abdominal fat but no\nsecondary signs of appendicitis are seen.  A heterogeneous mass in the\nanterior left abdomen measures 5.3 x 2.4 cm in axial dimension, similar to ___ (2:8).  It is unclear if this mass arises from the left hepatic\nlobe or from the gastric wall.\n\nPELVIS: 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.  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. Pancreatic head lesion appears marginally increased in size.  Multiple\nhepatic metastatic lesions appear slightly increased in size and number. \nFindings raise concern for progression of disease.\n2. No acute findings to account for acute abdominal pain.\n3. Moderate fecal burden in the colon.\n4. Severe emphysema.\n5. Emphysema with right lower lobe posterior basal consolidation similar to\nprior suggesting atypical chronic infection."
        },
        {
            "input": "LOWER CHEST: Chronic right lower lobe consolidation appears slightly decreased\nas compared to the prior study.  Mild right lower lobe bronchiectasis is again\nseen.  No definite pleural effusion is seen although there appears to now be\nnodular pleural thickening, particularly on the left.  No pericardial effusion\nis seen.  There are coronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Pneumobilia is seen, mostly in the left lobe.  Numerous\nintrahepatic metastatic lesions have increased in size and number.  For\nexample anterior hypodense lesion on series 6, image 22, today measures 2.0 x\n1.6 cm compared to 1.3 x 1.1 cm previously.  The gallbladder is not well seen\nportal vein appears patent.  There is severe attenuation of the splenic vein.\n\nPANCREAS: Lack of intra-abdominal fat makes accurate assessment of pancreatic\nmass suboptimal, but today grossly measures 4.6 x 4.2 cm compared to 3.6 x 4.0\ncm previously.  The more distal pancreas is again atrophic.\n\nSPLEEN: The spleen is surgically absent.\n\nADRENALS: The right adrenal gland is grossly unremarkable.  The left adrenal\ngland is not well assessed on this study.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nAgain seen small hypodensities in both kidneys are too small to further\ncharacterize, seen to represent cysts on prior MR from ___. No\nhydronephrosis is seen.\n\nGASTROINTESTINAL: The stomach is distended with ingested content and there is\nnarrowing of the proximal duodenum at the level of the pancreatic mass;\nfindings may be due to a component of gastric outlet obstruction.  There is\nirregular wall thickening of the posterior and medial walls of the gastric\nfundus ill-defined heterogeneous mass in the anterior abdomen to the left of\nmidline, adjacent to the stomach, series 6, image 16, today measures 5.4 x 3.5\ncm compared to today's measurement of the prior study of 5.0 x 3.1 cm. \nModerate to abundant colonic fecal loading is seen.  Moderate rectal stool\nball is noted without frank bowel obstruction.  The appendix is normal.\n\nPELVIS: The urinary bladder is not fully distended, apparent mild urinary\nbladder wall thickening may relate to incomplete distension, correlate with\nurinalysis.  No definite pelvic free fluid identified.\n\nLYMPH NODES: Lack of intra-abdominal fat makes assessment for mesenteric and\nretroperitoneal lymph nodes suboptimal, but none definitely identified.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Severe attenuation of the splenic vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen at the lumbosacral junction with mild\nretrolisthesis of L5 over S1, with there is also vacuum phenomenon and\nposterior disc osteophyte, which causes mild narrowing of the central canal at\nthis level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stomach distended with ingested content and there is narrowing of the\nproximal duodenum at the level of the pancreatic mass; findings may be due to\ngastric/partial gastric outlet obstruction.\n2. Moderate to abundant colonic fecal loading to the level of the rectum\nwithout bowel obstruction or definite bowel wall thickening.\n3. Interval progression of metastatic disease: interval increase in size and\nnumber of hepatic metastases.  Ill-defined pancreatic mass difficult to\naccurately measure due to lack of intra-abdominal fat, but appears increased\nin size.  Interval increase in size of heterogeneous soft tissue lesion along\nthe anterior left upper abdomen, possibly arising from the stomach.  New left\npleural nodularity and nodular thickening along the medial and posterior walls\nof the gastric fundus.\n4. New pneumobilia, correlate with sphincterotomy/biliary intervention.\n5. Chronic right lower lobe consolidation appears slightly improved."
        },
        {
            "input": "LOWER CHEST: There is linear 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status-post total pancreatectomy.\n\nSPLEEN: 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The distal thoracic esophagus contains enteric contrast. \nThe stomach is distended with debris and enteric contrast.  The\ngastrojejunostomy is patent.  Contrast courses into proximal loops of jejunum.\nPatient is status-post duodenectomy.  A small bowel loop in the right upper\nquadrant, presumably a hepaticojejunostomy loop, contains fluid and debris\nwithout evidence of obstruction.  There is severe colonic fecal loading. \nCecum is located in the midline pelvis.\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 extensive mesenteric lymphadenopathy more impressive in\nlymph node number than size, measuring up to 1.3 cm short axis.  No pelvic\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is mild abdominopelvic\natherosclerosis and severe partially imaged femoral atherosclerosis..  There\nis a linear filling defect in the left common femoral vein extending to the\nlevel of the left external iliac vein (series 5, images 63-78).\n\nBONES: There 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 left common iliac, external iliac, and common femoral deep\nvein thrombosis.\n2. Nonspecific mesenteric lymphadenopathy more notable for lymph node number\nthan size, measuring up to 1.3 cm.\n3. No evidence of acute hepatobiliary pathology.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:08 pm, approximately 20\nminutes after discovery of the findings."
        },
        {
            "input": "There is an unchanged 2 mm nodule in the lingula of the left lung (3a:7). The\nbases of the lungs are otherwise clear. There is no pleural effusion.\n\nLIVER: Again seen are multiple incompletely characterized hypodensities\nscattered within the liver, likely cysts or biliary hamartomas, as described\non the MRCP from ___. There is no intrahepatic biliary dilatation.\nThere is unchanged pneumobilia, compatible with the prior history of\nsphincteroplasty.\n\nThe portal vein is widely patent with no intraluminal filling defects to\nsuggest portal vein thrombosis.  Previously seen arterial hyper-enhancement of\nthe liver on MRCP has resolved.Patient is status post cholecystectomy with\nsurgical clips in the gallbladder fossa.\n\nSPLEEN: The spleen is normal in size. Two small adjacent splenules are present\n(605b:45), unchanged from the prior study.  The previously described splenic\ncyst is not apparent on the current study.\n\nPANCREAS: Again seen are 2 cystic lesions in the pancreas. At the head-neck\njunction, the cystic lesion measures 4 mm (3b:119), and the cystic lesion\nmeasures 3 mm in the pancreatic head (3b:126). Overall, these are unchanged\nsince ___ and were previously characterized as likely side branch IPMNs\non the MRCP in ___.\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no hydronephrosis.  There are unchanged, incompletely\ncharacterized millimetric hypodensities in the bilateral kidneys,\nstatistically most likely to be cysts.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.Again noted is midgut malrotation with the duodenum to the right of\nthe midline and SMA to the right of the SMV.  There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith no atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.There is a fibroid uterus.\n\nBONES: No focal lesion suspicious for malignancy.",
            "output": "1.  Previously-seen partial right portal venous thrombus and adjacent\nparenchymal arterial hyperenhancement have both resolved.  No new thrombus.\n2.  Unchanged subcentimeter pancreatic cystic lesions, most likely side branch\nIPMNs, described on the prior MRCP from ___.\n3.  Congenital midgut malrotation."
        },
        {
            "input": "Bibasilar atelectasis.\n\nPneumoperitoneum is present, likely secondary to recent completion\ncholecystectomy.  A single surgical drain is present within the right upper\nquadrant, adjacent to gallbladder fossa, with adjacent cholecystectomy clips. \nAdjacent postoperative changes are noted with mild edema within the\ngallbladder fossa.  No gallbladder fossa fluid collection.  Small amount of\nfocal fat adjacent to the falciform ligament.  No focal liver lesions.  Normal\npancreas without main duct dilation.\n\nNormal spleen and adrenals.\n\nNo hydronephrosis or suspicious renal lesions.\n\nContrast within stomach.  Relatively decompressed colon.  No small bowel\ndilation.\n\nNormal caliber abdominal aorta.  Mildly prominent retroperitoneal nodes,\nlargest 1.1 cm on the left, likely reactive.  A few subcentimeter hyperdense\nfoci are demonstrated anterior to the right psoas muscle, largest 7 mm (5,\n47).\n\nDecompressed bladder with indwelling Foley catheter.  Anteverted retroflexed\nuterus.  A 1.6 x 2.2 cm left ovarian probable cyst is noted.  No significant\nfree pelvic fluid.  No pelvic adenopathy.\n\nNo suspicious osseous lesions.",
            "output": "-Post completion cholecystectomy, with expected postoperative changes within\nthe gallbladder fossa, and adjacent surgical drain.  No fluid collection\nwithin the gallbladder fossa.\n-Two small hyperdensities anterior to the right psoas muscle, largest 7 mm,\npossibly dropped gallstones in the given clinical context.  Venous phleboliths\nare less likely.\n-No intrahepatic or extrahepatic biliary dilation.\n-Other expected postoperative changes including pneumobilia, pneumoperitoneum,\nfree air within the subcutaneous fat of the anterior abdominal wall and mild\ngeneralized abdominal fat stranding."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver is normal in attenuation with no intrahepatic\nbiliary dilatation. Hypodensity near the dome of the liver is unchanged from\nthe prior study, likely a cyst (2:9).  The gallbladder is surgically absent\nand there are cholecystectomy clips in the gallbladder fossa. No fluid\ncollection in the gallbladder fossa.  The previously seen surgical drain has\nbeen removed and there is minimal residual haziness the gallbladder fossa,\nlikely postsurgical. The pancreas, spleen, adrenal glands, and kidneys are\nnormal. There are no renal stones, or hydronephrosis. The bowel is normal in\ncaliber without obstruction. The colon contains a small amount of residual\noral contrast from the prior CT scan, with no evidence of colitis.  Again seen\nare calcified densities anterior to the right psoas muscle (2:47, 50), the\nlargest measuring up to 8 mm, which may represent venous phleboliths.  There\nis no intra-abdominal fluid collection.  Postsurgical changes in the lower\nanterior abdominal wall are again noted, improved from the prior scan.\n\nPELVIS:  The urinary bladder is decompressed. The uterus adnexae are\nunremarkable. There is no pelvic free fluid or lymphadenopathy.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Status post cholecystectomy with improvement in postoperative appearance\nof the anterior abdominal wall and haziness of the mesentery, and interval\nremoval of surgical drain from the right upper quadrant. No intra-abdominal\nfluid collection.\n2.  No renal stones are seen.\n3.  Unchanged calcified densities anterior to the right psoas muscle,\nmeasuring up to 8 mm, more likely venous pheleboliths than retained\ngallstones."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Surgical clips in the gallbladder fossa\ndenote 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 or adjacent stranding.\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\ngross focal renal lesions or hydronephrosis.  There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Colon and rectum are within normal limits. The appendix\nis surgically absent. There is no evidence of mesenteric lymphadenopathy. \nMultiple calcific densities anterior to the right psoas muscle are grossly\nunchanged and are likely venous phleboliths.\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 lesions.\nThe anterior abdominal wall haziness, post recent cholecystectomy, has\nimproved compared with the prior studies.",
            "output": "1. No acute intra-abdominal or intrapelvic process.\n2. Evaluation for splenic infarct is limited without the administration of IV\ncontrast.  However, the spleen appears homogeneous and normal.\n3. Post cholecystectomy, with improvement in the previously described anterior\nabdominal wall haziness.\n4. Unchanged small calcifications anterior to the right psoas muscle are\nlikely phleboliths."
        },
        {
            "input": "LOWER CHEST: Evidence of elevated right hemidiaphragm.  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. \nMultiple indeterminate hypodense lesions within the left lobe of the liver\n(series 2 images 41, 49), too small for further characterisation.  Otherwise,\nthere is no evidence of worrisome 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. \nNo evidence of focal lesions.  There is no evidence of hydronephrosis.  There\nis 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 bilateral adnexae are grossly 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 2 indeterminate lucent bone lesions within the right iliac\nbone (series 2, image 91).  No evidence of acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Indeterminate subcentimeter hepatic lesion.  This could be further\ncharacterized with MRI.\n2. Two indeterminate lucent bone lesions within the right iliac bone, likely\nbenign, but comparison with prior imaging is recommended.\n\nRECOMMENDATION(S):  Recommend further characterization of the hepatic lesions\nwith MR.\n\n___ obtaining prior imaging for comparison.  Specifically, evaluate\nprior imaging for presence the lucent bone lesions within the right iliac\nbone."
        },
        {
            "input": "Lingular atelectasis is noted. The heart is mildly enlarged. There is no\nevidence of pericardial effusion.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\npancreas, spleen, and bilateral adrenal glands, and right kidney are normal. \nThe patient is status post cholecystectomy. Again, the left kidney\ndemonstrates numerous hypodensities that are incompletely characterized on\nthis examination but likely cysts. A small left extrarenal pelvis is noted.\n\nThe stomach, small bowel, and large bowel are unremarkable in appearance\nwithout dilation or wall thickening.  Oral contrast is seen extending to the\ndistal small bowel. The appendix is normal in appearance (601b:31). Sigmoid\ndiverticulosis is present without evidence of acute diverticulitis. There is\nno overt retroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum.  A small, fat containing umbilical hernia\nis noted. The aorta and its major branches contain calcifications.\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.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nthroughout the visualized thoracolumbar spine. No focal lytic or sclerotic\nlesion concerning for malignancy.",
            "output": "1. Limited examination secondary to the lack of intravenous contrast. No acute\nintra-abdominal process.\n2. Sigmoid 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 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:There is a left parapelvic cyst.  A 1.6 cm relatively hyperdense\nlesion within the lateral cortex of the mid left kidney is not  fully\ncharacterized on current study.  The kidneys are of normal and symmetric size.\nThere is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction is seen.  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or 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\nabnormality 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: There has been interval widening of diastasis recti, with\ndiastasis seen anteriorly with a possible small Richter's hernia.  No bowel\nobstruction.  There is a healing midline scar.",
            "output": "1. No acute abdominopelvic pathology, specifically no evidence of small-bowel\nobstruction.\n2. No evidence of an incarcerated hernia.  Diastasis of the anterior abdominal\nwall with a possible nonobstructed small Richter's hernia.\n3. A subtle 1.6 cm hyperdense lesion along lateral cortex of the left mid\nkidney, not well characterized on current study.\n\nRECOMMENDATION(S):  A nonemergent follow-up dedicated renal ultrasound is\nrecommended.\n\nNOTIFICATION:  The updated findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:35 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "LUNG BASES:  Streaky opacities in the dependent portions of the lungs are\ncompatible with subsegmental atelectasis.  There is no pleural or pericardial\neffusion.  There is no hiatus hernia.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion.  There is\nno intrahepatic biliary ductal dilation.  The portal vein is patent.  The\ngallbladder does not show evidence of stones or wall thickening.  The pancreas\nenhances homogeneously.  There is no peripancreatic stranding or ductal\ndilation.  The adrenal glands are unremarkable.  There is no splenomegaly or\nfocal splenic lesion.  There is normal symmetric renal enhancement and prompt\nexcretion of contrast without evidence of hydronephrosis.\n\nThe stomach and duodenum are unremarkable.  Nondilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening or\nobstruction.  The colon is unremarkable.  The appendix is normal.  The\nabdominal aorta is normal in caliber without evidence of aneurysm or dilation.\nMajor proximal tributaries are patent.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe uterus is atrophic or surgically absent.  The bladder and terminal ureters\nare unremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is a small fat-containing umbilical hernia.  There is minimal\ndegenerative change of the imaged thoracolumbar spine.  Alignment is normal. \nNo concerning focal lytic or sclerotic osseous lesions are identified.",
            "output": "Unremarkable CT of the abdomen and pelvis without cause for pain evident."
        },
        {
            "input": "LOWER CHEST: Aside from mild dependent bibasilar atelectasis, the 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. \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. \nRedemonstrated are simple renal cysts bilaterally measuring up to 4.5 cm in\nthe left mid kidney and 7.9 cm in the right mid kidney.  Additional renal\nhypodensities bilaterally are too small to characterize, but likely represent\nsimple cysts.  There is no evidence of solid renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is pneumoperitoneum, with the bulk of the free\nintraperitoneal air localizing in the anterior upper abdomen.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThere is loculated air surrounding the wall of the transverse colon and\nhepatic flexure (2:35, 602:46-49) which is not intraluminal, suggestive of\nperforation, however there is no definite evidence of wall defect. \nDiverticulosis of the colon is noted, without evidence of wall thickening or\nfat stranding. The appendix is normal (601:32).\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\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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPartially visualized is a right hip replacement.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.  There is a\n1.5 cm soft tissue nodule lateral to the right iliac crest, which is\nindeterminate.",
            "output": "1. Pneumoperitoneum, likely secondary to colonic perforation, however the\nexact location of the source is not identified.\n2. Diverticulosis without evidence of acute diverticulitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:01 am, 2 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: There are multiple regions of geographic enhancement on\narterial phase imaging, particular at the dome liver.  These lesions do not\nhave mass-effect and appears to have vessels coursing through the most likely\nrepresenting transient hepatic attenuation differences (series 3, image 19). \nAgain seen is an 8 mm hypoattenuating lesion within the right lobe of the\nliver, previously characterized as a hamartoma.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: There are postsurgical changes from distal pancreatectomy for\npancreatic ductal adenocarcinoma.  Fiducials in situ.  Fluid collection\nimmediately distal to the suture line in the pancreatic bed is decreased in\nsize currently measuring 36 x 19 mm in the coronal plane (previously 25 x 45\nmm).  Infiltrative retroperitoneal soft tissue in the surgical bed as well as\nencasing the celiac axis and its branches as well as abutting the SMA (series\n3, image 32) is decreased in size compared to prior currently measuring in a\ncrude axial measurement 41 x 26 mm (previously 45 x 31 mm).  Retroperitoneal\nlymph nodes appear similar compared to prior imaging.\n\nSPLEEN: The patient is status post splenectomy.\n\nADRENALS: Bulky appearance of the left adrenal, without focal mass is\nunchanged.  Right adrenals normal.\n\nURINARY: There a few subcentimeter hypoattenuating cystic lesions within the\nbilateral kidneys which are too small to characterize.  There is a 19 mm\nsimple cyst of the midpole left kidney.  The kidneys are of normal and\nsymmetric size with normal nephrogram.  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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is borderline in size, measuring 5.3 x 3.7\ncm.  The visualized reproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There are multiple prominent subcentimeter retroperitoneal\nperiaortic lymph nodes measuring up to 14 mm (series 3, image 47) in short\naxis diameter at the level of the renal vessels.  These are similar in\nappearance to prior imaging.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is stenosis and occlusion of the proximal celiac artery with\ncollateral supply to the common hepatic artery via the GDA.  There is also\nhaziness of fat planes surrounding the common hepatic artery and SMA, similar\nto prior imaging.  Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes of the anterior abdominal wall. \nThe abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. The patient is status post distal pancreatectomy and splenectomy with\npostsurgical changes appearing slightly improved compared to prior imaging.\n2. The previously noted fluid collection in the surgical bed/area of body of\nthe pancreas (immediately distal to the suture line) is decreased in size\ncompared to prior.\n3.   The retroperitoneal infiltrative/ post treatment soft tissue is slightly\nless prominent compared to prior.\n4. Persistent vascular involvement with occlusion of the celiac artery is\nagain noted.  Hepatic artery receives collateral supply from the GDA.\n5. Geographic regions of hyperenhancement near the dome of the liver is most\nlikely perfusional in nature (transient hepatic attenuation difference). \nPlease re-evaluate on future follow-up imaging.  If there is associated\nelevation of tumor markers or clinical concern, hepatic MRI can be performed\nfor better characterisation.\n6. Retroperitoneal periaortic lymphadenopathy is similar to prior imaging.\n7. No new masses or lesions."
        },
        {
            "input": "CHEST:   The bases of the lungs demonstrate mild bibasilar atelectasis. There\nis trace right-sided pleural effusion.\n\nABDOMEN:  There is a hypodense lesion in segment 7 of the liver measuring 7\nmm. Otherwise the liver is normal without evidence of focal lesions or\nintrahepatic biliary ductal dilatation. The portal vein is patent. The splenic\nvein and SMV are patent. The patient is status post cholecystectomy. There is\na small amount of perihepatic and nonhemorrhagic ascites. The spleen is\nhomogeneous and normal in size. The pancreas is normal without evidence of\nfocal lesions or pancreatic duct dilatation. The left adrenal gland\ndemonstrates mild nodular hyperplasia of the lateral limb. The right adrenal\ngland is normal.\n\nA percutaneous nephrostomy tube is noted in appropriate position within the\nright renal pelvis. There is no evidence of hematoma formation or perinephric\nstranding surrounding the right kidney. There is persistent severe left\nhydroureteronephrosis.\n\nThere is a high grade small bowel obstruction with the transition point in the\nmid pelvis series 4, image 61. The there is significant amount of ascites\ntracking down into the pelvis.  There appears to be tethering of the small\nbowel at the superior dome of the bladder, likely secondary to inflammatory\nreaction of the underlying bladder cancer.\n\nPELVIS:  Again seen is an enhancing mass involving the inferior and left\naspect of the urinary bladder measuring 5.5cm x 6.1-cm, increased in size\ncompared to the prior exam ___, causing severe left hydronephrosis.\nThe mass in not indistinguishable from the uterus, which contains fibroids. \nThe urinary bladder again demonstrates diffusely thickened wall with\nsurrounding inflammatory changes.  Surrounding prominent inguinal and pelvic\nwall lymph nodes are stable.\n\nBONES AND SOFT TISSUES:  There is a sclerotic lesion measuring 1.2-cm x\n1.6-cm, in the right sacral ala, that appears to have increased in size. \nThere also appears to be progression of the lytic lesion involving L3.",
            "output": "1.  High grade small bowel obstruction, with the transition point in the\npelvis (4;61).  There appears to be tethering of small bowel to the superior\ndome of the bladder, which itself is thickened likely secondary to cystitis\nfrom the patient's cancer.\n\n2.  Interval increase in the size of the bladder mass with stable severe left\nsided hydronephrosis, compared to the exam from ___.\n\n3.  Interval worsening of bony metastatic disease as described above.\n\nNOTIFICATION:  ___ were d/w Dr. ___ 10-minutes after the\ndiscovery of the findings by Dr. ___ by phone on the day of the exam."
        },
        {
            "input": "VASCULAR:\n\nThere is no evidence of active extravasation.  There is no abdominal aortic\naneurysm.  There is moderate calcium burden in the abdominal aorta and great\nabdominal arteries.  The right hepatic artery is replaced to the right SMA.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  A 3 mm pulmonary\nnodule seen in the left lower lobe is unchanged since ___ (10; 3).  There is\nno pleural or pericardial effusion. Coronary artery calcifications are noted.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 seen measuring up to 3.6 cm in the upper pole of the\nright kidney.  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 diverticulosis of the colon without wall\nthickening or surrounding inflammation to suggest acute diverticulitis.  Fluid\nis seen within the colon.  The appendix is normal.  There is no evidence of\nmesenteric lymphadenopathy.  A fat containing and calcified mass in the pelvis\nlikely represents a torsed epiploic appendage.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder wall appears thickened, likely due to decompression.  The\ndistal ureters are unremarkable.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications.  The seminal\nvesicles are unremarkable.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: There is diastasis recti.  An umbilical hernia and a left\ninguinal hernia containing fat are noted.",
            "output": "Mild diverticulosis of the colon without evidence of active extravasation."
        },
        {
            "input": "PELVIS: The partially visualized small large bowel are nondilated.  The\nunenhanced uterus and bilateral adnexal are unremarkable.  There is trace free\nfluid in the pelvis.\n\nVP shunt catheter tip is seen terminating adjacent to a loop of small bowel in\nthe right pelvis.  The visualized portions of the catheter demonstrates.  No\ncatheter kinking or discontinuity.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The pelvic wall is within normal limits.",
            "output": "1. Visualized VP shunt catheter tip terminates adjacent to a loop of small\nbowel and does not demonstrate evidence of kinking or discontinuity.\n2. No acute findings 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: Liver shows a heterogeneous fatty infiltration including\nheterogeneous perfusion.  In the left lobe of the liver, there is a 5.8 x 2.9\nx 2.7 cm hypodense focus measuring approximately 5 ___, hypodense when compared\n___, likely representing markedly increased regional focal fatty\ndeposition (601:17, 2:22).   Left portal vein is now markedly attenuated,\nconsistent with interval thrombosis and resorption with attenuation of the\nvein.  There is at most minimal visible residual visible thrombus (2:14). \nIncreased regional fatty infiltration along the falciform ligament and, more\ngenerally, increased enhancement in the left lobe are most consistent with\nsequela of altered perfusion.  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 a 1.8 cm hypodense splenic cyst, not significantly changed\nfrom prior (02:16).  Ill-defined hypodensity inferior to the cyst measuring\napproximately 1 cm is 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: Status post sleeve gastrectomy.  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 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: VP shunt is seen.  The abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. No evidence of acute cholecystitis.  Mostly empty gall bladder makes acute\ncholecystitis unlikely.\n2. Narrowed occluded left portal vein.  Left portal vein appeared normal on\nprior examination from ___, and since that time has become\nmarkedly narrowed and nonopacified, although there is now probably only\nminimal remaining visible thrombus in the vein.\n3. Increased fatty infiltration along segment IV of the liver and increased\nrelative enhancement of most of the left lobe compared to the right,\nsuggesting perfusion anomalies caused by occlusion of the left portal vein.\n4. Unremarkable postoperative findings associated with recent sleeve\ngastrectomy.\n\nRECOMMENDATION(S):  Characterization with multiphasic CT or MR might be\nhelpful to evaluate further although it is not clear how much value further\nimaging may add.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:58 pm."
        },
        {
            "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 redemonstration of diffuse hypoenhancement of the\nliver relative to the spleen, as well as areas of heterogeneous hypoperfusion.\nA lesion within segment 4 B is hypoenhancing and measures 6.0 x 2.9 x 2.2\npreviously 5.8 x 2.9 x 2.7 cm, previously characterized as likely regional\nfocal fatty deposition.  No new suspicious lesions are demonstrated.  The\ngallbladder is within normal limits.  No intrahepatic or extrahepatic biliary\nductal dilatation.\n\nAs on the prior study, the left portal vein is not visualized, consistent with\nchronic occlusion.  The extrahepatic portal vein is patent.  The splenic and\nsuperior mesenteric veins 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 is normal size.  Along the anterior aspect of the spleen,\nthere is\nBenign appearing cystic change along the anterior spleen which is stable since\n___. A previously demonstrated perisplenic cystic structure is no\nlonger visualized, with some residual stranding denoting the area the prior\ncyst which has likely involuted (series 2, image 14).  These findings are\nstable since ___.\n\nADRENALS: The 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.  A punctate area of hyperdensity at the inferior right\nrenal collecting system (series 601, image 28) could reflect a small nidus for\nstone formation.  Additional nonobstructing calculus is demonstrated in the\nsuperior pole of the right kidney measuring 5 mm (series 2, image 23).\n\nGASTROINTESTINAL: Patient is status post sleeve gastrectomy which appears\ngrossly within normal limits.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nA ventriculoperitoneal shunt courses through the right hemiabdomen and\nterminates in the mid pelvis, without evidence of focal defect were\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid within the pelvis, most likely physiologic.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: No lymphadenopathy by 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Similar appearance of chronic occlusion of the left portal vein with local\nheterogeneous hypoperfusion of the liver.\n2. Hepatic steatosis similar compared to the prior studies.  A prominent area\nof hypodensity within hepatic segment 4B  is consistent with focal increased\nfatty deposition.\n3. Intact ventriculoperitoneal shunt terminating in the mid pelvis.\n4. Nonobstructing 5 mm renal stone within the right superior pole collecting\nsystem.  An additional punctate hyperdensity at the inferior renal pole\ncollecting system may represent an additional tiny stone or stone nidus."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen diffuse hypoenhancement of the liver relative the to\nthe spleen with heterogeneous hypoperfusion.  Again seen lesion within segment\n4 B which is hypoenhancing and measures 4.8 x 1.9 x 1.7 cm, previously 6.0 x\n2.9 x 2.2 cm and previously characterized as a likely regional focal fat\ndeposition.  No new suspicious lesions are demonstrated.  As on the prior\nstudy, the left portal vein is not visualized, consistent with chronic\nocclusion.  The extrahepatic portal vein is patent.  The splenic and superior\nmesenteric veins are patent.  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 normal in size.  Along the anterior aspect of the spleen\nthere is a benign appearing cystic change which is stable since ___.\n\nADRENALS: The 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 nonobstructing 4 mm stone is visualized in the upper pole of the right\nkidney and an additional nonobstructing 2 mm stone is visualized in the lower\npole of the right kidney.  There is no evidence of solid renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post sleeve gastrectomy which appears\ngrossly within normal limits.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. The colon and rectum are within\nnormal limits. The appendix is normal.\n\nA ventriculoperitoneal shunt courses through the right hemiabdomen and\nterminates in the mid pelvis, without evidence of focal defects.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of free fluid in the pelvis, likely physiologic.\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 findings in the abdomen or pelvis.\n2. Similar appearance of chronic occlusion of the left portal vein with\nheterogeneous hypoperfusion of the liver.\n3. Hepatic steatosis similar compared to prior studies.  Prominent area of\nhypodensity within hepatic segment 4B is consistent with focal fatty\ndeposition.\n4. Intact ventriculoperitoneal shunt terminating in the mid pelvis.\n5. Nonobstructing 4 mm stone in the upper pole of the right kidney and 2 mm\nstone in the lower pole of the right kidney."
        },
        {
            "input": "VASCULAR:\nPortal vein thrombosis is identified involving the right portal vein (301:45).\nTIPS is patent.\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Right anterior chest drain terminates in the anterior mediastinal\nfat.  There is no fluid collection at the site of the drain.  Right pleural\neffusion is small.  Small right lower lobe atelectasis.  Coarse calcification\nin the right lower lobe is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular liver contour is consistent with patient's known liver\ncirrhosis.  Multiple areas of post treatment changes are again noted in the\nliver. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  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: 1.6 cm fat containing left adrenal nodule is consistent with\nmyelolipoma.  Right adrenal gland is unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSeveral punctate hypodensities in bilateral kidneys are too small to be fully\ncharacterized.  There is no hydronephrosis.  There are no urothelial lesions\nin the kidneys or ureters. 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. There\nis no evidence of mesenteric 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 unremarkable.\n\nBONES: Bone island is noted in the right femoral head.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right portal vein thrombosis is new since ___.  TIPS is\npatent.\n2. Liver cirrhosis with posttreatment changes.\n3. Right anterior chest drain terminates in the anterior mediastinal fat.\nThere is no fluid collection at the site of the drain.\n4. Small right pleural effusion and right lower lobe atelectasis.\n\nNOTIFICATION:   Impression 1.  Was discussed with ___ , M.D. by ___\n___, M.D. on the telephone on ___ at 9:30 pm, 10 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: Dense peribronchovascular consolidations with surrounding\nground-glass in both lung bases have worsened from prior CT in ___.  No\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a cirrhotic morphology.  There is no\nevidence of focal lesions within the limitations of an unenhanced scan.  Trace\nperihepatic ascites has decreased since prior CTs in early ___.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or evidence of\ninflammation.\n\nPANCREAS: Ill-defined peripancreatic stranding appears minimally increased\nfrom CT on ___ with extension into the mesentery (series 2, image 29). \nNo evidence of peripancreatic fluid collection.  Assessment for necrosis is\nnot feasible without intravenous contrast.  The pancreas has normal\nattenuation throughout, without evidence of focal lesions within the\nlimitations of an unenhanced scan.  There is no pancreatic ductal dilatation.\n\nSPLEEN: Top normal in size measuring 13.5 cm.  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 suspicious\nrenal 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 and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Numerous small lymph nodes are present throughout the mesentery\nand retroperitoneum.  Porta hepatis lymph nodes are enlarged measuring 1.5 cm\nin short axis, potentially reactive in the setting of cirrhosis.\n\nVASCULAR: 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 left femoral head and sacrum are compatible with bone\nislands, stable from ___.\n\nSOFT TISSUES: Trace anasarca has increased from ___.  No organized\ncollection.",
            "output": "1. Consolidations in both lung bases suspicious for aspiration pneumonia.\n2. Acute interstitial pancreatitis with minimally increased peripancreatic\nstranding.  No evidence of peripancreatic fluid collections. Assessment for\npancreatic necrosis is not feasible without intravenous contrast.\n3. Cirrhotic liver morphology with decreased now trace ascites.\n4. Cholelithiasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:29 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  No pleural effusion.  No pericardial\neffusion.  Heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: Postsurgical changes of deceased donor liver transplant, with\ndiffuse periportal edema, and perihepatic soft tissue stranding, tracking\nalong the right lower quadrant.  There is a fluid collection along the hepatic\nhilum, in close proximity to the duodenum, measuring approximately 5.3 x 4.0\ncm in axial ___.  It has a thin wall and uniform low attenuation. \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: Splenomegaly measuring up to 15.2 cm in 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.  There is no suspicious\nrenal 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.  Gastric and duodenal wall\nthickening is probably postsurgical.  Large bowel is unremarkable.  The\nappendix is normal in caliber.\n\nPELVIS: Circumferential wall thickening of the minimally distended urinary\nbladder, could be related to underdistention.  Small volume abdominopelvic\nascites.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Redemonstrated prominent retroperitoneal lymph nodes, similar to\nprior.  Prominent bilateral inguinal lymph nodes, largest measuring 1.3 cm in\nshort axis (image 97, series 3)\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: No destructive osseous lesions.\n\nSOFT TISSUES: Right anterior abdominal surgical scar.  Subcutaneous fluid\ntracking right lateral abdominal wall, along the inferior aspect of the\nsurgical scar, may reflect a postsurgical collection, measuring measuring\napproximately 8.1 x 3.1 cm, not organized.  More generally, anasarca.",
            "output": "1. Postsurgical changes of hepatic transplant, with periportal edema and\nperihepatic soft tissue stranding tracking down to the right lower quadrant,\nalthough these are expected postoperative changes.\n2. Fluid collection along the inferior hepatic hilum, measuring up to 5.3 cm,\nnot significantly changed in size compared to prior ultrasound, given\ndifferences in technique, likely reflecting a postsurgical collection.\n3. Subcutaneous soft tissue fluid in the right lateral abdominal wall,\ntracking along the inferior aspect of the surgical scar, may reflect a\npostsurgical collection, measuring approximately 8.1 x 3.1 cm.\n4. Small volume abdominopelvic ascites."
        },
        {
            "input": "LOWER CHEST: Trace left basilar atelectasis.  Visualized lung fields are\notherwise within normal limits.  There is no evidence of pleural or\npericardial effusion.  Mild cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: Postoperative appearance status post disease donor liver\ntransplant.  Extent of periportal edema has decreased from prior.  Previously\nnoted fluid collection along the hepatic hilum has resolved.  The liver\notherwise demonstrates homogeneous attenuation throughout.  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 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: Moderate splenomegaly, measuring up to 15 cm as before.  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.  There is no suspicious\nrenal 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.  An enteric tube terminates\nwithin the duodenal jejunal junction.  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 wall is thickened, likely secondary to under\ndistention.  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 by CT\nsize criteria.  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 fluid in the right lateral abdominal wall, tracking\nalong the surgical scar and measuring up to 1.9 x 5.7 cm in the largest axial\ndimension, decreased from 3.1 x 8.1 cm.",
            "output": "1. No imaging features to explain patient's symptoms within the limits of an\nunenhanced scan.\n2. No evidence of bowel obstruction.\n3. Postsurgical changes status post hepatic transplant with decreasing\nperiportal edema. Resolution of previous noted fluid collection along the\ninferior hepatic hilum.\n4. Decreased subcutaneous soft tissue fluid in the right lateral abdominal\nwall, tracking along the surgical scar and measuring up to 5.7 cm, previously\n8.1 cm.\n5. Mild splenomegaly as before."
        },
        {
            "input": "Please refer to separate chest CT for further details.\n\nUnremarkable liver, gallbladder and pancreas without main ductal dilatation.\nPatent portal veins. Normal spleen and adrenals.\n\nModerately atrophic right kidney is again demonstrated.  No hydronephrosis.\nBilateral extrarenal pelvis. Multiple scattered left-sided renal cysts, as\npreviously demonstrated. Probable chronic infarct of the lower pole left\nkidney.  No hydronephrosis.  The right lower quadrant ileal loop and is\ndecompressed without adjacent fluid collection or significant stranding.  No\nsignificant ureteral dilatation.  Bilateral upper tract is unremarkable.\n\nDecompressed stomach. Stool throughout colon.  Normal appendix. No significant\nsmall bowel dilatation.  Normal appearance of enteroenteric right lower\nquadrant anastomosis.\n\nModerate atherosclerosis of normal caliber abdominal aorta. A right aortocaval\nnode measures 1.2 x 1 cm, similar to prior study and decreased in size from\nmore remote studies.\n\nPost Cystectomy. No free pelvic fluid. No pelvic adenopathy. Multiple pelvic\nsidewall surgical clips again noted.\n\nDegenerative changes of bilateral hip joints. Degenerative changes of the\nspine.",
            "output": "-Similar appearance of 1.2 x 1 cm aortocaval node. No other suspicious lymph\nnodes within the abdomen or pelvis.\n-Post cystectomy with diverting loop ileostomy, unremarkable appearance. No\napparent mass of the upper tracts. Moderate atrophy of the right kidney is\nagain noted."
        },
        {
            "input": "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 reflecting\nsteatosis.  Small hyperenhancing lesion within the right lobe of the liver is\nincompletely characterized, but likely represents a hemangioma (series 2,\nimage 26).  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 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: Chronic appearing fracture of the right transverse process at L1. \nThere 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.  Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar dependent atelectasis.  Otherwise, the remaining\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 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 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. The colon and\nrectum are within normal limits. The appendix is hyperemic and enlarged\nmeasuring up to 11 mm (2:59) with surrounding periappendiceal fat stranding\nand trace right lower quadrant (2:65).  No definite evidence of an\nappendicolith.  No evidence of free intraperitoneal air.  No evidence of\nperiappendiceal abscess.\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 are scattered mildly prominent mesenteric lymph nodes,\nparticularly the right lower quadrant, which are reactive.  Otherwise, the\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\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": "Acute uncomplicated appendicitis."
        },
        {
            "input": "LOWER 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 cirrhotic morphology.  There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is collapsed.  There is\nlarge volume abdominopelvic 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 measures 14.9 cm in AP dimension on axial images without\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 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 or fat\nstranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent peripancreatic node is noted.  The previously seen\ngastrohepatic lymph node is not well visualized.  Otherwise no enlarged\nretroperitoneal and mesenteric lymph nodes.  Prominent bilateral pelvic and\ninguinal lymph nodes are nonenlarged by CT criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  The celiac artery, SMA, and ___ are patent.  There is replaced left\nhepatic artery arising from the left gastric artery.  The portal venous system\nis patent.  Extensive esophageal and splenic varices and splenorenal shunt are\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerate changes of the lumbar spine are moderate.\n\nSOFT TISSUES: There is right fat containing inguinal hernia.  There is left\ninguinal hernia containing ascitic fluid.",
            "output": "1. Cirrhotic liver with findings of portal hypertension including large volume\nascites, portosystemic collateral, and splenomegaly.  No focal hepatic lesion\nidentified.\n2. No evidence of metastatic disease within the abdomen and pelvis.\n3. Please see separate report of the same date for evaluation of the chest."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions.  There is also minimal\natelectasis at the right lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken and nodular, compatible with cirrhosis.  No\nfocal hepatic lesions are identified, although this single-phase study is not\ntailored for detection of hepatocellular carcinoma.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\ncollapsed.  Gallbladder wall edema is likely due to third spacing.\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 14.3 cm.  Re-demonstrated\nis a 0.7 cm hypodense lesion, which is nonspecific (04:26).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Note is made of\ncolonic wall thickening predominantly affecting the ascending and transverse\ncolon, which is new from the prior exam in ___.  This is likely due to\nthird spacing given the increased ascites.  Medium amount of ascites,\nincreased from ___, including patchy thin smooth peritoneal\nenhancement in the pelvic cul de sac.\n\nPELVIS: Bladder is largely decompressed, and not adequately assessed.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: No significant interval change in size of a 1.1 cm gastrohepatic\nligament node (04:23).  Other upper abdominal lymph nodes including a 1.3 cm\nportacaval node, likely reactive (04:27).  Scattered retroperitoneal lymph\nnodes are subcentimeter in size, not enlarged by strict size criteria.  There\nis no pelvic sidewall or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Celiac artery is patent.  Left hepatic artery is replaced to the\nleft gastric artery.  Superior mesenteric artery and bilateral renal arteries\nare patent.  The portal venous system is patent.  Extensive esophageal and\nparaesophageal varices, as well as left splenorenal shunts, along with gastric\nwall varices, compatible with a sequela of portal hypertension.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are noted throughout the thoracolumbar spine.\n\nSOFT TISSUES: Evaluation of the soft tissues is notable for mild body wall\nedema.",
            "output": "1. Cirrhotic liver morphology with sequela of portal hypertension including\nmild splenomegaly, increased, medium quantity of ascites, extensive esophageal\nand gastric wall varices, as well as splenorenal shunt.  Mild peritoneal\nenhancement in the pelvic cul de sac which suggests superimposed\ninflammation/infection of ascites fluid.  Sampling of fluid may be helpful.\n2. Ascending and transverse colonic wall thickening, likely due to third\nspacing in the setting of increasing ascites.  However, an underlying\ninfection/colitis could have a similar imaging appearance, although this seems\nunlikely.\n3. Small bilateral pleural effusions, with atelectasis at the right lung base."
        },
        {
            "input": "LOWER 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 and shrunken, consistent with known\ncirrhosis.  There is no evidence of focal lesions, although the study is\nsuboptimal for hepatocellular carcinoma detection.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  Mild gallbladder-wall edema\nis expected in the setting of third-spacing.\n\nPANCREAS: The pancreas demonstrates normal morphology and attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: Stable mild splenomegaly, measuring 14.5 cm.  A stable 8 mm\nhypodensity near the splenic hilum is nonspecific, but likely cystic in nature\n(series 5, image 55).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 seen but there are no secondary signs for\nappendicitis.  Large amount of ascites, increased from a ___.\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: The previously identified gastrohepatic ligament node again\nmeasures 1.1 cm (series 5, image 57).  The previously 1.3 cm portacaval node\nnow measures 7 mm (series 5, image 59). There is no retroperitoneal\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  The celiac artery, SMA, bilateral renal arteries are remarkable. \nThe portal venous system is patent. Again visualized are extensive esophageal\nand paraesophageal varices, left splenorenal shunts, recanalized umbilical\nvein and gastric wall varices.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes in the thoracolumbar spine.  Multiple\nSchmorl's nodes are noted in the lower lumbar vertebral bodies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable enlarged gastrohepatic ligament lymph node, corresponding to known\nmalignancy.  The previously 1.3 cm portacaval node now measures 7 mm.\n2. Cirrhotic liver with sequelae of portal hypertension. Large amount of\nascites, increased from ___.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "Please note that there is streak artifact from the left hip prosthesis which\nmildly limits evaluation.\n\nPELVIS: The partially visualized small and large bowel are unremarkable. The\nurinary bladder is diffusely distended with relative increased attenuation of\nthe bladder contents which should be correlated clinically.  The attenuation\nof the fluid in the bladder approximates 36 Hounsfield units.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is an acute nondisplaced periprosthetic vertically oriented\nfracture extending along the left proximal femur from the level of the greater\ntrochanter to just below the distal femoral stem.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Periprosthetic nondisplaced fracture of the left proximal femur from the\ngreater trochanter to the proximal femur just below the femoral stem.\n2. Hyperdense appearance of the bladder contents, correlate with clinically,\nconsider urinalysis.\n\nRECOMMENDATION(S):  Recommend correlation with history of recent prior\ncontrast enhanced imaging."
        },
        {
            "input": "LOWER 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  Unchanged 6 mm hypodensity at the tail of the\npancreas likely suggestive of secondary channel IPMN.  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 is normal.  Status post right adrenalectomy.\n\nURINARY: Status post right nephrectomy.  No soft tissue in this nephrectomy\nbed.  The left kidney is unremarkable.  Left-sided extrarenal pelvis again\nseen.  Subcentimeter hypodense lesion within the upper pole of the left kidney\ntoo small to characterize and unchanged since previous exam.\n\nGASTROINTESTINAL: The stomach is 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: Interval increase in size of a solid nodule deep to the right\npsoas measuring today 16 x 17 mm(series 2, image 84)  previously 9 x 10 mm. \nIncreased size of 2 additional soft tissue masses next to the right common\niliac vein measuring today 12 x 22 mm and 16 x 17 mm previously measuring 12 x\n14 mm and 12 x 6 mm.\n\nNo new retroperitoneal adenopathy.  There is no pelvic or inguinal\nlymphadenopathy.  Decreased size of fluid attenuation lesion below the aortic\nbifurcation measuring 3.2 x 2.2 x 5.6 cm previously 4.8 x 3.6 x 6.8 cm likely\nrepresenting a postoperative lymphocele.\n\nVASCULAR: There is no 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 increase in retroperitoneal adenopathy as detailed above,\ncompatible with disease progression.\n2. Decreased size of previously described postoperative lymphocele.\n3. Please refer to the chest CT for 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 or\nextrahepatic biliary dilatation.  The gallbladder contains several stones..\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of \npancreatic ductal dilatation.  Previously identified hypodense lesion in the\ntail of the pancreas on series 3, ___ 63 is less well seen today due to\npartial volume effect.  It is stable in size.  It is most consistent with an\nIPMN.  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.\n\nURINARY: The patient is status post right nephrectomy.  There is no evidence\nof focal renal lesions or hydronephrosis in 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. 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.  A\nright common iliac lymph node on series 3 ___ 84 measures 1.6 x 1.7 cm stable\nin size, however demonstrates less enhancement consistent with treatment\nresponse.  A second right common iliac lymph node measures 1.8 x 1.6 cm\nunchanged compared to prior study.  There is a 2.7 x 1.9 cm right common iliac\nlymph node on series 3 ___ 89.  Previously this measures 2.2 x 1.2 cm, however\nit demonstrates less enhancement today.  The previously identified lymphocele\nis nearly completely resolved.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is dilatation of the left ovarian vein to 0.8 cm.  There are\nmultiple dilated vessels in the left parametrium.\n\nBONES: There 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 common iliac lymph node is slightly increased in size however this\nnode as well as 2 other nodes that are stable in size demonstrate decreased\nenhancement consistent with treatment response.\n2. No new lesions seen\n3. Resolution of previously identified lymphocele\n4. Please see chest CT report from the same day for 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: 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 without\nwall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  There is a stable 0.8 cm hypodense lesion the\ntail of the pancreas consistent with IPMN.  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.  Left adrenal gland is\nnormal.\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: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Seen again are multiple enlarged right common iliac nodes.  The\nlargest measures 2.5 x 3.2 cm, previously 1.9 x 3.3 cm.  Additional adjacent\nnodes measure 1.7 x 1.7 cm and 1.9 x 1.8 cm, both of which are unchanged from\nprior.  There is no retroperitoneal or mesenteric lymphadenopathy.  There is\nno pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The left gonadal vein is\ndistended.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nstable hemangioma seen in the vertebral body of L4.  Degenerative changes are\nseen along the thoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable appearance of surgical bed from prior right nephrectomy.   No\nevidence of new lesions in the left kidney or new lymphadenopathy.\n2. Interval increase in size of a right iliac node now measuring 2.5 x 3.2 cm,\npreviously 1.9 x 3.3 cm.  Remaining right iliac nodes are stable.\n3. Unchanged 0.8 cm hypodense lesion in the tail the pancreas.\n4. Cholelithiasis without evidence of cholecystitis.\n5. Stable hemangioma on the L4 vertebral body.\n6. Please see dedicated CT of the chest for 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 or\nextrahepatic biliary dilatation, there is a stable and isolated prominent\ndistal intrahepatic duct (series 2, image 77) in the right lobe of the liver,\na too small to characterize hypoattenuating lesion measuring 6 mm bordering\nthe gallbladder likely a small cyst.  The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence a\ndistal 9 mm lesion in the tail 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: Status post right adrenalectomy, left adrenal gland is normal in\nsize and shape.\n\nURINARY: The patient is status post right nephrectomy.  Nephrectomy bed is\nunremarkable.  The left kidney has extrarenal pelvis, but there is no\nhydronephrosis.  There is no focal lesion or renal stone.  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.  There is an enlarging right\nexternal iliac pelvic lymph node measuring 2.0 cm (series 2, image 107)\ncompared with 0.5 cm in its largest dimension previously.  Multiple additional\nstable right iliac chain lymph nodes are again seen.  The largest measuring\n3.2 x 2.6 cm (series 2, image 95), previously measuring 3.2 by 2.6 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There are prominent left-sided pelvic varices.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a stable L4 vertebral hemangioma.  Multilevel thoracolumbar,\nbilaterals sacroiliac and hips degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Stable appearance of the right nephrectomy surgical bed.\n2.  Redemonstration of right iliac lymph nodes with at least 1 demonstrating\ninterval enlargement.  The remaining right iliac nodes appear stable.\n3.  Stable 8 mm hypodense lesion in the tail of the pancreas.\n4.  Redemonstration of cholelithiasis and L4 vertebral body 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. \nRedemonstration of stable hypodense subcentimeter lesions bordering the\ngallbladder (2:68), likely cysts.  There is otherwise no evidence of focal\nlesions.  Stable and isolated prominent distal intrahepatic duct (4:22),\nunchanged since ___.  There is otherwise no evidence of intrahepatic\nor extrahepatic biliary dilatation. The gallbladder contains gallstones\nwithout wall thickening or surrounding inflammation.  Surgical clips are\nvisible around the porta hepatis, IVC, and aorta.\n\nPANCREAS: The pancreas has normal attenuation throughout. Re-demonstration of\n0.8 cm hypodense lesion in the tail of the pancreas, unchanged since ___. 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: Status post right adrenalectomy, with compensatory hypertrophy of\nleft adrenal gland, unchanged from prior. No evidence of left adrenal lesions.\n\nURINARY: Status post right nephrectomy.  No mass or suspicious lesion at\nnephrectomy site. The left kidney is of normal and symmetric size with normal\nnephrogram.  Re-demonstration of a 0.5 cm cyst in the interpolar region of the\nleft kidney (4:22) and a 0.3 cm cyst in the anterior pole of the left kidney. \nThere is otherwise no evidence of focal renal lesions and 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: There is a fibroid uterus. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Interval decrease in size of pelvic lymph node measuring 1.2 x\n1.9 cm (2:89), previously 2.6 x 3.2 cm on ___.  Interval decrease in\nsize of right iliac chain node measuring 1.4 x 0.7 cm (2:103), previously 2.0\nx 1.4 cm. 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 changes of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of new metastatic disease in the abdomen or pelvis.  Status\npost right nephrectomy and right adrenalectomy with no evidence of\nlocoregional recurrence.  Interval decrease in size of pelvic lymph nodes.\n2. Stable 0.8 cm lesion in the tail of the pancreas, likely a IPMN but should\nbe followed on subsequent imaging.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic 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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver enhances homogeneously.  No focal lesions.\nThe gallbladder is distended with radiopaque calculi within it without\npericholecystic inflammation.\nPANCREAS: Homogeneous enhancement without main duct dilation.  Unchanged 5 mm\nhypodensity in the pancreatic tail (07:30), either focal fat deposition or a\nbranch duct IPMN, continued attention on follow-up.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  The right adrenal gland is surgically absent.  There is unchanged\nmild uniform thickening of the left adrenal gland without a discrete nodule..\nURINARY: The right kidney is surgically absent.  No local recurrence in the\nright nephrectomy bed.\nThe left kidney demonstrates no solid enhancing renal masses within it.  No\nhydronephrosis.  Tiny simple cortical cysts in the superior pole and a\nperipelvic cyst in the lower pole are unchanged.\nGASTROINTESTINAL: No bowel obstruction.  Small hiatus hernia.  Moderate stool\nburden throughout the colon with scattered sigmoid diverticuli.\n\nLYMPH NODES: No enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Mild calcified atherosclerotic plaque within the abdominal aorta, no\naneurysmal dilation.  There are multiple surgical clips in the retroperitoneum\nrelated to prior lymph node dissection.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The uterus is\nretroflexed, unremarkable.  No adnexal masses or free fluid in the pelvis. \nThe left gonadal vein is dilated and tortuous, likely related to reflux..\n\nBONES AND SOFT TISSUES:\nThere is an unchanged 5 mm densely sclerotic focus within the right femoral\nhead.  Unchanged hemangioma within the L4 vertebra.  No new worrisome osseous\nlesions identified.",
            "output": "1. No metastatic disease in the abdomen or pelvis.\n2. Right nephrectomy and adrenalectomy with no evidence of local recurrence."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Patient is status post right adrenalectomy.  The left adrenal gland\nis unremarkable.\n\nURINARY: Patient is status post right nephrectomy.  The surgical bed is\nunremarkable without evidence of local recurrence.  The right kidney\ndemonstrates subcentimeter hypodensities, too small to characterize but likely\nrepresent simple cysts.  Otherwise there is no evidence of hydronephrosis or\nperinephric stranding.  No evidence of solid renal lesions.  No evidence of\nurothelial enhancement or thickening.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Mild colonic diverticulosis\nwithout evidence of diverticulitis..  The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: Small periaortic lymph nodes measuring up to 7 mm are noted\nwithout evidence of lymphadenopathy by CT size criteria.  No evidence of\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a 1.8 cm hemangioma in L4, unchanged from prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post left nephrectomy and adrenalectomy.  No evidence of disease\nrecurrence within the surgical bed.\n2. No evidence of lymphadenopathy or metastatic spread within the abdomen and\npelvis.\n3. Please see dedicated CT of the chest for thoracic findings."
        },
        {
            "input": "LOWER CHEST: There is dependent atelectasis.  The lung bases are otherwise\nclear. 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\npancreatic ductal dilatation.  A 7 mm hypodensity in the pancreatic tail is\nunchanged.  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.\n\nURINARY: Status post right radical nephrectomy.  There is no evidence of local\ndisease recurrence in the nephrectomy bed.  The left kidney demonstrates\nnormal postcontrast enhancement.  Subcentimeter cortical hypodensities are too\nsmall to characterize.  No left-sided 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: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is a 2.4 cm cystic\nstructure (4:129) adjacent to the right ovary which is probably an adjacent\nfluid-containing small bowel loop. The left gonadal vein is prominent.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAn L4 vertebral body hemangioma is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post right radical nephrectomy without evidence of local disease\nrecurrence or metastatic disease in the abdomen or pelvis.\n2. 7 mm hypodensity in the pancreatic tail is stable, probably reflecting a\nside branch IPMN.  Continued attention on follow-up is warranted."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There are dependent calculi in the\ngallbladder, no pericholecystic fat stranding, no gallbladder wall edema.  The\ngallbladder is under distended.\n\nPANCREAS: The pancreatic parenchyma enhances normally.  No pancreatic duct\ndilatation.  No peripancreatic fat stranding.  Again seen is a low-attenuation\nlesion in the tail the pancreas measuring 7 mm which appears to represent\ninterdigitating fat (4:35).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The left adrenal gland is unremarkable in appearance.\n\nURINARY: The right kidney has been resected.  No evidence of local recurrence.\nNo abnormal enhancement in the surgical bed.  The left kidney is normal in\nappearance.  There are several tiny hypoenhancing lesions (10:45, 43,1 38). \nThese are too small to characterize but statistically likely reflect cysts. \nNo hydronephrosis.  No filling defect seen on the urographic images.  The\nbladder is under distended but otherwise unremarkable in appearance.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Normal prominent pelvic sidewall veins again noted,\nparticularly on the left.  This can be seen with pelvic congestion syndrome.\n\nLYMPH NODES: Previously seen prominent left para-aortic/celiac lymph nodes are\nunchanged compared to the prior studies.  No enlarged retroperitoneal or\nmesenteric lymph nodes are seen.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged L4 nonaggressive appearing lesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of local recurrence or metastatic disease in the abdomen and\npelvis.\n2. Stable subcentimeter celiac axis lymph nodes.\n3. Please see the separate report of the same day CT chest"
        },
        {
            "input": "LOWER CHEST: There is linear subsegmental atelectasis in the bilateral lung\nbases.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nhepatic parenchyma is hypoattenuating relative to the spleen, suggestive of\nhepatic steatosis.  There is no evidence of focal lesions. There is no\nevidence of intrahepatic biliary dilatation.  The common bile duct is dilated\nmeasuring up to 9 mm (601:30) and demonstrates diffuse hyperenhancement of the\nwall, concerning for cholangitis.  No stone is seen within limitations of CT. \nThe gallbladder is mildly distended with wall thickening and hyperenhancement,\nas well as adjacent 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. \nCysts are seen in bilateral kidneys measuring up to 3.7 cm in 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. 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 STRUCTURES: 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: 3 mm sclerotic lesion in the L2 vertebral body compatible with a bone\nisland.  There is a transitional lumbosacral vertebral body with\npseudoarticulation of the right L5 transverse process with the sacrum.  There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left inguinal hernia repair postsurgical changes noted.",
            "output": "1. Mildly dilated common bile duct with diffuse wall enhancement concerning\nfor cholangitis.  Mild gallbladder distention with wall thickening and\nsurrounding inflammatory change, compatible with acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Bilateral breast implants are\npartially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a small 8 mm geographic hyperdensity seen in the left hepatic lobe\nwhich may represent a flash filling hemangioma or perfusion abnormality\n(2:17).  Otherwise, 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is relatively\ncollapsed..  There is a moderate-sized duodenal diverticulum (2:32) measuring\n3 cm.  Otherwise, small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  There is a moderate amount of stool in\nthe sigmoid and rectum..  The right colon is fluid-filled.  There are a few\nscattered diverticula without evidence of acute diverticulitis.  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 uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There are surgical clips in the retroperitoneum, likely from\nprior lymphadenectomy.  Otherwise, there is no 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: There 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.  Colonic diverticulosis without evidence of acute diverticulitis.\n3. 8 mm left hepatic lobe hyperdensity may represent a small hemangioma or\nperfusion 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 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 multiple well-circumscribed hypoattenuating lesions throughout the\nbilateral kidneys which are most consistent with simple renal cysts.  The\nlargest cyst is demonstrated at the mid right kidney it measures up to 2.5 cm.\nThere is no evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There are several loops of\nnondistended, fluid-filled small bowel with slight hyper-enhancement of the\nmucosa.  No evidence of bowel obstruction is seen.  The appendix is not\nvisualized.  There is a small fecal 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: 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There are several loops of slightly distended, fluid-filled small bowel\nwith mild hyper-enhancement of the mucosa which may represent an enteritis in\nthe appropriate clinical setting.  No evidence of bowel obstruction.\n2. The appendix is not identified."
        },
        {
            "input": "CT PELVIS:  The previously seen left psoas abscess is identified, measuring\n1.9 x 1.3 x 2.3 cm, unchanged in size compared with the prior MRI (2a:3,\n601b:30).  Adjacent postsurgical changes are noted with expansion of the left\npsoas muscle and possible infectious involvement of the L4-5 intervertebral\ndisc space. Of note, MRI is more sensitive in the detection of diskitis and\nosteomyelitis. The urinary bladder is decompressed by a Foley. No pelvic wall\nor inguinal lymph node enlargement by CT size criteria is seen. There is no\npelvic free fluid. The partially visualized large and small bowel demonstrate\npostsurgical changes and a large fecal load.",
            "output": "Left psoas abscess measuring 1.9 x 1.3 cm in the axial plane, 2.3 cm\ncraniocaudally, unchanged in size from the MRI of ___. Postsurgical\nchanges and possible infectious involvement of the L4-L5 intervertebral disc\nspace are noted, better evaluated by MRI."
        },
        {
            "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 focal narrowing\nof the proximal celiac axis which is otherwise patent.  The SMA and ___ are\npatent.  Prominent vessels within the left pelvis consider just component of\npelvic congestion.  Narrowing of the intrahepatic IVC may be due to decreased\nvolume status or extrinsic compression due to hepatomegaly.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged, measuring 19.4 cm in craniocaudad\ndiameter.  There is interposition of a small portion of the ascending colon\nbetween the liver and abdominal wall.  There is heterogeneous, reticular\nenhancement diffusely throughout the liver.  No apparent focal lesion.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is distended but 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 kidneys are otherwise of normal and symmetric size with normal\nnephrogram.  2 stones are seen within the interpolar region of the left kidney\nmeasuring up to 4 mm (02: 37, 38).  There is no hydronephrosis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is somewhat asymmetric wall thickening\nabout the cecum with slight pericecal fat stranding which is nonspecific but\nmay represent mild cecitis. There is diverticulosis without evidence of\ndiverticulitis.  The rectum is within normal limits.  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\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 unremarkable.  No adnexal abnormality.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate levoscoliosis of the upper lumbar spine with compensatory\ndegenerative changes most severe at the L4-5 level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of active bleeding within the gastrointestinal tract.\n2. Somewhat asymmetric wall thickening of the cecum with slight pericecal fat\nstranding is nonspecific but may represent mild cecitis. Follow-up to\nresolution is recommended.\n3. Diverticulosis without evidence of diverticulitis.\n4. Hepatomegaly with reticular enhancement pattern is nonspecific but can be\nseen with infiltrative processes, sinusoidal obstructive disease, and\nanecdotally oral contraceptive use.  Query whether possibly related to\nchemotherapy or history of malignancy.  No focal lesion identified.  Notably,\noutside MRCP from ___ reported similar findings without focal lesion.\nCorrelate with LFTs.\n5. No definite paraesophageal varices seen."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits.  No focal hepatic lesion is\ndetected.  There is trace sludge within the gallbladder (series 304, image\n37).  No radiopaque ductal stones are detected.\n\nThe pancreas is atrophic, without obvious duct dilation or focal lesion.\n\nThe spleen size is within normal limits.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size, without hydronephrosis.  There are multiple\nsubcentimeter bilateral renal lesions, the larger ones demonstrating uniform\nlow density, most compatible with cysts, the largest arising from the right\ninterpolar aspect measuring 7.0 cm (series 304, image 38).  Subcentimeter\nhypodensities are less specific, but are also statistically likely cysts.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  No focal gastrointestinal lesion is detected.\n\nThe bladder is mildly distended, and appears normal.  The prostate is mildly\nenlarged.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy.  There is mild abdominal ascites and diffuse moderate\nanasarca.\n\nExtensive atherosclerotic calcifications are demonstrated throughout the\nabdominal aorta and iliac branches.  There is a 4.0 cm infrarenal abdominal\naortic aneurysm (series 304, image 36, series 601, image 27).\n\nThere are no osseous lesions concerning for malignancy or infection.  There is\na moderate L1/2 and L5/S1 disc height loss with moderate endplate sclerosis\nand osteophytosis.  No spondylolisthesis is detected.\n\nEnlarged fat/fluid containing right inguinal hernia is incidentally noted\n(series 304, image 73).",
            "output": "1. Mild abdominal ascites.  Extensive abdominopelvic anasarca.\n2. No acute abdominopelvic process.  No primary abdominopelvic malignancy\nidentified.\n3. Trace gallbladder sludge.\n4. 4.0 cm infrarenal abdominal aortic aneurysm.  Extensive atherosclerotic\ncalcifications throughout the abdominal aorta and iliac branches.\n5. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions.  There is overlying bilateral\nlower lobe collapse, worse on the left, likely representing atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n0.9 cm hypodensity within hepatic segment VI was previously characterized as a\ncyst on the prior MR from ___.  No new or suspicious hepatic 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 within the limitations of an unenhanced scan.  A calcification\nnear the pancreatic head was present in ___.  The known cystic lesion within\nthe pancreatic head is not well visualized 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 partial right nephrectomy.  Postsurgical\nchanges at the upper pole are similar to the prior MRI.  A fiducial markers\ndemonstrated the interpolar region of the left kidney consistent with prior\nCyberKnife therapy for biopsy proven RCC.  There is cortical scarring along\nthe left kidney as on prior.  No new lesions within the limits of a\nnoncontrast enhanced scan.  A 0.8 cm dense cyst within the upper pole of the\nright kidney and a 1.3 cm dense cyst within the superior pole of the left\nkidney are unchanged in size from the prior study from ___, consistent with\nproteinaceous cysts.\n\nNo renal stones are demonstrated.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is contains an enteric tube which terminates\nnear the gastric antrum.  Small bowel loops demonstrate normal caliber and\nwall thickness throughout.  The patient is status post right colectomy.  There\nis evidence of colonic diverticulosis without evidence of diverticulitis most\nnotable in the sigmoid colon.  There is a short segment of wall thickening in\nthe rectosigmoid (series 2, image 73).  Enteric contrast is seen within the\ndistal colon and rectum.  The appendix is resected.\n\nPELVIS: The bladder is decompressed around a Foley catheter.  Air within the\nbladder is presumably post catheterization.  The distal ureters are normal. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains fiducial markers.\n\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\nfracture.Cortical irregularity along the lateral aspect of the right tenth rib\n(series 602, image 11) could represent a healed fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No renal, ureteric or bladder stones.  No hydronephrosis.  No evidence of\nurinary obstruction.\n2. Postprocedural changes status post right partial nephrectomy and left renal\nCyberKnife therapy appear overall unchanged from the prior MRI ___  within\nthe limits of a noncontrast enhanced CT.\n3. Diverticulosis without evidence of diverticulitis.\n4. Short segment of rectosigmoid wall thickening suspicious for neoplasm.\n5. Trace bilateral pleural effusions.  Overlying atelectasis slightly larger\non the left.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:13 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 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 partial right nephrectomy.  Postsurgical\nchanges are similar to prior CT.  A fiducial marker is again seen in the\ninterpolar region of the left kidney.  There appearing cortical scarring seen\nalong the left kidney.  There is redemonstration of a 1.3 cm hyperdense lesion\nthe upper pole of the left kidney, similar to prior.  No hydronephrosis.\n\nGASTROINTESTINAL: Gastrostomy tube is seen, with balloon in the anterior body\nof the stomach.  The stomach is collapsed.  No bowel obstruction is seen. \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding.  Patient is status post right colectomy.  The\nappendix 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 contains fiducial markers.\n\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 bowel obstruction.\n2.  Colonic diverticulosis without evidence of acute diverticulitis.  Status\npost right colectomy.\n3.  Gastrostomy tube in a collapsed stomach."
        },
        {
            "input": "LOWER CHEST: Minimal bibasal atelectasis.  No pleural effusion.  The heart is\nslightly enlarged.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.Punctate hypodensity in the right\nhepatic lobe small to characterize (series 2, image 11).  Otherwise, 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: 9 mm accessory spleen is noted adjacent to the tip of the pancreas\n(series 2, image 26).  The 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: Bilateral renal cysts measuring up to 2.0 cm are noted.  The kidneys\nare of normal and symmetric size with normal nephrogram.  There is no\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is relatively collapsed.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\ncolon is mildly distended with air.  However, there is no evidence of\nobstruction.  The rectum appendix are unremarkable.\n\nPELVIS: Diffuse thickening of the urinary bladder wall is likely a reflection\nof its minimal distension.  The distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is is mildly enlarged and partially\ncalcified.\n\nLYMPH NODES: A few prominent but not pathologically enlarged mesenteric nodes\nare noted (series 2, image 44).\n\nVASCULAR: Left retroaortic renal vein is noted.  There is no abdominal aortic\naneurysm.  No atherosclerotic disease is noted.\n\nBONES: Degenerative changes of the hip joints bilaterally with likely\nsubchondral cyst formation (series 2, image 78, 79).  Also noted are\nmultilevel degenerative changes of the thoracolumbar spine.  L5\nspondylolysis/pars defect is noted on the left.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No evidence of bowel obstruction, pneumoperitoneum, bowel perforation, free\nfluid, or other acute findings 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 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 biliary sludge 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.  Mild\nleft-sided pelvicaliectasis.  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.  Mild fecal loading noted within\nthe colon.  The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: Urinary bladder is decompressed with a Foley catheter in place.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Few brachytherapy seeds are seen in the region of 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe dextroconvex curvature of the lower thoracic/upper lumbar\nspine.\n\nSOFT TISSUES: Small left inguinal hernia containing fat.  The abdominal and\npelvic wall is otherwise within normal limits.",
            "output": "1. Within the limitations of an unenhanced study, there is no evidence of\ninfectious process or lymphadenopathy within the abdomen or pelvis.\n2. Mild left-sided pelvicaliectasis.\n3. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day."
        },
        {
            "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. A\nsubcentimeter enhancing focus at the hepatic dome (5:9) is too small to\ncharacterize, but may be a hemangioma.  There is no evidence of worrisome\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains gallstones without wall thickening or\nsurrounding inflammation. Focal hyperenhancement at the fundus likely reflects\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 left and right adrenal glands are mildly thickened and nodular,\nwithout discrete nodules.\n\nURINARY: The kidneys are normal and symmetric size.  Multiple, bilateral\nill-defined areas of hypoenhancement with associated subcapsular expansion\n(for example, ___:29, 31, 34), left greater than right, are concerning for\npyelonephritis.  No hydronephrosis.  The bilateral ureters are dilated, with\nmild hyperenhancement of the left distal ureter.\n\nGASTROINTESTINAL: The stomach is 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 demonstrates circumferential wall thickening and mild\nsurrounding fat stranding.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducial markers are within the prostate.  Hyperdense\nfoci within the base of the penis and left scrotum likely reflect\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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild anterolisthesis of L4-5 is likely degenerative.  Dextroconvex curvature\nof the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Cystitis, with bilateral hydroureter and multiple, bilateral, left greater\nthan right, ill-defined areas of hypoenhancement of the kidneys, concerning\nfor pyelonephritis.\n2. Cholelithiasis, without evidence of acute cholecystitis."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 4.4 cm\nLocation (head right of SMV, body left of SMV): Head (anterior and a right but\ncrossing over to the left of the superior mesenteric vein).\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent P\nBiliary tree abrupt cutoff with or without upstream dilatation: Common bile\nduct stent is present in appropriate position.  There is no intrahepatic\nbiliary duct dilation.\n\nA 2.2 cm, partly exophytic hypoattenuating round lesion is identified arising\nfrom the pancreatic tail (6:95)\n\nArterial evaluation\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\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:  absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: accessory left hepatic artery arising from common hepatic\nartery\nVariant vessel contact:  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):\npresent\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:  present\nThrombus within vein: absent; type of thrombus:  None\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: Small amount of fluid is identified along the left gerota's fascia\nand perisplenic region.\nSuspicious lymph nodes: There are multiple porta hepatis, pre caval and\nperipancreatic lymph nodes measuring up to 9 mm in short axis. A long chain of\nlymph nodes that enhance homogeneously but measure less than 1 cm are seen\nlocated cranial to the pancreas (6:96).\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nLYMPH NODES:  There are multiple porta hepatis, pre caval and peripancreatic\nlymph nodes measuring up to 9 mm in short axis.  A long chain of lymph nodes\nthat enhance homogeneously but measure less than 1 cm are seen located cranial\nto the pancreas (6:96).\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Common bile duct stent is present. \nPneumobilia is noted.  The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.  There is layering air within the gallbladder.\n\nPANCREAS: Pancreatic lesions and ductal dilation as described above. \nSignificant peripancreatic stranding of fat and trace fluid in the\nperipancreatic region extending along the anterior left perirenal space 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 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles 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. Pancreatic head extending to neck and proximal body mass causes narrowing\nof the main portal vein and SMV confluence with more than 180 degrees contact\nwith the common hepatic artery, superior mesenteric vein just beyond the\nconfluence and Porto splenic confluence respectively without occlusion of\nthese vessels.  Mild upstream main pancreatic duct dilation present.\n2. Signal peripancreatic fat stranding and trace fluid extending up to the\nleft anterior perinephric space raise suspicion for underlying acute\npancreatitis.\n3. 2.2 cm rounded partly exophytic lesion arising from the pancreatic tail may\nrepresent a small area of walled off necrosis versus a side branch IPMN.  No\nprior imaging is available to assess if this is a new lesion."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, ___, renal and\niliac arteries and their major branches are patent with no signs of occlusive\nor aneurysmal disease. The portal system including SMV, splenic and portal\nveins is patent. The renal veins, iliac veins and IVC are patent and\ndemonstrate normal caliber. There is moderate calcium burden in the abdominal\naorta 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.  CBD stent and fiducials in the pancreatic\nhead are in similar position compared to prior.  There is mild pneumobilia,\npredominantly in the left lobe and the gallbladder.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: 3.5 x 2 cm hypodense lesion in the head previously measured 4.4 x\n2.8 cm.  The tumor abuts the common hepatic artery, the GDA, and the main\nportal vein. The upstream main pancreatic duct measures up to 4 mm, decreased\nsince prior.  2.2 x 1.5 cm hypodense lesion arising from the lateral tail\n(3:121), 9 mm hypodense lesion arising from the tail (3:129), and 1.1 x 1 cm\nhypodense lesion arising from the body (3:123) are not significantly changed\nsince prior.  The pancreas otherwise has normal attenuation throughout. There\nis no significant peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\nMultiple prominent mesenteric, retroperitoneal, pelvic, and inguinal lymph\nnodes appear unchanged 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 unremarkable.\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. 3.5 cm mass in the pancreatic head appears slightly smaller compared to\nprior.  Upstream pancreatic ductal dilation is also slightly decreased since\nprior.\n2. Multiple prominent mesenteric, retroperitoneal, pelvic, and inguinal lymph\nnodes appear unchanged compared to ___."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no evidence of aortic injury\nor dissection.  There is mild calcium burden in the abdominal aorta and great\nabdominal arteries.  There is continued hazy soft tissue stranding contacting\nthe celiac axis and common hepatic artery, however the celiac axis, hepatic\nartery, splenic artery, and SMA are patent.  The portal vein, SMV and splenic\nvein are not well evaluated on this arterial study, however is at least\nnarrowing of the main portal vein and of the adjoining SMV and splenic vein.\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 hyopoattenuation throughout,\nsuggestive of steatosis.  There is no evidence of focal lesions.  The common\nbile duct is stented with a metallic stent, stable in position, terminating in\nthe duodenum, with a small amount of expected pneumobilia.  The gallbladder\ncontains a small foci of air, and is otherwise within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: Compared with CTA pancreas on ___, a hypodense pancreatic\nhead mass measuring 3.3 x 2.3 cm is not significantly changed in size. \nFiducial markers are again seen in the region of the mass.  There is\npersistent upstream dilation of the pancreatic duct.  Small cystic lesions in\nthe pancreatic body and and tail are not significantly changed, the larger\nmeasuring 1.7 cm in the pancreatic tail.  There is been interval increase in\nsize and decreased in attenuation of the body and tail of pancreas in addition\nto some peripancreatic fat stranding.  Some stranding of the adjacent\nretroperitoneal appears increased from 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 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(3:102).  There 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.  Prominent\nright pelvic sidewall lymph nodes measuring up to 1.0 cm are not significantly\nchanged.  There is no evidence of left pelvic or inguinal lymphadenopathy. \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 left inguinal hernia containing fat is noted.  A tiny\numbilical hernia containing fat is noted.",
            "output": "1. No evidence of dissection or other acute aortic pathology.\n2. Edema of the pancreatic body and tail in addition to increase in fat\nstranding surrounding the pancreas, may reflect superimposed pancreatitis.\n3. No significant change in size of a hypodense pancreatic mass.\n4. This study is not tailored to evaluate the venous vasculature, however\nthere is persistent at least narrowing of the main portal vein and of the\nadjoining SMV and splenic vein."
        },
        {
            "input": "LOWER CHEST: Lung bases are clear.\n\nPANCREAS: Compared to prior, the large region of hypoattenuation involving the\npancreatic neck and body measuring 2.0 x 4.5 cm, is unchanged from the most\nrecent prior examination but increased from ___ (series 4, image 43). The\npancreatic head, body, and tail are diffusely enlarged with surrounding\nperipancreatic stranding similar to prior.\n\nNo walled-off pancreatic collection is identified.  A 2.2 x 1.3 cm cystic\nlesion in the pancreatic tail a probable cystic lesion in the pancreatic body\nmeasuring 0.9 x 0.9 cm are unchanged (series 4, image 40, 37).  Fiducial seeds\nare unchanged in position.\n\nSince ___, there has interval worsening of attenuation of the veins.  For\nexample, there is now severe attenuation of the proximal portal vein once. \nThere is now only a tiny sliver of patent proximal superior mesenteric vein. \nThe splenic vein is also now severely attenuated along its proximal portion.\n\nNo pseudoaneurysm identified.\n\nThere continues to be soft tissue involvement surrounding less than 180\ndegrees of the celiac axis.  There is greater than 180 degrees soft tissue\ninvolving the common hepatic artery.  There is mild stranding around the\nsuperior mesenteric artery, not seen on ___, likely related to acute\ninflammation.\n\nVASCULAR: There is moderate atherosclerotic calcification of the abdominal\naorta.  There is no abdominal aortic aneurysm.  Hepatic arterial anatomy is\nconventional.\n\nHEPATOBILIARY: The liver is fatty in attenuation.  No focal liver lesion is\nidentified.  There is pneumobilia and air within the gallbladder, secondary to\ninstrumentation.  A common bile duct stent is unchanged and appropriately\npositioned.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 no hiatal hernia.  There is no bowel obstruction. \nThe appendix is normal.  There is no intra-abdominal free air.  There are\nscattered mesenteric lymph nodes measuring up to 6 mm.\n\nRETROPERITONEUM: There scattered retroperitoneal lymph nodes measuring up to 6\nmm.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nenlarged bilateral external iliac chain lymphadenopathy, not largely changed. \nFor example a right external iliac lymph node measures 12 mm and a left\nexternal iliac chain lymph node measures 9 mm (series 4, image 123).\n\nREPRODUCTIVE ORGANS: The prostate is 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. Acute pancreatitis overall unchanged in severity since ___.\n2. Large hypoattenuating region in the pancreatic head/neck/body although\nunchanged from ___ has increased ___, unclear if related to\npancreatic necrosis versus tumor progression.\n3. Severe attenuation of the proximal portal, superior mesenteric, and\nproximal splenic vein progressed from ___.\n4. Unchanged mildly enlarged external iliac chain lymph nodes, continued\nattention on follow-up."
        },
        {
            "input": "LOWER CHEST: Abutting left lower lobe pulmonary nodules have increased in\nsize, spanning 0.9 x 0.5 cm in aggregate, previously 0.5 x 0.3 cm (series 4,\nimage 11).  A 0.7 cm subpleural right lower lobe pulmonary nodule is new since\nat least ___ (series 4, image 8).  A 0.4 cm pulmonary nodule in the\nanterior aspect of the right lower lobe is new since at least ___\n(series 4, image 5).  A partially imaged nodular opacity in the subpleural\nright middle lobe probably also reflects a new pulmonary nodule (series 4,\nimage 1).  No pleural effusion.  Heart size is mildly enlarged.  Partially\nimaged pacing leads terminate in the right atrium and right ventricle.  No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is new occlusive thrombus at the right anterior and\nposterior portal vein bifurcation extending into the proximal right anterior\nportal vein and throughout the length of the right posterior portal vein. \nThere is significant adjacent periportal edema and the affected right hepatic\nlobe parenchyma enhances somewhat heterogeneously.  A more focal area of\nheterogeneous enhancement in segment V is located adjacent to a focus of\nhypoattenuation similar in appearance to the portal vein thrombus elsewhere,\nprobably reflecting focal right portal vein branch occlusion and resulting\nperfusional heterogeneity. There is also partial cavernous transformation of\nthe portal vein.  No intrahepatic biliary ductal dilation, the left hepatic\nlobe pneumobilia is minimally changed, presumably related to history of\nextrahepatic bile duct stent placement.  The gallbladder is moderately\ndistended with focal wall thickening at the fundus probably reflecting\nadenomyomatosis, unchanged since the prior examination.  Trace perihepatic\nnonhemorrhagic ascites.\n\nPANCREAS: The previously seen hypoattenuating lesion in the pancreatic neck is\ndecreased in size, with a subtle appearing area of hypoattenuation measuring\nup to approximately 1.4 x 1.1 cm, not definitely reflecting a discrete mass\nlesion (series 7, image 102).  There are fewer fiducials in the pancreatic\nneck. There is new occlusion of the superior mesenteric vein adjacent to the\nportal confluence, previously severely attenuated. There is increased\nattenuation of the splenic vein and proximal main portal vein at the portal\nconfluence (series 7, images 102 and 103). There is greater than 180 degrees\nof hazy soft tissue surrounding the affected portions of superior mesenteric,\nsplenic, and portal veins. There is slightly greater than 180 degrees of hazy\nsoft tissue surrounding the celiac trunk and proximal common hepatic and\nsplenic arteries, not appreciably changed since ___. There is\napproximately 180 degrees soft tissue contact with the proximal superior\nmesenteric artery, not appreciably changed.  The pancreatic head enhances\nhomogeneously without focal lesions.  The pancreatic body and tail are\natrophic with top-normal main pancreatic duct size.  Significant fat stranding\nadjacent to the pancreatic body and tail has essentially resolved since ___.\n\nSPLEEN: Splenomegaly has increased since ___ measuring up to 16.0 cm,\npreviously 14.2 cm.  The spleen otherwise enhances normally with 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 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.  The\nappendix appears unremarkable with a small amount of adjacent fat stranding,\nsimilar in appearance to the prior CT scan and likely reactive given a small\namount of intra-abdominal ascites.\n\nLYMPH NODES: Variable changes in mesenteric and retroperitoneal lymph nodes. \nA centrally hypoattenuating lymph node in the mesentery is slightly decreased\nin size and measures 1.0 cm, previously 1.3 cm (series 7, image 93).  A lymph\nnode just superior to the splenic artery is unchanged in size and measures 1.1\ncm (series 7, image 93).  A peripancreatic lymph node is minimally changed and\nmeasures 0.9 cm (series 7, image 100).  A portal caval lymph node is unchanged\nand measures 1.0 cm (series 7, image 104).  A left periaortic lymph node is\nunchanged and measures 0.9 cm (series 7, image 120).  An aortocaval lymph node\nhas increased in size and measures 1.0 cm, previously 0.7 cm (series 7, image\n121).  A right external iliac lymph node has decreased in size and measures\n0.9 cm, previously 1.2 cm (series 7, image 172).  No inguinal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.    There is\ntrace free fluid in the pelvis, similar to ___.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Moderate, fat containing, left inguinal hernia.",
            "output": "1. Decreased size of a hypoattenuating pancreatic neck lesion with minimally\nchanged infiltrative soft tissue in the adjacent fat.  Minimally changed\nretroperitoneal lymphadenopathy.  Additional details as described in the\nfindings.\n2. New occlusive portal vein thrombosis in the proximal right anterior portal\nvein and throughout the length of the right posterior portal vein with\nresulting heterogeneous enhancement of the right hepatic lobe.\n3. New superior mesenteric vein occlusion, probably extrinsic or scarring, and\nincreased, severe attenuation of the splenic vein and portal vein at the\nportal confluence.\n4. New trace perihepatic ascites and increased splenomegaly.\n5. New and increasing bibasilar pulmonary nodules.  Please refer to separate\nreport for same-day CT chest for complete description of the thoracic\nfindings.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:27 pm, approximately\n120 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Respiratory motion limits evaluation of lung parenchyma. There\nare bilateral basilar consolidations concerning for aspiration/pneumonia.\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 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: 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.  There is no suspicious\nrenal 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.\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. Bibasilar lung consolidations are concerning for aspiration/pneumonia.\n2. No intra-abdominal process identified, within the limitations of an\nunenhanced study.  Evaluation for liver laceration is limited.  There is no\nfree fluid."
        },
        {
            "input": "VASCULAR:\n\nPlease see separately submitted report of CTA chest and heart from the same\ndate for detailed evaluation of the aortic valve and vascular access.\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal 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.  A\npunctate hyperdensity in segment VII/segment VIII likely represents a\ngranuloma (4:77).  No other lesion is seen on this early arterial phase\nsequence.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains small sludge and stones and is otherwise\nunremarkable.\n\nPANCREAS: The pancreas is markedly atrophic without focal lesion.  Mild\nprominence of the main pancreatic duct is likely due to relative atrophy of\nthe pancreatic parenchyma.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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, suspicious focal renal lesions, or\nhydronephrosis.  Hypodensity in the interpolar right kidney is too small to\nfully characterize but likely represents a simple cyst (4:124).  There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is largely decompressed but otherwise\nunremarkable.  Visualized loops of small bowel are unremarkable without wall\nthickening or abnormal dilatation.  There is extensive colonic diverticulosis\nwithout evidence of diverticulitis.  The appendix is not visualized but there\nare no secondary signs of in the right lower quadrant to suggest acute\nappendicitis.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nBONES: There is severe degenerative changes at L5-S1, including near complete\nloss of the intervertebral disc space, subchondral sclerosis, vacuum\nphenomenon, and grade 2 anterolisthesis of L5 on S1.  There is no suspicious\nosseous lesion.  Bilateral L5 pars defects are noted.  Age-indeterminate\nvertebral body compression fractures of T9, T11, and T12 are noted.  There is\nno retropulsion into the spinal canal at these levels.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Severe degenerative changes at L5-S1, including grade 2 anterolisthesis.\n2. Age-indeterminate vertebral body compression fractures of T9, T11, and T12\nare present without retropulsion into the spinal canal.\n3. Please see separately submitted report of CTA chest and heart from the same\ndate for detailed evaluation of the aortic valve and vascular access."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: There is extensive edema extending from the region of the pancreatic\nneck towards the hepatic hilum and anteriorly toward the lesser curvature of\nthe stomach which demonstrate wall thickening.  The visualized portions of the\nuncinate process, pancreatic head and pancreatic tail enhance normally.  There\nis a 9.3 x 7.9 x 8.6 cm peripancreatic fluid collection with an enhancing rim\narising from the region of the pancreatic neck/body (02:36; 601:24).  There is\nnarrowing at the portal confluence due to mass effect by the pancreatic\ncollection which lies directly anterior to the confluence (02:36). \nAdditionally, the main portal vein is severely narrowed by the edematous\nchanges at the hepatic hilum just prior to the bifurcation, however remains\npatent (02:26; 601:34).  The right and left portal veins are patent.  The SMV\nand splenic vein remain patent though are narrowed.  There are numerous\ncollateral vessels in the left upper quadrant.\n\nSPLEEN: The spleen shows top normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Previously seen stent has been\nremoved.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits. The\nappendix is normal (02:54).\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 grossly\nunremarkable.\n\nLYMPH NODES: There is scattered enhancing reactive lymph nodes in the upper\nabdomen measuring up to 2.1 cm (02:25).  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: Compared with ___, there is worsening severe degenerative\nchange in the right hip with flattening of the femoral head and large\nsubchondral cysts, likely due to avascular necrosis with subsequent collapse\nof the articular surface.  There is a serpiginous subchondral sclerotic foci\nin the left femoral head, similar to prior and likely representing chronic\navascular necrosis.  Bilateral L5 spondylolysis is noted without\nspondylolisthesis.\n\nSOFT TISSUES: An umbilical hernia containing fat and mesenteric vessels is\nnoted.",
            "output": "1. A 9.3 cm peripancreatic fluid collection arising from the region of the\npancreatic neck/body, with surrounding extensive edema extending to the\nhepatic hilum and lesser curvature of the stomach which causes mass effect\nincluding severe narrowing of the main portal vein at the hepatic hilum just\nprior to its bifurcation.\n2. Visualized portions of the pancreatic uncinate process, head and tail\nenhance normally.\n3. Findings compatible with progressed avascular necrosis of the right hip\nwith new subchondral collapse compared with ___.  Avascular necrosis of the\nleft hip without subchondral collapse is not significantly changed."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Heterogeneous liver density secondary to patchy patent\nsteatosis.  Perfusion all changes is demonstrated in segment IV.  No focal\nliver lesions are identified.  The caudate lobe is enlarged.  A recannulized\numbilical vein is identified.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is slightly distended and\nfilled with sludge.  There is no gallbladder wall edema or thickening.  Small\nvolume ascites is new compared to ___.\n\nPANCREAS: There has been interval removal of the previously seen axios stent. \nThe head and proximal body of the pancreas demonstrates low attenuation\nconcerning for necrotizing pancreatitis with surrounding soft tissue\nstranding.  The remainder of the body and tail the pancreas demonstrates\nnormal parenchymal enhancement.  There is no evidence main ductal dilatation. \nNo organized fluid collection or pseudoaneurysm formation.\n\nSPLEEN: The spleen is enlarged up to 17.2 cm.  No focal splenic 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. \nThere is no evidence of solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis underdistended, limiting its evaluation.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is small volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Extensive porta hepatic lymphadenopathy, progressed in size and\nnumber compared to the prior exam examination.  For example there is a 3.4 x\n2.1 cm enlarged lymph node adjacent to the extrahepatic portal vein which\npreviously measured 2.5 x 1.6 cm (series 7, image 31).  Additional enlarged\nperiaortic and mesenteric lymph nodes can be found on the following images\n(series 7, image 35, 41, 49).  Prominent right external iliac lymph node\nmeasures 1.8 x 1.0 cm, essentially unchanged compared to ___. \nFindings may be reactive due to background liver disease.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nThe main portal vein, SMV, and splenic vein is patent with extensive\nmesenteric collateral vasculature with splenorenal shunt.  Perigastric and\nperiesophageal varices are demonstrated.  Varices within the wall of the\nabdomen are also seen.\n\nBONES: Severe degenerative changes of the right hip with flattening of the\nfemoral head and large subchondral cysts, likely reflective avascular necrosis\nwith collapse of the articular surface.  Serpentine subchondral sclerotic\nfocus in the left femoral head is similar to the prior examination and likely\nreflects chronic avascular necrosis.  Degenerative changes of the\nthoracolumbar spine are most pronounced at L5.  There is a chronic fracture\ndeformity of the posterior left eleventh rib, unchanged compared to the prior\nexamination.\n\nSOFT TISSUES: Large fat mesenteric vessel containing umbilical hernia with a\nneck measuring approximately 4.6 cm in transverse dimension (series 7, image\n61) and 2.2 cm in craniocaudal dimension (series 10, image 43).",
            "output": "1. Interval removal of the Axios stent with no residual pseudocyst at this\nsite.  There is persistent decreased attenuation of the proximal body and head\nof the pancrea, with no evidence of an organized peripancreatic collection,\npseudoaneurysm formation, or main ductal dilatation.\n2. Extensive porta hepatis and peripancreatic lymphadenopathy appears\nincreased in size and number compared to the prior examination of ___.  It is unusual for lymph nodes to continue to enlarge given improvement\nof pancreatic and peripancreatic inflammation.  Sampling of these lymph nodes\nmay be considered via EUS.\n3. Cirrhotic liver morphology, diffuse hepatic steatosis with associated\nfindings compatible with background portal hypertension including\nsplenomegaly, extensive upper abdominal varices, and small volume ascites.\n4. Stable avascular necrosis of the bilateral femoral heads, right greater\nthan left.\n\nRECOMMENDATION(S):  PLease see impression #2"
        },
        {
            "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 suspicious 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Oral contrast has reached the\nmid ileum.  Bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. There is mild pancolonic 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: 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes about the L5-S1 level.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings within the abdomen or pelvis to explain the patient's\nreported symptoms.  Specifically, no evidence of colitis or bowel obstruction.\n2. Diverticulosis without acute diverticulitis.\n3. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  There is mild cardiomegaly.\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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is suggestion of a small\nduodenal diverticulum (02:29).  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. Scattered diverticular seen\nthroughout the colon without evidence of wall thickening or adjacent\nmesenteric 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 enlarged and contains fibroids.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRedemonstrated are moderate degenerative changes centered at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic abnormality.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. 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. \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: There are bilateral renal subcentimeter low attenuation lesions, too\nsmall to characterized.  There is no evidence of solid renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal.  Small bowel loops\ndemonstrate no signs of ileus or obstruction.  The appendix is normal.  The\ncolon contains a mild fecal load without evidence of wall thickening or acute\ninflammation.  No free air or free fluid.\n\nPELVIS: The urinary bladder is decompressed.  No free pelvic fluid.\n\nREPRODUCTIVE ORGANS: There are multiple exophytic fibroids visualized. \nBilateral ovaries 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. \nThere is degenerative changes at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings to account for pain.\n2. Fibroid uterus.\n\nNOTIFICATION:  Updated findings discussed with Dr. ___ at 2:36 p.m. on ___"
        },
        {
            "input": "VASCULAR:\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.  There is an\naccessory left renal artery, and an accessory right hepatic artery arising off\nthe SMA.  No active contrast extravasation is seen within the bowel.\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.  Two\nsubcentimeter hepatic hypodensities are too small to characterize, however\nlikely represent hepatic cysts or biliary hamartomas. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal 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, concerning focal renal lesions, or\nhydronephrosis.  Sub cm hypodensities in both kidneys are too small to fully\ncharacterize, likely cysts.  Left peripelvic cysts are noted.  There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis diffuse colonic diverticulosis, with no evidence of acute diverticulitis. \nThe rectum is within normal limits.  Appendix contains air, has normal caliber\nwithout evidence of fat stranding (604b:51).  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: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES:  There are degenerative changes in lumbar spine.  There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.  Asymmetry of\nthe right chest wall likely represents prior mastectomy.",
            "output": "1. No evidence of active arterial or venous contrast extravasation.\n2. Diffuse colonic diverticulosis with no evidence of acute diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nNo active contrast extravasation is identified within the bowel.  The celiac\naxis, SMA, ___, and renal arteries and their major branches appear patent with\nno evidence of occlusion.  There is an accessory left renal artery, and an\naccessory right hepatic artery arising from the SMA.  There is no abdominal\naortic aneurysm.  There is minimal calcium burden in the abdominal aorta and\ngreat 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 concerning focal lesions.  There are two subcentimeter\nhypodensities in the left hepatic lobe, too small to characterize by CT though\nlikely compatible with simple hepatic cysts or biliary hamartomas.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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. \nSubcentimeter hypodensities in the bilateral kidneys are too small to\ncharacterize, though likely compatible with simple renal cysts.  Bilateral\nperipelvic cysts are noted.  There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nExtensive diverticulosis of the colon without evidence of wall thickening or\nsurrounding inflammatory stranding.  Appendix contains air, has normal caliber\nwithout evidence 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: The uterus is not visualized.  No adnexal abnormality\nidentified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative change of the lower lumbar spine.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.  Asymmetry of\nthe right chest wall likely represents prior mastectomy.",
            "output": "1. No evidence of active arterial or venous contrast extravasation.\n2. Extensive colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nA fusiform bilobed abdominal aortic aneurysm starts at the diaphragmatic\nhiatus and extends through the aortic bifurcation.  The aneurysm measures up\nto 7.9 x 7.4 cm at the level of the aortic bifurcation.  There is no evidence\nof leak.  There may be an intramural hematoma (02:44). The right common iliac\nartery is aneurysmal measuring up to 3.6 cm and the left common iliac artery\nis also aneurysmal measuring up to 2.5 cm.  There is no flow within inferior\nmesenteric artery which may be due to delayed filling and cannot be assessed\nwithout a delayed phase of contrast.  Remaining mesenteric vessels are patent.\nThe right renal artery is attenuated but remains patent.  The left renal\nartery is patent. There is severe calcium burden in the abdominal aorta and\ngreat abdominal arteries.\n\nLOWER CHEST:  Atelectasis at the lung bases.  Mild interlobular septal\nthickening may be secondary to volume overload. Small bilateral pleural\neffusions are present.  There is pleural calcification on the right. The heart\nis severely enlarged.  A partially visualized lead terminates in the right\natrium.  Moderate coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are a few subcentimeter hypodensities in the liver, too small to\ncharacterize. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains hyperdense layering material consistent\nwith sludge, without gallbladder wall thickening.\n\nPANCREAS: The pancreas is atrophied, 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 adrenal glands are thickened without nodularity consistent\nsecondary to adrenal hyperplasia.\n\nURINARY: The right kidney demonstrates chronic atrophy.  A 3.1 cm hypodensity\nin the lower pole of the left kidney is consistent with a simple cyst.  A 2.1\ncm hypodensity in the interpolar region of the right kidney is consistent with\na simple cyst.  Multiple subcentimeter hypodensities are seen in bilateral\nkidneys, too small to characterize, likely simple cysts. There is no evidence\nof stones 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.\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: Mild vertebral compression deformity of the superior endplate of L1 and\nL4 appears likely acute in the setting of recent fall without retropulsion of\nfracture fragments.  Mild degenerative changes of the lower thoracic and\nlumbar spine with facet joint arthropathy of the lower lumbar spine.  There is\nmild posterior disc bulge at L4-5 and L5-S1.  Severe osteopenia noted. \nChronic right rib fractures noted.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  A right inguinal\nhernia contains a nonobstructed loop of bowel.  Diffuse anasarca is noted.",
            "output": "1. An approximately 7.9 x 7.4 cm  fusiform bilobed abdominal aortic aneurysm\nstarts at the diaphragmatic hiatus and extends through the aortic bifurcation.\nNo evidence of active ongoing aneurysmal leak.  No retroperitoneal hematoma. \nOutside imaging is not available for comparison to assess size stability.\n2. The right common iliac artery is aneurysmal measuring up to 3.6 cm and the\nleft common iliac artery is also aneurysmal measuring up to 2.5 cm.\n3. There is no flow within the inferior mesenteric artery which may be due to\ndelayed filling and cannot be assessed without a delayed phase of contrast. \nThe remaining mesenteric vessels are patent.\n4. Right kidney is asymmetrically small and the right renal artery is\nattenuated but remains patent.\n5. Mild vertebral compression deformity of the superior endplate of L1 and L4\nlikely acute in the setting of recent fall and back pain.  There is no\nretropulsion of vertebral fracture fragments into the adjacent spinal canal.\n6. Mild interlobular septal thickening may be secondary to volume overload.\n7. Small bilateral pleural effusions are present. There is pleural\ncalcification on the right.\n8. Severe cardiomegaly.\n9. The adrenal glands are thickened without nodularity consistent likely\nsecondary to adrenal hyperplasia.\n10. Right inguinal hernia contains a nonobstructive loop of bowel.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 10:27 AM, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is aneurysmal dilatation of the infrarenal aorta measuring up to 3.6 x\n3.5 cm.   There is severe calcium burden in the abdominal aorta and great\nabdominal arteries.  There is no evidence of dissection.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Sub cm hypodensity of the liver are consistent with simple\nhepatic cysts.  Low-attenuation of the liver is consistent with fatty\ninfiltration.  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.  The 1.7 x 1.3 cm\ncystic lesion arising from the tail of the pancreas (series 4A, image 46)\nlikely represents 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 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 extensive diverticulosis without\nevidence of diverticulitis.  Appendix is not visualized.  There is no evidence\nof mesenteric 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: Reproductive organs are within normal limits.\n\nBONES: There is extensive degenerative disease in the visualized thoracic and\nlumbar spine.  No evidence of infection or malignancy.\n\nSOFT TISSUES:  A large right inguinal hernia appears to contain a portion of\nthe urinary bladder.  There is a large left fat containing and hernia.",
            "output": "1. Aneurysmal dilatation of the infrarenal aorta measuring up to 3.6 x 3.5 cm.\nAtherosclerotic disease throughout the abdomen is extensive.\n2. If clinically indicated a nonemergent MRCP is recommended for further\nevaluation of a cystic lesion in the pancreatic tail."
        },
        {
            "input": "Low density, possibly loculated right pleural fluid is identified posteriorly\nwith some adjacent architectural distortion consistent with postoperative\nchange. Fluid has not increased or changed in density. Calcified coronary\nplaque also seen. Please see the separately dictated chest CT report for\ncomplete intrathoracic findings.\n\nNo focal abnormality is seen in the liver, spleen, stomach, duodenum, or\npancreas. There are surgical clips at the hilum of the liver status post\ncholecystectomy.\n\nThe renal cortices enhance symmetrically and no hydronephrosis is seen. At the\nupper pole of the left kidney medially, a 17 mm low-density cortical lesion is\nseen which is not a simple cyst. This enhances heterogeneously with contrast\nadministration, not significantly changed compared to ___ but appears\nincreased compared to the older studies and completely new compared to the\npatient's earliest exam. It is not of homogeneous signal on the patient's\nthoracic spine MRI study from ___. The patient's other renal\nhypodensities have characteristics of simple cysts or are unchanged from prior\nexams. Stranding around both kidneys is unchanged.\n\nCalcification in the right adrenal gland is unchanged, probably from old\nhemorrhage.\n\nNo bowel obstruction or mesenteric mass is evident. Diverticulosis of the\nsigmoid colon is seen. The appendix is normal in appearance.\n\nThe abdominal aorta is severely atherosclerotic and becomes aneurysmal in a\nbilobed fashion infrarenal ly with a maximum diameter of 3 cm which is within\na mm of previous measurements. There is prominent circumferential low-density\nplaque and or chronic thrombus and irregular plaque is seen just beyond the\norigin of the superior mesenteric artery. Calcified Atherosclerotic plaque\nextends into both iliac systems.\n\nSmall retroperitoneal lymph nodes have not increased from the patient's\nearliest study and no new pelvic sidewall adenopathy or fluid is seen. A small\nfat containing umbilical hernia is seen with no new herniation evident. The\nurinary bladder is normal in appearance. There is some impression on to its\nbase from the prostate but overall prostate volume is not significantly\nenlarged.\n\nEvaluation of bones shows diffuse demineralization of the lumbar spine. No\nfocal osteoblastic or osteolytic lesions are seen nor compression fractures\nevident. Dense calcification adjacent to the superior aspect of the right\ngreater trochanter may be related to previous bursitis. .",
            "output": "1. Marked calcific atherosclerotic disease in the abdominal aorta and its\nbranches. Stable size and appearance of abdominal aortic aneurysm compared to\n___.\n2. 17 mm left renal cortical hypodensity at the upper pole medially is a solid\nlesion and should be further evaluated with with magnetic resonance imaging or\nultrasound. The metastatic lesion is not excluded. 3. Unchanged findings\ninclude sigmoid diverticulosis, and renal cysts\n\nNOTIFICATION:  Entered into critical results dashboard just after dictation at\n15:40 on ___"
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion with subjacent\natelectasis which has decreased in size compared to prior.  The left pleural\neffusion has resolved.  Nodular thickening is again seen along the right minor\nfissure (5:1). A 7 mm nodule is again seen at the left lung base (5:11).  The\nheart is enlarged.  Coronary artery, mitral annular, and aortic root\ncalcifications are noted.  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 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 1.6 x 1.3 cm partially calcified lesion is seen arising from the\nright adrenal gland.  Nodular thickening of the left adrenal gland is again\nnoted.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of hydronephrosis.  There is bilateral cortical thinning.\nA 2.2 cm cyst is seen arising from the upper pole of the right kidney with rim\ncalcification.  A heterogeneously enhancing 2.5 cm intermediate density lesion\nis seen arising from the upper pole of the left kidney (5:31).  A 7 mm\nhyperdense lesion is again seen arising from the lower pole the left kidney\n(5:47).  A 1 cm cyst is seen arising from the lower pole of the left kidney. \nAdditional subcentimeter hypodensities arising from the left kidney are too\nsmall to characterize but are statistically likely to be simple cysts.  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 or 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: Calcifications are noted within the prostate.  The\nseminal vesicles are unremarkable.\n\nLYMPH NODES: Small aortocaval lymph nodes measuring up to 6 mm are unchanged. \nThere are no pathologically enlarged retroperitoneal or mesenteric lymph\nnodes.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There aorta is tortuous with a partially thrombosed infrarenal\nabdominal aortic aneurysm measuring up to 3.7 cm.  Extensive atherosclerotic\ndisease is noted.  There is severe narrowing of the bilateral common femoral\narteries.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: An umbilical hernia and bilateral inguinal hernias containing\nfat are noted.",
            "output": "1. Stable 2.5 cm exophytic left upper pole renal lesion concerning for renal\ncell carcinoma.  Stable 7 mm left lower pole hyperdense lesion which may\nrepresent a second RCC.\n2. Grossly stable 3.7 cm infrarenal abdominal aortic aneurysm.\n3. Stable partially calcified right adrenal nodule.\n4. Interval decrease in size of a small right pleural effusion."
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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: A punctate right lower pole renal hypodensity (604B:27) is too small\nto characterize. Otherwise, the bilateral kidneys present symmetric\nnephrograms excretion of contrast. There is no evidence of stones or\nhydronephrosis bilaterally.  No perirenal abnormality is detected..\nGASTROINTESTINAL:  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout.  The colon and rectum contain a moderate\namount of stool throughout, and are otherwise unremarkable.. Appendix contains\nair, has normal caliber without evidence of fat stranding.\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.  A focal area of low density between the aorta and IVC, just\nbelow the level of the renal veins likely represents a dilated lymphatic\nchannel (4:28).\nVASCULAR:  There is no abdominal aortic aneurysm.\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\nA pessary device is in place in the lower pelvis (4:75).\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "1. No evidence of renal or ureteral stone, hydronephrosis, or other acute\npathology in the abdomen or pelvis.\n2. Moderate colonic fecal loading."
        },
        {
            "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: Foci of calcifications in the pancreas likely represent prior\nepisodes of pancreatitis.  Otherwise 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: No definite adrenal nodule is seen in the right adrenal gland.  1.4\ncm left adrenal nodule is unchanged.\n\nURINARY: Patient is status post right nephrectomy. There is no evidence of\nresidual cancer or recurrence surgical bed.  Small soft tissue nodule in\nposterior right pararenal space has decreased in size measuring 0.6 cm,\npreviously 0.8 cm.  The left kidney appears normal in this noncontrast exam\nwith mild perinephric stranding again seen, 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\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 6.6 cm and 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: Stable appearance of mixed lytic lesion anterior to the right\nacetabulum.  No new metastatic osseous lesion noted.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia and\numbilical hernia.",
            "output": "1. Decrease in size of soft tissue nodule in posterior right pararenal space\n2. Stable 1.4 cm left adrenal nodule.\n3. Stable right anterior acetabulum metastatic lesion.  No new metastatic\nosseous lesion noted.\n4. Non-contrast CT is insensitive for detection of soft tissue organ\nmetastasis.  Consider MRI of the abdomen pelvis with and without contrast for\nfuture evaluation for metastases.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "The lack of intravenous contrast administration limits the evaluation of the\nintra-abdominal 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.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder has been surgically removed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. There is no pancreatic duct dilatation.\n\nAdrenal glands: Unchanged appearance of the adrenal glands, with a 1.4 cm left\nadrenal gland nodule.\n\nUrinary: Previous right nephrectomy. Interval stability of 5 mm soft tissue\nnodule in the posterior right pararenal space.\n\nThe left kidney is 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\nProstatomegaly.\n\nGastrointestinal: There is no evidence of bowel dilatation or obstruction.\n\nVascular: There are moderate atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: There are no size significant lymph nodes. Stable subcentimeter\nretroperitoneal lymph nodes are seen.\n\nBone and soft tissues: Unchanged appearance of the right anterior acetabular\nmixed lytic sclerotic lesion.  No new suspicious metastatic lesions. Moderate\ndegenerative disc disease is seen of the lumbar spine.  Bilateral\nfat-containing inguinal hernias. Injection site granulomas are seen in the\nsubcutaneous tissues of the left gluteal region.",
            "output": "1. Limited examination for soft tissue organ metastasis due to lack of IV\ncontrast administration. Consider MRI for further evaluation if clinically\nindicated.\n\n2. Stable right anterior acetabular metastatic lesion. No new osseous\nmetastatic lesions.\n\n3. Unchanged soft tissue nodule in the posterior right pararenal space.\n\n4. Stable 1.4 cm left adrenal nodule.\n\n5. Please see the report of the CT chest performed on the same day for more\ndetails."
        },
        {
            "input": "LOWER CHEST: Please refer to same day CT of chest for description of thoracic\nfindings.\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.  Clips\nare visible in the gall bladder 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: Unchanged appearance of left and right adrenal glands since ___.  Redemonstration of mild thickening of right adrenal.  Redemonstration\nof 1.5 cm nodule on the left adrenal.\n\nURINARY: Status post right nephrectomy.  Interval stability of 0.5 cm nodule\nin the posterior right nephrectomy bed (2:91).  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: There is no evidence of bowel obstruction.\n\nPELVIS: Diffuse bladder wall thickening, likely secondary to outlet\nobstruction, unchanged since ___.  Distal ureters are unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly, with some prostatic calcifications..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Stable prominent retroperitoneal\nand mesenteric lymph nodes are redemonstrated (2:62 and 601:29).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Unchanged appearance of the right anterior acetabular mixed lytic\nsclerotic lesion (2:102).  There is no evidence of worrisome osseous lesions\nor acute fracture.  Degenerative disease of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nInjection site granulomas are seen in the subcutaneous tissues of the left\ngluteal region.",
            "output": "1. Stable right anterior acetabular metastatic lesion.  No new osseous\nmetastatic lesions.\n2. Unchanged soft tissue nodule in the posterior right pararenal space.\n3. Unchanged 1.4 cm left adrenal nodule, unchanged thickening of right\nadrenal.\n4. Please refer to same day CT of chest for description 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: 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 1.5 cm left adrenal nodule is unchanged.  Mild thickening of the\nright adrenal gland is unchanged.\n\nURINARY: Status post right nephrectomy. There is stable postsurgical\nappearance of the right nephrectomy surgical bed with two focal nodularities\nmeasuring 1.2 and 0.8 cm, previously 1.2 and 0.8 cm (3:65).\n\nThere is no suspicious renal lesions within the limitations of an unenhanced\nscan.  An exophytic cortical nodule in the superior left kidney measures 5 mm,\nwith a stable from at least ___ (6:39).  A second exophytic\ncortical nodule in the anterior interpolar left kidney measures 6 mm,\npreviously 6 mm--unchanged from ___ (6:27).  There is a small cortical simple\ncyst arising from the inferior pole of the left kidney (6:38).  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 left ureter are unremarkable.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Stable prostatomegaly.  Seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There are few prominent lymph nodes anterior to the left psoas\nmuscle at the level of the renal artery which are stable from prior measuring\n1.1 and 1.0 cm (3:68; 3:66).  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: Sclerotic focus in the left iliac wing is stable and is likely a bone\nisland given stability over time (3:98).  The mixed lytic sclerotic lesion in\nthe anterior right acetabulum is unchanged (3:112).  There is multilevel\ndegenerative disease of the thoracolumbar spine.\n\nSOFT TISSUES: There is a at small midline anterior abdominal wall hernia\ncontaining fat.  There is a small fat containing right inguinal hernia.",
            "output": "1. No evidence of local recurrence or new abdominopelvic metastases on this\nnoncontrast study.\n2. Stable right anterior acetabulum metastatic lesion and soft tissue\nnodularity in the right nephrectomy bed.\n3. Stable 1.5 cm left adrenal nodule.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: There is a basilar atelectasis of up pericardial or pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Compared with the prior study, there is a more conspicuous,\nincreased irregular hypodensity at the pancreatic head (02:38), measuring 2.0\ncm.  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.  Re-demonstration of extensive\nsoft tissue mass, centered in the mesentery, encasing numerous small bowel\nloops and mesenteric vessels, compatible with the patient's known desmoid\ntumor.  The previous 9.9 x 5.3 cm component in the left mid abdomen is\nunchanged in size (02:47).  Multiple sinus tracts again noted in the left\nhemiabdomen, now opacified with p.o. contrast.  There is a similar appearance\nof the enteric cutaneous fistula in the midline abdominal wall.  The small and\nlarge bowel loops are nondistended.  The appendix 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: Multiple enlarged mesenteric lymph nodes are again seen and not\nsignificantly changed from the prior study.  No new retroperitoneal\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: Other than the enteric cutaneous fistula noted above, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1.  Extensive infiltrative soft tissue mass centered in the small bowel\nmesentery, consistent with known desmoid tumor, complicated by development of\nan enterocutaneous fistula.  Overall appearance is not significantly changed\nsince the CT from ___.\n2.  No 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is atrophy of the pancreatic tail with mild ductal dilatation\nup to 5 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. \nMild scarring of the upper pole of the left kidney.  There is no evidence of\nsolid 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: Distal ureters appear normal.  Small bilateral bladder diverticula. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducial markers 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Postsurgical changes from L4 laminectomy.  Is there is grade 1\nanterolisthesis of L5 on S1 and mild retrolisthesis of L3 on L4 and L4 on L5. \nThere is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel spinal degenerative change noted.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.",
            "output": "1. Atrophy of the pancreatic tail with mild ductal dilatation up to 5 mm-this\nappearance is nonspecific but could be seen in the setting of a chronic\npancreatitis or a small intraductal mass.  MRCP is recommended for further\nevaluation.\n2. Normal CT appearance of the liver or biliary system.\n3. No hydronephrosis.\n\nRECOMMENDATION(S):  MRCP pancreas for further evaluation."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases demonstrates bibasilar\natelectasis.  No pleural effusion. The visualized heart is normal in size\nwithout pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones. The portal vein, SMV, and splenic vein are\npatent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  Multiple\nsubcentimeter renal hypodensities are too small to characterize. No\nhydronephrosis or hydroureter identified.  No renal or proximal ureter\ncalculi.\n\nSmall hiatal hernia noted. The stomach is grossly unremarkable in appearance.\nThe small bowel is normal in caliber without wall thickening. Mild sigmoid\ndiverticulitis with minimal wall thickening with small fat stranding (2:59). \nNo pneumoperitoneum. No fluid collection. No thrombophlebitis.  The large\nbowel is otherwise normal in caliber without wall thickening, fat stranding,\nor focal mass lesion. Severe colonic diverticulosis present. The appendix is\nnot visualized however no evidence of acute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  The iliac arteries are normal in\ncourse and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. Fibroid uterus with a thickened endometrium in a post menopausal woman.\nThe ovaries are not identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Mild sigmoid diverticulitis with minimal wall thickening with small amount\nof fat stranding.  No extraluminal air, fluid collection, or thrombophlebitis.\n2.  Thickened endometrial cavity in a post menopausal woman.  Non emergent\nultrasound evaluation is recommended.\n3. Fibroid uterus.\n4.  Multiple subcentimeter renal hypodensities, too small to characterize.\n5.  Small hiatal hernia.\n\nNOTIFICATION:  Multiple attempts were made to page ___:  Impression\nnumber 2.\n\nThe impression above was entered by Dr. ___ on ___ at 09:00 into\nthe Department of Radiology critical communications system for direct\ncommunication 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.  Hypodensity adjacent to the falciform\nligament likely represents an area of focal fat.  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.  Redemonstration of a 7 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. \nNo hydronephrosis.  Multiple subcentimeter hypodensities seen bilaterally are\ntoo small to further characterize but statistically cysts.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Extensive diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening or 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: Redemonstration of a 2.0 x 0.9 cm uterine hypodensity,\nlikely representing a fibroid, unchanged compared to prior CT dated ___. Apparent endometrial stripe thickening is likely due to fluid within the\nendometrial canal in the setting of cervical stenosis as seen on prior\nultrasound.\n\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. \nDegenerative changes noted at the hips, right more so than left.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No acute findings in the abdomen or pelvis to explain patient's symptoms.\n2. Extensive diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "Thorax: Intrathoracic findings will be dictated under another clip number.\n\nLiver, Gallbladder: A subcentimeter hypodensity in the right lobe of the liver\n(series 2 image 65) is stable from the prior exam.  Liver is normal in size\nand enhancement. The portal and hepatic veins are patent. There is no intra or\nextrahepatic biliary ductal dilatation. The gallbladder is normal.\n\nSpleen: The patient is status post splenectomy. A small accessory spleen is\nagain demonstrated, unchanged in size.\n\nPancreas: The pancreas is normal in enhancement with no evidence of pancreatic\nlesion or peripancreatic fat stranding.\n\nKidneys, Adrenals: The bilateral adrenal glands are normal.  The kidneys are\nnormal in displaced symmetric nephrograms. There is no evidence of\nhydronephrosis.\n\nBowel: The small bowel is normal appearing with no evidence of obstruction.  A\nright lower quadrant ileostomy is stable in appearance from the prior study.\n\nVessels: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent. Note is made of moderate calcified\natherosclerosis of the abdominal aorta.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The bladder is unremarkable. Surgical material is again seen adjacent\nto the rectum. There is no pelvic sidewall lymphadenopathy.\n\nOsseous Structures: There is moderate degenerative change of the lumbar spine\nand most significant at L2-L3. No suspicious lytic or blastic lesions are\nidentified.",
            "output": "No evidence of recurrence or 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 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:  Patient is status post splenectomy.  A splenule adjacent to the tail\nof the pancreas is re- demonstrated.\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 show no evidence of hydronephrosis or focal lesions.  A 3\nmm stone is noted in the upper pole the right kidney.\n\nGASTROINTESTINAL:  Patient is status post loop ileostomy, cecectomy, resection\nof the transverse, sigmoid colon and rectum. The anastomotic sites appear\npatent and without complication. Appendix has normal caliber without evidence\nof fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is some thickening of the mesenteric\nnoted in the left upper quadrant (Series 5, image 73).  There is no free air. \nSome matted mesentery and loops of small bowel are noted in the left upper\nquadrant, which appear unchanged from ___.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.  There is no\nevidence of clot within the main portal vein and SMV.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy. Reproductive organs are within\nnormal limits\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "There is no evidence of recurrent or metastatic disease within the abdomen and\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: Since the CT in ___, there are multiple newly\nidentified, ill-defined hepatic hypodensities concerning for metastases.  The\nlargest of these is in segment II and measures 1.0 x 0.9 x 0.9 cm (2:71 and\n601b:12), but several other lesions are identified in the caudate lobe (2:67,\n601b:19) and hepatic segments ___ (2:73) are also present.  In addition,\nthere is new subdiaphragmatic soft tissue density adjacent to the stomach and\nthe liver, calcified at some points (601b:25, 28), and also concerning for\nprogressive metastatic disease.  Mild intrahepatic biliary dilatation is new. \nThere is also new mild dilatation of the CBD to 8 mm, which may be due to\ninfiltration around the hepatoduodenal ligament (2:79).  The nondistended\ngallbladder is unremarkable in appearance.\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 is post splenectomy, with a small accessory spleen identified\nadjacent to the tail of the pancreas (2:72).\n\nADRENALS: The right and left adrenal glands 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 indistinctness and slightly increased soft tissue\ndensity about the gastric antrum, suggesting disease involvement.  This was\nsimilar appearing on the prior study of ___ but less prominent. \nPatient is post loop ileostomy, partial cecectomy, and partial resection of\nthe transverse colon, and rectosigmoid resection.  Anastomotic sites are\nunremarkable.  Prominence of bowel loops and mesentery in the left upper\nquadrant are unchanged.  Remaining loops of bowel are normal in caliber,\nwithout evidence of obstruction.  A newly identified 0.8 cm rounded, slightly\nhyperdense lesion in the left abdomen at the level of the iliac crest is\nconcerning for a peritoneal metastasis (2:89, 601b:25).  A similar-appearing\n1.9 cm enhancing lesion is identified in the left subdiaphragmatic region\n(601b:29).  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 mild 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.  Previously described soft tissue nodule at the left vaginal cuff is\ngrossly unchanged in size and appearance, measuring 1.6 x 1.5 cm (2:110).\n\nREPRODUCTIVE ORGANS: Patient is post hysterectomy.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nMultilevel moderate lumbar spine degenerative changes are again noted.  Except\nfor a loop ileostomy, abdominal and pelvic wall is within normal limits.",
            "output": "1.  Since the prior CT in ___, there has been progression of metastatic\ndisease in the abdomen.  Most notably, multiple liver lesions, peritoneal\nenhancing lesions, and indistinct soft tissue density along the gastric antrum\nand liver are concerning for metastatic involvement.\n\n2.  The previously described soft tissue nodule at the left vaginal cuff is\ngrossly unchanged in size."
        },
        {
            "input": "LOWER CHEST:  There is small bilateral pleural effusions with adjacent\ncompressive atelectasis, which appears to improved as compared to the prior\nstudy.  Multiple subpleural nodules are unchanged.  The heart is not enlarged.\nThere is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  Numerous known hepatic mass lesions are better assessed on\nrecent CT of the abdomen and pelvis with intravenous contrast.  The patient is\nstatus post placement of an internal-external left hepatic biliary drain, with\npersistent intrahepatic biliary ductal dilatation, which is not fully assessed\nwithout intravenous contrast.  There is a small amount of perihepatic ascites.\nThe gallbladder appears distended, however is thin walled.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 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\npunctate nonobstructing stone is seen within the upper pole of the right\nkidney.  There is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A gastrojejunostomy tube is present.  Wall thickening in the\nantrum of the stomach is less conspicuous on this exam given the absence of\nintravenous or oral contrast.  Two linear metallic densities adjacent to the\nwall of the stomach in the region of the gastrojejunostomy tube are consistent\nwith T tacks.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  An additional linear metallic density is seen within the proximal\njejunum, consistent with the third T tack.  Patient is status post partial\nlarge bowel resection, with an anastomosis seen within the transverse colon,\nand a rectal-colonic anastomosis present.  Furthermore, the patient has an end\nileostomy present.  There is a small amount of intra-abdominal free fluid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  The known  nodule\nof the left vaginal cuff is difficult to assess without intravenous contrast,\nbut appears grossly unchanged.\n\nLYMPH NODES:  A 1.4 x 1.2 cm epicardial lymph node is unchanged.  A small\nleft-sided peritoneal nodule (2:45) appears grossly unchanged.  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: The right lower quadrant ostomy is present.",
            "output": "1. Two linear metallic densities adjacent to the wall of the stomach in the\nregion of the gastrojejunostomy tube are consistent with T tacks.  A third\nlinear metallic density is seen within the proximal jejunum, consistent with\nthe third T tack.\n2. Status post placement of an internal-external biliary drain with persistent\nintrahepatic biliary ductal dilatation, which is difficult to fully assess\ngiven the lack of intravenous contrast.\n3. Numerous known hepatic metastases and a nodule at the left vaginal cuff are\nbetter assessed on recent CT with contrast.\n4. Interval decrease in size of bilateral pleural effusions with adjacent\ncompressive atelectasis.\n5. Unchanged appearance of an epicardial lymph node and left peritoneal\nnodule.\n6. Distended, thin-walled gallbladder."
        },
        {
            "input": "LOWER 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 nephrolithiasis, 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 extensive\ncolonic 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 endometrium appears diffusely bulky and\nheterogeneous, presumably related to the known malignancy.  No adnexal masses\nare demonstrated.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  A 1.1\ncm periportal node is likely benign.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is noted.  There is noted to be central hypodensity in the bilateral\ncommon femoral veins, with the left being asymmetrically larger.\n\nBONES: There 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. Central hypoenhancement of the bilateral common femoral veins, left larger\nthan right.  This could be due to contrast mixing but DVT is not excluded. \nBilateral leg ultrasound suggested.\n3. Please refer to the separate report for the CT chest.\n\nRECOMMENDATION(S):  Bilateral Doppler ultrasound of the lower extremities.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nThe findings were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 5:05 pm, 15 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. 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.  There is\ndiverticulosis of the sigmoid colon, otherwise the colon and rectum are within\nnormal limits.  There is mesenteric stranding along the sigmoid colon near the\nsurgical bed as well as the site of the prior hematoma (series 2, image 105),\nwhich is likely postprocedural without clear soft tissue mass or\nlymphadenopathy.  The appendix is normal.\n\nPELVIS: Postsurgical changes are seen along the anterior bladder, which is\notherwise decompressed.  The distal ureters are not well visualized.  No free\nintrapelvic fluid.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  No discrete adnexal lesion is\ndemonstrated.\n\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 are postsurgical changes along the anterior midline\nconsistent with recent surgery.  There is an area of focal soft tissue\nthickening without clear fluid collection (series 2, image 99).  Resolution of\nthe previously demonstrated large hematoma.",
            "output": "1. Status post hysterectomy and exploratory laparotomy with hematoma drainage.\nNo evidence of recurrence or metastatic disease within the abdomen or pelvis. \nNo persistent hematoma is demonstrated.\n2. Diverticulosis without evidence of diverticulitis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions, left greater than right.  No\npericardial effusion.  The lung bases are otherwise clear.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Tiny\nsegment 4 B hypodensity is too small to characterize but likely represents a\nhepatic cyst or biliary hamartoma (02:21).  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 enlarged up to 18.9 cm.  No focal splenic lesions are\nidentified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys demonstrate patchy areas of hypoenhancement within\nthe renal parenchyma without evidence of significant fat stranding (for\nexample 02:28).  This does not have the classic appearance for an infectious\nor embolic etiology and may be medication induced (e.g.  NSAIDs).  Scattered\nbilateral renal cortical hypodensities are too small to fully characterize. \nThere is bilateral collecting system fullness with extrarenal pelves with\ntapering at the UPJ.  No evidence of an obstructing stone or lesion.  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 uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Multiple enlarged and predominantly left-sided retroperitoneal,\npelvic, and inguinal lymph nodes are demonstrated (02:30, 32, 62, 76, 77). \nThe largest measures up to 1.3 cm in the left external iliac station (2:72). \nThere is a prominent right external iliac lymph node measuring up to 1.1 cm in\nshort axis (2:76).\n\nVASCULAR: There is no 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 asymmetric anasarca, left greater than right. \nNo organized or rim enhancing fluid collection is identified.",
            "output": "1. Diffuse asymmetric anasarca, left greater than right.  No evidence of a rim\nenhancing or organized fluid collection.\n2. Multiple enlarged and prominent retroperitoneal, pelvic, and inguinal lymph\nnodes are predominantly left-sided and measure up to 1.3 cm in short axis. \nRecommend close attention on follow-up imaging or FNA if clinically indicated.\n3. Bilateral collecting system fullness with extrarenal pelves without\nevidence of obstructing stone or lesion, likely secondary to mild UPJ\nnarrowing.\n4. Bilateral mild patchy areas of renal parenchymal hypoenhancement are not\nclassic for infection or embolic phenomena and may be medication induced (e.g.\nNSAIDs).  Correlation with urinalysis and history is recommended.\n5. Splenomegaly.\n6. Small bilateral pleural effusions.\n\nRECOMMENDATION(S):  Urinalysis and correlation with history for the mild\npatchy renal parenchymal abnormalities.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:30 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 homogeneous attenuation throughout. \nThere are hypodense lesions in hepatic segment 2 measuring 2.0 cm (04:13) and\nsegment 5 measuring 1.5 cm (04:28), likely hepatic cyst.  Additional\nsubcentimeter hypodense lesions in the right hepatic lobe are too small to\ncharacterize (04:26 and 04:25).  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or evidence of inflammation.  A 5 mm stone is seen within the\ndistal common bile duct (04:30).\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 redemonstration of cortical atrophy of the bilateral kidney\nis, left greater than right.  There is a 1.7 cm exophytic lesion in the\nmidpole of the left kidney, previously characterized as a simple renal cyst on\nultrasound dated ___.  there is an additional 6 mm lesion in the midpole\nof the right kidney, too small to characterize (04:26).  There is no evidence\nof other 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.  There is extensive large and\nsmall bowel diverticulosis.  There is an area fat stranding and phlegmonous\nchange in the left mid abdomen adjacent to loops of jejunum, compatible with\nacute diverticulitis (04:39).  There is no evidence of focal fluid collections\nor extraluminal air.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed.  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 a sclerotic lesion in the left iliac bone measuring 1.2 cm,\nwhich appears unchanged compared to prior pelvic radiograph dated ___ (04:59).  There is minimal anterolisthesis at L4-L5, likely degenerative.\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. Acute uncomplicated small-bowel diverticulitis.  No evidence of focal fluid\ncollection or extraluminal air.\n2. 5 mm stone within the distal common bile duct without evidence of ductal\ndilatation or adjacent stranding.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Bilateral renal cortical atrophy, left greater than right.\n5. Hypodense lesion in the midpole of the left kidney measuring 1.7 cm,\npreviously characterized as a simple cyst on ultrasound dated ___.\n6. Multiple hypodense hepatic lesions measuring up to 2 cm, likely hepatic\ncysts.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:17 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.  The heart is top-normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nMultiple hypodense lesions are unchanged, including a 1.9 cm hypodense lesion\nin segment 2, (series 2, image 10) and a 1.5 cm hypodense lesion in segment 5\n(series 2, image 26).  Additional hypodense lesions are too small characterize\non CT.  There is no evidence of new focal lesions within the limitations of an\nunenhanced scan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  Calcification in the distal common bile duct similar prior\n(02:29) is likely choledocholithiasis the gallbladder contains gallstones\nwithout 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: Cortical atrophy of the kidneys, left greater than right, is\nunchanged.  A 1.8 cm exophytic lesion from the interpolar region of the Left\nkidney was previously characterized as a simple renal cyst on ultrasound front\n___.  A subcentimeter hypodense lesion from the interpolar right kidney\nis too small characterize (series 2, image 23).  There is no evidence of any\nnew or suspicious focal renal lesions within the limitations of an unenhanced\nscan.  There is mild right hydroureteronephrosis.  There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\nright hemicolectomy.  Again seen is extensive large and small bowel\ndiverticular disease.  An area of fat stranding with bowel wall thickening in\nthe left in mid abdomen (series 2, image 30) is at the site of previously seen\nacute diverticulitis.  A few scattered associated foci of extraluminal likely\nextraluminal air are identified potentially from micro perforation. \nPreviously seen extraluminal 3 cm air pocket is no longer visualized.  The\noverall appearance in this area is improved, though recurrent acute\ndiverticulitis remains a consideration.\n\nPELVIS: The urinary bladder is significantly distended. There is no free fluid\nin 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: A 12 mm sclerotic lesion in the Left ileum (series 2, image 55) is\nunchanged from prior.  Grade 1 anterolisthesis of L4 on L5 is unchanged.  No\nevidence of a cute fracture or new suspicious bony lesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent fat stranding with mild bowel wall thickening in the left mid\nabdomen, overall improved from the study 2 months prior, though recurrent\nacute diverticulitis remains a consideration.  Small associated foci of air\nwhich are likely extraluminal in the setting of micro perforation.  No abscess\nformation.  Resolution of previously seen 3 cm extraluminal air pocket.\n2. Unchanged cholelithiasis and choledocholithiasis with a 4 mm stone in the\ndistal CBD near the ampulla, without intra or extrahepatic biliary dilatation.\n3. Distension of the bladder and mild right hydroureteronephrosis, potentially\nrelated to outlet obstruction in the setting of prostate enlargement. \nAtrophic left 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: There are innumerable hypoenhancing lesions replacing the\nhepatic parenchyma, compatible with metastatic disease.  The liver has a\nnodular contour secondary to the metastatic disease. The largest lesions are\nin segment 6 measuring 3.4 x 3.5 x 3.8  cm (series 5, image 113) and segment 7\nmeasuring 4.3 x 4.4 by 4.5 cm (series 5, image 75).\n\nPANCREAS: The pancreas has normal attenuation throughout without pancreatic\nductal dilatation.  Loss of the fat plane between the pancreas and an inferior\nlymph node conglomerate concerning for malignant involvement.\n\nSPLEEN: There is a 0.7 cm hypoattenuating lesion at the upper margin of the\nspleen (series 5, image 65).  The spleen is normal size.\n\nADRENALS: There is a heterogeneous enhancing right adrenal nodule measuring\n3.5 x 2.4 cm (series 5, image 86).  The left adrenal gland is normal size and\nshape.\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.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia with the gastric\nfundus partially in the mediastinum.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. Diverticulosis of the\nsigmoid colon is noted, without evidence of wall thickening or fat stranding.\nThe appendix is not visualized.\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 uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is a peripancreatic lymph node conglomerate measuring\napproximately 4.9 x 7.4 x 4.5 cm.  There are a few prominent mesenteric lymph\nnodes.  For example the 0.6 cm node in the SMA distribution (series 5, image\n105).  No mesenteric lymphadenopathy.  No retroperitoneal or pelvic\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\nDetailed evaluation vasculature is limited due to phase of contrast.  The\nproximal celiac and SMA arteries appear patent.  There is severe narrowing of\nthe portal vein confluence due to the peripancreatic lymph node conglomerate\n(series 5, image 95).  The splenic vein is nonvisualized due to compression by\nthe peripancreatic mass.  The main portal vein and right and left portal veins\nare also narrowed due to multiple liver metastases.\n\nBONES: There is an expansile mass involving the left sacrum measuring 5.5 x\n4.8 x 6.0 cm (series 5, image 159 and series 8, image 78).  Lateral to this is\na lesion within the ileum measuring 2.3 x 2.0 x 1.9 cm (series 5, image 149). \nThere is a hypoattenuating lesion measuring 1.2 x 1.5 x 1.4 cm measuring\nwithin the right ilium with a cortical defect (series 5, image 152).  Endplate\ndefects seen within the T10 vertebral body could represent Schmorl's nodes\nversus underlying metastatic disease.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Innumerable metastatic lesions within the liver wi"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.  Celiac trunk, SMA, bilateral\nrenal arteries, and ___ are patent.\n\n LOWER CHEST: Atelectasis is mild in bilateral lung bases.\n\nABDOMEN:\nThere is no ascites.\n\nHEPATOBILIARY: Liver is diffusely hypoattenuating.  No focal loop liver lesion\nis identified.  Intra and extrahepatic bile ducts are not dilated. \nGallbladder is unremarkable.\n\n\nPANCREAS: A 0.8 cm fatty lesion in the pancreatic body is likely lipoma. \nAnother fatty lesion more anteriorly located in the pancreatic body is likely\ninterdigitating fat.  Pancreatic duct is not dilated.\n\nSPLEEN: Spleen is not enlarged.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: 1.5 cm hypodense lesion in the upper pole of left kidney is\nconsistent with a simple renal cyst. Other subcentimeter lesions in bilateral\nkidneys are too small to be fully characterized. Bilateral nephrograms are\nsymmetric. There is no hydronephrosis.  Small amount of perinephric fluid is\nnoted bilaterally.\n\nGASTROINTESTINAL: Stomach is distended with fluid.  Small and large bowel\nloops are normal caliber.  The bowel loops demonstrate normal enhancement\nwithout evidence of ischemia.  There is no pneumatosis.  Appendix is\nunremarkable.\n\nPELVIS: Bladder is extremely distended, measuring 13.4 x 10.6 x 17.5 cm. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Moderately enlarged prostate measures 5.4 x 4.2 x 5.3 cm.\n\nLYMPH NODES: No pathologically enlarged lymph node is identified.\n\nBONES: Lucent lesion at the L4 inferior endplate is likely a Schmorl's node.\n\nSOFT TISSUES: Small fat containing right inguinal and umbilical hernias are\nnoted.",
            "output": "1. No evidence of bowel ischemia or portal vein thrombosis.\n2. Bladder is extremely distended.\n3. Prostate is moderately enlarged.\n4. Hepatic steatosis.\n\nNOTIFICATION:  The impression 1 and 2 were discussed with Dr. ___.\nby ___, M.D. on the telephone on ___ at 9:20AM, 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 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 heterogeneous lesion measures 1.5 x 1.5 cm, previously\n0.9 x 1 cm.  The left adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hyperdense foci in bilateral kidneys are likely vascular\ncalcifications.  There is no evidence of focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: On the very small amount of contrast is seen in the stomach.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder is very distended.  Distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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.  Metallic clip is seen in the left common iliac artery.  Stable 1.9\ncm left common femoral artery aneurysm.  Metallic clip seen in both groins. \nBilateral internal iliac arteries are poorly opacified, unchanged from prior\nstudy.\n\nBONES: There 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. Interval increase in size of the right adrenal heterogeneous lesion,\nincompletely characterized. An MRI is recommended for further evaluation in\nnon urgent fashion."
        },
        {
            "input": "LOWER CHEST: Redemonstration of chronic atelectasis at the right base, with\ntrace pleural fluid or thickening.  Cardiomegaly is similar.  Pleural\ncalcification is also seen at the right base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.  Small volume ascites is present, and\nstranding in the retroperitoneum is also likely related to third spacing.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: Mild splenomegaly is similar, measuring up to 14 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic with bilateral cysts, likely related\nto chronic dialysis.  Bladder is decompressed.\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.\n\nPELVIS: Small volume nonhemorrhagic pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Numerous upper abdominal and retroperitoneal lymph nodes are\nsimilar to ___, including a 16 mm gastrohepatic lymph node.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Diffuse sclerotic appearance of the osseous structures, consistent with\nrenal osteodystrophy.  There is no fracture or focal aggressive osseous\nlesion.  There is an L3 Schmorl's node.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic process.  No CT findings directly correlating to\nthe reported history of abdominal pain.\n2. Nonspecific diffuse abdominopelvic lymphadenopathy is unchanged since ___.\n3. Small volume ascites.\n4. Unchanged cardiomegaly, right lower lobe atelectasis and splenomegaly."
        },
        {
            "input": "KIDNEYS:  There is a simple cyst arising from the lower pole of the partially\nvisualized right kidney\n\nGI:  The partially assessed small and large bowel are within normal limits,\nwithout wall thickening or evidence of obstruction.A normal appendix is\nvisualized.There is colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with occasional\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free\nfluid.There is an ill-defined soft tissue density in the medial right buttock\nmeasuring up to 2.5 x 2.6 x 3.3 cm, which is consistent with inflammatory\nchange. The inflammation extends superiorly to the perineal fascia and to the\nperirectal soft tissues, but does not involve the musculature or adjacent bony\nstructures. .\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. 3.3 cm ill-defined inflammatory changes in the right medial buttock\nextending to the perineal fracture."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  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 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.  Surgical clips project adjacent to the splenic\nhilum, unchanged since at least ___\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no suspicious focal lesion or hydronephrosis.  A 3.3 x 2.8 cm cyst is\npresent in the left upper pole.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is been prior Nissen\nfundoplication small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThere is markedly hyperdense material in the cecum, possibly reflecting\nconcentrated barium.  The appendix is not visualized.  A 2.3 by 1.6 cm soft\ntissue lesion is present in the right hemipelvis which has previously been\ncharacterized as a surgical plug from a right inguinal hernia repair in ___. \nThis is stable dating back to at least ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace 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: There is no 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.  A spinal\nstimulator generator is again visualized over the right lower back with the\nleads extending cranially toward the thoracic spine.",
            "output": "1. No evidence of acute pancreatitis.  No biliary ductal dilatation.\n2. No bowel obstruction."
        },
        {
            "input": "LOWER CHEST: There is linear scarring involving the lower lobes bilaterally. \nNo interstitial or airspace disease at the lung bases.  No pleural effusions. \nNo pericardial effusion.  Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Pneumobilia within the CBD and left-sided\nbiliary system in keeping with previous sphincterotomy.  The gallbladder is\nsurgically absent.\n\nPANCREAS: On the most recent CT from ___, the pancreas\ndemonstrates homogeneous attenuation throughout.  The pancreatic duct is at\nthe upper limits of normal, measuring 3.5 mm in the pancreatic head and 2.5 mm\nin the pancreatic body. The pancreatic duct then bifurcates in the pancreatic\ntail as seen on prior MRCPs.  Both ducts are normal in caliber measuring less\nthan 1.5 mm.\n\nThe CT previous to this dated ___ demonstrated diffuse smooth\ndilatation of the main pancreatic duct, measuring 5.1 mm in the pancreatic\nhead, up to 4.6 mm in the pancreatic body, and 3.1 mm in the tail.\n\nThe area of hypoattenuation involving the proximal pancreatic tail described\non CT from ___ is favored artifactual.  No abnormality is seen\nin this region on CT from ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild diffuse thickening of the left adrenal gland, mildly increased\nsince ___.  No discrete lesion.  The right adrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions.  3.1 x 3.3 cm cyst involving the\nmid left kidney with a thin internal septation, with a thin calcified\ncomponent.  This is unchanged since ___ and is in keeping with a\nBosniak 2 renal cyst. There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The bladder is collapsed.\n\nGASTROINTESTINAL: There has been prior Nissen fundoplication which is located\nabove the diaphragm.  The stomach is normal.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits.\n\nStable ill-defined stranding in the right lower quadrant (series 3, image\n108), likely related to prior right inguinal hernia repair, stable compared to\nCT from ___.\n\nPELVIS:  A sliver of free fluid is seen in the right hemipelvis.\n\nREPRODUCTIVE ORGANS: Prior prostatectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild burden of calcified atheromatous disease involving the\nabdominal aorta which is nonaneurysmal.  The portal venous system is patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Implanted neurostimulator overlying the right lumbar\nmusculature.",
            "output": "1. CT from ___ demonstrates the pancreatic duct which measures\nat the upper limits of normal.  The pancreatic duct is bifid in the pancreatic\ntail.  The pr"
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nfocal consolidation.  There is no evidence of pleural or pericardial effusion.\nScar tissues are seen in both basilar lobes.  Heart is borderline in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic\nbiliary dilatation.  Extrahepatic biliary ductal CBD are prominent likely due\nto cholecystectomy and sphincterotomy.  CBD measures up to 8 mm.  Gallbladder\nis surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Pancreatic duct is slightly prominent measures up to 4 mm. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Right adrenal is within normal limits.  Lipid rich left adrenal\nnodule is seen measures 1.3 cm.\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.  A notice made of simple cyst within midpole of the left kidney,\nmeasuring 3.5 x 3.3 cm.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: Status post Nissen fundoplication with intact wrap.  Mucosal\nthickening is seen in distal antrum and first portion of the duodenum.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement.  Oral\ncontrast is seen in colon.  The colon and rectum are within normal limits.\nAppendix has not been visualized, however there is no pericecal fat stranding\nor edema.\n\nPELVIS: There is no sizable free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPostsurgical changes related to prior right inguinal hernia is seen.\nA note is made of neural stimulator with intraspinal leads within subcutaneous\ntissues of posterior right hemipelvis.",
            "output": "1. Mucosal thickening is seen in distal antrum and first portion of the\nduodenum, correlate with endoscopy results with gastritis duodenitis.\n2. Mild prominence of pancreatic duct, extrahepatic biliary duct and CBD,\nlikely due to prior cholecystectomy and sphincterotomy.\n3. Lipid rich left adrenal nodule measures up to 1.3 cm.\n4. Left renal cyst measures up to 3.5 cm."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  Otherwise, 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. \nApproximately 1 cm x 0.9 cm hypodensity in the right lobe with minimal\nperipheral nodular enhancement most likely represents a hemangioma, (series\n602: Image 22).  There is no evidence of concerning 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: Small 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. 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 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": "No acute abdominopelvic findings.  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.  A\n1.0 cm hypodensity in the left hepatic lobe (04:17) is too small to\ncharacterize but likely represents a cyst.  A punctate calcification in the\nright hepatic lobe (02:18) likely represents a calcified granuloma.  There is\nno 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: A heterogeneously enhancing left adrenal gland mass involving both\nlimbs measures 2.4 x 2.3 x 5.0 cm (3:61, 602:47) and is worrisome for\nmetastasis.  The right adrenal gland is thickened without apparent focal\nnodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.2 cm fat containing hypodensity in the interpolar region of the right\nkidney (3:67, 601:33) likely represents an angiomyolipoma.  Simple cysts in\nthe bilateral kidneys measure up to 3.9 cm (3:61).  Few other subcentimeter\nhypodensities throughout the bilateral kidneys are too small to characterize\nbut likely cysts as well.  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 descending\ncolon is largely decompressed.  The colon and rectum are within normal limits.\nThe appendix is not visualized.\n\nPELVIS: Irregular focal bladder wall thickening about the posterior left base\nof the urinary bladder measures 2.0 x 1.1 x 1.0 cm (3:106, 601:35).  Diffuse\nbladder wall thickening elsewhere is likely sequela of chronic bladder outlet\nobstruction in the setting of prostatomegaly.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: A prominent subcentimeter right retrocrural node measures 7 mm in\nshort axis diameter (03:59).  Otherwise, there is no retroperitoneal or\nmesenteric lymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an accessory right hepatic vein.  The abdominal aorta is\nectatic measuring up to 2.5 cm (3:73) and exhibits significant atheromatous\nplaque (3:81) with associated mild-to-moderate luminal narrowing.  Extensive\natherosclerotic disease is noted with moderate stenosis of the celiac trunk\nand SMA.  There is poststenotic dilatation of the celiac trunk which is\notherwise patent.\n\nBONES: Multiple sclerotic foci measuring up to 1.3 cm in the bilateral pelvis\n(3:112) may represent bone islands, although in the current clinical setting\nand given their multiplicity, are worrisome for osseous metastatic disease. \nThere is no acute fracture. Minimal anterolisthesis of L5 on S1 is age\nindeterminate but likely degenerative in etiology.\n\nSOFT TISSUES: There is a small left inguinal hernia containing loops of\nnonobstructed small bowel.  No evidence of strangulation.",
            "output": "1. 5.0 cm enhancing left adrenal gland mass is concerning for metastasis.  The\nright adrenal gland is thickened without apparent focal nodularity.\n2. Multiple sclerotic foci measuring up to 1.3 cm in the bilateral pelvis,\nsome of which may represent bone islands, are worrisome for osseous metastatic\ndisease in the current clinical setting.\n3. Irregular focal bladder wall thickening is worrisome for primary urothelial\nneoplasm until proven otherwise. Urine cytology, urology consult, and possible\ncystoscopy is recommended.\n4. 1.2 cm right renal angiomyolipoma.\n5. Small bowel containing left inguinal hernia.  No evidence of obstruction or\nstrangulation.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. Limited view of\nthe portal vein demonstrates patency. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder surgically absent.\n\nThe spleen and adrenal glands are unremarkable. The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening. The appendix is not visualized but no\nsecondary signs of appendicitis are seen within the right lower quadrant.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches contain calcifications and are normal in course and caliber.\nIncidental note is made of the common hepatic artery arising directly from the\naorta. An IVC filter is present within the infrarenal portion, in similar\nlocation to prior. Again seen are prominent retroperitoneal lymph nodes with\nthe largest measuring 1.2 cm in short axis dimension, not significantly\nchanged from ___ (3a: 20). There is no free abdominal fluid or\npneumoperitoneum.\n\nPELVIS:\n\nTwo calcified densities, one along the right posterior measuring 15 mm with\nthe other along the left posterior bladder measuring 7 mm, likely represent\nstones. The right-sided density was seen previously, the left-sided density is\nnew.  There is no pelvic side-wall or inguinal lymphadenopathy by CT size\ncriteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. Severe levoconvex scoliosis of the\nlumbar spine is unchanged. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Bladder calculi. No obstructing renal or ureteral stones.\n2. No evidence of retroperitoneal hematoma.\n3. Retroperitoneal lymphadenopathy, not significantly changed dating back to\n___."
        },
        {
            "input": "LOWER CHEST:  Bibasilar atelectasis is noted without evidence of pleural or\npericardial effusion.The right hemidiaphragm is mildly elevated, but\nunchanged.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout.  A\nsub-cm hypodensity is seen in the left lobe of the liver, which is too small\nto characterize, but likely represents an hepatic cyst.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, without 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:  There is cortical scarring of the upper pole of the left kidney. \nScattered sub-cm hypodensities are seen bilaterally which are too small to\ncharacterize but likely represent renal cysts.  There is no evidence of\nhydronephrosis or renal calculi.\n\nGASTROINTESTINAL:  A small hiatal hernia is seen.  The small and large bowel\nare normal in course and caliber without obstruction. Colon and rectum are\nwithin normal limits. Appendix has a normal caliber without evidence of fat\nstranding.\n\nMESENTERY AND RETROPERITONEUM:  Retroperitonal lymphadenopathy is most\npronounced within the aortocaval station with the largest lymph node measuring\nup to 13-mm in short axis dimension, not significantly changed from ___.  No mesenteric lymphadenopathy is noted. There is no free fluid and no\nfree air.\n\nVASCULAR:  An infrarenal IVC ___ is seen.  There is no evidence of thrombus\nwithin the arterial or venous systems, specifically the IVC, common, external\nand internal iliac veins.\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and major mesenteric arteries.  The main portal vein,\nsplenic vein and SMV are patent.\n\nPELVIS:  A calcified density measuring up to 4.8 x 0.8 cm is seen along the\nposterior aspect of bladder lumen, likely reflective of bladder calculi,\nhowever the morphology is slightly unusual.  No bladder mass or areas of\nabnormal bladder enhancement are noted.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.  Patient is\nstatus post hysterectomy.\n\nBONES AND SOFT TISSUES: Severe scoliosis and moderate degenerative changes are\nseen within the thoracic and lumbar spine.",
            "output": "1.  Infrarenal IVC filter in place with no evidence of thromus within the\nvenous system, specifically the IVC, common, internal or external iliac veins.\n2.  Retroperitoneal lymphadenopathy.  This finding does not appear changed\nfrom CT of the lumbar spine from ___, and clinical correlation is\nrecommended.\n3.  Calcified lesion within the posterior aspect of the bladder measuring up\nto 4.8 x 0.8 cm likely reflects bladder calculi, without other abnormality\nidentified in the bladder."
        },
        {
            "input": "Lower Thorax: The see CT chest from same day for further details.\n\nPeritoneal Cavity: There is a small amount of free fluid in the abdomen, which\nis new. There is no free air or focal fluid collection.  There is new\nanasarca.\n\nLiver, Gallbladder and Biliary System: There is intrahepatic biliary ductal\ndilatation, as described previously, with minimal increase in degree,\nparticularly in the right liver lobe in segment VIII/VII where there are\npericholangitic hypodensities that are new and likely represent millimetric\ntiny abscesses ( 02:51 ). There is also more filling of the intrahepatic ducts\nwith fluid and less pneumobilia.  The liver is otherwise unchanged. There are\nunchanged intrahepatic stones, as described previously.The gallbladder has\nbeen surgically removed and there is a choledochoduodenostomy.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits with\nno evidence of bowel obstruction.\n\nPelvis: The urinary bladder is unremarkable. Uterus and ovaries are not seen.\n\nLymph Nodes: There is no size significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: There are multiple gastric, splenic and esophageal varices ( 02:44 ).\nThe left portal vein is thrombosed and not seen ( 02:56 ).\n\nBones: There is stable vertebra plana of the L1 vertebral body.  There has\nbeen mild interval progression of the L5 anterior compression fracture, now\nwith approximately 50% height loss.",
            "output": "1. Interval development of small pericholangitic millimetric hypodensities in\nthe right liver, likely related to mini abscesses from new infection\ncomplicating Caroli's disease. The remainder of the hepatobiliary findings\nincluding stones in bile ducts are grossly stable since previous.\n2. Interval progression of L5 vertebral body compression fracture."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions are present with subjacent\natelectasis.  Similar appearance of cardiomegaly.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic morphology is again seen.  Re-demonstration of\nextensive pneumobilia, similar to prior.  As on prior, there is intra and\nextrahepatic biliary dilation, with CBD measuring up to 11 mm at the porta\nhepatis, series 601, image 27.  Ill-defined areas of branching hypodensity in\nsegments II, III and VII (for example 02:19, 02:25) appear less conspicuous\nthan on prior, thought to reflect areas of as cholangitis on the previous CT\nscan.  The overall appearance suggests chronic cholangitis, difficult to\nexclude an acute component.  No drainable collection.  A 4 mm calcific density\nin the region of the distal CBD (02:32, 601:27) was not seen on the prior\nstudy and is difficult to discern whether it is intra or extra ductal.  The\ngallbladder is surgically absent.  There is new 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 hypodensities within the bilateral kidneys are too small to\ncharacterize but statistically likely represent cysts.  There is no\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Diffuse gastric wall edema has resolved.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. \nCircumferential thickening of the ascending colon is again seen, there was\nmuch improved, and may be related to portal colopathy.  Otherwise, the colon\nis unremarkable.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume simple pelvic ascites.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  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.  Moderate atherosclerotic\ndisease is noted.  The main and right portal veins are patent.  The splenic\nvein and SMV are patent as well.  The left portal vein is not seen, consistent\nwith chronic thrombosis.  Paraesophageal and perirectal varices are again\nseen.\n\nBONES: There is diffuse osseous demineralization.  Chronic compression\ndeformities of the L1 and L5 vertebrae with resultant grade 1 anterolisthesis\nof L4 on L5 are unchanged.  There is no evidence of worrisome osseous lesions\nor acute fracture.\n\nSOFT TISSUES: Anterior abdominal wall dehiscence is again seen.  Soft tissue\nthickening and calcification within the subcutaneous tissues overlying the\nbilateral gluteal muscles likely represent injection granulomas.",
            "output": "1. Persistent areas of branching hypodensity within the liver within segments\n2, 3 and 7, slightly improved, likely reflecting chronic cholangitis,\ndifficult to exclude an acute component.  No discrete abscess.\n2. 4 mm calcific density in the region of the distal CBD is new compared to\nthe most recent prior study and is difficult to discern whether it is\nintraductal, such as a stone, or extraductal.  Stable prominence of the\nbiliary tree and extensive pneumobilia unchanged.  If indicated, MRCP may be\nobtained for further evaluation.\n3. Cirrhosis with new small volume ascites.  Portosystemic varices, as above,\nappear similar.  No splenomegaly.\n4. Chronic left portal vein thrombosis.\n5. Trace bilateral pleural effusions.\n6. Unchanged compression deformities of the L1 and L5 vertebrae with resultant\ngrade 1 anterolisthesis of L4 on L5."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with associated\natelectatic changes.  There is mild septal prominence that may relate to mild\ncongestion.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic morphology of liver.  Given lack of contrast, the\npreviously suspected areas of cholangitis in segments 2, 3 and 7 are not as\nwell visualized.  Marked oral contrast reflux is noted into the intrahepatic\nbiliary tree, providing clear delineation of the choledochal duodenostomy\n(___:23).  Associated pneumobilia.  The gall bladder is absent.  No\npneumoperitoneum to suggest perforation.\n\nPANCREAS: There is mild loss of normal pancreatic lobulations in the region of\nthe pancreatic head compared to the body and tail, with slightly increased\nsurrounding fat stranding.  This is concerning for acute pancreatitis (post\nERCP).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 left kidney\ndemonstrates a partially duplicated collecting system.  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.  There is mild circumferential\nthickening of the ___ portions of the duodenum (___:32).  Mild colonic mucosal\nthickening is also noted in the region of the hepatic flexure, likely related\nto portal colopathy\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small amount\nof free fluid is present in the dependent pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is present and atrophic.  No adnexal\nabnormality is 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 to moderate\natherosclerotic disease is noted.\n\nBONES: There is S shaped scoliosis of the thoracolumbar spine with associated\nsevere degenerative changes particularly in lower lumbar region.  Severe\ncompression deformities of L5 and L1 are similar in appearance compared to\nexamination of ___ year ago.  There is overall decreased bone mineral density.\n\nSOFT TISSUES: A moderate amount of fat stranding is present throughout the\nsubcutaneous tissues of the visualized thoraco abdominal wall.  In addition\nthere is moderate fat stranding throughout the abdomen and pelvis.  Tiny\nperisplenic and pelvic ascites are present.",
            "output": "1. Cirrhosis with features of portal hypertension.\n2. Loss of lobulations and relatively increased peripancreatic fat stranding\nin the region of the pancreatic head is concerning for acute pancreatitis. \nPlease correlate with amylase/lipase.\n3. No evidence of pneumoperitoneum to suggest perforation.\n4.   Mild duodenal thickening may relate to mild duodenitis versus post ERCP.\n5. Diffuse anasarca with associated small ascites and small bilateral pleural\neffusions.\n6.   Known duodenal choledochostomy with oral contrast as well as air seen in\nthe biliary system.\n7.   Previously suspected cholangitis is less well visualized compared to\nprior imaging due to the absence of IV contrast.\n\nRECOMMENDATION(S):  Further evaluation with serum lipase and amylase levels is\nrecommended.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:45 pm, 30 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Small right and trace left pleural effusions are seen with\nsubjacent atelectasis.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and mildly nodular consistent with\ncirrhotic morphology.  There is no evidence of focal lesions. Extensive\npneumobilia and reflux of oral contrast into the intrahepatic biliary ducts is\nagain seen, consistent with known choledochoduodenostomy.  Ill-defined areas\nof branching hypodensity are again noted, for example in hepatic segment 2, 3,\n7, and 8 (4; 10, 12, 13, 15).  There are no fluid collections.  The common\nbile duct is enlarged measuring 1.2 cm.  The gallbladder is surgically absent.\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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and 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 are seen in bilateral kidneys, which are too small to\ncharacterize but are statistically likely to be simple cysts.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Again seen are multiple air\nand fluid-filled periampullary duodenal diverticula (4; 24, 21).  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nMild wall thickening along the ascending colon is suggestive of portal\ncolopathy.  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 is unremarkable.  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.  The main and right portal veins are patent.  The left portal vein\nis not visualized suggestive of chronic thrombosis.  Periesophageal and\nperirectal varices with a splenorectal shunt are again noted.\n\nBONES: Chronic L1 and L5 compression deformities are seen.  There is grade 1\nanterolisthesis of L4 on L5.\n\nSOFT TISSUES: Calcifications in bilateral gluteal tissues is likely related to\nprior injections.",
            "output": "1. Persistent areas of branching hypodensity within the liver likely reflect\nchronic cholangitis and are not significantly changed compared to prior.  No\nevidence of hepatic abscess.\n2. Status post choledochoduodenostomy with persistent extensive pneumobilia\nand reflux of oral contrast into the biliary tree.\n3. Cirrhosis with stable sequelae of portal hypertension including small\nvolume ascites and abdominal varices.\n4. Small right and trace left pleural effusions."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Redemonstrated\nis a trace left pleural effusion.  The small right pleural effusion has\nresolved.  There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: As before, the liver is shrunken and mildly nodular consistent\nwith cirrhosis.  ___ pneumobilia, particularly in the left hepatic lobe is\nunchanged and suggests a patent choledocoduodenostomy.  Ill-defined areas of\nbranching hypodensity in segments 2, 3, 7 and 8 appear grossly unchanged. \nThere are no discrete fluid collections.  The common bile duct remains\nenlarged measuring up to 1.4 cm, previously 1.2 cm.  The gallbladder is\nsurgically absent.  There is only trace intra-abdominal ascites.\n\nThere is a linear filling defect within the main portal vein extending into\nthe superior mesenteric vein, which may represent a nonocclusive thrombus\n(2:43, 2:52) or less likely mixing artifact.  The right portal vein remains\npatent.  As before, the left portal vein is not visualized, likely due to\nchronic thrombosis.  Periesophageal and perirectal varices with a splenorenal\nshunt 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 size with normal nephrogram. \nSubcentimeter hypodensities bilaterally are too small to characterize, but\nstatistically likely represent simple cysts.  There is no evidence of solid\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 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. \nRedemonstrated are severe multilevel degenerative changes in the lumbar spine.\nThere is unchanged compression deformity of the L5 and L1 vertebral bodies. \nThere is unchanged 5 mm posterior retropulsion of the L1 vertebral body as\nwell as approximately 1.1 cm of retropulsion of the L5 vertebral body\n\nSOFT TISSUES: Calcifications in the bilateral gluteal tissues are likely\nrelated to prior injections.",
            "output": "1. Apparent filling defect in the main portal vein, extending into the\nsuperior mesenteric ___ represent mixing artifact vs thrombus.  Findings\ncould be further assessed on ultrasound or repeat CT abd"
        },
        {
            "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 1.2 x 0.8 cm cyst in segment VI is unchanged.  Additional\nhypoattenuating lesions are too small to completely characterize on CT, but\ncorrespond to small cysts or biliary hamartomas on outside hospital MRI.  The\nremaining hepatic parenchyma demonstrates homogeneously decreased attenuation.\nNo suspicious hepatic lesions.  The hepatic veins and portal veins are patent.\nNo intrahepatic or extrahepatic biliary ductal dilation.  The gallbladder is\nwithin normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: The neck, body, and tail enhances heterogeneously, similar to the\nrecent outside hospital MRI, presumably correlating with infiltrative mass as\nrevealed on recent biopsy.  The diameter of the involved pancreatic tail has\nonly slightly increased since ___. This portion of the pancreas abuts, but\ndoes not efface the superior mesenteric vein/splenic vein confluence, splenic\nvein, splenic artery, lesser curvature of the stomach, and a loop of adjacent\nsmall bowel.  No evidence of clear extra pancreatic structure invasion.  The\nhead of the pancreas enhances more avidly, within the range of normal, but\nwith multiple small cystic lesions and numerous calcifications in keeping with\nsequela of chronic pancreatitis.  No peripancreatic fat stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, 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.  Slight left lower pole\ncortical thinning and irregularity suggests prior infectious or ischemic\ninsult.  No suspicious renal lesion.  No hydronephrosis, nephrolithiasis, or\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: A peripancreatic lymph node abutting the second portion of\nthe duodenum measures up to 14 mm in short axis (series 3, image 118). \nPeriportal lymph nodes measures 8 mm in short axis (series 3, images 112 and\n115)\n\nPELVIS: The urinary bladder wall is somewhat thickened and irregular, raising\nthe possibility of chronic outlet obstruction in the setting of prostatomegaly\nno adjacent fat stranding suggests cystitis.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\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. Heterogeneous enhancement of the pancreatic neck/body/tail is similar to\nrecent outside hospital imaging, possibly all reflecting infiltrating poorly\ndifferentiated carcinoma.  This heterogeneous parenchyma-based soft tissue\nabuts, but does not clearly invade the superior mesenteric vein/splenic vein\nconfluence, splenic vein, splenic artery, lesser curvature of the stomach, and\na loop of adjacent small bowel.\n2. Peripancreatic and periportal lymph nodes measure up to 1.4 cm in short\naxis.\n3. No evidence of distant metastasis 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 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia the contains the gastric fundus and\npart of the body.  Stomach is collapsed and otherwise difficult to assess but\nno specific indication of gastritis.  Small bowel loops demonstrate normal\ncaliber and wall thickness throughout. There is a loop of redundant sigmoid\ncolon that is located to the far right of the abdomen, even to the right of\nwhat is probably a somewhat mobile cecum and ascending colon.  There is no\nwall thickening, twisting or obstruction.  Oral contrast has passed through\nthe whole small bowel into the rectum.  However, the configuration of the\nsigmoid is unusual and it may be that there is a mesenteric defect through\nwhich it passes posterior to the cecum.  No evidence of colitis.  The appendix\nis not visualized.  There is no bowel obstruction.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Retroflexed uterus with a probable fibroid noted in the\nanterior mid uterine segment (2:66).  No adnexal masses 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\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post intramedullary rod and gamma pin through the right\nfemur.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings in the abdomen or pelvis.  No evidence of colitis.\n2. Moderate to large hiatal hernia.\n3. Unusual anatomy of the sigmoid colon, a redundant portion of which has\nshifted to the far right abdomen, passing posterior the cecum.  This may be\ndue potentially to an acquired or congenital defect in the cecal mesentery\n(pericecal hernia).\n\nRECOMMENDATION(S):  Correlation with any prior outside available imaging may\nbe helpful to consider the findings further."
        },
        {
            "input": "CT LOWER ABDOMEN:  The visualized portion of the lower liver enhances\nhomogeneous ___ without focal lesion.  The lower portion of the gallbladder is\nvisualized and contains a single hyperdense gallstone (9:2). The visualized\nportion of the pancreas is unremarkable. There is an unchanged millimetric\nhypodensity at the upper pole of the right kidney, too small to characterize\nbut likely a cyst. Visualized portions of the small bowel are unremarkable,\nwithout wall thickening or obstruction. There sigmoid colonic diverticulosis\nwithout diverticulitis.\n\nCT PELVIS: The urinary bladder contains air and a Foley catheter. The uterus\nis unremarkable.\n\nThere has been interval placement of a screw fixating the comminuted sacral\nfracture. The screw itself traverses through the left iliac fossa, left SI\njoint, body of S1, right SI joint, and terminates in the right iliacus muscle.\nThere is another screw fixating the displaced fractures of the left superior\nand inferior pubic rami.  The lateral portion of the screw may involve the\nleft femoroacetabular joint space (11b:49). There is re-demonstration of the\nright L4 transverse process fracture and bilateral L5 transverse process\nfractures.\n\nThere is a presacral hematoma, as well as left groin and left flank tracking\nblood. The asymmetric enlargement of the left greater than the right obturator\ninternus is likely due to hematoma in that location. Incidental note is made\nof a small fracture across the right pubic symphysis. Hemangiomas of the L5\nand L3 vertebral bodies are present.\n\nCTA PELVIS: Please note that evaluation of the left pelvic vessels is somewhat\nlimited by streak artifact from the newly placed pelvic hardware.  There is no\nevidence of active extravasation from the pelvic vessels common either on the\narterial or delayed phases.",
            "output": "1.  No evidence of active extravasation in the abdomen or pelvis.\n\n2.  Interval placement of 2 screws fixating the comminuted sacral fracture and\nleft superior and inferior pubic rami fractures.\n\n3. Small presacral hematoma, small left obturator internus hematoma, and blood\ntracking along the left groin and flank."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nThe liver, spleen, pancreas, and bilateral adrenal glands are normal. There\nare no radiodense stones in the bilateral kidneys, ureters, or bladder. There\nis no hydronephrosis.\n\nThe stomach and bowel loops are normal without evidence of obstruction. There\nis no free fluid or free air. The appendix is normal.\n\nThe aorta is normal in caliber.\n\nThere is no mesenteric, retroperitoneal, pelvic sidewall or inguinal\nlymphadenopathy.\n\nThe bony structures are unremarkable without suspicious lesions.",
            "output": "1. No radiodense stones. No hydronephrosis\n2. No acute intraabdominal process.  Normal appendix."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The non-distended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly.  There is a 1.8 x 1.2 cm simple-appearing cyst in the upper pole of\nthe left kidney. There is no focal lesion or hydronephrosis.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.The small bowel is within normal limits, without wall thickening or\nevidence of obstruction.Colonic diverticulosis is present. In the sigmoid\ncolon, there is an area of wall thickening and mild adjacent stranding of the\nmesocolon fat, best seen on the coronal view (___), consistent with early\nuncomplicated diverticulitis.  A normal, air-filled appendix is visualized.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.The prostate is unremarkable.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.",
            "output": "1.  Focal area of wall thickening and mild adjacent stranding of the mesocolic\nfat, consistent with early non-complicated sigmoid diverticulitis. No\ndrainable fluid collection."
        },
        {
            "input": "CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings including bilateral pulmonary nodules.\n\nABDOMEN:\n\nThe liver enhances homogeneously without focal lesion.  The portal vein is\npatent. There is unchanged mild intrahepatic biliary dilatation with expected\npneumobilia. The patient is status post Whipple procedure with expected\npostoperative appearance. Effacement of the fat around the portal vein and\nceliac artery is new compared to the prior study. The residual pancreas\nenhances homogeneously with no focal lesions. The spleen and adrenal glands\nare unremarkable.  Note is again made of a splenule in the splenic hilum The\nkidneys present symmetric nephrograms and excretion of contrast with no focal\nlesions, stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  There are multiple prominent mesenteric lymph nodes measuring up\nto 6 mm in short axis which have increased compared to the prior study (6:72\nthrough 76). No ascites, free air or abdominal hernia.  The abdominal aorta is\nof normal caliber.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.  A 1.4 x\n2.3 cm fluid density rounded lesion along the right lower anterior abdominal\nwall adjacent to a surgical clip likely represents a postop seroma.",
            "output": "1. Status post Whipple with normal appearance of the residual pancreas.\n2. New effacement of the fat around the portal vein and celiac artery, and new\nprominent nearby mesenteric lymph nodes could be reactive changes related to\nadjuvant radiation, though close attention on followup is recommended.\n3. For details regarding the chest including pulmonary nodules, please see\ndedicated chest CT report."
        },
        {
            "input": "LOWER CHEST: Partially visualized lung fields are within normal limits.  There\nis 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 biliary\ndilatation.  The common bowel duct measures 9-10 mm.  The gallbladder is\nsurgically absent.\n\nPANCREAS: The pancreas displays fatty infiltration, without evidence of focal\nlesions or pancreatic ductal dilatation.  There is subtle haziness of the fat\nanterior to the pancreas which is nonspecific, but can be correlated with\nlipase levels.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 a 2.1\nx 2.2 cm hypodense lesion in the lower pole of the left kidney, incompletely\ncharacterized but likely representing a simple renal cortical cysts.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Patient is status\npost low anterior resection of sigmoid colon and rectum, with colorectal\nanastomosis.  The anastomosis appears intact, without evidence of fluid\ncollection or abscess.  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 foci of extraluminal air within\nthe pelvis, likely postoperative in nature.\n\nREPRODUCTIVE ORGANS: The anteverted uterus and bilateral adnexae are grossly\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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Minimal stranding and foci of air at the umbilicus, as well as\nmultiple small foci of air in soft tissues of the right abdominal wall, likely\npostsurgical in nature.",
            "output": "1.  Status post low anterior resection of sigmoid colon and rectum, with\ncolorectal anastomosis via laparoscopic approach.  The anastomosis appears\nintact, without evidence of adjacent fluid collection or abscess.\n2. Common bile duct dilatation with prominent intrahepatic biliary ducts, may\nrelate to history of prior cholecystectomy and there is no evidence of\ndefinite biliary obstruction.  If there is clinical concern, correlate with\nLFTs.\n3. Multiple foci of extraluminal air in the pelvis are likely postsurgical in\nnature. Multiple foci of air in the soft tissues of the right abdominal wall\nlikely represent the site of a prior JP drain.\n4.  Equivocal subtle haziness of the fat anterior to the pancreas, please\ncorrelate serum lipase levels.\n\nRECOMMENDATION(S):  Clinical correlation with labs as described above."
        },
        {
            "input": "LOWER CHEST: There is dependent atelectasis bilaterally.  In addition to the\natelectasis, there is a focal consolidation within the left lower lobe\nconsistent with pneumonia.  No pleural or pericardial effusion.  The patient\nis post aortic valve replacement.  Calcification of the mitral valve and\ncoronary arteries is noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic.  The patient is post tace of a segment\n7 lesion which is overall unchanged in appearance since ___. There\nare no new focal lesions on the single phase 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 measures up to 13.6 cm and is otherwise 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 with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Simple\nappearing left parapelvic cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Again noted is a duodenal\ndiverticulum.  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\nmoderate to large volume ascites, increased since the prior MRI.  No\nperitoneal enhancement or focal collections are identified.\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 main portal vein is patent as well as a recanalized\nparaumbilical vein.  The anterior posterior branches of the right portal vein\nare again noted to be diminutive but appear patent.  Gastroesophageal varices\nare again noted.  There is no abdominal aortic aneurysm.  Moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an umbilical hernia, which in comparison to prior now\ncontains a small amount of ascites and varices.",
            "output": "1. No evidence of abdominopelvic abscess.\n2. Left lower lobe pneumonia.\n3. Cirrhotic liver and findings of portal hypertension.  No new suspicious\nlesions on this single-phase study.\n4. Slight interval increase in amount of abdominopelvic ascites.\n5. Umbilical hernia containing ascites and varices."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Increased size and number of numerous hypoenhancing lesions\nthroughout the liver, with representative lesions as follows:\nA 4.9 cm lesion in the right hepatic lobe (10:82), previously measured 2.8 cm.\nA 3.6 cm lesion in the left hepatic lobe (10:76), previously measured 2.7 cm.\nA 2.2 cm lesion in the right hepatic lobe (10:113), previously measured 1.1\ncm.\nA few subcentimeter lesions are seen, for instance on series 2, image 103.\n\nThere is no biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: The kidneys are unremarkable except for stable multiple bilateral\nsubcentimeter hypodensities are too small to characterize by CT.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  No bowel obstruction or ascites. \nThere is mild hyperemia without wall thickening or soft tissue stranding\nthroughout the colon.\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.  The hepatic vasculature is\npatent.\n\nBONES: Unchanged 1.0 cm sclerotic lesions in the right and left iliac bones\nare unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval progression of hepatic metastatic disease.\n2. Unchanged sclerotic lesions in the iliac bones.\n3. Mild hyperemia and wall thickening of the colon may represent mild colitis.\n4. Please refer to separate report of CT chest performed same day for\ndescription thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is active arterial contrast extravasation noted within the low anus (3A:\n196-203).  No active extravasation is noted within the rectum or sigmoid\ncolon.  Multiple collateral vessels are noted within the abdomen and pelvis\nanterior to the bladder including a recannulized umbilical vein.\n\nThere is no abdominal aortic aneurysm.  There is conventional arterial anatomy\nof the celiac axis and SMA.  The portal vein, SMV and intrahepatic veins are\npatent.  There is no calcium burden in the abdominal aorta and great abdominal\narteries.\n\nLOWER CHEST: Bilateral patchy consolidative opacities are present.  Again\npresent is collapse of both right and left lower lobes.  No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver re- demonstrates heterogeneous attenuation throughout\nwith large areas of focal steatosis.  Again noted is atrophy of the left\nhepatic lobe and hypertrophy of the caudate lobe, consistent with cirrhosis.\nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is distended without wall\nthickening or pericholecystic fluid.  No radiopaque gallstones 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 size of the spleen is at the upper limits normal however\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 stones, focal renal lesions, or hydronephrosis. \nInterval decrease in the prominence of the left collecting system.  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.  Again noted is a substantial stool burden within\nthe colon but primarily involving the rectum.  This is however decreased in\nextent since the prior examination however there is new circumferential wall\nthickening of the rectum extending over a distance of 17 cm proximal to the\nanal verge.  There is no evidence of pneumatosis or free\nintraperitoneal/mesenteric air.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter.  There is\nno evidence of pelvic or inguinal lymphadenopathy.\n\nThere has been interval increase in the extent of abdominopelvic ascites,\nparticularly within 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: Increasing anasarca.",
            "output": "1. Active arterial extravasation within the low anus, possibly secondary to\nhemorrhoids.  Less likely although also a consideration is bleeding secondary\nto varices.\n2. Large fecal load within the colon, particular the rectum with new\ncircumferential wall thickening concerning for stercoral colitis.\n3. Increasing ascites and anasarca.\n4. Multifocal pneumonia.\n5. Interval decrease in the prominence of the left renal collecting system."
        },
        {
            "input": "VASCULAR:  The abdominal aorta is normal in caliber without aneurysmal\ndilatation.  The celiac axis, SMA, bilateral renal arteries, and ___ are\npatent.  Note is made of an accessory left hepatic artery.  Bilateral common\nand internal and external iliac arteries as well as bilateral femoral arteries\nare patent.\n\nLOWER CHEST: There are areas of atelectasis at the bilateral lung bases as\nwell as the lingula.  A trace left pleural effusion is noted.  The heart is\nnormal in size.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged and diffusely heterogeneous with a large\narea of steatosis in the right lobe.  There is unchanged atrophy of the left\nlobe as well as hypertrophy of the caudate lobe compatible with known\ncirrhosis.  There is no intra or extrahepatic biliary ductal dilatation.  A\nlarge recanalized paraumbilical vein is present with extensive periumbilical\nand abdominal wall varices.  The gallbladder is distended but there are no\nfindings to suggest acute cholecystitis such as wall thickening.  There is\nlarge amount 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 is homogeneous in attenuation but enlarged measuring 14.1\ncm.\n\nADRENALS: The right adrenal gland is difficult to identify.  The left adrenal\ngland is normal.\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\nis no perinephric abnormality.\n\nGASTROINTESTINAL:  Enteric tube is noted terminating in the gastric body. \nThere is progressive enhancement of the gastric rugae which suggest gastritis\nor portal gastropathy.  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.  Patient is status post coiling of the superior rectal artery.  There\nis no evidence of active contrast extravasation within the small or large\nbowel.  No definite mesenteric lymphadenopathy is identified.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is mostly decompressed due to presence of a Foley\ncatheter.  There is no evidence of pelvic or inguinal lymphadenopathy.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse severe anasarca.",
            "output": "1. No evidence of active contrast extravasation in the small or large bowl. \nNo source of bleeding identified on CT.\n2. Progressive enhancement of the gastric rugae can be seen in gastritis or\nportal gastropathy, although may merely reflect underdistention.\n3. Cirrhosis with sequelae of portal hypertension including recanalized\nparaumbilical vein, extensive abdominal wall varices, large ascites, and\nsplenomegaly.\n4. Severe anasarca."
        },
        {
            "input": "FINDINGS:\n\nVASCULAR:  The abdominal aorta is normal in caliber without aneurysmal\ndilatation.  The celiac axis, SMA, bilateral renal arteries, and ___ are\npatent.  Note is made of an accessory left hepatic artery.  Bilateral common\nand internal and external iliac arteries, bilateral femoral arteries are\npatent.\n\nUnchanged embolization coils are noted within the pelvis.  There are\nparaesophageal and perigastric varices as well as a small splenorenal shunt. \nA large recanalized paraumbilical vein is present with extensive periumbilical\nand abdominal wall varices.  In addition there are varices within the pelvis.\n\nLOWER CHEST:  There is dependent bibasilar consolidation and volume loss in\nthe lower lobes, more pronounced on the right, stable on the left, similar on\nthe right since prior.  There is a rounded area of consolidation in the\nlingula which may represent a developing pneumonia.  A trace left pleural\neffusion is noted.  The heart is normal in size.  There is no pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged and diffusely heterogeneous with large\nareas of steatosis, most prominent in the right hepatic lobe.  There is\nunchanged atrophy of the left lobe as well as hypertrophy of the caudate lobe\n.  There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is contracted.  There is no calcified gallstone\n\nThere is large amount of abdominal, pelvic 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 homogeneous in attenuation and without focal lesion but\nenlarged measuring 13.9 cm in coronal plane.\n\nADRENALS:  Normal\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\nis mild bilateral nonspecific stranding.\n\nGASTROINTESTINAL:  Enteric tube is noted terminating in the gastric body.  \nSmall bowel loops demonstrate normal caliber.  There is abnormal mucosal hyper\nenhancement of multiple loops of jejunum which is nonspecific and may be due\nto an infectious etiology.  There is circumferential wall thickening of the\nrectum, mildly improved since prior.  There are 2 metallic clips noted within\nthe lumen of the transverse colon of unclear etiology.  Correlate with history\nof intervention.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed due to presence of a Foley catheter. \nThere is air within the bladder.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is a large amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS:  No pelvic mass.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse severe anasarca.",
            "output": "1.  There are moderate amount of atelectasis at the bilateral lung bases. \nRounded area of consolidation in the lingula which may represent a developing\npneumonia.\n\n2.  The wall of the rectum is mildly thickened, mildly improved since prior,\nmay be infectious.  There is abnormal mucosal hyper enhancement of multiple\nloops of jejunum which is a nonspecific finding, may be reactive, consider\nenteritis.  Ischemia less likely.  No bowel dilatation.\n\n3. Cirrhosis, varices, large volume ascites, splenomegaly.  Areas of\nsteatosis, may represent a component of steatohepatitis.  This is also\nunchanged when compared to most recent prior\n\n4. Severe anasarca."
        },
        {
            "input": "Lung Bases:  Atelectasis in the lower lobes noted posteriorly.  The imaged\nportion of the heart is notable for aortic valvular calcification.\n\nAbdomen: The liver contains numerous hypodensities likely representing cysts,\nthe majority are too small to characterize.  Main portal vein is patent. \nThere is mild biliary ductal dilation status post prior cholecystectomy.  The\npancreas enhances normally.  The spleen, and both adrenal glands are normal. \nThe kidneys enhance symmetrically with prompt excretion of contrasts noted. \nNo hydronephrosis, signs of pyelonephritis or worrisome renal lesion.  The\nabdominal aorta is moderately calcified, mildly tortuous and normal in\ncaliber.  No retroperitoneal or mesenteric adenopathy.  The stomach and\nduodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is not visualized though there are no secondary signs of\nappendicitis.  Fecal loading of the colon is mild.  Diverticulosis is present\nwith an acutely inflamed diverticulum residing in the left lower quadrant,\nbest seen on series 2 image 55. mild adjacent fat stranding noted without\nsigns of perforation.  The prostate gland is markedly enlarged measuring 6.9 x\n7.0 cm.  There is associated bladder base indentation with a diverticulum at\nthe bladder dome.  There is no pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome bony lesion.  Multilevel degenerative disease in the\nlumbar spine noted with grade 1 anterolisthesis of L3 on L4.",
            "output": "1. Acute uncomplicated diverticulitis involving the distal descending:.\n2. Massively enlarged prostate gland with bladder base indentation.\n3. 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. \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 is enlarged measuring up to 13.2 cm.  A wedge-shaped area\nof hypoperfusion is present in the superomedial spleen most consistent with\ninfarct.  At the renal hilum is a 0.9 x 0.8 cm hypodensity with peripheral\ncalcifications which may represent a thrombosed splenic artery aneurysm (02:18\nand 601:38), though evaluation is limited secondary to phase of contrast.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 visualized though no\nsecondary signs of appendicitis are seen.\n\nPELVIS: The bladder is under distended though appears mildly thickened, which\nis nonspecific.  The distal ureters are unremarkable.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Splenomegaly with findings most consistent with splenic infarct.  9 mm\nhypodensity at the splenic hilum with peripheral calcifications may represent\nthrombosed splenic artery aneurysm though evaluation is limited given phase of\ncontrast.\n2. No findings of pancreatitis, colitis, or pyelonephritis. Appendix not\nvisualized though no secondary signs of appendicitis are seen."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  There is a retroaortic left\nrenal vein.  There is nearly complete resolution of previously seen thrombosed\nsplenic artery aneurysm (series 5, image 24).\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 hypoattenuation, 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, 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.  Previously seen infarction has resolved.\n\nADRENALS: The right and left adrenal glands 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\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\ndiverticulosis without diverticulitis.  The appendix is not visualized.\n\nRETROPERITONEUM: Prominent retroperitoneal lymph nodes are not enlarged by\nsize criteria and are unchanged compared to prior.  Hyperdensity measuring 5\nmm in the uterine cavity may represent a potential polyp or intracavitary\nfibroid.\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. Previously seen splenic infarction has resolved with near complete\nresolution of thrombosed splenic artery aneurysm.\n2. Intrauterine 5 mm lesion may represent a potential polyp versus\nintracavitary fibroid.  Pelvic ultrasound is recommended for further\nevaluation.\n\nRECOMMENDATION(S):  Pelvic ultrasound\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 14:39 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider."
        },
        {
            "input": "LOWER CHEST: Mild, bibasilar atelectasis.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered, subcentimeter hepatic hypodensities are too small to characterize. \nA focal hyperdensity with the right hepatic lobe (2:36) may reflect a\ncalcified granuloma.  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: An ill-defined hypodensity within the spleen (2:25) is too small to\ncharacterize.  The spleen otherwise demonstrates homogeneous enhancement\nthroughout, with normal 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. \nMultiple cysts of the left kidney measure up to 3.3 cm.  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. Scattered colonic\ndiverticulosis, without evidence of acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS: The bladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable for age.  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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny, fat containing umbilical hernia.",
            "output": "Scattered colonic diverticulosis, without evidence of acute diverticulitis. \nNo acute intra-abdominal abnormality."
        },
        {
            "input": "LOWER CHEST: Calcified punctate nodule at the left lung base is suggestive of\nprior granulomatous disease.  Otherwise, the lung bases are clear.  No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There are extensive\nvascular calcifications.  There are 2 slightly more coarse calcifications\nwhich is difficult to determine whether these are vascular calcifications or\npunctate nonobstructing stones without IV contrast.  These measure up to 4 mm\nin the right kidney (series 2, image 60) and 3 mm in the left kidney (series\n2, image 57).  No hydronephrosis or hydroureter.  There is no suspicious renal\nlesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall\nthickness. The colon and rectum are within normal limits. The appendix is not\nvisualized.\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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic 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": "No acute intra-abdominal pathology.\nExtensive vascular calcifications.\nThere are 2 slightly more punctate/coarse calcifications in the kidneys\nbilateral measuring 4 mm on the right and 3 mm on the left.  It is difficult\nto differentiate whether these are nonobstructing stones or slightly coarser\nvascular calcifications without IV contrast.  No hydronephrosis or\nhydroureter.\nNo ureteric or bladder calculi."
        },
        {
            "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. 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.  Small accessory spleen inferiorly.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Subcentimeter hypodensity within the interpolar region of the right\nkidney is too small to characterize, but likely represents a cyst.  Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Descending and sigmoid colonic diverticulosis.  There is\nmoderate fat stranding and wall thickening surrounding a sigmoid colonic\ndiverticulum, compatible with acute diverticulitis (series 2, image 65). \nThere is a small amount of nonhemorrhagic free fluid within the pelvis,\nhowever there are no focal fluid collections.  There is no evidence of\npneumoperitoneum.  The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. 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: Hyperenhancing lesion arising from the anterior\nmyometrium measuring approximately 2.6 cm, compatible with a fibroid.  No\nadnexal 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.  No atherosclerotic disease\nis noted.\n\nBONES: Fixation hardware is partially imaged within the lower thoracic spine,\nunremarkable in appearance.  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. Moderate fat stranding and wall thickening surrounding a sigmoid colonic\ndiverticulum, compatible with uncomplicated acute diverticulitis.  Small\namount of nonhemorrhagic free fluid within the pelvis.  No focal fluid\ncollections.  No pneumoperitoneum.\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 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 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.  Patient is status\npost partial sigmoid resection with intact anastomosis.  There is diffuse\ncolonic diverticulosis without diverticulitis.  A loop of mid transverse colon\nis demonstrated within a large anterior abdominal wall defect.  Minimal fat\nstranding is seen within the hernia sac, but no obstruction.  No free air.  No\nfree fluid.  The appendix 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 grossly 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: Posterior surgical fixation hardware along the lower thoracic spine is\nunremarkable in appearance.  No evidence of worrisome osseous lesions or acute\nfracture.  Defect in the left iliac bone likely reflects a prior graft donor\nsite.\n\nSOFT TISSUES: Anterior ventral hernia containing large bowel and mesenteric\nfat, with a neck measuring approximately 6.0 cm in the transverse plane. \nThere is mild fat stranding within the hernia sac, but no fluid.",
            "output": "1. Ventral hernia containing a loop of mid transverse colon with minimal\nsurrounding fat stranding which could suggest mild inflammation, but no bowel\nobstruction or other complication.\n2. Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There are partially calcified fibroids in the uterus. \nThere is increased prominence of the right adnexa in comparison to the prior\nstudy, which on this examination measures 2.4 cm (series 400, image 74 on the\ncoronal view and series 2, image 44 on the axial view).  Pelvic ultrasound\ncould be obtained for further evaluation.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate to severe atherosclerotic disease is noted.  There is\nunchanged tortuosity and dilatation of the left common iliac artery and left\ncommon iliac vein.\n\nBONES: Redemonstration of diffuse bony demineralization and bilateral total\nhip arthroplasties.  There is no evidence of an acute fracture.  As before,\nthe intertrochanteric region of the right hip shows lucencies that are\nunchanged and likely related to previous fracture and metallic streak\nartifact.  Cerclage wires around the chronic, comminuted, ununited fracture of\nthe left femur are intact and unchanged.  Vertebral body height loss of L5 is\nunchanged.  Moderate to severe multilevel facet arthropathy is unchanged. \nThere are no worrisome osseous lesions.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias are unchanged.",
            "output": "1. No evidence of acute fracture in the pelvis.\n2. Redemonstration of bilateral total hip arthroplasties and a chronic,\ncomminuted nonunited fracture of the proximal left femur with cerclage wires\nin place.\n3. Increased prominence of the right adnexa in comparison to the prior study,\non this examination measuring 2.4 cm.  Pelvic ultrasound could be obtained for\nfurther evaluation."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate to severe atherosclerotic disease is noted.\n\nBONES: There is diffuse bony demineralization.  Bilateral total hip\narthroplasties are noted.  There is mild vertebral body height loss of L5,\nunchanged from prior.  There are cerclage wires about the proximal left femur\nfrom a chronic, comminuted, ununited fracture.  There is no evidence of an\nacute fracture.  Intratrochanteric region of the right hip shows lucencies\nthat can likely be explained by old injuries and artifacts associated with\nmetallic artifact.  There is moderate multilevel facet arthropathy.  There is\nno evidence of worrisome osseous lesions.\n\nSOFT TISSUES: There are fat containing inguinal hernias bilaterally.",
            "output": "1. No evidence of acute fracture in the pelvis.\n2. Redemonstration of bilateral THAs and a chronic, comminuted nonunited\nfracture of the proximal left femur.\n\nRECOMMENDATION(S):  MR with metal reduction protocol may be helpful to\nevaluate further if needed clinically.  Particularly of the hardware in the\nright femur was placed more than ___ year ago bone scan may be potentially\nhelpful as an alternative.."
        },
        {
            "input": "LOWER CHEST:\nThere is minimal right basilar dependent atelectasis. Dense coronally artery\ncalcification noted. No pleural or pericardial effusion present.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  There is a 10 mm focus of homogeneous enhancement at the right\nhepatic dome (series 8, image 16) that demonstrated faint nodular enhancement\non the prior CT dated ___, may represent a hemangioma, although given\nthe difference in enhancement phase on multiple prior CTs has not be clearly\ncharacterized. Attention to this area to be paid on subsequent imaging scans\nstable nodular contour of the left hepatic lobe. There is no intrahepatic\nbiliary ductal dilatation or no other focal hepatic mass lesion. Portal vein\nis patent.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN:  There is no splenomegaly. 11 mm splenule at the hilum noted.\nADRENALS:  Unremarkable.\nURINARY:  There are unchanged bilateral multiple simple cortical cysts. A 2.7\nx 2.3 cm left parapelvic cyst in the inferior pole demonstrates mild interval\nincrease in size compared to the prior of 1.6 x 1.4 cm. Again identified is a\nan enhancing right renal lower pole mass (series 8, image 48) measuring 1.8 x\n1.7 cm , previously 1.9 x 1.7 cm. Differentials remain an oncocytoma versus\nrenal cell carcinoma. No hydronephrosis seen bilaterally. Visualized opacified\nportions of the ureters bilaterally demonstrate no filling defects within\nthem.\nGASTROINTESTINAL:  There is a small hiatus hernia. Scattered colonic\ndiverticulosis without evidence of diverticulitis. There is no bowel wall\nthickening or bowel obstruction.\nLYMPH NODES: There are sub cm enhancing aortocaval, bilateral common iliac and\nbilateral inguinal lymph nodes.\nVASCULAR: Abdominal aorta is normal in caliber.  Scattered atherosclerotic\ncalcification of the abdominal aorta and its branches noted.\n\nPELVIS:\nThe bladder is partially distended, unremarkable no bladder wall thickening\nnoted. There is prostatomegaly. The prostate measures 5.2 x 5.9 by 6.2 cm.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  Unchanged degenerative changes of\nthe thoracolumbar spine noted.",
            "output": "1.  Stable appearance of solid enhancing exophytic lesion arising from the\nlower pole of the right kidney, still concerning for oncocytoma renal cell\ncarcinoma.\n2.  The residual urinary bladder demonstrates no wall thickening or mass\nlesion.\n3.  No pathologically enlarged mesenteric, retroperitoneal inguinal or pelvic\nlymph nodes present."
        },
        {
            "input": "A CT of the chest has been performed as part of this examination and will be\nreported separately.\n\n4 mm lesion in segment 4A anteriorly, and 5 mm lesion in segment 4B/5 of the\nliver are too small to accurately characterize but likely represent small\nhemangiomas as these appear to partially fill (4B/5) and fill completely (4A)\non the 3 minute delayed phase images.  There is no additional hepatic lesion\ndemonstrated. The gallbladder is unremarkable.\n\nThe spleen is normal size. There is no pancreatic mass or ductal dilatation.\nThe adrenal glands are unremarkable.  There is no hydronephrosis involving\neither kidney.  The left kidney is duplex.\n\nThere is right hemi circumferential wall thickening involving the lower rectum\n___ o'clock), with single wall thickness of up to 11 mm. The tumor measures\n3 cm in craniocaudal length extending distally to the upper margin of the\ninternal anal sphincter/anorectal junction (4cm from the anal verge). The\nouter margin of the tumor is angulated / irregular, which may reflect\ndesmoplasia or tumor extension into the mesorectal fat. An adjacent 5 mm lymph\nnode is noted in the meso rectal fat along the right border of the\ntumor(3,118).  In addition multiple presacral lymph nodes are noted measuring\nup to 7 mm (601b,41).\n\nThere is no ascites.  The uterus is retroverted, and contains a ring shaped\nmetallic intrauterine device.  The bladder is unremarkable.\n\nNo osseous lesion is demonstrated.",
            "output": "1. Low rectal mass extending to the anorectal junction. The outer margin of\nthe tumor is irregular, which may reflect desmoplasia or tumor extension/T3\ndisease.  Given its location, local extent of disease might be assessed using\nendorectal ultrasound.\n2. 5 mm right mesorectal lymph node, and four presacral lymph nodes measuring\nup to 7 mm.\n3. 4 mm and 5 mm right hepatic lesions are most in keeping with small\nhemangiomas. Definitive characterization however would require MRI."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen are two, hypodense lesion within segment 4a,\nanteriorly in segment 4B.  They are unchanged in size or character since the\nprior examination.  They appear to partially fill on the 3 minutes delayed\nimages, and likely represent small hemangiomas.  No new hepatic lesions are\nidentified.  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.  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 circular IUD is present within the uterus.  The\nreproductive organs are otherwise unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  The\npreviously noted presacral and mesial rectal lymph nodes are no longer well\nseen.\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. No evidence of disease recurrence or metastases in the abdomen or pelvis\npre"
        },
        {
            "input": "LOWER CHEST: Multiple masses in the imaged lung bases measure up to 1.8 cm in\nthe anterior middle lobe (05:40).  Please refer to separate report of CT chest\nperformed on the same day for a detailed description of the thoracic findings.\n\nABDOMEN:\n\nLIVER: The liver demonstrates homogenous attenuation.  Two large hypoenhancing\nareas in segments ___ and ___, associated with capsular retraction likely\nrelated to prior Y-90 radioembolization treatment, are not significantly\nchanged, measuring 6.6 x 5.0 cm (05:54) and 3.9 x 2.8 cm (05:50), previously\n6.3 x 5.6 cm and 3.7 x 2.4 cm, respectively.\n\nIn segment ___, there is a new 1.4 cm hypoattenuating lesion (05:53).  In the\nsuperomedial part of segment ___, a 2.1 x 2.0 cm hypoenhancing lesion is\nbigger, previously 1.6 x 1.6 cm (___:46).\n\nSeveral additional ill-defined hypoattenuating lesions in segment V (5:62) are\nmildly bigger.\n\nThe portal vein and its main branches are patent.\n\nBILIARY:\nNo intrahepatic biliary dilatation.  Prominence of the CBD is unchanged in\nlikely reflects sequela of 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 is enlarged at 15.2 cm, previously 14.7 cm.  A 1.3 cm\nhypoattenuating focus in the posteromedial spleen is similar.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Postsurgical changes from\nprior LAR and small bowel anastomosis are again noted.  Small and large bowel\nloops are normal in caliber.  No ascites.\n\nFindings of omental and peritoneal carcinomatosis are progressed.  For\nexample, a conglomeration of nodules in the right omentum now measures up to\n2.2 cm (5:79), previously 1.4 cm.  Several smaller omental and peritoneal\nnodules along the anterior abdominal wall are more prominent.\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: Numerous prominent periportal, periaortic and right pelvic nodes\nare mildly bigger.  For example a 0.8 cm periportal node (5:61) previously\nmeasured 0.7 cm.  A 1.0 cm left periaortic node (5:67) previously measured 0.9\ncm.  A 0.8 cm posterior right pelvic sidewall node (5:98) previously measured\n0.7 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: A subcentimeter sclerotic focus in the left sacral ala (5:93) is\nunchanged.\n\nSOFT TISSUES: Postsurgical changes are again noted in the anterior abdominal\nwall.  A 1.3 cm enhancing soft tissue nodule in the left ischial rectal fossa\nis mildly bigger (5:122), previously 1.2 cm.",
            "output": "1. Progression of hepatic, omental and nodal metastatic disease, as detailed\nabove.\n2. Persistent splenomegaly.\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 homogenous attenuation. Multiple liver\nlesions have increased in size.  The dominant mass in segment 4 measures 8.1 x\n7.2 x 9.3 cm, previously 6.6 x 5.0 x 8.6 cm.  A mass in segment 8 measures 4.3\nx 3.0 x 5.2 cm, previously 3.9 x 2.8 x 4.3 cm.  A mass in segment 8 measures\n2.5 x 3.0 x 3.4 cm, previously 2.1 x 2.0 x 2.5 cm.  A few additional small\nlesions have slightly increased.  There is a new 7 mm hypodense lesion in\nsegment ___ (05:57), a new 8 mm lesion in segment 3 (5:63) and a few\nadditional tiny, subtle suspected new lesions elsewhere. There is stable mild\ndilation of the extrahepatic duct at 11 mm, tapering in the pancreatic head\nand likely benign.  There is no intrahepatic ductal dilation. 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 is enlarged at 16 cm, previously 15.6 cm.  There is a\nstable nonspecific 1.4 cm hypodensity in the posterior 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 a\ncolorectal anastomosis.  The residual colon is unremarkable.\n\nThere has been progression of omental and peritoneal metastatic disease.  For\nexample, a left greater omental nodule measures 1.1 cm (5:75), previously 0.5\ncm.  A conglomerate of right greater omental nodules anterior to the ascending\ncolon has increased, with the largest contiguous mass measuring 3.5 cm (5:81),\npreviously 2.2 cm.  There is increased peritoneal nodularity in the right\nperihepatic region.\n\nThere is increased, small volume ascites in the upper quadrants and pelvis.\n\nPELVIS AND REPRODUCTIVE ORGANS: There has been progression of heterogeneously\nenhancing tissue extending between the anterior aspect of the colorectal\nanastomosis and the vagina.  This is approximately measured at 4.8 x 2.5 cm\n(5:120), previously 3.5 x 2.0 cm.  There is also direct abutment of this mass\non the right posterior aspect of the bladder, and invasion would not be\nexcluded.\n\nLYMPH NODES: Multiple retroperitoneal lymph nodes have increased in size.  For\nexample, a precaval node measures 1.7 cm in short axis (5:64), previously 0.9\ncm.  A right common iliac node measures 1.2 cm (5:93), previously 0.6 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: A soft tissue density nodule adjacent to a previous right lower\nquadrant ostomy site is stable at 1.5 x 0.9 cm.  There has been progression of\nsoft tissue nodules in the left ischioanal fossa, with 1 lesion measuring 1.6\ncm (5:123), previously 1.3 cm.  There are also multiple new nodules in the\nbilateral ischioanal fossae.",
            "output": "1. Progressive hepatic, omental/peritoneal and pelvic metastases as detailed\nabove  as well as retroperitoneal and right iliac lymph nodes.  Increased\nascites.\n2. Please refer to the separate report for the CT chest."
        },
        {
            "input": "Please see the dedicated CT chest report from the current date for the\nthoracic findings.\n\nLIVER: Again seen is a 2.4 x 2.3 cm hypodensity in segment VIII, unchanged in\nsize from the prior exam, though incompletely characterized on this study.\nFurther workup with ultrasound or MR is recommended. The liver otherwise\nenhances homogeneously without focal lesion or intrahepatic biliary duct\ndilation. The portal vein is patent.The gallbladder is surgically absent.\n\nSPLEEN: The spleen is enlarged and measures 18.3 cm, although it previously\nmeasured up to 22 cm.  There is a small, indeterminate splenic hypodensity\n(5:65), which was also present on the prior study.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized. A fat-containing ventral abdominal wall hernia is again seen.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild atherosclerotic calcifications.\n\nLYMPH NODES:  Overall, there has been interval decrease in the size of\nmultiple enlarged lymph nodes. The previously seen enlarged lymph node\nadjacent to the right hepatic artery is smaller, measuring 0.9 x 1.1 cm\ncompared to 3.1 x 2.3 cm on the prior study (5:61) a portacaval node measuring\n3.1 x 1.8 cm on the prior study now measures 1.7 x 1.5 cm (5:67). A previously\nreported 1.1 cm left pelvic sidewall lymph node now measures 3 mm (5:109). The\nlarge right external iliac lymph node measuring 2.0 x 1.7 cm on the prior\nstudy now measures 6 x 7 mm (5:115).\n\nCT PELVIS: The urinary bladder contains multiple saccules and is trabeculated,\ndue to an enlarged prostate. There is no pelvic free fluid.Multiple pelvic\nphleboliths are noted.  Again seen are small bilateral fat-containing inguinal\nhernias.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy\npresent.Increased sclerosis at the posterior ninth left rib is again seen and\nunchanged compared to the prior study.",
            "output": "1.  Overall interval decrease in the size of multiple enlarged lymph nodes, as\ndescribed above. Decreased degree of splenomegaly (22 cm vs 18.3 cm).\n\n2. Indeterminate 2.4 cm hypodensity in hepatic segment VIII. Further workup\nwith MRI or ultrasound is recommended.\n\n3.  Please see the dedicated CT chest report from the current date for the\nthoracic findings."
        },
        {
            "input": "LOWER CHEST: Mild atelectasis in the lung bases. 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. \nSubcentimeter hypodense lesions seen in the liver are too small to further\ncharacterize.  The gallbladder is surgically absent. There is mild central\nbiliary prominence, which is expected post cholecystectomy. Otherwise, there\nis no evidence of extrahepatic biliary dilatation.\n\nPANCREAS: The pancreas is mildly atrophic but 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. \nMultiple subcentimeter hypodense lesions, which are too small to characterize\nbut likely represent renal cysts, are seen in the renal cortices bilaterally. \nThere is no hydronephrosis.  There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Diverticulum is seen in the\nsecond portion of the duodenum. Small bowel loops demonstrate normal caliber\nand wall thickness throughout.  Extensive diverticulosis of the sigmoid colon\nwithout evidence of wall thickening or fat stranding. Adjacent to the sigmoid\ncolon in the left lower quadrant, there is an ovoid fat density structure with\na hyperdense rim and center with surrounding mesenteric fat stranding,\ncompatible with epiploic appendagitis (series 2, image 59). The appendix\nappears surgically absent.\n\nPELVIS: Redemonstration of two right posterior bladder diverticula..Distal\nureters are unremarkable.  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 ectasia of the infrarenal abdominal aorta, measuring up to\n2.8 cm (series 2, image 30). No abdominal aortic aneurysm.  Moderate\natherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Small to moderate-sized umbilical hernia containing fat is\nnoted.  Surgical clips seen from prior right inguinal hernia repair again\nnoted.",
            "output": "1. Epiploic appendagitis in the left lower quadrant.\n2. Colonic diverticulosis without diverticulitis.\n3. No urolithiasis or hydronephrosis.\n4. Infrarenal abdominal aortic ectasia measuring up to 2.8 cm.  No abdominal\naortic aneurysm.\n5. Small to moderate size fat containing umbilical hernia."
        },
        {
            "input": "The imaged lung bases are clear.\n\nAbdomen: The kidneys are unremarkable.  No focal lesions are identified,\nwithin the limitations of the unenhanced scan.  There is no ureteral\ndilatation.  No urinary tract calculi are identified.\n\nThe unenhanced appearance of the liver, spleen, gallbladder, pancreas, and\nadrenal glands is normal. The abdominal aorta appears normal in course and\ncaliber.  The stomach and duodenum appear normal. Scattered nonenlarged\nmesenteric and retroperitoneal lymph nodes are seen.  Minimal mesenteric\nstranding is seen in the left upper quadrant, which may reflect mild\nmesenteric panniculitis.\n\nPelvis: Loops of small and large bowel show no signs of ileus or obstruction.\nThe appendix is not visualized, however, there are no secondary signs of\nappendicitis.  .  No free fluid.\n\nBones: Multilevel degenerative changes are seen throughout the visualized\nthoracolumbar spine.  There is mild anterior wedging of the T11 vertebral\nbody, which appears chronic in nature.",
            "output": "1.  No urinary tract calculi.\n2.  Nonspecific mild mesenteric stranding may represent mesenteric\npanniculitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are unremarkable.  There is a small\nnonhemorrhagic pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nInnumerable hypoattenuating lesions, the largest measuring up to 3.8 cm in\nsegment 8 and likely representing a cyst with internal septation. \nSubcentimeter hypodensities are too small to characterize by CT but likely\nrepresent cysts or biliary hamartomas.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  A\nsubcentimeter hypodensity in the left kidney (series 2:36), too small to\ncharacterize by CT but likely representing a cyst.  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 or fat\nstranding.\n\nPELVIS: Apparent bladder wall thickening could be due to under distension or\nreflect cystitis.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly.  There is a 2.2 x 1.7 cm area of central\nhypoenhancement with peripheral rim enhancement in the right paramedian\nprostate gland, consistent with prostatic abscess.\n\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. \nL4-5 posterior approach hardware appears unremarkable.\n\nSOFT TISSUES: A 8 mm low attenuating abdominal wall lesion (series 2:56), is\nnonspecific, possibly related to prior medication injection.  The abdominal\nand pelvic wall is within normal limits.",
            "output": "1. Prostate: Enlarged prostate with a 2.2 x 1.7 cm prostatic abscess.\n2. Bladder: Bladder wall thickening may be due to under distension, chronic\nbladder outlet obstruction, or reflect cystitis.\n3. Pericardium: Small pericardial effusion measuring up to 1.0 cm in\nthickness.\n\nNOTIFICATION:  The updated findings of prostatic abscess were discussed with\n___, M.D. by ___, M.D. on the telephone on\n___ at 9:35 am, 5 minutes after discovery of the updated findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Calcification is seen in the\naortic annulus.\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 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\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\nmultiple simple renal cysts measuring up to 7.2 cm on the right and 4.3 cm on\nthe left.  Additional cortical hypodensities are too small to characterize by\nCT are not significantly changed and likely represent simple cysts.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe transverse, descending and sigmoid colon is noted.  There is mild\nthickening noted with possible mild adjacent mesenteric stranding along a\nshort segment of the sigmoid colon (series 2, image 68).  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: Redemonstration of a fibroid uterus.  No adnexal\nabnormality 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.  There is a short-segment\ninfrarenal abdominal aortic dissection (series 601, image 24) which is not\nsignificantly changed the prior study, spanning approximately 2.7 cm. \nModerate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStatus post right partial hip prosthesis which appears overall intact without\nevidence of perihardware complication.  Compression deformities of the T9 and\nT11 vertebral bodies are slightly advanced compared to ___ (series 602, image\n40).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Prominence of a short segment of the sigmoid colon with mild thickening and\nmild mesenteric stranding is concerning for acute diverticulitis.  No free\nfluid.  No free air.\n2. Interval progression of anterior compression deformities of the T9 and T11\nvertebral bodies compared to ___.  Findings are indeterminate in chronicity,\nhowever likely subacute to chronic.\n3. No significant interval change in a chronic infrarenal abdominal aortic\ndissection a short segment of the infrarenal abdominal aorta, spanning\napproximately 2.7 cm.\n4. Cholelithiasis without cholecystitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___. \n___, M.D. on the telephone on ___ at 1:00 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal. The kidneys enhance normally and excrete\ncontrast briskly. There are no solid renal lesions or hydronephrosis. The\nstomach and duodenum are normal. The small bowel and large bowel are normal in\ncaliber, without wall thickening or mass.  The appendix is not well seen but\nthere are no secondary signs of appendicitis.  There is no significant\ndiverticulosis.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.  The splenic\nvein is chronically attenuated/occluded and there is a prominent mesenteric\ncollateral from the splenic hilum emptying into the superior mesenteric\n(602b:40).\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The prostate and seminal vesicles are\nunremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection.",
            "output": "1. No acute process in the abdomen or pelvis.  No evidence of appendicitis,\ndiverticulitis. No imaging evidence of acute pancreatitis, however this is a\nclinical diagnosis.\n2. Chronic attenuated/occlusion of the splenic vein, bypassed via a prominent\nmesenteric collateral, possibly from prior episode of acute pancreatitis\n(___)."
        },
        {
            "input": "LOWER CHEST: There is mild dependent bibasilar atelectasis, without pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: As before, extensive hepatic a heterogeneously enhancing\nhypodense lesions compatible with known metastases, are identified.  The large\ndominant lesions in the left hepatic lobe measure approximately 7.1 x 5.4 cm\nand 7.1 x 5.8 cm, similarly to the prior study, allowing for differences in\nmeasuring technique and slice selection (2:12, 17).  In the right hepatic\nlobe, a dominant 5.3 x 4.4 cm lesion is unchanged (2:19).  These lesions\nexhibits central hypodensity, compatible with areas of necrosis.  Dilation of\nthe common hepatic duct to approximately 1.0 cm is unchanged.  The gallbladder\nis within normal limits.\n\nPANCREAS: The body and tail the pancreas are atrophic.  The uncinate process\nis unremarkable.  There is no peripancreatic stranding or 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: Note is again made of 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: There is re-demonstration of the known ill-defined left\npresacral mass measuring approximately 3.6 x 2.5 cm on the current study,\nlikely unchanged since the prior CT, given differences in the scan plane. \nThere is involvement of the left sacral neural foramina, as described\npreviously (2:59).  Postsurgical changes are again noted in the anterior\nabdominal wall, with multiple injection site granulomas/hematomas.",
            "output": "1.  No significant change since the CT torso from ___.  Grossly\nstable or minimally larger hepatic metastases and left presacral soft tissue\nmass, with involvement of the left sacral neural foramina.\n\n2.  No new findings detected.  The gallbladder is unremarkable."
        },
        {
            "input": "LOWER CHEST: Mild bilateral dependent atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates decreased attenuation throughout with\nfoci of fatty sparing, consistent with 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. \nMultiple punctate, too small to characterize, hypodensities are likely simple\nrenal cysts.  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. Colonic\ndiverticulosis is noted 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 visualized reproductive organs are unremarkable. \nVasectomy clips are noted.\n\nLYMPH NODES: Multiple conspicuous, non-pathologically enlarged mesenteric\nlymph nodes with surrounding mesenteric fat stranding, most prominent in the\nmidline and left abdomen (2:58, 50), concerning for mesenteric panniculitis. \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. \nBilateral L5 pars interarticularis defects noted with grade 1 L5 on S1\nanterolisthesis.\n\nSOFT TISSUES: Small fat containing umbilical hernia.",
            "output": "1. Fat stranding with multiple conspicuous nonenlarged mesenteric lymph nodes\ncan be due to mesenteric panniculitis.\n2. No evidence of renal calculus or other findings to explain patient's\nsymptoms.  The abdominal aorta is unremarkable.\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 suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal (series 601, image 20).\n\nPELVIS:  Trace intermediate density fluid is demonstrated in the pelvis,\npossibly related to a ruptured corpus luteum.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits.  Peripheral\nhyperenhancing corpus luteal cyst is seen in the right adnexa measuring up to\n1.4 x 1.3 cm (series 2 image 62).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Right corpus luteal cyst with trace intermediate density fluid suggestive\nof rupture.  Correlate with any recent acute right lower quadrant pain.\n2. Otherwise, no imaging findings to correlate with provided history of\nabdominal distension.  Specifically no evidence of a hernia."
        },
        {
            "input": "The visualized lung bases are clear.  There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\ngallbladder, spleen, and adrenal glands are normal. There is fatty atrophy of\nthe pancreas. The kidneys are mildly atrophic a subcentimeter hypodensity in\nthe midpole of the right kidney is too small to characterize (series 2, image\n33).\n\nThe distal esophagus is normal without a hiatal hernia. Oral contrast extends\nto the distal small bowel. The small bowel is normal in caliber without wall\nthickening. The large bowel is also normal in caliber without wall thickening.\nThere is diverticulosis of the sigmoid colon without evidence of\ndiverticulitis. The appendix is not visualized but there are no secondary\nsigns of appendicitis within the right lower quadrant. There is no abdominal\nfree fluid or free air. There is a fat containing umbilical hernia.\n\nThere is atherosclerotic disease of the abdominal aorta without abdominal\naortic aneurysm. There are no enlarged retroperitoneal or mesenteric lymph\nnodes by CT size criteria.\n\nPELVIS:\n\nThe bladder is well distended and normal in appearance. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.  The prostate is mildly enlarged with internal\ncalcifications.\n\nOSSEOUS STRUCTURES: Mild multilevel degenerative changes of the lumbar spine\nare present. No focal lytic or sclerotic lesion concerning for malignancy.  No\nfracture is identified.",
            "output": "1. No acute intra-abdominal process.\n2. Diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Minimal basilar dependent atelectasis is seen.  There is no\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: There is a delayed nephrogram on the right.  There is mild right\nhydroureteronephrosis to the level of a 3 mm distal right ureteral stone. \nThere is mild right periureteral stranding.  There may be a very punctate\ncalculus in the upper pole the right kidney.  7 mm hypodensity in the anterior\nleft kidney is too small to further characterize.  No left hydronephrosis is\nseen.  The urinary bladder is relatively collapsed, but grossly unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No bowel obstruction or bowel\nwall thickening is seen.  The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 3 mm distal right ureteral stone with upstream mild right\nhydroureteronephrosis and delayed right-sided nephrogram and delayed excretion\nof contrast into the right renal collecting system.  Mild right periureteral\nstranding.\n2. Normal appendix."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nsubcentimeter hypodense lesion in segment V is too small to characterize\n(2:57).  Otherwise there is no suspicious focal lesion.  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. \nSubcentimeter hypodense lesions in the bilateral kidneys are too small to\ncharacterize.  Otherwise, there is no evidence of solid renal lesions.   There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe urinary bladder is unremarkable.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement.  Sigmoid diverticula are present with extensive wall\nthickening and pericolonic stranding and edema involving an approximately 12\ncm segment of the sigmoid colon.  There is a small gas and fluid collection\nmeasuring approximately 2.7 x 1.5 cm (2:131), directly abutting the adjacent\ninflamed sigmoid colon, concerning for abscess.  The appendix is normal.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\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 no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lower thoracic and lumbar\nspine.  There is levocurvature of the lumbar ___ at the L1-L2 disc\nspace.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "Acute complicated sigmoid diverticulitis with a small abscess measuring 2.7\ncm.  Colonoscopy or cross-sectional imaging following treatment and resolution\nof the acute process is recommended to ensure absence of a mass 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 demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left 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.  No small bowel obstruction is\nappreciated.  Status post total colectomy and proctectomy with ileoanal pouch\ncreation.  Anastomotic sutures are appreciated.\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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is scarring in the right lower quadrant at the site of\nprior ostomy.",
            "output": "No evidence of metastatic disease appreciated."
        },
        {
            "input": "LOWER 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. Status post\ncolectomy and proctectomy with an ileoanal pouch.\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 place.  No adnexal mass.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.  There is a small splenorenal shunt.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is scarring in the right lower quadrant at the site of\nprior ostomy.  Multiple injection sites are noted.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to separate chest CT done the same day 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. There\nis a new 5.5 x 6.7 x 6.7, irregular, heterogeneously enhancing mass within the\nright lobe of the liver (5:44, 8:26).  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter. The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No bowel obstruction.  The\npatient is status post colectomy and proctectomy with creation of ileoanal\npouch.\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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  A linear filling defect within the superior mesenteric vein\nis favored to represent mixing artifact.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Scarring at the site of the prior right lower quadrant ostomy\nagain noted.  The abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. 6.7 cm new enhancing mass within the right lobe of the liver is highly\nconcerning for metastatic disease.\n2. No other sites of metastatic disease or lymphadenopathy within the abdomen\nor pelvis.\n3.  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.  An epicardial node measuring up\nto 5 mm in short axis is noted, increased in prominence since prior\nexaminations.\n\nABDOMEN:\n\nHEPATOBILIARY: The previously described lobulated, heterogeneously enhancing\nmass in segments ___ shows mild increase in size, now measuring 7.3 x 5.8 x\n8.0 cm in largest ___, where it previously measured 6.9 x 4.5 x 7.1 cm.\nThere is mild vascular shunting surrounding the mass.\n\nA subcentimeter low-density lesion measuring 0.8 cm (5:34), best seen on\ncoronal views (8:26) is new since previous examinations, and shows surrounding\nshunting similar to the larger mass.  No new lesion is identified in the left\nhepatic lobe.  Portal and hepatic veins remain patent.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: A gastrojejunal anastomosis is seen in the right upper\nquadrant.  The proximal stomach is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. Postsurgical\nchanges of proctocolectomy and ileoanal anastomosis are again noted, stable. \nChanges seen as sequelae from prior ileostomy.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Few focal rounded areas of fat stranding in the anterior\nabdominal wall (5:94) markedly decreased since ___, likely relate to\ninjection granulomas.  A ring shaped area stranding in the right gluteal\nsubcutaneous tissues (5:89) is also decreased in size, and likely relates to\nfocal necrosis from a prior injection.",
            "output": "1. Interval mild increase in size of the right hepatic lobe mass, measuring\n8.0 cm in maximum dimension, where it previously measured 7.1 cm.\n2. Additional new subcentimeter lesion in the medial hepatic dome demonstrates\nsimilar characteristics, and may a"
        },
        {
            "input": "VASCULAR:\n\nArterial evaluation:\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nVariant anatomy:  None.  Note is made of a short proper hepatic artery, ~ 1\ncm, with early branching to the left and right hepatic arteries.\n\nVenous evaluation:\nMPV involvement:  Absent.  Note is made of trifurcation of the left portal\nvein, right anterior portal vein, right posterior portal vein.\nSMV involvement: absent\nExtension to first draining vein:  absent\nThrombus within vein: absent\nVenous collaterals: absent\n\nThere is no abdominal aortic aneurysm.  There is no atherosclerotic plaque\nseen in the abdominal aorta.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Please see separate report on CT chest\nperformed on the same date for discussion of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There has been interval placement of a CBD\nstent with marked interval improvement in the intra and extrahepatic biliary\nductal dilatation.  There is pneumobilia secondary to the patent CBD stent. \nAir is seen within an otherwise unremarkable gallbladder, presumably related\nto recent ERCP.  The portal vein is patent.\n\nPANCREAS: The pancreas has normal attenuation throughout without\nperipancreatic stranding or intrapancreatic mass.  There is mild dilatation of\nthe main pancreatic duct leading up to the ampulla measuring up to 6 mm.  At\nthe ampulla, there is a 2.0 cm bulge which presumably represents the ampullary\nmass described in the recent ERCP (8:51).  There is no local invasion of this\nmass 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 hydronephrosis.  Scattered hypodense lesions are noted\nin the right kidney, too small to fully characterize but likely represent\nsimple 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.  The\nappendix is visualized and normal.  There is no evidence of mesenteric\nlymphadenopathy.  Scattered non pathologically enlarged and possibly reactive\nlymph nodes are identified in the retroperitoneum and periportal region\n(10:88, 90).\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 and seminal vesicles are grossly within normal\nlimits.\n\nBONES: There 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 cm rounded bulge at the ampulla presumably represents the ampullary mass\nseen on ERCP with mild upstream dilatation of the main pancreatic duct\nmeasuring up to 6 mm.  There has been interval marked improvement in the intra\nand extrahepatic biliary ductal dilatation secondary to CBD stent placement.\n2. This mass does not appear to involve adjacent organs or vasculature.  Note\nis made of scattered non pathologically enlarged, possibly reactive lymph\nnodes in the retroperitoneum and periportal region."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 1.1 cm interpolar cyst in 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.  The colon and\nrectum are within normal limits.  The appendix is not directly visualize, but\nthere are no secondary inflammatory findings of acute appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: There is a right adnexal cystic structure measuring\napproximately 2.1 cm (02:59).  Trace, if any, free pelvic fluid.  Endometrial\ncavity contains fluid, to be correlated with the phase of menstruation.\n\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 not directly visualized, but there are no secondary\ninflammatory findings of acute appendicitis.\n\n2.  2.1 cm right adnexal cystic structure.  If clinically indicated, consider\npelvic ultrasound for further evaluation.\n\nNOTIFICATION:  The above findings were communicated in person by Dr. ___\nto Dr. ___ at 00:58 on ___, 2 min 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:\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 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.\n\nADRENALS: The right adrenal gland is normal.  There is thickening of the left\nadrenal gland but no discrete nodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions.  There is mild bilateral\nhydronephrosis and hydroureter, without evidence of cause for obstruction. \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 or fat\nstranding.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post prostatectomy, with multiple\nsurgical clips in the prostatectomy bed and along the pelvic sidewalls.  A\npenile prosthesis is noted.\n\nLYMPH NODES: Retroperitoneal lymph nodes measure up to 0.7 cm (series 2, image\n60), unchanged and not enlarged by CT size criteria.  There is no mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is moderate atherosclerotic disease.  There is ectasia of the\ninfrarenal abdominal aorta, measuring up to 2.9 x 2.7 cm in axial dimension,\nunchanged and previously 2.8 x 2.6 cm on the study from ___.  There\nis aneurysmal dilatation of the bilateral common iliac arteries, measuring up\nto 2.4 cm on the right, previously 2.2 cm, and 2.3 cm on the left, previously\n2.4 cm.  Fusiform dilatation of the celiac artery up to 1.3 cm is also\nunchanged.\n\nBONES: Diffuse osseous metastases throughout the visualized osseous structures\noverall unchanged in distrubution and extent compared to the study from\n___.  Chronic severe compression deformity of L5.  No acute\nfractures identified.  A total right hip prosthesis is partially imaged.\n\nSOFT TISSUES: Redemonstration of an intramuscular lipoma within the right\nlateral abdominal musculature measuring 2.1 x 5.5 cm.",
            "output": "1. Diffuse osseous metastases appear slightly more sclerotic but are overall\nunchanged in distribution and extent compared to the prior study from ___.\n2. Mild bilateral hydronephrosis and hydroureter, without evidence of cause\nfor obstruction.\n3. Sigmoid diverticulosis without evidence of acute diverticulitis.\n4. Cholelithiasis without evidence of acute cholecystitis.\n5. Unchanged ectasia of the infrarenal abdominal aorta, aneurysmal dilatation\nof the bilateral common iliac arteries, and fusiform dilatation of the\nproximal celiac artery.\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST:\nThere is minimal bibasilar dependent atelectasis.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There is homogeneous enhancement of the hepatic parenchyma with\nfocal wedge-shaped hypodensity at the falciform ligament.  No focal liver\nlesions.  The hepatic veins, portal vein and its branches are widely patent.\nThe gallbladder is distended with a single calculus in the region of the neck\nand no pericholecystic inflammation.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  Unchanged uniform thickening of the medial limb of the left adrenal\ngland.  No discrete nodules on either side.\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is no bowel obstruction.  Small hiatus hernia.  Large\nstool burden throughout the colon.  Extensive sigmoid diverticulosis.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: There is moderate calcified atherosclerotic plaque within a highly\ntortuous abdominal aorta.  No aneurysmal dilation.  Both common iliac arteries\nare ectatic and aneurysmal measuring up to 1.9 cm on the left and 2 cm in\ndiameter on the right respectively.\n\nPELVIS:\nThe bladder is minimally distended and appears normal.  Post prostatectomy\nstatus with numerous surgical clips noted in the pelvis and along the pelvic\nsidewalls.  Partly visualized are penile prosthesis in place..\n\nBONES AND SOFT TISSUES:\nAgain visualized are innumerable sclerotic lesions throughout the visualized\nbones in keeping with the known metastatic disease from prostate cancer. \nOverall, the disease burden is unchanged compared to ___.  No\npathologic fractures identified.  Severe degenerative changes of the right hip\njoint noted.",
            "output": "1. No interval change in extent or size of osseous metastases.  No pathologic\nfracture.\n2. Stable thickening of the left adrenal gland.  No abdominal or pelvic\nlymphadenopathy.  Cholelithiasis and sigmoid diverticulosis as before.\n3. Unchanged bilateral common iliac artery aneurysms and ectatic 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:\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 a 14 mm calcified\ngallstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  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.  The left adrenal gland is\nhyperplastic but stable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 post prostatectomy.  There is a penile prosthesis\npresent.\n\nLYMPH NODES: Previously noted the 11 mm retroperitoneal lymph node now\nmeasures 8 mm.  There is no evidence of retroperitoneal lymphadenopathy. \nThere is no mesenteric lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Post ostial dilation of celiac artery due to the prominent effect\nof the median arcuate ligament.\n\nBONES: Multiple sclerotic lesions involving the axial skeleton.  There is\nenlargement of many sclerotic lesions, now some demonstrate ill-defined margin\nand haziness, concerning for increased osseous metastatic burden.  There is a\nright hip prosthesis\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Enlargement of the sclerotic lesions concerning for increased osseous\nmetastatic burden.\n2. Interval slight improvement of retroperitoneal 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: 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 a gallstone 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.\n\nADRENALS: The right adrenal gland is normal in size and shape.  There is left\nadrenal nodular thickening, 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: There is small hiatal hernia. The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. There is a moderate amount of stool throughout the colon with\nextensive sigmoid diverticulosis.\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.\n\nLYMPH NODES: Status post lymph node dissection with no lymphadenopathy noted\n\nVASCULAR: Bilateral common iliac artery aneurysms measuring up to 2.2 cm on\nthe right and 2.4 cm on the left unchanged from prior exam.  Also fusiform\ndilatation of celiac artery measuring up to 1.1 cm, is unchanged from prior\nexam.  Moderate calcified atherosclerotic plaque is noted throughout the\nabdominal aorta and its branches.\n\nBONES: Diffuse sclerotic osseous metastases involving the spine in the\nvisualized pelvic bones have increased in extent from prior exam.  There is a\nnew compression fracture deformity of superior endplate of L5.\n\nSOFT TISSUES: There is an intramuscular lipoma within the right lateral\nabdominal musculature measuring 1.5 x 6.4 cm.",
            "output": "1. Interval progression of diffuse sclerotic osseous metastases involving the\nspine and the pelvic bones with a new (at least since ___\ncompression fracture deformity of superior endplate of L5.  No retropulsion of\nfracture fragments into the adjacent spinal canal noted.\n2. Stable bilateral common iliac artery aneurysms and fusiform dilatation of\nproximal celiac artery.\n3. Cholelithiasis.\n4. 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 Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 9:58 am, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: A 3 mm left lower lobe nodule is unchanged (series 2, image 9). \nA possible 3 mm right upper lobe nodule is incompletely imaged (series 2,\nimage 1).  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 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.  Several\nsubcentimeter hypodensities within the interpolar region of the left kidney\nare unchanged from prior, too small to characterize by CT but likely represent\nbenign entities.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable.  There is mild bowel wall edema along several loops of small\nbowel in the left mid abdomen/left lower quadrant with prominence of the Vasa\nrecta (series 2, image 42; series 601, image 21).  There is increased wall\nthickening along the sigmoid colon and rectum compared to the prior study\n(series 2, image 68).  New wall edema is demonstrated along the cecum and\nproximal ascending colon (series 2, image 73).  Minimal adjacent mesenteric\nstranding is demonstrated.  Appendix is not visualized.  There are associated\nprominent mesenteric lymph nodes without lymphadenopathy by CT size criteria,\nlikely reactive.\n\nPELVIS: Patient is status post hysterectomy.  Surgical clips are seen at the\nresection bed as long as along the periaortic station.  There is a small\namount of new low-density free fluid.  The bladder and distal ureters are\nwithin normal limits.\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: No change in appearance of grade 1 anterolisthesis of L5 or S1 (series\n602, image 36), almost certainly degenerative in nature.  There is severe\nT12/L1 disc narrowing with sclerotic changes at the endplates as on prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Worsening of bowel wall edema of in the pelvis with small free fluid pelvic\nfluid is concerning for acute on chronic enteritis, possibly post radiation\ngiven the distribution.  Other etiologies including infection, inflammatory or\nischemia are not excluded however.  No vascular abnormalities are\ndemonstrated. Findings should be correlated with patient's immune status, as a\ncomponent of typhlitis cannot be completely excluded.\n2. Subcentimeter lung nodules including a 0.3 cm left lower lung nodule which\nis unchanged from prior study. Findings are amenable to follow-up on routine\nsurveillance."
        },
        {
            "input": "LOWER CHEST: There is partial visualization of the 3 mm left lower lobe\nnodule, unchanged from prior study (2:2).  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 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 redemonstration of bilateral subcentimeter hypodense renal lesions,\nunchanged from prior study and too small to characterize, likely representing\ncysts.  There is no evidence of hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is otherwise\nunremarkable.  There is interval resolution of the previously seen small bowel\nwall edema.  The small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is redemonstration of wall thickening along\nthe sigmoid colon and rectum, unchanged from prior study and compatible with\nchronic inflammatory changes (02:54).  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 patient is status post hysterectomy with surgical\nclips seen at the resection site and along the para-aortic station.  There are\nno suspicious soft tissue densities in the hysterectomy bed.  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. \nThere is redemonstration of endplate sclerotic changes and disc space\nnarrowing at T12-L1, unchanged from prior study (602:37).  There is grade 2\nanterolisthesis at L5-S1, unchanged from prior study.\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: 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 surgical clips are seen adjacent to the liver in keeping with\nprevious liver transplant.  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 is no suspicious\nrenal 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.\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 innumerable lucent lesions in the pelvis and upper femur\nbilaterally.  Majority of the lesions are small measuring under 5 mm but a few\nprominent lesions measuring up to 13 mm are seen in both iliac bones adjacent\nto the sacroiliac joint.\n\nSOFT TISSUES: Surgical clips are seen in the anterior abdominal wall most\nlikely relating to previous liver transplant.  The abdominal and pelvic wall\nis within normal limits.",
            "output": "1. No soft tissue mass or lymphadenopathy in the abdomen or pelvis on this\nnon-contrast study.\n2. Innumerable lucent lesions measuring up to 1.3 cm in the pelvis and upper\nfemur bilaterally that are indeterminate but raise the possibility of myeloma\nor metastases.  In the absence of prior CT imaging for comparison, further\nevaluation with MRI scan of the pelvis is recommended.\n\nRECOMMENDATION(S):  In the absence of prior CT imaging of the pelvis, further\nevaluation of bone findings with an MRI scan of the pelvis is recommended.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 10:44 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There is a 1.0 cm round STIR hyperintense T1 iso to hypointense lesion in the\nleft iliac bone adjacent to the sacroiliac joint which remains hyperintense on\nout of phase images however is likely too small to accurately characterize on\nin and out of phase, corresponding to the lesion seen on recent CT abdomen\npelvis from ___.  A 1.1 cm T2 hyperintense and T1 isointense lesion\nin the right iliac bone adjacent to the right SI joint corresponding to a\nlesion seen on recent CT demonstrates signal dropout on out of phase images. \nAnother 0.8 cm STIR hyperintense and T1 hypointense lesion in the proximal\nright femur also demonstrates signal dropout on out of phase images.  There\nare other scattered hyperintense foci on out of phase images in the pelvis\nwithout definite STIR and T1 correlate.\n\nNo fracture.  There are mild degenerative changes of the bilateral hips and SI\njoint.  Degenerative changes of the lower lumbar spine are most severe at\nL5-S1 with moderate to severe loss of disc heights.  No evidence of avascular\nnecrosis of the bilateral femoral head.  There are trace hip joint effusions\nbilaterally.\n\nThere is edema of the bilateral gluteus minimus muscles which could represent\nstrain.  There is also mild edema of the bilateral adductor, obturator\nexternus, and proximal quadriceps musculature.  The right hamstring tendons\nare intact.  There is increased signal intensity in the left conjoint tendon\nof the hamstring tendons which could represent tendinosis or minimal low-grade\ntear.  No greater trochanteric bursitis.  Limited evaluation of the\nintrapelvic organs is unremarkable.",
            "output": "1.  1.0 cm lesion in the left iliac bone adjacent to the left SI joint\ncorresponds to a lytic lesion seen on recent CT from ___, likely\ntoo small to accurately characterize on in and out of phase.  Additional T2\nhyperintense and T1 hypointense foci corresponding to the lytic lesion seen on\nrecent CT demonstrates signal dropout on out of phase images.  Scattered foci\nof hyperintense lesions on out of phase images do not have definite T1 or STIR\ncorrelates.  Although some of these lesions that demonstrates signal dropout\non out of phase images could represent island of red marrow, multiple myeloma\nmay have a similar appearance on MRI.  Laboratory correlation and PET-CT can\nprovide more definitive evaluation.\n2.  No acute osseous abnormalities.\n3.  Grade 2 strain of the gluteus minimus muscles bilaterally.\n4.  Mildly increased signal intensity in the conjoint tendon of the left\nhamstring tendon, likely representing tendinosis or minimal partial-thickness\ntear."
        },
        {
            "input": "Within the left paracolic gutter and centered in the retroperitoneal fluid\ncollection there is a 2.1 x 1.2 cm venous aneurysm. There is no evidence of\nactive extravasation on delayed phase imaging.  The feeding vessel likely\noriginates from a splenic varix (3b:235-248).\n\nThe size of the abscess is unchanged and measures 3.9 x 3.7 cm. The abscess\nagain is noted to track inferiorly into the pelvis and expands the iliacus\nmuscle.  The presence of air again reflects the known fistulous connection.\nThe pigtail drainage catheter has been retracted and now partially terminates\nin the soft tissues of the left flank, largely removed from the bulk of the\nfluid collection.\n\nThe small bilateral pleural effusions with overlying atelectasis are\nunchanged. The included heart is normal size and there is no pericardial\neffusion.\n\nThe liver enhances homogeneously without focal liver lesions. Nodularity of\nthe hepatic contour and enlargement of the caudate is compatible with\nsuspected cirrhosis. Extensive pneumobilia is unchanged. The spleen is\nenlarged. The adrenal glands are unremarkable. There is persistent dilation of\nthe main pancreatic duct up to 1.2 cm, with atrophy of the pancreatic tail. A\npunctate calcification is noted within the main pancreatic duct (3B:240) from\nchronic pancreatitis.\n\nThe kidneys enhance symmetrically and excrete contrast without hydronephrosis.\nRetained intravenous contrast from the prior CT is seen in the right\ncollecting system on the unenhanced images.  The large and small bowel are\nnormal caliber.  Small bowel is edematous but non-obstructed.  There has been\nunchanged dilation of the stomach and proximal duodenum from the known\nunderlying stricture. There is a moderate amount of abdominal ascites,\nincreasing in volume since ___.  There is no free air.\n\nThere is persistent occlusion of the main portal vein and splenic vein.\nExtensive splenic and gastric varices are noted. The aorta is normal caliber.\nThe celiac, superior mesenteric and inferior mesenteric arteries are patent. \nThere is a replaced right hepatic artery arising from the SMA.  Persistent\ntethered appearance of the mesentery is likely from secondary sclerosing\nmesenteritis from recurrent pancreatitis.\n\nThe bladder, uterus and rectum are unremarkable.\n\nThere is extensive anasarca. There are no worrisome lytic or blastic osseous\nlesions.",
            "output": "1. 2.1 cm venous pseudoaneurysm centered within the retroperitoneal abscess.\nNo evidence of active extravasation. This is thought to originate from a\nsplenic varix.\n2. The left pigtail drainage catheter has been pulled back and is now a remote\nfrom the bulk of the abscess.  Overall size of the abscess is unchanged from 2\ndays prior.\n3. Portal hypertension with splenomegaly, varices and increasing moderate\nvolume ascites.\n4. Extensive anasarca.\n5. Secondary sclerosing mesenteritis from recurrent pancreatitis. No bowel\nobstruction.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 1:21 ___, 15 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST:  In comparison to CT abdomen pelvis without contrast ___ there is near resolution of prior bilateral pleural effusions.\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nPatient is status post choledochoduodenostomy with expected pneumobilia.\nStable intrahepatic biliary dilatation is re- demonstrated.\nThe gallbladder is not visualized.\n\nSPLEEN:  The spleen is enlarged measuring 14.6 cm. The spleen otherwise\nappears normal.\n\nPANCREAS: The pancreas is atrophic secondary to chronic pancreatitis. Re-\ndemonstrated severe pancreatic duct dilation, which appears unchanged.\n\nADRENALS:  The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly. Mild\nright-sided hydronephrosis is unchanged.\n\nGASTROINTESTINAL:  There is mild distention of the stomach and duodenum.\nOtherwise the all small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits.  Appendix not\nclearly identified.\n\nMESENTERY AND RETROPERITONEUM: Re- demonstrated fluid collection in the\nretroperitoneum on the left is slightly smaller and has a larger component of\nair. The pigtail catheter which was previously seen within this fluid\ncollection is no longer visualized. The previously seen pseudoaneurysm is not\nopacified. There is mild interval decrease in ascites.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  Re- demonstrated chronic\nocclusion of the portal and splenic veins. Gastric varices are again seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is re- demonstrate free\nfluid in the pelvis.  Uterus and ovaries are unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "1. The left-sided retroperitoneal fluid collection is marginally smaller with\na larger component of air and interval removal of the previously seen pigtail\ncatheter.\n\n2.  No new focal abnormalities to explain the patient's symptoms. Findings as\non the previous examination include chronic occlusion of the splenic and\nportal veins, chronic pancreatitis, and intrahepatic biliary dilatation with\npneumobilia.\n\n3.  Interval decrease in size of bilateral pleural effusions and decreased\namount of intra-abdominal ascites since ___.\n\nNOTIFICATION:  The updated WET READ was communicated to Dr. ___ by Dr.\n___ at 1324 on ___."
        },
        {
            "input": "Suboptimal evaluation due to body habitus and motion at the lower chest.\n\nLOWER CHEST: Patchy peribronchovascular opacities and surrounding ground-glass\nopacification in the bilateral lower lobes could reflect changes of\natelectasis.  Detailed evaluation is limited by motion.  There is mild\ncardiomegaly with asymmetric enlargement of the left atrium.  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. \nFew subcentimeter hypodensities within the bilateral kidneys are too small to\ncharacterize but statistically cysts.  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.  Hyperdensities\nwithin the ascending colon likely represent ingested material.  The colon and\nrectum are otherwise within normal limits. The appendix is not visualized.\n\nPELVIS: There is mild thickening of the bladder wall.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Suboptimal evaluation due to body habitus and respiratory motion at the lung\nbases.  Within this limitation no acute findings within the abdomen or pelvis\nto explain the patient's reported symptoms.  Appendix is not visualized though\nno inflammatory changes identified in its expected location.\nEvaluation of lung bases is obscured by respiratory motion.  There is\nsuggestion of most likely atelectasis and regions of air trapping potentially\nfrom small airway disease."
        },
        {
            "input": "Quality of the study is limited by body habitus.  Specifically, the left\nabdominal subcutaneous soft tissue is not included in its entirety in the\nfield of view.  Allowing for this limitation:\n\nLOWER CHEST: Lung bases, visualized pleural spaces, and lower mediastinal\nstructures are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Gallbladder is collapsed.  No intrahepatic or\nextrahepatic bile duct dilatation.\n\nPANCREAS: Pancreas is normal in bulk and attenuation.  No focal parenchymal\nlesions identified.  No main pancreatic duct dilatation.\n\nSPLEEN: The spleen is not enlarged (8 cm).  No focal parenchymal lesions\nidentified.\n\nADRENALS: Adrenal glands normal.\n\nURINARY: Kidneys are normal in appearance.  There is a simple cyst at the\nlower pole of the left kidney, unchanged from prior.  No focal parenchymal\nlesions otherwise.  No hydronephrosis.\n\nGASTROINTESTINAL: No gross abnormality of the visualized large or small bowel.\nStomach similarly normal.  Surgical clip in the distal sigmoid.  No mural\nthickening.  No luminal distention.\n\nPELVIS: Urinary bladder unremarkable.\n\nREPRODUCTIVE ORGANS: No discrete abnormality of the pelvic organs.  No adnexal\npathology.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta normal in caliber.  No significant atherosclerosis.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Small well-circumscribed nodular focus of hyperattenuation in\nthe subcutaneous fat along the right lower abdominal wall, measuring\napproximately 2.2 cm in diameter.  No surrounding fat stranding.  Appearance\nis suggestive of an injection granuloma.  There is no evidence of abdominal\nhematoma.",
            "output": "1. Allowing for the technical limitations of the study, there is no evidence\nof abdominal wall hematoma.\n2. No acute abdominal or pelvic pathology."
        },
        {
            "input": "LOWER CHEST: There is bilateral linear atelectasis (2:7).  Otherwise the\nvisualized lung fields are within normal limits. There is no evidence of\npleural effusion.  There is slight pericardial effusion without evidence of\ntamponade.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a hepatic hypodensity too small to characterize which is consistent\nwith a cyst or hamartoma (02:30).  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 rectum are\nwithin normal limits.  There is focal area of wall thickening and fat\nstranding of the posterior aspect of descending colon with two sub-centimeter\nrim enhancing fluid collections along the bowel wall (601:31, 602:49).  The\nappendix is normal.  There is no evidence of 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 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Substantial focal colitis of the posterior descending colon which appears\nconsistent diverticulitis with no drainable abscess or free air.\n2.  Two subcentimeter microabscesses within the bowel wall of the descending\ncolon which are not amenable to drainage.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:58 ___, 2 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 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. \nNo hydronephrosis.  Partial duplication of the right ureteral system,\ndifficult to evaluate extent of distal ureter duplication due to not included\narea on 3 minute delay imaging.   There is a lobulated, 5.2 cm fluid density\ncyst within the superior left kidney.  An additional subcentimeter hypodensity\nwithin the right renal cortex too small to characterize by CT but\nstatistically likely represents a benign entity.  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 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\nfracture.Bone islands in the bilateral acetabuli and right femur.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of malignancy within the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\nThe patent endovascular abdominal aortic aneurysm stent is re-demonstrated in\nsitu.  The patent celiac axis, SMA, bilateral renal origin and bilateral\ncommon iliac artery stents are also noted in situ.  The excluded infrarenal\nabdominal aortic aneurysm sac measures 5.3 x 5.7 cm (04:55), overall stable\nsince ___ when it measured 5.1 x 6.0 cm.  There is a tiny right lumbar\ntype 2 endoleak (7:72).  The right common iliac artery aneurysm is also\nstable, it continues to measure 18 mm in maximum diameter (4:67), unchanged\nfrom ___.\n\nThe major branches of the celiac axis are patent.  There hepatic vasculature\nis conventional.  The Circumaortic left renal vein is re-demonstrated.\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 6.2 cm\nDiameter (Center-line): 5.3 x 5.7 cm\nVolume:\n\n1. Aneurysm: 102.1 ml\nENDOLEAK: Tiny right lumbar Type II endoleak is noted (7:72).\n\nEVAR MIGRATION\nNo evidence of migration.\nLength proximal graft to lowest renal artery: 8.6 cm cm.\nLength distal graft to iliac bifurcation:  Right: 2.0 cm; Left: 3.0 cm.\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.  Punctate calcified densities within the\ngallbladder lumen likely represent small 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 left and right adrenal glands remain diffusely thickened without\na discrete mass.\n\nURINARY: Re-demonstrated within the upper pole of the left kidney is low\ndensity oval cortical 1.6 cm lesion (7: 48) consistent with a renal cyst. \nThere are other multiple small bilateral subcentimeter hypodensities which are\ntoo small to characterize but likely also represent renal cysts.  Wedge-shaped\ngeographic areas of parenchymal nonenhancement within the lower pole of the\nleft kidney and the midpole of the right kidney are re-demonstrated, in\nkeeping with areas of known prior infarct.  There is a nonobstructing 4 mm\ncalcified stone within the lower pole of right kidney.  No hydronephrosis,\nhydroureter or bladder stones.\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.\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 and seminal vesicles are grossly\nunremarkable.\n\nBONES: Lower thoracic and lumbar spine multilevel degenerative disc disease is\ndemonstrated.\n\nSOFT TISSUES: Diastasis of the midline abdominal musculature.  Left lower\nquadrant ostomy is noted without evidence of obstruction.",
            "output": "1. Small right type II endoleak.  Stents are otherwise patent.  There is no\nevidence of stent migration.\n2. Bilateral renal cysts and nonobstructive 4 mm right lower pole stone.\n\nNOTIFICATION:  The updated  impression and recommendation above was entered by\nDr. ___ on ___ at 17:09 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider.\n\nThe impression and recommendation above was entered by Dr. ___ on\n___ at 16:28 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: 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 adrenal gland is normal in size and shape.  The left\nadrenal gland contains a 13 mm nodule, consistent with an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Bilateral\nrenal scars are noted.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a 7.3 cm wide dilated\nloop of small bowel in the right upper quadrant seen on 13.3 cm long.  This is\nlikely a loop of hepaticojejunostomy given the presence of anastomotic suture\nlines and the known history of bile leak complicating the previous\ncholecystectomy.  The 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 uterus and bilateral adnexae are grossly 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 1 cm sclerotic lesion involving the anterior body of L1, likely a\nsmall bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. There is no evidence of metastatic disease to the abdomen and pelvis.\n2. Isolated small bowel loop dilation, likely postoperative changes of\nhepaticojejunostomy and jejunojejunostomy.  Correlate with prior surgical\nhistory.\n3. Left adrenal adenoma.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings"
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal aorta and great abdominal arteries.  In particular, extensive\ncalcific plaque is seen in the splenic artery, with focal plaque in the celiac\nand SMA origin resulting in mild stenosis of the celiac ostia, and severe\nstenosis in the SMA origin.  Partially calcific mural thrombus is also present\nin the mid to distal SMA.  There is conventional anatomic variation of the\nceliac and SMA.  Single right and single left renal arteries, with focal\nostial calcifications, resulting in at least moderate stenosis on the right\nside.\n\nLOWER CHEST: Bibasal evidence of interlobular septal thickening with\nhoneycombing and fibrosis.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates slightly heterogeneous attenuation,\nfavored to be related to the phase of contrast. There is no evidence of focal\nlesions.  There is a CBD stent in situ, which is in appropriate position. \nThere is evidence of pneumobilia indicating stent patency.  The CBD wall is\nthickened for roughly 2 cm, involving the suprapancreatic segment but not\nextending to the confluence of the right and left ducts.  There is no mass\noutside the wall of the CBD. The gallbladder is within normal limits, without\ngallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions there is no peripancreatic stranding.  The main pancreatic duct\nis mildly dilated up to 5 mm, but can be followed to the CBD stent and\npapilla.\n\nSPLEEN: Multiple calcific granulomas are appreciated within the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Small areas of parenchymal thinning and scarring particularly in the\nright anterior interpolar region.  Symmetric nephrograms.  No evidence of\nhydronephrosis.  The bladder is moderately distended, and unremarkable in\nappearance.  There are central prostatic calcifications with sequela of prior\nTURP.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Colonic diverticulosis without evidence of\ndiverticulitis.  Appendix contains air, has normal caliber without evidence of\nfat stranding.  There is no evidence of mesenteric lymphadenopathy.  No free\nfluid within the abdomen or pelvis.\n\nLYMPH NODES:  No evidence of intra-abdominal or pelvic 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. Thickened suprapancreatic CBD, with a CBD stent in situ.  Tumor can not be\ndifferentiated from post biopsy/stenting changes.  No evidence of nodal or\nmetastatic disease.\n2. Background of extensive atherosclerosis with severe stenosis of the SMA\nostium and at least moderate stenosis of the right renal artery ostium. \nOtherwise conventional anatomy of the visceral arteries."
        },
        {
            "input": "LOWER CHEST: There is a 4 mm nodular density at the right lower lobe (2:1),\nwhich may represent a pulmonary nodule.  Visualized lung fields are 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 suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.  There are no organized\nintra-abdominal fluid collections.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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 appendicitis, diverticulitis, or organized intra-abdominal\nor intrapelvic fluid collections.\n2. Normal CT appearance of the uterus and bilateral adnexae.\n3. 4 mm pulmonary nodule at the right lower lobe. For incidentally detected\nnodules smaller than 6mm in the setting of an incomplete chest CT, no CT\nfollow-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 lungs are normal. 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 normal, without radiopaque\nstones 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. \nThe ureters are normal in caliber along their visualized course the bladder. \nThere is no evidence of hydronephrosis, concerning mass lesions, or\nperinephric abnormality.\n\nGASTROINTESTINAL:  There is a small hiatal hernia.  The stomach is somewhat\nunderdistended, but grossly normal.  The small and large bowel are normal in\ncourse and caliber.  There is no evidence of small bowel obstruction.  The\nappendix is not definitely seen, however there are no secondary signs of\nappendicitis.\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 lesions.  Incidental\nnote is made of partial sacralization of the L5 vertebral body.",
            "output": "1. No acute process in the abdomen or pelvis to account for the patient's\nsymptoms.\n2. Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Trace bilateral pleural effusions. \nOtherwise, the lung fields are clear.  Heart size is mildly enlarged with\ncoronary artery and mitral annular calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nRedemonstration of 2 hypodense lesions in the dome of the liver, measuring up\nto 1.5 cm, similar to prior and incompletely characterized.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation, with tiny amount\nof pneumobilia seen in the common bile duct, an expected finding status post\nbiliary enteric anastomosis.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post total pancreatectomy.  Transplant pancreas is\nseen in the right lower quadrant without ductal dilatation or peripancreatic\nstranding.  No evidence of focal lesions within the limitations of an\nunenhanced scan.  No peripancreatic fluid collections.\n\nSPLEEN: This spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic bilaterally with bilateral renal\ncysts noted.  Transplanted kidney is seen in the left iliac fossa.  The\ntransplant kidney demonstrates moderate hydroureteronephrosis due to a 7 mm\nstone seen in the distal transplant ureter (series 2, image 60).  There is\nperinephric stranding seen around the transplant kidney.  A hyperdense lesion\nin the interpolar region of the transplant kidney may represent a hemorrhagic\ncyst.  A punctate calcification is also seen in the cortex of the transplant\nkidney.  Additionally, there is stranding seen around the bladder which is\ndecompressed, which can be seen in the setting of acute cystitis.\n\nGASTROINTESTINAL: Patient is status post gastrojejunostomy and biliary enteric\nanastomosis which appear intact.  Small bowel loops demonstrate normal caliber\nand wall thickness 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 uterus and bilateral adnexae are grossly 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Redemonstration of\nmild wedge deformity of the L2 vertebral body.\n\nSOFT TISSUES: Patient is status post ventral hernia repair.",
            "output": "1. Moderate hydroureteronephrosis of the transplanted kidney seen in the left\niliac fossa secondary to an obstructing 7 mm stone in the distal transplant\nureter.\n2. Mild stranding seen around the bladder can be seen in the setting of acute\ncystitis.  Recommend correlation with urinalysis.\n3. Trace bilateral pleural effusions.\n4. Status post pancreatectomy with unremarkable appearance of right lower\nquadrant transplant pancreas."
        },
        {
            "input": "PELVIS:  There is extensive sigmoid diverticulosis without evidence of\ndiverticulitis.  A Foley catheter is seen terminating within the bladder.  The\nbladder is moderately distended with contrast.  There is a 1.5 cm focal\noutpouching within the right posterior bladder wall (series 4, image 27), that\nlikely represents a bladder diverticulum.  There is no evidence of contrast\nextravasation.  There is no significant bladder wall thickening.  The distal\nureters are unremarkable.  There is a small amount of complex free fluid\nwithin the pelvis, likely hemorrhage from the right pubic rami fractures.\n\nREPRODUCTIVE ORGANS: Multiple calcified fibroids are demonstrated.  No adnexal\nmasses visualized.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted involving the distal\nabdominal aorta and the iliac vessels bilaterally.\n\nBONES: The bones are diffusely demineralized.  The acute comminuted mildly\ndisplaced fractures of the right superior and inferior pubic rami are re-\ndemonstrated.  The pubic symphysis is intact.  There are no additional\nfractures visualized.  No suspicious osseous lesions are seen.\n\nSOFT TISSUES: There is a small amount of soft tissue stranding overlying the\nright gluteal muscles.",
            "output": "1. No evidence of intra or extraperitoneal bladder rupture.\n2. Focal outpouching of the right posterior bladder wall likely represents a\nbladder diverticulum.\n3. Mildly displaced right superior and inferior pubic ramus fractures with a\nsmall amount of complex free fluid within the pelvis, likely hemorrhage.\n4. Diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nStatus post endovascular repair of abdominal aortic aneurysm with stent\ngrafts.  The stents are satisfactorily in place extending from the suprarenal\naorta to the distal common iliac arteries.  There is mild stenosis of the\norigin of the celiac axis noted. Reconstructions from the 3D lab with more\nspecific measurements are pending.    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 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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  Diffuse thinning of the renal cortical parenchyma bilaterally\nlobulated contour.  Unchanged bilateral cortical renal cysts.  There is also\nan unchanged left lower pole parapelvic cyst.  The kidneys are of normal and\nsymmetric size with normal nephrogram. 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.\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.  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. \nThere are stable surgical clips consistent with prior prostatectomy.\n\nBONES:  Stable spinal degenerative disease of the lumbar spine. \nAnterolithesis of L4/L5.  Fatty marrow expanding the bilateral iliac bones.  \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. Aortic stents are satisfactorily intact.  No evidence of endoleak.\n2. Stable cortical renal simple cysts bilaterally and left parapelvic 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: 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 is enlarged, 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: There is a small hiatal hernia .  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 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: Expansile osseous lesion in right posterior ilium has slightly\nincreased in size measuring 5.4 cm, previously 4.6 cm, however demonstrating\nincreased sclerosis suggestive of treatment effect.\nAdditional osseous lesion posterior right 12 rib is unchanged from prior exam\nmeasuring 5.5 cm, also demonstrates increased sclerosis suggestive of\ntreatment effect.  Please note these lesions demonstrate decreased FDG avidity\non most recent PET-CT ___.  No new osseous lesion noted.  Left\nproximal femur hardware is seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval increase in sclerosis of expansile osseous lesions in posterior\nright 12 rib and right posterior ileum, likely related to treatment.  No\npathologic fracture.  No new osseous or abdominopelvic metastases.\n2. 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.\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: Minimal decrease of splenomegaly, measuring up to 14.2 cm.  The spleen\notherwise demonstrates normal 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. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise 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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Expansile osseous lesion in the right posterior twelfth rib now\nmeasures 1.5 x 0.5 cm (02:37), previously 1.8 x 0.5 cm in ___. \nAdditional 1 cm osteolytic component is noted within the right posterior\ntwelfth rib, new from prior.  Otherwise, the expansile osseous lesion in the\nright posterior ilium has increased in size, now measuring up to 6.1 cm,\npreviously 5.4 cm.  This may reflect treatment effect.  Left femoral head\nfixation device is unremarkable.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic process.\n2. Expansile osseous sclerotic lesion in the right posterior twelfth rib now\nmeasures 1.5 x 0.5 cm, previously 1.8 x 0.5 cm in ___. Additional 1\ncm osteolytic component is noted within the right posterior twelfth rib, new\nfrom prior. Otherwise, the expansile osseous lesion in the right posterior\nilium has increased in size, now measuring up to 6.1 cm, previously 5.4 cm.\nThis may reflect treatment effect."
        },
        {
            "input": "LOWER 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.   1.1\ncm relatively hyperenhancing lesion in segment 2 (2:41), which becomes less\napparent on delayed phase sequences and is stable since at least ___, likely a 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 is mildly enlarged, measuring 15.3 cm in the AP dimension. \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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Moderate hiatal hernia.  Otherwise, the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement. The colon and rectum are within normal limits. The appendix\nis normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is an expansile lesion involving the left ninth transverse\nprocess, the lateral aspect of the left T9 vertebral body (2:39), and the\nadjacent component of the posterior left ninth rib, with increase in the\ndegree of lytic changes since PET-CT ___.  Additionally, there is\na heterogeneous expansile appearance of the posterior aspect of the right\neleventh rib (2:64), similar to ___.  Redemonstration of a 6.1 cm\nexpansile lytic lesion involving the right posterior iliac bone (2:96),\nsimilar in appearance to prior.\n\nMetallic hardware is again seen within the left femoral neck and proximal\nfemoral shaft.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.",
            "output": "Interval progression of a lytic lesion centered at the left ninth transverse\nprocess, which also involves the left T9 vertebral body and posterior aspect\nof the left ninth rib.  Additional osseous metastasis are similar compared to\nthe prior exam.  No new lesions."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  There is new mild dilatation of the\ncommon bile duct measuring 8 mm with mild prominence of the central\nintrahepatic bile ducts.  Recommend correlation with liver function tests. \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: There is redemonstration of a 1.2 x 0.8 cm incompletely characterize\nright adrenal nodule (series 5, image 93).  There is thickening without\ndiscrete nodularity of the left adrenal gland.\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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Moderate-sized hiatus hernia.  Stomach is otherwise\nunremarkable in appearance.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement. The colon and rectum are within normal\nlimits. The appendix is not definitely visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post bilateral salpingo-oophorectomy. \nThe uterus is normal in appearance.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Minimal atherosclerotic disease is noted.  There is no abdominal\naortic aneurysm.\n\nBONES: There is redemonstration of a large mixed lytic and sclerotic lesion in\nthe right iliac bone, which is not significantly changed compared to prior\nexam dated ___.  However, there has been interval enlargement of\nthe expansile lytic metastases involving the left lateral aspect of T9,\nposterior ninth left rib, and posterior right eleventh rib (series 5, images\n65, 104).  Additionally, there is a new lytic lesion in the L1 vertebral body\n(series 5, image 104).  There is a new area of cortical destruction along the\nleft iliac wing (5:175) although no discrete soft tissue mass is seen, the\nappearance is highly suspicious for metastatic lesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New lytic metastatic lesion seen in the L1 vertebral body and new area of\ncortical destruction along the left iliac wing highly suspicious for a\nmetastatic lesion.\n2. Interval enlargement of the lytic metastatic lesions involving the left\nlateral aspect of T9, posterior left ninth rib, and posterior right eleventh\nrib.\n3. Unchanged appearance of the lytic metastatic lesion involving the right\niliac bone.\n4. New mild intrahepatic and extrahepatic biliary duct dilatation.  Recommend\ncorrelation with liver function tests."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 in the lateral aspect of segment II is a 3.6 x 3.4 cm lesion\nwhich demonstrates progressive discontinuous peripheral nodular enhancement\nand fill-in on delayed phase images, compatible with a hemangioma (05:22). \nThis appears unchanged from prior CT performed ___.  In the\nright hepatic lobe (hepatic segment VI), indistinct 1.0 cm hypodensities\ndemonstrate slight peripheral enhancement and appear to progressively fill in\non delayed phases, which are too small to definitively characterize but\nsuggest additional hemangiomas (05:38, 05:54).  No suspicious focal hepatic\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: Postsurgical changes from sleeve gastrectomy are\nredemonstrated.  No evidence of obstruction.  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: Replaced right hepatic artery arising from the SMA.  There is no\nabdominal aortic aneurysm.  Noatherosclerotic disease is seen.\n\nBONES: There is no evidence of worrisome osseous lesions.  Previously\ndescribed clavicle and rib fractures on the CT torso from ___\nare not included in the field of view.  No new fractures are identified.\n\nSOFT TISSUES: Postsurgical changes in the anterior abdominal wall without\nconcerning lesions or fluid collections..",
            "output": "1. 3.6 cm hemangioma in the lateral aspect of hepatic segment II, unchanged\ncompared to CT from ___.\n2. No suspicious hepatic lesions."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  There is moderate to high-grade\nstenosis of the SMA with at least 60-70% narrowing distally.  Multiple\nenhancing lymph nodes measure 1.2 x 1.7 cm and 1.1 x 0.8 cm, posterior to the\nintraperitoneal portion of the femoral hardware along the right pelvic wall\nand between the right external iliac artery and vein (3B: 301, 304).  The\nabdominal aorta and iliac arteries are intact.  No evidence for aneurysm or\nvascular injury to the major abdominal and pelvic vessels.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  There is a moderate size hiatus hernia with\nconcentric wall thickening of the distal esophagus likely related to reflux\nesophagitis or ___ esophagus.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout with\nat least mild diffuse fatty infiltration.  There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is surgically absent.  Portacaval lymph node\nmeasures 6 mm.  Periportal lymph node measures 1.1 cm (3B: 221).\n\nPANCREAS: The main pancreatic duct is focally dilated near the ampulla,\nmeasuring 10 mm with tapering towards the head and neck.  No radiopaque\nfilling defect is seen within the duct.  Otherwise, there is no evidence of\nfocal pancreatic lesion.  The uncinate process is mildly fatty replaced. \nConsider further workup with MRI.  Findings could be related to a main duct\nIPMN or possible stricture at the ampulla.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands diffusely thickened, possibly due\nto adrenal hyperplasia.\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 colonic diverticulosis without bowel\nwall thickening.  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 and distal ureters are unremarkable.  There is no\nevidence of inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There is acute comminuted periprosthetic femoral neck fracture on the\nleft with mild posteromedial displacement of the proximal femur with respect\nto the femoral neck.  Multiple fragments are seen around the fracture site. \nThe lesser trochanter is medially displaced by 1.2 cm.  The displaced gamma\nnail through the femoral neck has been displaced medially through the\nacetabulum and resting within the lower pelvis, adjacent to a loop of bowel,\nabove the broad ligament.  The gamma nail tip abuts the right adnexal region\nadjacent to small uterine vessels with no evidence for extravasation at this\ntime.  There is a hematoma involving the obturator internus on the right.  A 5\nsmall focal collection of contrast within the obturator internus hematoma is\ncompatible with a tiny pseudoaneurysm and/or extravasation for which follow-up\nimaging may be performed..\n\nSOFT TISSUES: 2.8 cm defect inferior to the fat containing umbilical hernia\ncontains intra-abdominal fat and no bowel. Asymmetric thickening of the right\npelvic wall is likely a hematoma in the right obturator internus region. \nThere is moderate edema within the soft tissues lateral to the right hip in\nkeeping with soft tissue contusion.  A small fluid collection compatible with\na hematoma lateral to the right hip is also noted.",
            "output": "1. Comminuted periprostatic femoral neck fracture with mild posteromedial\ndisplacement of the proximal femur with respect to the femoral neck.  The\nhardware is likely located intra peritoneum, abutting the bowel wall and\nresiding within the right adnexal region in close proximity to the right\nlateral wall of the uterus and uterine vessels.\n2. Small pelvic hematoma on the right containing a tiny collection of contrast\nwithin the obturator internus muscle on the right which may be related to a\nsmall pseudo aneurysm or small extravasation for which follow-up imaging is\nrecommended to ensure stability\n3. SMA atherosclerotic disease with flow limiting stenosis and post stenotic\ndilation.\n\nNOTIFICATION:  The updated findings were discussed with orthopedic resident,\nM.D. by ___, M.D. on the telephone on ___ at 8:14 am, 10 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: See report of contemporaneously acquired CT chest\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged appearance of the small focal hypodensities in the\nright lobe of the liver.  There is no evidence of intrahepatic or extrahepatic\nbiliary 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 mild splenomegaly again measuring 13.8 cm (measured\non axial image 7.19) and 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 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. Fluid and stool\nfilled proximal colon.  There is lack of opacification of the colon however\nthere is suggestion of circumferential wall thickening involving the cecum and\nascending colon through the level of the hepatic flexure.  There are no\nsignificant pericolonic inflammatory changes.  The appendix appears within\nnormal limits.  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: Prior hysterectomy 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: Subcutaneous edema in the flanks.  The abdominal and pelvic wall\nis otherwise within normal limits.",
            "output": "-Nonopacified colon however there is suggestion of circumferential wall\nthickening of the cecum and ascending colon which could be seen in the setting\nof neutropenic colitis/typhlitis given the provided clinical history.  There\nare however no significant surrounding inflammatory changes.\n-Unchanged mild splenomegaly.\n-Unchanged small hepatic hypodensities."
        },
        {
            "input": "LOWER CHEST: Please refer to separately dictated CT chest report from the same\nday for full description of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are scattered millimetric right hepatic lobe hypodensities which are too\nsmall to characterize but stable compared to prior.  Otherwise, 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 has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits.  Thickening of the ascending colon seen on\nprior exam is no longer visualized and likely resolved.  The appendix is\nwithin 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 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.\nStable multilevel degenerative changes of the visualized thoracolumbar spine\nare noted.\n\nSOFT TISSUES: There is interval decrease in extent of bilateral flank\nsubcutaneous edema.  There are stable multiple soft tissue nodules in the\nlower anterior abdominal wall, likely from prior injections.  There is a\ndystrophic calcification in the right gluteal muscles, stable.",
            "output": "1.  No evidence of lymphadenopathy.\n2. No acute abdominopelvic process.\n3. Interval resolution of right sided colitis compared to ___.\n4.  Please refer to separately dictated CT chest report from the same day for\nfull 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 are scattered hypodensities in the liver which are too small to\ncharacterize, and likely represent simple cysts or hamartomas.  The largest of\nthese measures 6 mm in segment 6 (6:68) and 10 mm in segment 5 (6:65) and are\nunchanged from prior exam.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Redemonstration of soft tissue nodules in the lower anterior\nabdominal wall likely from prior injections.  Stable coarse calcification in\nthe right gluteal musculature.  STIR",
            "output": "1. No acute abdominopelvic process.\n2. Chronic/incidental findings as described above.\n3. Please see separate report for CT chest."
        },
        {
            "input": "LOWER CHEST: Mild dependent bibasilar atelectasis, increased from prior study.\nVisualized lung fields are otherwise within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense lesions are again demonstrated throughout the liver,\nsimilar in appearance to prior study with the largest measuring 3.7 x 3.5 cm\n(05:27).  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: Mild splenomegaly, measuring up to 14.6 cm (05:19).  The spleen shows\nnormal 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. \nMinimal residual soft tissue at the anteromedial aspect of the left upper\nrenal pole measures up to 2 mm (05:30), substantially decreased from 6 mm on\nprior study from ___.  Few tiny subcentimeter hypodensities within\nthe bilateral renal cortices, too small to characterize on CT but likely\ncompatible with simple renal 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.  Previously\ndemonstrated wall thickening involving multiple loops of jejunum is no longer\nseen on the current study, likely compatible with interval resolution.  The\ncolon and rectum are within normal limits.  Mild fecal loading noted\npredominantly within the ascending and 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. 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: Calcification again demonstrated within the subcutaneous soft\ntissues in the gluteal region, possibly posttraumatic.  Mild anasarca is\nnoted.  The abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Interval resolution of previously demonstrated jejunal enteritis.\n2. Overall similar appearance of multiple liver lesions, consistent with\nbiopsy proven diffuse large B-cell lymphoma.\n3. Minimal residual soft tissue thickening at the anteromedial aspect of the\nleft upper renal pole, substantially decreased in size compared to prior CT\nabdomen/pelvis from ___.\n4. Mild splenomegaly."
        },
        {
            "input": "LOWER CHEST: There is atelectasis at both lung bases.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hypodense hepatic lesions wax and wane in size\ncompared to prior exams, and represent biopsy proven diffuse large B-cell\nlymphoma.  No new hepatic lesions are identified.  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: Mild splenomegaly is again noted.  The spleen 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. \nThe previously described soft tissue at the anteromedial aspect of the left\nupper kidney is not appreciated on the current exam.  A subcentimeter\nhypodensity in the upper pole of the left kidney is too small to characterize,\nbut likely represents a cyst.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The bowel is normal in course and caliber.  There is no\nevidence of 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.  No adnexal mass is\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 degenerative changes are noted in the spine.\n\nSOFT TISSUES: Calcifications are again noted within the soft tissues of the\nright gluteal region.  Small densities and air within the subcutaneous tissues\nof the lower anterior abdominal wall are likely related to subcutaneous\ninjections.",
            "output": "1. No acute abnormality in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Relatively unchanged hypodensities within the liver consistent with biopsy\nproven diffuse large B-cell lymphoma.\n3. Stable splenomegaly.\n4. Interval resolution of soft tissue at the anteromedial aspect of the upper\npole of the left 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 demonstrates homogenous attenuation throughout. \nMultiple hypodensity attic lesions are overall unchanged from prior common\nrepresent biopsy-proven diffuse large B-cell lymphoma.  The largest lesion\nmeasures 3.1 cm at the junction of segment 4B   and 5 (series 5, image 65). \nNo new hepatic lesions are identified.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  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 is homogeneous and measures 12.2 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 ascending\ncolon shows mild wall hyperhymia which could be seen in the setting of the\ncolitis.  There is also mild submucosal hyperenhancement of the rectum.  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: Status post hysterectomy.  No adnexal mass.\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy.  Ascites.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is a replaced right hepatic artery origin a from the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple subcutaneous injection sites are noted in the abdominal\nwall.",
            "output": "1. Features suggesting mild ascending colitis and proctitis.\n2. Overall unchanged hypodensities within the liver consistent with biopsy\nproven diffuse large B-cell lymphoma.\n3. Please refer separate chest CT done the same day"
        },
        {
            "input": "LOWER CHEST: Micronodule within the right lower lobe (05:15).  Otherwise, the\nimaged lungs are clear.  No pleural effusion or pneumothorax.  A right port\ncatheter tip is partially imaged, terminating within the right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodense lesions at the junction of segments IVB and V and within segment VI\nmeasure approximately 1.9 x 1.5 cm and 1.7 x 1.2 cm respectively, decreased in\nsize and conspicuity from the prior study, when the measured up to 3.1 cm.  No\nnew lesions are identified.  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. \nA subcentimeter left renal hypodensity is too small to characterize (05:30). \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 patient is status post hysterectomy.  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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple rounded soft tissue densities are seen within the\nsubcutaneous fat of the anterior abdominal wall, likely sequela of prior\ninjections.",
            "output": "1. Interval decrease in size and conspicuity of hypodense hepatic lesions, now\nmeasuring up to 1.9 cm, compatible with biopsy-proven diffuse large B-cell\nlymphoma.  No definite new hepatic lesions identified.\n2. No evidence of intra-abdominal fluid collection, suggestion of abdominal\ninfection or 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. \nContinued interval decrease conspicuity of multiple hepatic hypodensities,\ncompatible with biopsy proven diffuse large B-cell lymphoma.  For example, a\n1.4 x 1.1 cm hypodensity in segment ___ previously measured 1.9 x 1.5 cm\n(series 4, image 26).  No new lesions are identified.  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 demonstrates normal attenuation throughout and is mildly\nenlarged, measuring up to 13.8 cm in greatest AP dimension (series 4, image\n14).  This is unchanged compared to the most recent prior 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 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. The colon and\nrectum are within normal limits. The appendix is identified.  It measures 7 8\nmm in diameter and does not contain air.  No definite stranding about of\nbackground.\n\nPELVIS: The urinary bladder is under distended and filled with contrast. \nThere is mild wall thickening of the urinary bladder, which may be exaggerated\nin the setting of underdistention.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: 1.1 cm left periaortic lymph node is new compared to prior\nexamination (series 4, image 26).  Scattered subcentimeter retroperitoneal\nlymph nodes, which are predominantly within the aortocaval station, are more\npronounced compared to the prior examination and associated with mild fat\nstranding.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Sclerosis along the bilateral sacral side of the sacroiliac joint is\nunchanged.  No aggressive osseous lesions are identified.\n\nSOFT TISSUES: Multiple soft tissue densities are demonstrated within the\nanterior abdominal wall, likely reflecting sequelae of prior injection.  A\ncoarse calcification in the right gluteal muscle is not appreciably changed\ncompared the prior examination (series 4 image 66).",
            "output": "1. Enlarged 1.1 cm left periaortic lymph node is new compared to the prior\nexamination and is associated with small but prominent retroperitoneal lymph\nnodes and fat stranding.  Findings may be related to known history of\nlymphoma, which is worrisome for worsening lymphoma since ___, versus\npotentially, alternative reactive and/or infectious etiologies.\n2. Appendix is borderline in caliber.  This is probably not significant\nclinically if no specific symptoms refer to the site.  Correlation with\nphysical findings is recommended as well as other clinical information.  In\nthe appropriate clinical setting, a 6-8 mm diameter appendix is indeterminate\nfor appendicitis although this range can be entirely normal and finding is\nvery unlikely to represent acute pathology without localizing findings or\nsymptoms.\n3. Scattered hepatic hypodensities corresponding to biopsy-proven diffuse\nlarge B-cell lymphoma appear less conspicuous compared to the prior\nexamination ___.\n4. Concentric bladder wall thickening may be exaggerated in the setting of\nunderdistention.  Cystitis is not excluded, however.  Recommend correlation\nwith clinical signs and symptoms of cystitis."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar atelectasis.  There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are 2 adjacent hypodense rounded structures within segment 6 of the\nliver, the larger of which measures 2.6 x 2.4 cm.  These most likely represent\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: The kidneys are of normal and symmetric size with normal nephrogram. \nParapelvic renal cysts are seen bilaterally, with the largest located within\nthe left kidney measuring up to 2.6 cm.  There is no evidence of additional\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Circumferential wall thickening is seen of the distal\nsigmoid large bowel, with adjacent soft tissue stranding, suggestive of\ndiverticulitis.  No evidence of adjacent fluid collections.  No extraluminal\nair.\n\nThe stomach is unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. Pancolonic diverticulosis is seen.\nThe appendix is not visualized.\n\nPELVIS: The urinary bladder is unremarkable.  There is trace free fluid within\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The left adnexa is slightly engorged as comparison to the\nright adnexa, which may represent reactive inflammation from adjacent\ndiverticulitis.  The uterus and right 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.  There is fusiform ectasia of\nthe left common iliac artery, measuring up to 1.6 cm in diameter (series 2,\nimage 50).  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": "Wall thickening of the distal sigmoid colon along with adjacent soft tissue\nstranding without adjacent fluid collections, suggestive of uncomplicated\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. \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: 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. \nNote is made of a transitional L5 vertebra with a left-sided L5-S1\npseudoarthrosis and asymmetric right-sided L4-L5 degenerative disc changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of primary malignancy or metastatic disease in the abdomen or\npelvis.\n2. Please refer to the separate report for the CT chest."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver shows diffusely decreased attenuation, consistent with\nfatty liver.  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. There is colonic\ndiverticulosis without surrounding inflammation to suggest diverticulitis. \nThere is subtle inflammation in the right lower quadrant adjacent to the\ncecum.  Additionally the appendix is hyperemic and mildly enlarged, measuring\nup to 9 mm in greatest dimension (series 602; image 25).  Overall, these\nfindings are suggestive of uncomplicated, 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 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": "Subtle inflammation of the right lower quadrant, adjacent to the cecum. \nAppendix is hyperemic and mildly enlarged, measuring up to 9 mm in greatest\ndimension.  Overall, these findings are suggestive of uncomplicated, acute\nappendicitis."
        },
        {
            "input": "LOWER 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 with vicarious excretion of\ncontrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 up to 14.7 cm.  No evidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Delayed nephrogram of the right kidney with residual contrast from\nprior CTA noted. Unchanged moderate right hydronephrosis, likely secondary to\nobstruction secondary to infiltrative soft tissue density surrounding the\nright ureter along its course including within the pelvis (02:43).  This\nretroperitoneal soft tissue density extends inferiorly along the bilateral\niliacs and into the pelvis.  There is no 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\nnormal.\n\nPELVIS: The aforementioned infiltrative soft tissue density is seen in\nbilateral pelvic walls and obscures the presacral fat.  Soft tissue obscures\nthe fat planes around the right common and proximal internal and external\niliac vasculature.  It also surrounds the distal abdominal aorta and bilateral\ncommon iliac arteries.  A discrete enlarged right external iliac lymph node\nmeasures 1.2 cm.  The urinary bladder is decompressed and demonstrates a\nthickened wall, potentially due to underdistention.  The distal ureters are\nnot well-seen.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged fibroid uterus with multiple calcified fibroids,\nwith the largest measuring 8.2 x 6.6 x 7.4 cm.  Additionally, there is a 12.7\nx 10.3 x 7.2 cm exophytic fibroid, extending into the right upper quadrant of\nthe abdomen (601:21).\n\nLYMPH NODES: There is no mesenteric lymphadenopathy.  There is no 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. \nMultilevel degenerative changes of the imaged spine.  There is soft tissue\ndensity with obscuration of the normal fat along the right aspect of the T9\nvertebral body (601:44).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent delayed right nephrogram with moderate hydronephrosis, likely\nsecondary to an infiltrative soft tissue density that encases the right\nureter, extending down to the pelvic and presacral region.  This\npresacral/pelvic wall soft tissue density also encases iliac vasculature,\nright greater than left.  Additionally, obscuration of normal fat on the right\naspect of the T9 vertebral body.  Altogether, findings are highly concerning\nfor malignancy.\n2. Mild splenomegaly.\n3. Large 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: 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.  Redemonstrated\nborderline splenomegaly measuring 14 cm.\n\nADRENALS: Unchanged appearing.\n\nURINARY: S/p percutaneous nephrostomy tube placement, pigtail catheter\nterminating low in an extrarenal pelvis.  Mild residual right-sided\nhydronephrosis.  Complex right perinephric fluid collection along the\nposterior-lateral aspect of the kidney, measuring 4.4 AP x 2.0 transverse x\n6.2 craniocaudal cm.  This is consistent with evolution of a hematoma that was\nseen on the prior PET-CT,, since placement of the nephrostomy tube, very\nsimilar in size.  Redemonstrated infiltrative soft tissue mass along the\ncourse of the upper right ureter density along the course of the whole right\nureter.\n\nGASTROINTESTINAL: The stomach is decompressed no abnormally dilated loops of\nbowel.  Scattered colonic diverticulosis in the descending:.  Normal caliber\nappendix.\n\nPELVIS: Partially distended urinary bladder trace free fluid in the right\nparacolic gutter, new compared to prior.  Redemonstrated obscured presacral\nfat, right greater than left, and pelvic sidewall infiltration with soft\ntissue density, similar to prior.\n\nREPRODUCTIVE ORGANS: Bulky, enlarged fibroid uterus, similar to prior, aside\nfrom shift in positioning suggesting fairly mobile fibroids, including a large\npedunculated fibroid that is shifted toward the right.  Smaller heavily\ncalcified pedunculated fibroid also again visualized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy with\nlimited evaluation given bulky enlarged fibroid uterus.  There is no pelvic or\ninguinal lymphadenopathy, given the limited evaluation.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSoft tissue thickening along the anterior and lateral aspects of several lower\nthoracic levels, showing FDG avidity on the prior PET, is consistent with an\nadditional area of tumor involvement, in addition to extensive posterior\npelvic retroperitoneal tumor.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post right percutaneous nephrostomy tube placement, with mild\nresidual right hydronephrosis.  Pigtail catheter terminates in an extrarenal\npelvis.\n2. Evolving right perinephric hematoma without change in size since the prior\nPET-CT.  This does not appear liquified, however.  This is very doubtful as a\nsource of infection.  New trace free fluid along the right paracolic gutter.\n3. Redemonstrated soft tissue density along the right ureter extending into\nthe right pelvic sidewall, and obscuring the presacral fat, consistent with an\nextensive neoplastic process (chloroma in the setting of acute myelogenous\nleukemia).  Similar soft tissue thickening about the lower thoracic spine,\nalso consistent with tumor involvement and unchanged in extent.\n4. Borderline splenomegaly measuring 14 cm.\n5. Redemonstrated bulky enlarged fibroid uterus, fairly mobile including large\npedunculated fibroid."
        },
        {
            "input": "LOWER CHEST: Trace right 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 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 attenuation throughout without evidence of\nfocal lesions.  Borderline splenomegaly measuring up to 12.9 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Status post right percutaneous nephrostomy tube placement with the\npigtail catheter again seen in the extrarenal pelvis.  The position is overall\nunchanged compared to the prior exam.  There is mild residual right-sided\nhydronephrosis, also unchanged.  Complex right perinephric fluid collection\nalong the posterolateral aspect of the kidney measuring 4.0 x 1.9 cm is\nconsistent with an evolving hematoma, and is not significantly changed\n(05:34).  Again demonstrated is an infiltrative soft tissue mass along the\ncourse of the right ureter, similar appearance compared to multiple prior\nexams.\n\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 is unremarkable.  The distal ureters are not well\nseen.  Trace free pelvic fluid.  Infiltrative soft tissue density is again\nseen in the bilateral pelvic side walls obscuring the presacral fat as well as\nobscuring the fat planes around the right common and proximal internal and\nexternal iliac vasculature.\n\nREPRODUCTIVE ORGANS: Again demonstrated is a bulky enlarged fibroid uterus\nwith a large pedunculated left-sided fibroid.  Additional heavily calcified\nfibroids are unchanged.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy. \nPelvic adenopathy is not well evaluated.  No 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 right percutaneous nephrostomy tube placement with mild\nresidual hydronephrosis, unchanged compared to ___.\n2. Evolving right perinephric hematoma appears similar in size to prior exam.\n3. Soft tissue density along the right ureter is unchanged.\n4. Extensive infiltrating soft tissue density in the bilateral pelvic\nsidewalls and surrounding the right common and proximal internal and external\niliac vasculature, compatible with a neoplastic process.\n5. Enlarged fibroid uterus, 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 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 status post right percutaneous nephrostomy tube\nplacement with the pigtail catheter again seen in the extrarenal pelvis.  The\nposition is largely unchanged to prior imaging dating back to ___. \nAgain seen is complex right perinephric fluid collection along the\nposterolateral aspect of the kidney measuring approximately 4.1 x 2.0 cm,\nsimilar in size to prior CT from ___.  This is most consistent with\nevolving hematoma.  Again seen is an infiltrative soft tissue mass along the\ncourse of the right ureter which is similar appearance to prior exams.\n\nGASTROINTESTINAL: The stomach is 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.  The distal ureters are not\nappreciated.  There is trace free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Again seen is able key enlarged fibroid uterus with a\nlarge pedunculated left-sided fibroid.  There are additional calcified\nfibroids which are unchanged..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 are no new findings on CT to explain the patient's neutropenic fever.\n2. Again seen is a right percutaneous nephrostomy tube which is unchanged in\npositioning.\n3. The right perinephric hematoma is unchanged in size from ___.\n4. Again seen is a soft tissue density along the right ureter which was\npreviously characterized as a neoplastic process in the setting of AML.\n5. Bulky multi fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate minimal dependent, left\ngreater than 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 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: Right percutaneous nephrostomy tube pigtail catheter is in stable\npositioning with stable minimal right-sided hydronephrosis.  Complex right\nperinephric fluid collection along the posterolateral aspect of the kidney\nmeasuring 4.0 x 2.0 cm (image 30 on series 5) is stable/minimally decreased in\nsize from ___.  Soft tissue attenuating nodularity along the course\nof the right ureter is similar in appearance to multiple prior examinations. \nThere is no evidence of solid renal lesions.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  There are few colonic diverticula without\nevidence of diverticulitis.  There is mild fecal distention of the distal\nsigmoid/colon with minimal perirectal stranding. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  Previously described trace\nintrapelvic free fluid has decreased in size.\n\nREPRODUCTIVE ORGANS: There is redemonstration of bulky enlarged partially\ncalcified fibroid uterus with a large pedunculated left-sided partially\ncalcified fibroid which is 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.\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 acute findings in the abdomen or pelvis.\n2. Small to moderate amount of stool in the colon and rectum.\n3. Trace intrapelvic free fluid which has decreased in size.\n4. Stable positioning of right percutaneous nephrostomy tube.  Stable to\nminimally improved right perinephric 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 suspicious focal lesion.  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: Improved right perinephric hematoma.  Unchanged mild right\nhydronephrosis and proximal hydroureter status-post right percutaneous\nnephrostomy tube removal, possibly caused by the markedly enlarged, fibroid\nuterus.  No concerning lesions.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is mild colonic\ndiverticulosis.  The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Redemonstrated severely enlarged fibroid uterus,\nincluding a pedunculated fibroid arising from the left uterine fundus located\nmid abdomen measuring up to 11.9 x 8.8 cm.  Some fibroids are calcified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.  Known FDG avid lymph nodes\nare not as well evaluated on this scan.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\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 mild right hydronephrosis and proximal hydroureter now\nstatus-post percutaneous nephrostomy tube removal.\n2. Severely enlarged fibroid uterus including an approximately 12 cm\npedunculated fibroid extending into the mid abdomen.  The fibroid uterus may\ncause the mild right hydroureteronephrosis.\n3. Mild colonic diverticulosis.\n4. FDG avid lymph nodes were better evaluated on the prior PET scan dated ___."
        },
        {
            "input": "LOWER 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 nephrograms.\nNo evidence of solid renal lesions.  Prior insult noted in the interpolar\nregion of the right kidney is unchanged.  A 3.5 cm cyst is again noted in the\nlower pole of the right kidney. There is bilateral hydroureteronephrosis,\nsimilar on the right and slightly worse on the left compared to prior.\n\nGASTROINTESTINAL: The stomach is unremarkable within the limitations of CT. \nNo small bowel obstruction.  There are scattered colonic diverticula without\nevidence of diverticulitis. No focal fluid collections abdominal abscesses are\nidentified.\n\nPELVIS: Urinary bladder is only minimally distended and not well evaluated. As\nbefore, the large fibroid uterus exerts mass-effect on the bladder. The distal\nureters are unremarkable.\n\nREPRODUCTIVE ORGANS: There is a stable interval appearance of a severely\nenlarged fibroid uterus including multiple pedunculated fibroids. The uterus\nmeasures up to 16 cm in largest craniocaudal dimension. The largest fibroid is\npedunculated and measures 11.3 x 8.5 x 7.5 cm in largest axial diameter (TV x\nAP x CC). Several of the fibroids demonstrate calcifications as on prior.\n\nLYMPH NODES: Conspicuous retroperitoneal periaortic soft tissue with extension\nalong the proximal common iliac vessels is similar appearance to the study\ndated ___ and was not found to be FDG avid on the PET-CT dated ___.  No new retroperitoneal or pelvic adenopathy, however assessment\nof the pelvis is limited secondary to the large fibroid uterus.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No substantial calcified\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. Bilateral hydroureteronephrosis, similar on the right and slightly worse on\nthe left compared to prior imaging.  The hydroureteronephrosis may be the\nsequelae of retroperitoneal soft tissue, incompletely assessed in the absence\nof a delayed excretory phase.\n2. Stable interval appearance of retroperitoneal periaortic soft tissue with\nextension along the proximal common iliac arteries, not seen to be FDG avid on\nthe PET-CT dated ___.  Attention on follow-up is recommended.\n3. Severely enlarged fibroid uterus including calcified and pedunculated\nfibroids as described above.\n4. Please refer to the separately dictated CT chest for full description of\nthe subdiaphragmatic findings."
        },
        {
            "input": "CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously without focal lesion or intrahepatic biliary\ndilatation. The gallbladder is unremarkable and the portal vein is patent. The\npancreas, spleen and adrenal glands are unremarkable.  There is a 2.2 cm\nsimple cyst in the lower pole the right kidney which is unchanged.  The\nkidneys present symmetric nephrograms and excretion of contrast with no focal\nlesions, stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  The appendix is  visualized and there is no evidence of\nappendicitis.  There is diverticulosis without evidence of diverticulitis.\n\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nNo ascites, free air or abdominal hernia.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.  A vaginal\ncyst appears unchanged.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.",
            "output": "1. No evidence of acute intra-abdominal process. Normal appendix.\nDiverticulosis 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 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 simple cyst in the right lower pole is unchanged.  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 sigmoid\ndiverticulosis is noted.  There is marked colonic wall thickening and adjacent\nfat stranding involving an approximately 10 cm segment at the junction of the\ndescending and sigmoid colon (2:66).  The appendix is normal.  No\nintra-abdominal free fluid, organized fluid collections or pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Enlarged retroflexed uterus, with small volume hypodense\nmaterial within the endometrial cavity appears similar.  3 cm cyst in the left\nvaginal wall, essentially unchanged since the pelvic ultrasound from ___.  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.  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": "Colitis involves an approximately 10 cm segment at the junction of the\ndescending and sigmoid colon.  Given extensive sigmoid diverticulosis, an\ninfectious etiology related to diverticular disease is favored, however an\ninflammatory or ischemic process is also possible.  No free extraintestinal\nair or abscess / fluid collection."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis.  There is no evidence of pleural or\npericardial effusion.  Aortic valve and coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are two subcentimeter hypodensities in the right hepatic lobe, too small\nto characterize by CT but possibly representing cysts biliary hamartomas. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder does contain anti dependent high density material, potentially\nvicarious excretion of contrast in the background of sludge/stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 numerous large cystic lesions in the kidneys bilaterally,\nthe largest measuring 7.4 x 5.5 x 7.9 cm in the left interpolar kidney.  There\nis some high density at the periphery of some of these lesions for example the\nlower pole the left kidney (02:41) and at the interpolar region of the left\nkidney (02:36).  There is no hydronephrosis.  Contrast material seen within\nthe renal collecting system from prior CT examination with intravenous\niodinated contrast. There is some stranding with loss of fat planes posterior\naspect of the left kidney inferiorly.\n\nGASTROINTESTINAL: The stomach is unremarkable.  An enteric tube tip is located\nin the body of the stomach.  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. Portion the appendix is\nvisualized and is unremarkable.\n\nPELVIS: There is a 3.0 cm filling defect in the bladder adjacent to the foley\ncatheter balloon, possibly representing blood products, less likely to\nrepresent a mass.  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.  Ectatic infrarenal abdominal\naorta measures up to 2.6 cm in diameter.  Extensive atherosclerotic disease is\nnoted.\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. Filling defect within the bladder adjacent to the Foley catheter balloon\ncould represent blood products, less likely represent a mass.\n2. Numerous bilateral renal cysts measuring up to 7.9 cm.  There is some high\ndensity periphery of some of these lesions, potentially due to calcification\nand or adjacent hemorrhagic cysts.  Recommend comparison to prior imaging\nstudies if available.  Otherwise, follow-up contrast enhanced exam can be\nconsidered if clinically warranted.\n3. Perinephric stranding and fluid adjacent to the lower pole the left kidney,\npotentially due to a ruptured renal cyst.  No frank hematoma.\n4. No other acute process within the abdomen or pelvis within the limitations\nof a nonenhanced scan.\n5. Two subcentimeter hypodensities in the right hepatic lobe are incompletely\ncharacterized on this noncontrast examination but possibly represent cysts or\nbiliary hamartomas."
        },
        {
            "input": "LOWER 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 throughout consistent\nwith hepatic steatosis.  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 measures 4 mm in diameter, and\nis without significant surrounding inflammation to suggest appendicitis (2;\n55).\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\nseen.  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. No evidence of acute appendicitis.\n2. Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST:\n\nBibasilar linear atelectasis is mild.  There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  A small hypoenhancing focus along the falciform ligament in\nthe left hepatic lobe (04:26) is likely perfusion related.  Otherwise, the\nliver demonstrates homogenous attenuation throughout.  There is no evidence of\nsuspicious 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\nthickness and enhancement throughout.  Colon and rectum are within normal\nlimits.\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.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nAn 18 mm sclerotic focus in the left iliac bone (4:60) is indeterminate. \nOther punctate well-circumscribed sclerotic foci in the more inferior left\niliac bone (4:57, 55) may represent bone islands.  Abdominal and pelvic wall\nis within normal limits.",
            "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Indeterminate 18 mm sclerotic focus in the left iliac bone.\n\nRECOMMENDATIONS:    Nuclear medicine bone scan is recommended for further\ncharacterization of indeterminate 18 mm sclerotic focus in the left iliac\nbone."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 few scattered subcentimeter hypodensities in the in segment VII and\nVI too small to characterize on CT but statistically likely hamartoma or\nhepatic 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is bulky and heterogenous enhancing consistent\nwith a fibroid uterus.  Bilateral adnexae are within normal limits.  A corpus\nluteum is noted within 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.",
            "output": "No acute intra-abdominal process, specifically no evidence of diverticulitis\nor appendicitis."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusion with compressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSided geographic hypodensity along the falciform ligament, likely focal fatty\nsparing.  No worrisome hepatic lesion.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits. \nPortal hepatic veins are patent.\n\nPANCREAS: Pancreas is mildly atrophic.  There is a 1 cm hypoenhancing\nill-defined lesion the pancreatic tail (303:42) which was likely present in\n___.  The main pancreatic duct is not 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: There is atrophy with hypoenhancement and extensive calcification in\nthe left upper pole, unchanged compared to the exam from 2 days ago by\nprogressed since ___.  There is also scarring at the left lower pole. \nThere is no hydronephrosis bilaterally.  No solid enhancing lesion.  Bilateral\nperinephric stranding, unchanged compared to ___.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe sigmoid colon is noted there is minimal stranding and thickening of the\nsigmoid colon as it passes along the below described large hematoma.  There is\nno sign of diverticulitis.\n\nPELVIS: There is significant perivesicular stranding, new since the exam from\n2 days prior, likely reactive to the nearby hemorrhage.\n\nREPRODUCTIVE ORGANS: Prostate gland 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. \nGrade 1 retrolisthesis of L5 on S1.\n\nSOFT TISSUES: There is a 12.5 x 5.1 x 7.8 cm (craniocaudal, AP, transverse,)\nhematoma that extends along the left anterior abdominal wall from the level of\nthe pubic symphysis superiorly into the left rectus sheath.  Branches of the\ninferior epigastric artery seen coursing around it.  There are few hyperdense\nfoci which are not seen on the noncontrast study, concerning for active\nextravasation (303:147 and 145).  There is surrounding fat stranding.  There\nis overlying subcutaneous edema along the left anterolateral abdominal wall.",
            "output": "1. 13 x 5 x 8 cm left anterior abdominal wall hematoma extending from the\npubic symphysis superiorly into the left rectus sheath, new compared to the\nexam from 2 days prior and with findings concerning for active extravasation.\n2. Extensive prevesicular stranding, new since the exam from 2 days ago,\nlikely reactive.\n3. 1 cm hypoenhancing lesion the pancreatic tail, likely present in ___"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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.  There is wall\nthickening and hyperenhancement and several areas of the colon involving the\ncecum, descending colon, splenic flexure, and rectum, likely reflecting\ncolitis which may be inflammatory or infectious in etiology.  The appendix is\nnormal (series 602:37).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall pelvic free fluid, likely physiologic.\n\nREPRODUCTIVE ORGANS: An IUD is present 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": "1. Findings consistent with colitis which may be infectious or inflammatory.\n2. Appropriate positioning of the intrauterine device.\n\nNOTIFICATION:  The updated findings of colitis with a normal appearing\nappendix were discussed with ___, m.D. by ___, M.D. in\nperson on ___ at 10:17 am, 5 minutes after discovery of the updated\nfindings."
        },
        {
            "input": "LOWER CHEST: There is right greater than left basilar atelectasis.  No pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple patent metastases are re-demonstrated.  The largest in\nsegment II measures 4.8 cm, previously 4.3 cm.  Intra and extrahepatic biliary\ndilation is unchanged.  The gallbladder is within normal limits.  The main\nportal vein remains severely attenuated by this mass.\n\nPANCREAS: Mass obstructing the common bile duct in porta hepatis remains\nill-defined, measuring approximately 3.2 x 2.7 cm, previously 3.3 x 2.5 cm\n(02:29).  Ill-defined pancreatic tail mass measuring 2.4 x 2.2 cm is unchanged\n(02:30).  There is no peripancreatic stranding.  The main pancreatic duct is\nnot 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. \nThere is no evidence of focal renal lesions 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 trace\nascites.\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 abnormality is seen.\n\nLYMPH NODES: Unchanged left para-aortic lymph node measuring 15 mm (02:49). \nSimilar appearance of gastrohepatic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Enhancing mass in the right breast measuring 2.4 x 1.8 cm is\nnoted.  There also an enhancing mass in the left breast.  Correlation with\nmammography is required.  Subcutaneous injections are noted along the anterior\nabdominal wall.",
            "output": "1. No acute abdominopelvic abnormality.\n2. Hepatic metastases with stable biliary dilation related to a mass in the\nporta hepatis.  There is unchanged decreased caliber of the main portal vein.\n3. Stable pancreatic tail mass.\n4. Trace ascites.\n5. Bilateral breast masses.  Recommend correlation with prior mammography."
        },
        {
            "input": "Lung Bases: Within the right breast, there is a partially visualized\nmetastatic lesion measuring 2.3 x 1.9 cm, appears enlarged when compared with\nthe recent prior exam.  Mild atelectasis in the lower lungs, left greater than\nright.  Emphysema noted.  The heart appears within normal limits of size with\nPort-A-Cath tip terminating in the right atrium.\n\nAbdomen: Multiple metastatic lesions within the liver appear slightly\nincreased from recent prior exam concerning for short interval disease\nprogression.  The main portal vein appears patent.  The gallbladder appears\nnot fully distended with a small amount of adjacent free fluid. \nLymphadenopathy at the porta hepatis is again noted, increased in size from\nprior.  For example a lymph node near the gallbladder neck measures 2.1 cm in\nshort axis on series 601, image 42, previously 16 mm at a similar level. \nThere is resultant malignant biliary obstruction with moderate to severe\nintrahepatic biliary ductal dilation.  Pancreatic tail lesion is similar in\noverall size compared with recent prior.  Spleen is intact.  Adrenal glands\nappear normal.  The kidneys are intact and enhances normally.  The abdominal\naorta is normal in caliber and course with widely patent major branches and\nminimal atherosclerotic calcification.  Retroperitoneal lymphadenopathy is\nagain noted with a left para-aortic lymph node appearing grossly unchanged\nmeasuring 13 mm in short axis on series 2, image 80.\n\nThe stomach and duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  Small\nvolume free fluid tracks into the pelvis.  No hematocrit level is seen.  No\nfree air.  The appendix is normal.  The colon is unremarkable.  The uterus and\nadnexal regions are unremarkable.  Pelvic veins are somewhat prominent. \nUrinary bladder is only partially distended appearing normal.  No pelvic\nsidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1.  No acute sequelae of trauma.\n2.  Pancreatic tail lesion appears unchanged though there is slightly\nincreased size of hepatic metastasis and nodal metastasis at the porta\nhepatis, as well as a metastatic nodule within the inferior right breast.\n3.  Persistent intrahepatic biliary ductal dilation likely due to malignant\nobstruction at the level of the porta hepatis.\n4. Small volume free fluid appears simple."
        },
        {
            "input": "CHEST:  Wall thickening of the lower third of the esophagus is unchanged since\n___, correlation with endoscopic findings is recommended. \nParaesophageal lymph node is smaller since ___, measuring 1.4 x 0.9 cm\nwas 1.2 x 1.5 cm. There are no nodules at the lung bases. Please refer to\nseparate report of CT chest performed on the same day for description of the\nthoracic findings.\n\nABDOMEN:  All metastatic liver lesions are smaller since ___, for\nexample the largest lesion in segment III is 1.6 cm was 2.3 cm; dome of the\nliver 0.4 cm lesion dose 0.6 cm; segment ___ lesion is 0.8 cm was 1.1 cm;\nsegment V lesion is 0.4 x 0.9 cm was 0.8 x 1.1 cm. There is no evidence of new\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. The adrenals glands\nare unremarkable bilaterally.\n\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones or hydronephrosis.  Bilateral hypodensities ranging up\nto 1.4 cm are unchanged since ___ and compatible with simple cysts\n(4:64). Stable appearance of the gastrohepatic lymph nodes of 1.7 x 1.4 cm.\nStomach and small bowel are unremarkable. There is diverticulosis without\ndiverticulitis.\n\nThere is no evidence of retroperitoneal and mesenteric lymphadenopathy.\n\nThe abdominal aorta demonstrates severe atherosclerosis, with almost\ncircumferential calcification of the distal abdominal aorta.\n\nPELVIS:  The urinary bladder and distal ureters are unremarkable. Uterus and\nadnexa are unremarkable. External iliac chain lymph nodes are unchanged since\n___. There is no evidence inguinal lymphadenopathy. There is no free\nfluid or air into the abdomen.\n\nBONES AND SOFT TISSUES:  No bone lesions suspicious for malignancy or\ninfection. Mild degenerative changes of the lumbar spine are unchanged since\n___.",
            "output": "1. Interval size reduction of liver metastasis and paraesophageal lymph node\nsince ___.\n2. Stable size of the gastrohepatic lymph node and lower third esophageal wall\nthickening\n3. Unchanged bilateral kidney cysts.\n4. Diverticulosis without diverticulitis."
        },
        {
            "input": "ABDOMEN:\n\n\n\nThe low attenuation lesion within segment III of the liver now measures 1.5 x\n1.2 cm (4:67; previously 1.7 x 1.3 cm). The lesion within segment V of the\nliver now measures 1.3 x 1 cm (4:70; previously 1.3 x 0.8 cm).  The lesion in\nsegment VIII of the liver is no longer visible. There is also a 1.1 x 0.6 cm\ncystic lesion in segment ___ that is unchanged since previous and likely\nrepresents a cyst.  No new liver lesions.  The portal and hepatic veins are\npatent.  No intra or extrahepatic duct dilatation.  The gallbladder is\nunremarkable.\n\n\n\nThere are multiple hypodensities within both kidneys that are of intermediate\nattenuation and cannot be further characterized on this study - however ,they\nare unchanged in size and appearance since previous, with the largest\nmeasuring 1.5 cm in the upper pole of the left kidney (4:59).  There is a\nprominent column of Bertin within the interpolar region of the left kidney\nwhich is unchanged since ___. No hydronephrosis. The adrenals and spleen are\nunremarkable. There is a 7 mm cystic lesion within the neck of the pancreas\n(4:65) that is unchanged since ___ and likely represents a small IPMN (4:65).\nCough the pancreas is otherwise unremarkable.\n\n\n\nThere is diffuse thickening of the distal esophagus which appears unchanged\nsince previous and is consistent with the known esophageal malignancy. There\nis a 1.7 x 1.1 cm paraesophageal lymph node within the posterior mediastinum\nthat is unchanged since previous (4:43). There is also a 2.1 x 1.6 cm\ngastrohepatic lymph node which is also unchanged (4:54). No new adenopathy is\nidentified the abdomen or pelvis.\n\n\n\nColonic diverticulosis is noted which is most marked within the sigmoid colon.\nNo evidence of diverticulitis. The large bowel is otherwise unremarkable. The\nsmall bowel is within normal limits. A moderate amount of calcified\natheromatous plaque is noted within the abdominal aorta and both common iliac\narteries. The abdominal aorta is of normal caliber.\n\n\n\nPlease see the chest CT report for details of the chest.\n\n\n\nPELVIS:\n\n\n\nThe bladder is within normal limits. The uterus is unremarkable. No pelvic\nadenopathy. Note is made of a 2.6 x 1.2 cm subcutaneous cystic lesion within\nthe subcutaneous fat of the right lower back that likely represents a\nsebaceous cyst.\n\n\n\nOSSEOUS STRUCTURES:\n\n\n\nMultilevel degenerative changes are noted throughout the lumbar spine which\nare most marked from L3-S1. Severe degenerative change is noted at both\nsacroiliac joints. No concerning sclerotic or lytic lesions are identified\nwithin the abdomen or pelvis.",
            "output": "1.  Overall stable disease with minimal decrease in size of segment III liver\nmetastasis, stable segment V liver metastasis and stable paraesophageal and\ngastrohepatic lymph nodes.  The segment VIII liver lesion is no longer\nidentified. The segment ___ lesion appears to represent a cyst.  Unchanged\ndiffuse thickening of the distal esophagus.\n\n\n\n2. Multiple stable hypodensities within both kidneys that are of intermediate\ndensity and possibly represent hyperdense cysts.\n\n\n\n3. Stable 7 mm cystic lesion within the neck of the pancreas that is unchanged\nsince ___ and likely represents an IPMN.\n\n\n\n4. Colonic diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: There is left lower lobe atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous enhancement.  There is a 1.0\ncm hypodense lesion in segment VI, too small to characterize but likely\nrepresents a biliary hamartoma or cyst (2; 32).  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 mild bilateral cortical scarring left greater than right\nwith malrotation of the left kidney.  There are indeterminate bilateral\nhypodense lesions measuring up to 1.5 cm in the left kidney 1.8 cm in the\nright kidney with ___ of 35, (2; 62, 50).  There is no hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is concern for gastric volvulus through the left\ndiaphragmatic hernia with the antrum located superior to the gastroesophageal\njunction.  The gastric fundus is located below the left diaphragm.  There is\npossible hyperemia of the mucosa of the stomach.  No free fluid or free air is\nidentified.  There is a loop of small bowel, likely the jejunum, which is also\nwithin the left diaphragmatic hernia with 2 transition points at the level of\nthe hernia concerning for closed loop obstruction (601; 37, 39). \nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or 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.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 2.0 cm L1 vertebral body hemangioma (602; 43).\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. Left diaphragmatic hernia with concern for gastric volvulus as well as a\nclosed loop small bowel obstruction involving a loop of jejunum within the\nhernia.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. Indeterminate bilateral renal lesions.  Recommend nonurgent renal MRI.\n\n\nRECOMMENDATION(S):   MRI renal\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 12:50 pm, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST:  There is a peripheral opacity in the posterior left lower lobe\n(8:5) that is similar in appearance compared to the prior CT performed 1 day\nearlier.  This is new from ___, and could represent atelectasis or\ninfection in the appropriate clinical setting.  No pleural effusions.  Heart\nsize is normal, without pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  There is a dominant 2.0 x 2.1 cm hypodense lesion in the\nhepatic dome (8:6) that is new from the CT chest dated ___.  Several\nadditional sub-cm hypodensities are noted, predominantly in the right lobe of\nthe liver (Se 8:  Im 10, 11, 12, 21).  These are new from the prior CT on ___, and highly concerning for metastases. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  There is vicarious excretion\nof contrast.  Gallbladder is otherwise within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 x 1.1 cm simple cyst arises from the lower pole of the left kidney\n(8:39).  There is a 5 mm stone in the lower pole of the left kidney (3:37). \nNo nephrolithiasis on the right.  No enhancing parenchymal masses.  No\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube terminates within the\nstomach.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  The colon and rectum are within normal limits. \nNormal appendix.  No free fluid or free air within the peritoneal cavity.\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 are moderate to severe multilevel degenerative changes throughout the\nthoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Several new hepatic hypodense lesions, the largest measuring up to 2.0 x\n2.1 cm in the hepatic dome.  Given interval development and known underlying\nmalignancy, these are concerning for metastases.\n2. No other findings concerning for metastatic disease within the abdomen or\npelvis.\n3. Non-obstructing 5 mm left lower pole renal stone.\n4. Posterior left lower lobe opacity unchanged from 1 day earlier."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. \nNo hydronephrosis.  Multiple hypodense lesions, too small to further\ncharacterize, but statistically cysts are seen bilaterally.  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 noted in the right lower\nquadrant.\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, compatible with\nknown fibroid uterus, better characterized on same-day ultrasound dated ___.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 in the abdomen or pelvis to explain patient's symptoms.\n2. The appendix is not visualized; however, there are no secondary signs of\nacute appendicitis noted in the right lower quadrant.\n3. The uterus is enlarged and heterogeneous, compatible with fibroid uterus,\nbetter characterized on same-day pelvic ultrasound."
        },
        {
            "input": "VASCULAR:\n\nThere is redemonstration of an infrarenal aortic aneurysm status post EVAR\nwith the aneurysmal sac measuring 5.1 x 4.4 cm, located superior to the iliac\nartery bifurcation, similar to the prior study in ___.  Moderate\natherosclerotic disease is seen along the vasculature.  There is no evidence\nof endoleak.\n\nThe proper hepatic artery is completely replaced off the SMA.\n\n POST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 4.5 x 5.1 cm\nVolume:\n\n1. Aneurysm: 76 ml\n2. Renal to Aortic bifurcation: 123.7 ml\n3. Renal to Iliac bifurcation: 150.3 ml\nENDOLEAK: no\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 1.5 cm\nLength distal graft to iliac bifurcation:  Right: 13.9 cm; Left: 17.2 cm\n\n\nLOWER CHEST: Linear atelectasis seen in the left lung base.  Atherosclerotic\ncalcifications are seen in the coronary arteries.  There is no pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\ncompatible with hepatic steatosis.  Multiple subcentimeter hypodensities are\nseen scattered throughout the liver, the largest measuring up to 9 mm, too\nsmall to fully characterize but likely represent hepatic cysts or biliary\nhamartomas.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is contains\nstones, without evidence of gallbladder wall thickening or pericholecystic\nfluid.\n\nPANCREAS: The 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 accessory spleen is incidentally seen.  Normal\nsize and 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 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.  Colonic diverticulosis is noted without evidence\nof acute diverticulitis.  Otherwise, the remaining visualized colon and rectum\nare within normal limits.  Appendix is not visualized.  There is no evidence\nof mesenteric 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: The prostate is unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a large ventral hernia containing fat, small and large\nbowel, and stomach.  Edema and inflammatory changes are seen in the left groin\nregion, likely due to recent procedural sequela.",
            "output": "1. Interval placement of an EVAR for a 5.1 x 4.4 cm infrarenal aortic aneurysm\nwithout evidence of endoleak compared to the prior study in ___\nwith measurements detailed in the findings section above.\n2. Large ventral hernia containing fat, small and large bowel, and stomach is\nunchanged since the prior study.\n3. Colonic diverticulosis without evidence of acute diverticulitis.\n4. Hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: Minimal bilateral dependent atelectasis is seen.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are patchy areas of hypodensity in the liver, which could\nrelate to fatty infiltration.  The portal vein appears patent.  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is relatively collapsed.  No bowel obstruction is\nseen.  There is colonic diverticulosis.  At the proximal sigmoid colon there\nis an inflamed diverticulum, focal wall thickening of the colon and adjacent\nfat stranding/inflammatory change.  No drainable fluid collection or\nextraluminal gas is seen.  The appendix is not well 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 enlarged and contains multiple fibroids. \nLargest fibroid or rises subserosal from the uterine fundus, and measures\napproximately 7.7 x 6.6 cm on coronal series 601, image 18.\n\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 loss of height of the T10 vertebral body superior endplate.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Proximal sigmoid colon acute diverticulitis.  No drainable fluid collection\nor extraluminal gas.\n2. Large fibroid uterus, with largest fibroid measuring approximately 7.7 x\n6.6 cm arising subserosal from the uterine fundus.  Multiple additional\nfibroids."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis with possible scarring.\n\nABDOMEN:\n\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 likely due\nto iatrogenic volume resuscitation.  Calcified gallstones are seen within the\ngallbladder.  The gallbladder wall is normal.  There is no pericholecystic\nfluid.\n\nPANCREAS:  There is a 9mm hypodense lesion in the pancreatic tail that was not\ndefinitively identified on prior examination (601b: 28).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  Again seen is a bilobed right adrenal lesion, unchanged since prior\nand consistent with an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size.  The a nephrogram\nbilaterally delayed, more so on the right in comparison to the left.  There is\nmoderate hydroureteronephrosis on the right.  A 4 mm right mid ureteral\ncalculus is noted.  There is mild proximal the urothelial enhancement.  In\naddition, there is slight prominence of thickening of the urothelium at the\nlevel of the stone (02:44).  Moderate right perinephric fat stranding present.\nNumerous, the subcentimeter, bilateral hypodense lesions are identified, which\nare too small to characterize but most likely representing simple cysts.  The\nlarger hypodense lesion is noted in the upper pole of the left kidney\nmeasuring 1 x 1.4 cm, likely a simple cyst.\n\nGASTROINTESTINAL:  Again noted is small to moderate free fluid in the abdomen\nand pelvis which had been present on prior.  The stomach is unremarkable. \nSmall bowel 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 reproductive organs are unremarkable.\n\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 origins of the celiac, superior mesenteric, and\ninferior mesenteric as well as renal arteries are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe patient has undergone prior right hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Obstructive 4 mm right ureteral stone with right perinephric fat stranding\nand mild urothelial enhancement.  Focal more prominent thickening and\nenhancement of the right ureter at the level of the stone, potentially related\nto inflammatory changes from the calculus however underline urothelial lesion\nis not entirely excluded.\n2. Free fluid in the abdomen and pelvis, uncertain etiology but had been\npresent on prior exam.\n3. 9mm cystic lesion in the pancreatic tail.  Follow-up with MRI in 6 months\nis recommended.\n4. Cholelithiasis.\n\nRECOMMENDATION(S):  Urine cytology suggested and followup imaging (CT or MR\nurogram) suggested to exclude underlying urothelial mass lesion.\n\nNOTIFICATION:  Updated wet read discussed with Dr. ___ by Dr. ___ at\n19:00 on ___."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Trace\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 no evidence of focal renal lesions 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 5 mm benign-appearing calcification in the\nposterior prostate.  The visualized reproductive organs 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. 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 cause found for patient's right lower quadrant pain symptoms.\n2. Benign-appearing prostatic calcifications."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Nonspecific\nfecalized material is seen in several loops of small bowel.  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 significant\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral spondylolysis of L5 is noted without spondylolisthesis.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia is noted.  The abdominal\nand pelvic wall is otherwise within normal limits.",
            "output": "No findings to explain patient'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 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 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. 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is\ndiverticulosis of the sigmoid colon with focal wall thickening of the sigmoid\ncolon and adjacent mesenteric fat stranding.  Multiple extraluminal locules of\ngas are seen adjacent to the sigmoid colon, likely sequelae of micro\nperforation.  No organizing mesenteric fluid collection or evidence of\nabscess..  The appendix is normal.  There is no evidence of mesenteric injury.\n\nThere is no free fluid or free air in the abdomen.\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 or retroperitoneal hematoma. \nNo atherosclerotic disease is noted.",
            "output": "Acute sigmoid diverticulitis with minimal adjacent extraluminal air.  No\norganizing mesenteric fluid collection or abscess."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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. Wall thickening of\na short segment of sigmoid colon in a region of diverticula with stranding of\nthe mesentery has worsened when compared to the prior CT scan from ___ (2: 67).  Several small foci of extraluminal air are redemonstrated, and\ncompatible with microperforation (2: 59, 61).  While there is no organized\nfluid collection, there has been interval development of an area of phlegmon\nand small volume fluid measuring 1.9 x 2.2 cm (2:63).  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 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.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Worsening sigmoid diverticulitis with increased inflammation including\ninterval development of a small amount of pericolonic phlegmonous change and\nfluid measuring 1.9 x 2.2 cm.  No organized or drainable fluid collection. \nRedemonstration of small extraluminal foci of air adjacent to the sigmoid\ncolon compatible with microperforation.\n2. Small fat containing umbilical hernia is incidentally noted."
        },
        {
            "input": "LOWER CHEST: There is minimal atelectasis at the left lung base.  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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:\nThere is a rectal tube and contrast visualized within the rectum extending\nthrough the transverse colon.  Redemonstrated wall thickening of a short\nsegment of sigmoid colon in the region of diverticula with surrounding\nstranding, similar in appearance compared to CT scan from ___. \nSeveral small foci of extraluminal air are redemonstrated, consistent with\nmicroperforation are mildly increased compared to prior (series 5, images 63\nand 64).  There is no contrast leak.  Stable phlegmon superior to the sigmoid\ncolon (series 7, image 19).  No evidence for drainable fluid collection.  No\nevidence for fistula to the bladder.\n\nThere is a small hiatal hernia.  The stomach is unremarkable.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe 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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is transitional lumbosacral anatomy with partial lumbarization of\nS1.  No acute fracture or suspicious osseous lesion is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Sigmoid diverticulitis with unchanged adjacent phlegmon but slightly\nincreased foci of free air, compatible with microperforation. No drainable\nfluid collection.\n2.  No rectal contrast leak .\n3.  The inflammatory changes extend to the dome of the bladder but there is no\nspecific evidence of a colovesical fistula."
        },
        {
            "input": "LOWER CHEST: There is a small left pleural effusion with overlying\natelectasis.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is moderate extrahepatic biliary\nductal dilatation, decreased in extent since prior.  The common bile duct\nmeasures up to 7.5 mm.  No intrahepatic biliary ductal dilatation.  The\ngallbladder surgically absent\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Mild dilatation of the main pancreatic duct is again\ndemonstrated.  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 worrisome renal lesions or hydronephrosis.  There is a\nright lower pole cyst measuring up to 2.2 cm.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The tip of an enteric tube\nextends into the stomach.  The bowel is again noted to be malrotated.  The\npatient is status post right hemicolectomy and sigmoidectomy.  The amount\nanastomoses are patent.  No evidence of extraluminal contrast or contained\nfluid collection.  A small amount of pneumoperitoneum is present, presumed to\nbe postsurgical in nature.  A right lower quadrant approach drainage catheter\nis present, the tip extending to the left pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs 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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere right iliac and sacral bone islands.\n\nSOFT TISSUES: Postsurgical changes are noted at midline.  Skin staples remain\npresent.",
            "output": "1. No evidence of an anastomotic leak or stenosis.\n2. A small amount of pneumoperitoneum is presumed to be postsurgical.\n3. No focal fluid collection.\n4. Small left pleural effusion with subjacent atelectasis."
        },
        {
            "input": "LOWER CHEST: There is a 3 mm left lower lobe pulmonary nodule (02:22). \nVisualized lung fields are otherwise within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nSubcentimeter hypodensity in segment two is incompletely characterized though\nis present on prior.  There is no evidence of new 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: Patient is status post left nephrectomy.  There is mild right\nhydroureteronephrosis secondary to a 3 mm calculus at the ureterovesicular\njunction.  Mild right-sided perinephric stranding.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Again seen is a linear\nradiopaque structure adjacent to the duodenum as on prior, likely strut from\nIVC filter.  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.  Left pelvic sidewall surgical clips are noted.\n\nREPRODUCTIVE ORGANS: Included portion of the prostate 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.  Filter noted within the\ninfrarenal IVC in similar configuration compared to 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. Obstructing 3 mm calculus at the right ureterovesicular junction with mild\nupstream hydroureteronephrosis.\n2. A 3 mm left lower lobe pulmonary nodule.\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": "Left femoral neck fracture with a cannulated and dynamic hip screw in place.\n\nThere is a diffusely mottled appearance of the bones.\n\nSmall pelvic hematoma, likely due to postsurgical changes is noted.  There is\nasymmetric enlargement of the left iliacus muscle.  There is no hematocrit\nlevel identified.  There is expected air and fluid/hematoma noted within the\nleft quadriceps muscles.  Very mild subcutaneous edema seen along the incision\nline of the lateral left thigh.\n\nExamination was not done with contrast, and thus active extravasation cannot\nbe assessed for.  There is no definite evidence of significant hematoma or\nbleeding however.\n\nNo other significant finding in the soft tissue or bony structures of the\npelvis and bilateral thighs.",
            "output": "Expected postsurgical changes.  Of note, the lack of IV contrast does not\nallow us to completely rule out active extravasation.\n\nDiffusely mottled appearance of the bones, unexpected given the patient's age.\nCorrelate clinically with any history of chronic disease or marrow replacing\nprocess."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There are minimal atherosclerotic\ncalcifications of the infrarenal abdominal aorta.  Major mesenteric vessels\nare normal in caliber and patent.\n\nLOWER CHEST: Visualized lung bases are clear.  There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nhepatic parenchyma is hypoattenuating relative the spleen, suggestive of\nhepatic steatosis.  There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis is resected.\n\nPANCREAS: There is moderate diffuse atrophy of the pancreas.  There is no\nfocal pancreatic lesion or main ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen is normal in size.  The spleen demonstrates multiple\nnonspecific subcentimeter hypodense lesions, grossly similar compared to CT of\nthe abdomen/pelvis from ___, likely hemangiomas or other benign\nvascular lesions.\n\nADRENALS: The right and left adrenal glands 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\nis a 10 mm cyst in the upper pole of the right kidney and a few other tiny\ncortical hypodensities bilaterally which are too small to characterize. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops are normal\nin caliber.  There is descending and sigmoid colonic diverticulosis.  There\nare innumerable small locules of free air scattered throughout the abdomen. \nThe source is likely perforated sigmoid diverticulitis given the presence of\nlocules of gas in the region of the left adnexa, mild fat stranding of the\nadjacent sigmoid colon (series 3, images 133-134), and a small amount of\ncomplex free fluid in the pelvis.  The appendix is normal.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is only minimally fluid-filled and grossly\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is a small amount of complex free fluid in the pelvis.  There is no\norganized fluid collection.\n\nREPRODUCTIVE ORGANS: Fibroid uterus, unchanged.  The right adnexa is\nunremarkable.  There are inflammatory changes about the left adnexa, as above.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel degenerative changes of the lumbar spine with slight\nretrolisthesis of L3-L4 and L5-S1, likely degenerative.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Innumerable small locules of free air scattered throughout the abdomen\n(overall small volume pneumoperitoneum).  The source is likely perforated\nsigmoid diverticulitis given the presence of locules of gas in the region of\nthe left adnexa, mild fat stranding of the adjacent sigmoid colon, and a small\namount of complex free fluid in the pelvis.  No organized fluid collection.\n\nRECOMMENDATION(S):  Surgical consultation is recommended.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___ the surgery\nservice, by ___, M.D. in person on ___ at 12:30\nam, 1 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is very trace pleural effusion with dependent atelectasis\nwhich is new.\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: There is fatty infiltration of the pancreas.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size.  Multiple hypoattenuating lesions are\nagain identified which appear stable from ___, likely\nhemangiomas.\n\nADRENALS: The right and 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 hypoattenuating focus along the upper pole right kidney,\nlikely reflecting a cyst.  Additional smaller too small to characterize\nhypoattenuating foci are seen.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is\nredemonstration of sigmoid diverticulitis with interval development of a rim\nenhancing fluid collection containing gas in the left hemipelvis measuring 3.9\nx 5.4 x 4.2 cm in greatest transverse by AP by craniocaudal ___\ncompatible with abscess best seen on image is 71 series 2 pound image 43 and\nseries 602.    There is additional smaller rim enhancing fluid collection in\nthe right hemipelvis measuring 3.8 x 1.4 x 1.5 cm in greatest AP by transverse\nby craniocaudal ___ best seen on image 71 series 2 and image 35 series\n602.  These are likely to intercommunicate.\n\nOverall quantity of distant pneumoperitoneum is probably unchanged although it\nis redistributed and is now mostly beneath the right hemidiaphragm.  There is\nno evidence of bowel obstruction. The appendix is fluid-filled and prominent\nmeasuring up to 8 mm in greatest diameter, however stable in size from CT\ndated ___.    No secondary signs of appendicitis including no\nsignificant periappendiceal inflammatory changes or appendiceal wall\nthickening.  This seems secondary to what is more generally prominent Fluid\ncontent extending from the cecum through transverse:.\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 multilevel degenerative changes of spine with multilevel vacuum\ndisc phenomenon, including degenerative retrolisthesis of L3 onto L4 and L5 in\nrelation to S1. moderate spinal stenosis from L2-L3 through L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Complicated sigmoid diverticulitis with interval development of two\nperisigmoid abscesses measuring 3.9 x 5.4 x 4.2 cm in the left and 3.8 x 1.4 x\n1.5 cm on right although these likely intra communicate.  Increased air in\nthese confine collections, although the amount of distant free air is probably\nunchanged, although redistributed."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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\nintrahepatic biliary ducts likely related to prior 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 solid renal lesions or hydronephrosis.  A 9 mm\nhypodensity is seen arising from the upper pole the right kidney, likely a\nsimple cyst.  Additional punctate hypodensities are too small to characterize\nlikely also 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. There is wall\nthickening of the sigmoid colon surrounding diverticula.  There is surrounding\nfat stranding and engorgement of the Vasa recta.  The inflamed loop of bowel\nabuts the posterior wall of the uterus.  There is no drainable fluid\ncollection.  There is no free air.  The 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.  The left ovary is\ntethered likely from prior inflammation.  A small amount of free fluid is seen\naround 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: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Uncomplicated sigmoid diverticulitis.  No free air or 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: The liver 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.  There is sigmoid\ncolonic diverticulosis, with an area of adjacent fat stranding and wall\nthickening in the left lower quadrant, compatible with acute diverticulitis\n(601b:31, 2:61).  No evidence of free intraperitoneal air or drainable fluid\ncollection.  Hyperdense material is identified in the appendix, spanning\napproximately 1 cm (02:54).  This may be an appendicolith.  The proximal\nappendix is air-filled.  The distal tip of the appendix measures approximately\n7-8 mm in diameter (02:55).  There is no significant adjacent 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: 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 grade 1 retrolisthesis of L3 on L4, with mild moderate lumbar spinal\ndegenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Sigmoid diverticulosis with adjacent fat stranding and wall thickening in\nthe left lower quadrant compatible with acute diverticulitis.  No evidence of\nfree intraperitoneal air or drainable fluid collection.\n\n2.  Hyperdense material in the appendix spans approximately 1 cm and is likely\nan appendicolith.  The proximal appendix is normal in caliber an air-filled,\nwhile the distal tip of the appendix measures approximately 7-8 mm in\ndiameter.  There is no significant adjacent fat stranding.  While acute\nappendicitis is not entirely excluded, this is felt to be unlikely, given the\nlack of fat stranding and extensive findings of sigmoid diverticulitis.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 15:21 on ___, 2 min after discovery."
        },
        {
            "input": "VASCULAR:\n\nThere is moderate diffuse atherosclerotic calcification of the abdominal aorta\nwithout aneurysmal dilatation.  There is <50% narrowing of the takeoffs of the\nceliac artery and SMA secondary to atherosclerotic plaque.  The ___ is patent.\nThere is also atherosclerotic plaque involving the ostia of both renal\narteries with mild-to-moderate narrowing bilaterally.\n\nThere is no evidence of active extravasation of intravenous contrast to\nindicate acute bleed.\n\nThere is an IVC filter with tip at the L2 level.  Again seen is extensive\nvenous thrombosis involving the IVC below the filter, pelvic and femoral\nveins, with no significant change in clot burden compared to the prior CT from\n___.  There is additional middle filter in the right paraspinal soft\ntissues, also present on prior.  The\n\nLOWER CHEST: There is a small right pleural effusion with associated\ncompressive atelectasis.  Again seen is partially seen elevated left\nhemidiaphragm, with intrathoracic herniation of the mesenteric fat, containing\nthe stomach, transverse colon, and a small portion of the pancreatic body,\nunchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in size and smooth in contour.  Hypodensity\nadjacent to the falciform ligament is compatible with fatty sparing.  A 5 mm\nhypoattenuating focus in segment VI (series 3B, image 236) is too small to\ncharacterize, but remains unchanged and statistically likely represents a cyst\nor biliary hamartoma.  There is no suspicious hepatic lesion.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis surgically absent.  A 1.5 x 1.2 cm fluid density focus in the gallbladder\nfossa adjacent to the surgical clips may represent a small gallbladder remnant\nor chronic postoperative collection.\n\nPANCREAS: There is mild diffuse fatty atrophy of the pancreas.  There is a 1.3\nx 1.0 cm cystic lesion in the pancreatic head (series 3B, image 238),\nunchanged and likely representing a side-branch IPMN.  There is no main ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size and attenuation.  No focal lesion is\ndetected.\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.\nNo renal stones are seen.  There are a few small bilateral renal cysts. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement. Colon and rectum are within normal limits.\n\nLYMPH NODES: There is no mesenteric or retroperitoneal lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\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 ovaries are unremarkable.\n\nBONES: No suspicious osseous lesion is identified.  A 1.6 x 1.6 cm lesion in\nthe left lateral aspect of the L3 vertebral body with coarsened trabecula is\nmost compatible with a hemangioma.\n\nSOFT TISSUES: Again seen is expansion of the left iliopsoas secondary to most\nlikely subacute intramuscular hematoma, which demonstrates mild peripheral\nenhancement, also present on prior.  There is no adjacent soft tissue\ninfiltration of stranding ___ just infection.  Measuring up to 3.1 x 2.5\ncm in axial dimension, unchanged from prior.  There is no evidence of active\nextravasation of contrast into the hematoma.  There is diffuse anasarca of the\nbody wall.  Again seen is right lower abdominal wall subcutaneous nodule\nmeasuring 1.6 cm.",
            "output": "1. Redemonstration of expansion of the left iliopsoas most likely from\nsubacute intramuscular hematoma, measuring up to 3.1 x 2.5 cm in axial\ndimension, unchanged from prior. No evidence of active extravasation or new\nhemorrhage.\n2. No new abdominopelvic hematoma.\n3. Extensive venous thrombosis involving the infrarenal IVC (with an IVC\nfilter in place), pelvic and femoral veins, with no interval change in clot\nburden.\n4. Other unchanged findings as above, including a 1.3 cm probable side-branch\nIPMN in the pancreatic head, markedly elevated left hemidiaphragm with\nintrathoracic herniation of mesenteric fat and viscera, and small right\npleural effusion with associated compressive atelectasis."
        },
        {
            "input": "ABDOMEN:\n\nThere is a duplex collecting system within the right kidney with the 2 ureters\njoining proximally.  There is longstanding obstruction of the upper pole\nmoiety with severe thinning of the cortex. Within the lower pole moiety, there\nis moderate hydronephrosis. There is also right-sided hydroureter with two\nobstructing calculi identified within the mid ureter measuring 9 mm and 4 mm\n(601b:35). There is perinephric fat stranding on the right which has increased\nsince the previous PET-CT. The calculi that were identified within the lower\npole of the right kidney and in the proximal ureter on the previous PET-CT are\nno longer identified. There is a punctate non-obstructing calculus within the\ninterpolar region of the left kidney (2:38). There is a 1.6 cm simple cyst\nwithin the lower pole of the left kidney. The left kidney is otherwise\nunremarkable. No left-sided hydronephrosis or hydroureter. Multiple bladder\ndiverticula are noted, with the largest arising from the anterior bladder\nmeasuring 2.2 cm (2:82). The bladder is otherwise unremarkable.\n\nThe liver is unremarkable on this non-contrast examination. No intra or\nextrahepatic duct dilatation.  The gallbladder is unremarkable.  The adrenals\nand spleen are within normal limits.  The pancreas is atrophic but is\notherwise unremarkable.  An accessory spleen is noted at the tail of the\npancreas.\n\nScattered diverticula are noted within the ascending colon. The large bowel is\notherwise unremarkable. The appendix is normal. The small bowel is within\nnormal limits.  There is a small sliding hiatus hernia.\n\nNo mesenteric or retroperitoneal adenopathy.  The abdominal aorta is of normal\ncaliber.\n\nThere are small bilateral non-hemorrhagic pleural effusions with associated\ncompressive atelectasis within both lower lobes.  There is a trace pericardial\neffusion. The visualized portion of the heart and pericardium is otherwise\nunremarkable. Note is made of bilateral gynecomastia.\n\nPELVIS:\n\nAs described above, there are multiple bladder diverticula.  The bladder is\notherwise unremarkable. The prostate gland is enlarged measuring 5.2 x 5.6 x\n3.8 cm, yielding a calculated volume of 58 cc.  Punctate calcifications are\nnoted within the prostate gland.  The seminal vesicles are unremarkable. \nMultiple surgical clips are noted within the suprapubic region. No pelvic\nadenopathy.\n\nOSSEOUS STRUCTURES:\n\nA hemangioma is noted within L1 vertebral body.  The osseous structures of the\nabdomen and pelvis are otherwise unremarkable.",
            "output": "1.  Two obstructing calculi within the mid right ureter with moderate right\nhydroureter and hydronephrosis within the lower pole moiety of the duplex\nright collecting system. These findings have worsened since the previous\nstudy.\n\n2. Long-standing obstruction of the upper pole moiety of the right duplex\ncollecting system with severe thinning of the cortex in the upper pole.\n\n3. Punctate non-obstructing calculus within the interpolar region of the left\nkidney.\n\n4.  Small bilateral pleural effusions.\n\n5.  Multiple bladder diverticula.\n\n6.  Enlarged prostate gland."
        },
        {
            "input": "GASTROINTESTINAL: Patient is status post sigmoid colectomy and anastomosis.  A\nright lower quadrant ileostomy is noted.  The previous percutaneous drain has\nbeen removed.  Interval placement of a JP drain is noted in the right\nhemipelvis.  No discrete fluid collection is seen. Multiple locules of air are\nnoted in this region compatible with postoperative changes.\n\nPELVIS: No discrete fluid collection is seen however multiple locules of air\nare noted in the pelvis compatible with postoperative changes. The urinary\nbladder contains multiple foci of air compatible with foley catheterization. \nNo findings of colovesical fistula.\n\nLYMPH NODES: There is no pelvic lymphadenopathy.\n\nBONES: No aggressive bone lesions.\n\nSOFT TISSUES:  Right lower quadrant ileostomy as noted above.",
            "output": "Postoperative changes in the pelvis.  No findings of colovesical fistula.  No\ndrainable collections 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: The liver demonstrates heterogenous attenuation due to the\npresence of multiple confluent hypoenhancing lesions throughout the liver, \nthe largest conglomerate measuring approximately 11.8 x 7.2 cm (series 2,\nimage 82).  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.  In the splenic hilum, there is a 1.6 cm 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 with normal nephrogram. \nThere is no evidence of solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  Mild concentric\nbladder wall thickening may be due to incomplete distension.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin 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: There are multiple prominently enlarged upper abdominal and\nretroperitoneal lymph nodes including but not limited to portocaval 18 mm,\naortocaval  15mm and 12 mm,  8 mm lower paraesophageal node (series 2, image\n76), 8 mm gastrohepatic lymph node (series 2, image 86) 11 mm gastrohepatic\nlymph node (series 2, image 97), 10 mm periaortic lymph node (series 2, image\n101).  No pelvic or inguinal lymphadenopathy by size criteria.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Multiple coalescent hypoenhancing ill-defined hepatic lesions and enlarged\nupper abdominal and retroperitoneal lymphadenopathy, concerning for metastatic\ndisease without a discrete primary identified in the abdomen or pelvis.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Please see separate same day CT chest report for description of the\nintrathoracic findings.\n\nRECOMMENDATION(S):  Recommend ultrasound-guided liver tissue sampling and\noncology consultation.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:38 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:  Evaluation is limited due to relative paucity of ___\nfat.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 4.4 x 3.7 x 4.7 cm 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 atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Even with p.o. contrast, evaluation of the right lower quadrant is limited\ndue to paucity of ___ fat.  Within this limitation, no secondary\ninflammatory findings in the right lower quadrant.\n\n2.  4.7 cm right adnexal cystic structure, which is likely physiologic in a\npatient of this age.  However, if clinically warranted, nonemergent pelvic\nultrasound could be obtained.\n\nNOTIFICATION:  These findings and recommendations were communicated via\ntelephone by Dr. ___ to Dr. ___ at 05:57 on ___, immediately\nafter discovery."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. Aneurysmal dilatation of to 2.7 cm is\nagain noted involving the right common iliac artery. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  An infrarenal IVC\nfilter has been placed over the interval.  Filling defects are seen within the\nbilateral common femoral veins, consistent with known deep vein thrombosis.\n\nLOWER CHEST:  Again seen are filling defects within lobar, segmental, and\nsubsegmental pulmonary arteries, consistent with the patient's history of\npulmonary emboli.  There is a small right and trace left pleural effusion with\nadjacent volume loss.  The heart is not enlarged.  There has been interval\ndevelopment of a moderate-sized simple pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Centered in segment 4 is the known heterogeneous mass with\nill-defined borders, which appears grossly unchanged in size as compared to ___.  Again, this appears inseparable from the gallbladder wall,\nwhich is indented due to the mass effect from the surrounding tumor.  Portions\nof the mass are nonenhancing, suggesting the presence of necrosis.  There is\nongoing associated capsular irregularity.  Innumerable satellite lesions are\nagain seen throughout the liver.  There is mild bilateral intrahepatic biliary\nductal dilatation.  The known short segment hepatic vein thrombus is stable. \nThe portal veins are patent.  As before, there are numerous enlarged\nperiportal, retroperitoneal, retrocrural, and mesenteric lymph nodes.  There\nis a small amount of nonhemorrhagic perihepatic ascites.  A gallstone is\npresent within the gallbladder.  Nodularity and stranding is again seen within\nthe omentum surrounding segment 4.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Note is made of 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 cyst in the left kidney is unchanged.  Again seen is a punctate\nnonobstructing stone in the interpolar region of the right kidney.  There is\nno 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.  There is colonic diverticulosis.  Appendix\ncontains air, has normal caliber without evidence of fat stranding.  No\nevidence of intraperitoneal or retroperitoneal hemorrhage.\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: There 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 intraperitoneal or retroperitoneal hemorrhage.\n2. Again seen are central, lobar,  segmental and subsegmental pulmonary\nemboli.  Filling defects in the bilateral common femoral veins are consistent\nwith the patient's known deep vein thrombosis.  There has been interval\nplacement of a infrarenal IVC filter.\n3. Grossly unchanged appearance of the dominant mass in hepatic segment 4,\nwith evidence of extensive metastatic disease, including innumerable hepatic\nsatellite lesions, omental/extrahepatic nodules, and lymphadenopathy.\n4. Trace intra-abdominal simple ascites.\n5. Interval development of a moderate sized simple pericardial 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: The liver demonstrates homogenous attenuation throughout.  An\n18 mm cyst in segment ___ and ___ hypodensities too small to\ncharacterize are unchanged compared to prior CT from ___.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: There is mild fatty atrophy of the pancreatic body.  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 adrenal gland is normal in size and shape.  Stable 13 mm\nleft adrenal adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nNo hydronephrosis.  Stable left renal hypodensities, likely cysts.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Status post distal gastrectomy with gastrojejunostomy for\ngastric adenocarcinoma.  No evidence of recurrence.  Small bowel loops are\nnormal in caliber.  The colon and rectum are unremarkable. 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 left ovary is unremarkable.  Fibroid uterus.  There\nis a 2.9 cm cystic lesion in the right adnexa, unchanged from prior CT and\npreviously evaluate on pelvic ultrasound 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes involving the spine and hips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post distal gastrectomy, without evidence of local recurrence or\ndistant abdominopelvic metastases.\n2. Unchanged cystic right adnexal lesion, previously evaluated with pelvic\nultrasound in ___.\n3. Unchanged left adrenal adenoma.\n4. Please refer to the dedicated CT chest performed the same day for\ndescription 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. A 1.8\ncm cyst in segment IV a is re-demonstrated, as well as additional\nsubcentimeter hypodensities too small to characterize, unchanged.  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 adrenal gland is normal in size and shape.  A 1.1 cm left\nadrenal adenoma is unchanged.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple left subcentimeter hypodensities, too small to characterize, are\nunchanged.  There is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post partial gastrectomy with\ngastrojejunostomy, with expected postsurgical anatomy, and no evidence of\nlocal recurrence.  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: There is an enlarged, fibroid uterus.  A 3.2 cm cystic\nstructure in the right adnexa is unchanged, better evaluated on recent 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. 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 distal gastrectomy, with no evidence of local recurrence or\nmetastatic disease in the abdomen and pelvis.\n2. Unchanged cystic structure in the right adnexa, better evaluated on recent\nMRI.\n3. Unchanged left adrenal adenoma.\n4. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Visualized lung fields are within\nnormal limits.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHepatic hypodensities are grossly unchanged dating back to the noncontrast CT\nfrom ___ when the larger ones could be characterized as cysts.  There\nis no evidence of new 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 adrenal gland is normal in size and shape. \nRedemonstration of a 1.2 cm left adrenal adenoma, stable since the noncontrast\nCT from ___ when it was characterized as adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple left subcentimeter hypodensities, too small to characterize, grossly\nunchanged from priors.  There is no evidence of hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post partial gastrectomy with\ngastrojejunostomy, with expected postsurgical anatomy, and no evidence of\nlocal recurrence.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Unchanged\nsmall amount of free fluid in the pelvis (series 5, image 70).\n\nREPRODUCTIVE ORGANS: Redemonstration of the enlarged, fibroid uterus.  The\nright adnexal lesion measures 3.1 x 3.9 cm, previously 2.8 x 3.3 cm, grossly\nunchanged in size since ___ (series 5, image 68).  The anterior cystic\nlesion measures 2.8 x 3.3 cm, previously 2.2 x 3.3 cm, grossly unchanged in\nsize since ___ (series 5, image 68).\n\nLYMPH NODES: Subcentimeter retroperitoneal lymph nodes, unchanged from prior. \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.\n\nBONES: There 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. Right adnexal mass, better characterized on the MRI from ___.\n3. 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. \nRedemonstration of multiple hypodense lesions in the liver stable since ___.  No evidence of 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 adrenal gland is normal in size shape.  Redemonstration of\na 1.2 cm left adrenal adenoma, stable since ___.\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.\n\nGASTROINTESTINAL: Status post distal gastrectomy and gastrojejunostomy with no\nevidence of local recurrence or bowel obstruction.  The colon and rectum are\nwithin 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 present with multiple fibroids. \nRedemonstration of a right adnexal structure previously characterized as a\npossible fibroma ___ tumor on prior MRI of ___.  This is\nunchanged in appearance best seen on series 5, image 169.  Posterior portion\nof this structure measures 3.6 x 3.4 cm, previously 3.1 x 3.9 cm.  The\nanterior cystic portion measures 2.3 x 3.0 cm, previously 2.8 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. Status post distal gastrectomy and gastrojejunostomy with no evidence of\nmetastatic disease.\n2. Stable right adnexal mass possible fibroma ___ tumor as\ncharacterized on prior MRI of ___.\n3. Stable left adrenal adenoma."
        },
        {
            "input": "LOWER CHEST: No pleural effusion.  No pericardial effusion.  The heart is\nmildly enlarged with cardiac pacing leads in situ.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation, consistent\nwith steatosis.  There is no evidence of focal lesions within the limitations\nof an unenhanced scan.  There is no evidence of intrahepatic biliary\ndilatation.  Gallbladder contains multiple stones in the gallbladder neck\nwithout substantial gallbladder wall thickening.  An area of hypodensity along\nthe gallbladder fundus likely represents focal fatty deposition.  The common\nbile duct measures up to 9 mm.\n\nPANCREAS: Diffuse fatty atrophy of the pancreas.  There is possible stranding\nnear the head and body of the pancreas without focal fluid collection.  No\nfocal lesions.  No 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.  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.  There is a punctate 3 mm stone within the superior pole of the\nright kidney.  Several cortical hypodensities are too small to characterize by\nCT but likely represent benign entities.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Focal stranding is seen near\nthe third portion of the duodenum (series 2, image 32).  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, without secondary signs in the\nright lower quadrant near the cecum to indicate acute appendicitis..\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nLYMPH NODES: There is periaortic stranding near the epigastrium and pancreas,\nwith multiple prominent but not enlarged by size criteria lymph nodes, in both\naortic chains, of unclear etiology.\n\nVASCULAR: There is no 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 umbilical hernia containing fat.  No evidence of abscess\nformation within the body wall.",
            "output": "1. There is questionable stranding near the diffusely atrophic pancreas near\nthe head and body, as well as along the third portion of the duodenum, but the\nstranding also extends around the periaortic region.  Additionally, is\nprominence of the common bile duct up to 0.9 cm.  No focal fluid collections. \nFindings are equivocal for pancreatic pathology, with questionable associated\nduodenitis.\n2. Multiple stones are noted the gallbladder without additional evidence of\nacute cholecystitis.  No radiopaque stones are demonstrated within the CBD.\n3. Nonobstructing 3 mm stone in the superior pole of the right kidney.\n4. Diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  The splenic artery arises\ndirectly from the aorta. The common hepatic artery arises from the SMA.\nModerate calcific atherosclerotic changes involving the abdominal aorta\nincreased abdominal arteries.  Calcific atherosclerotic plaque causing\nmild-to-moderate narrowing of the origin of the celiac axis/splenic artery\norigin and involving the origin of the left renal artery.\n\nPatient is status post cholecystectomy.  Multiple high-density areas are seen\nwithin the surgical bed/gallbladder fossa on the noncontrast study indicative\nof hemorrhage.  On the arterial phase (series 4 image 43) there is evidence of\na linear contrast opacification along the lateral aspect of segment 4 within\nthe surgical bed (series 4, image 43), with adjacent tiny contrast blush. \nThis is in close vicinity of a surgical clip (___)\n\nOn the venous phase images there is increase in size of the contrast blush\n(series 4, image 255-256) with pooling of hyperdense contrast within the\ngallbladder fossa (series 4, image 256).  These findings are consistent with\nactive extravasation within the surgical bed.  There is mild-to-moderate\nhigh-density fluid within the gallbladder fossa extending to the perihepatic\nregion and into the right paracolic gutter.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Few\npunctate hypodensities in the liver are too small to be characterized.  There\nis no evidence of intrahepatic biliary dilatation.  The CBD is normal in\ncaliber.\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.  Multiple tiny splenule seen near the anterior\npole.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The left is normal in size with normal nephrogram.  Few tiny cortical\nhypodensities in the left kidney are too small to be characterized.  There is\nno evidence hydronephrosis.  There has been a prior right nephrectomy.  No\nrecurrent mass seen in the right nephrectomy bed.\n\nGASTROINTESTINAL: There is a percutaneous g tube in situ.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nare a few scattered colonic diverticulae.  Appendix is normal in caliber.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nPELVIS: The urinary bladder is grossly unremarkable.  There is no evidence of\npelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is evidence of spinal hardware and posterior instrumentation from L3-5\nlevels.  A left hip arthroplasty hardware is seen in situ.  Significant\ndegenerative changes involving the right hip joint.\n\nSOFT TISSUES: There is a small fat containing periumbilical hernia.\n\nLOWER CHEST: Bilateral small pleural effusions with subsegmental passive\natelectasis involving both lower lobes.  Multiple tiny punctate nodules seen\nin the partially imaged right lung base.",
            "output": "1. Status post cholecystectomy with findings suggestive of hemorrhage in the\nsurgical bed with evidence of active extravasation.  High-density/hemorrhagic\nfluid extends into the perihepatic region in the right pericolic gutter.\n2. Prior right nephrectomy, no recurrent mass seen in the nephrectomy bed.\n3. Bilateral small pleural effusions and subsegmental atelectasis.  Multiple\ntiny punctate nodules in the partially imaged right lung base, since no prior\nCT chest is available for comparison further assessment with a dedicated CT\nchest can be performed if clinically indicated.\n\nNOTIFICATION:  Amended urgent findings were communicated to the Dr ___\n(___) at 11:20am by Dr. ___."
        },
        {
            "input": "CHEST: There is minimal opacification of the left lung bases, unchanged from\n___, and likely representing atelectasis. The heart is enlarged. There is\nno pericardial or pleural effusion. A 3 mm lung nodule at the right lung base\nis stable dating back to ___ (2:2).  Coronary artery calcifications are\nnoted.\n\nABDOMEN: The liver enhances homogeneously and is without focal lesions.  Mild\nintrahepatic biliary duct dilation is unchanged from prior.  The small amount\nof pneumobilia seen (02:20). Again noted, is cholelithiasis. The gallbladder\nis not distended. There is air within the gallbladder, unchanged from ___,\nand likely related to prior procedure. There is no surrounding fat stranding.\nThe common bile duct stent appears unchanged in position with appears to\nterminate proximally in the common hepatic duct. The portal venous system is\npatent.\n\nThe spleen and adrenal glands are unremarkable. The pancreas is atrophic but\nwithout focal lesions. The pancreatic duct is not dilated.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. Multiple\nsubcentimeter hypodensities are scattered throughout the kidneys, which are\ntoo small to characterize.  The largest is located in the midpole of the right\nkidney measures 1.2 cm, and represents a simple cyst (02:31).  There is no\nhydronephrosis. The ureters are normal in caliber and course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening. The appendix is well visualized and\nnormal (02:51)..\n\nCalcifications are noted of the abdominal aorta. The abdominal aorta and its\nmajor branches are patent.  There is dense calcification involving the SMA\ndistally, seen on ___.  There is no retroperitoneal or mesenteric\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum. There is a small fat containing groin hernia on the left.\nAdditionally, there is a fat containing epigastric hernia, unchanged.\n\nPELVIS: The bladder is decompressed with a Foley catheter..  There is no\npelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.  Trace presacral fluid is new from ___, and is of\nuncertain clinical significance.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Cholelithiasis without findings to suggest acute cholecystitis.\n2. Unchanged mild intrahepatic biliary duct dilation.  Small amount of\npneumobilia.\n3. Stable position of common bile duct stent.\n4. Stable right lower lobe pulmonary nodule dating back to ___ requiring no\nadditional followup.\n5. Trace presacral fluid is new from ___ and is of uncertain clinical\nsignificance."
        },
        {
            "input": "CHEST: A 3 mm right lung nodule is stable dating back to ___ (2:7).  There is\nno pericardial or pleural effusion. There is minimal bibasilar atelectasis.\n\nABDOMEN:\n\nSince prior, there has been interval removal of a common bile duct stent.\nSmall foci of pneumobilia are again seen. Mild intrahepatic biliary duct\ndilation is unchanged. Radiopaque gallstones are seen without evidence of\nacute cholecystitis. The liver enhances homogeneously and is without focal\nlesions. The portal vein is patent.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  A\nsubcentimeter hypodensity in the midpole of the right kidney, is stable. There\nare no focal renal lesions. There is no hydronephrosis. The ureters are normal\nin caliber and course to the bladder.\n\nA small hiatal hernia is noted..  The stomach is decompressed.  The small and\nlarge bowel are normal in caliber and without evidence of wall thickening. The\nappendix is well visualized and normal (02:56).\n\nThe abdominal aorta and iliac vessels obtained dense calcifications.\nCalcifications are again noted at the takeoff of the celiac axis. There is no\nretroperitoneal or mesenteric lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.  Mild presacral edema is again seen. A small focus of air within\nthe bladder may be from prior instrumentation; correlate with urinalysis.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Interval removal of common bile duct stent with stable mild intrahepatic\nbiliary duct dilation and multiple foci of pneumobilia.\n2. Stable right lower lobe pulmonary nodule dating back to ___.\n3. Unchanged trace presacral edema, of uncertain clinical significance.\n4. Focus of air within the bladder may be from recent instrumentation,\ncorrelate with urinalysis to assess for infection."
        },
        {
            "input": "Lung Bases:  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.  Gallbladder is surgically absent.  Mild\nprominence of the biliary tree likely reflect prior cholecystectomy.  Main\nportal vein and central branches are patent.  The spleen appears normal. \nAdrenals are normal bilaterally.  The pancreas enhances normally.  The kidneys\nenhance symmetrically and demonstrate prompt excretion of contrast.  No\nworrisome renal lesion or hydronephrosis.  The abdominal aorta is normal in\ncourse and caliber without appreciable atherosclerotic calcification.  No\nretroperitoneal or mesenteric lymphadenopathy.  The stomach is decompressed. \nThe duodenum is normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThere is fluid distension of small and large bowel which raises potential\nconcern for gastroenteritis.  The appendix is normal.  The colon is thin\nwalled.  Trace free pelvic fluid noted.  A left ovarian corpus luteal cyst is\nnoted measuring up to 2.2 cm.  The right ovary is normal.  Uterus is\nunremarkable.  Urinary bladder is mostly decompressed.  No pelvic sidewall or\ninguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Mild fluid distension of small bowel may reflect gastroenteritis.\n2. Status post cholecystectomy.\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 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: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Diverticulosis of\nthe descending 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 contains a small amount of fluid within the\nendometrial cavity.  There is a 2.4 x 1.9 cm hypodense cystic structure in the\nleft adnexa, consistent with 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.  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 pathology to explain the patient's\npain.  Specifically, no evidence for bowel obstruction.\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 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 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. 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": "Unremarkable CT of the abdomen and pelvis.  Specifically no CT evidence of\npancreatitis."
        },
        {
            "input": "Partially imaged lung bases are notable for a stable small left and moderate\nright pleural effusions and adjacent atelectasis.\n\nCT abdomen: The liver enhances homogeneously without concerning lesions or\nbiliary dilatation. Portal vein is patent. The gallbladder, spleen and\npancreas are within normal limits. Redemonstrated is a 1.9 x 2.5 cm right\nadrenal adenoma. A 7 mm nodular density in the left adrenal gland remains\nindeterminate. Kidneys enhance symmetrically. There is no hydronephrosis.\n\nThe stomach is partially distended with gas and ingested material. Nondilated\npartially fluid filled loops of small bowel do not show wall thickening or\nsigns of obstruction. Patient is status post coil embolization of a colonic\nbranch of the ileocolic artery in the region of the cecum. More inferiorly in\nthe cecum, there is a linear hyperdensity on arterial phase imaging that\nexpands on the venous phase, not visualized on the initial noncontrast images,\nconsistent with active extravasation (6a:129, 6b:307). Small volume ascites\npredominantly in the pelvis is unchanged. Extensive atherosclerotic disease is\nagain noted.\n\nCT pelvis: A Foley catheter is in place. Air in the bladder is likely due to\ninstrumentation. A small amount of simple pelvic free fluid is noted. There is\nno pelvic or inguinal lymphadenopathy.\n\nDiffuse abdominal wall edema is similar to the prior examination. No\nsuspicious lytic or sclerotic osseous lesion is present.",
            "output": "1. Persistent active extravasation in the region of the cecum.\n\n2.  Stable small to moderate bilateral pleural effusions, small volume\nascites, and diffuse body wall edema.\n\n3. Right adrenal adenoma and incompletely characterized small left adrenal\nnodule.\n\n4.  Extensive atherosclerotic disease.\n\nNOTIFICATION:     Findings and recommendations were discussed by Dr. ___\n___ with Dr. ___ , on ___ at 11:30p, via telephone, 5 min\nafter discovery."
        },
        {
            "input": "THORAX: There are moderate bilateral nonhemorrhagic pleural effusions and\nminimal bibasilar atelectasis bilaterally.  The visualized heart and\npericardium are within normal limits. Pacing wires are seen overlying the\nheart.\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:  There is a subcentimeter hypodensity in the midpole region of the\nleft kidney which is too small to characterize on CT.  The kidneys display\nsymmetric nephrograms and there is no evidence of hydronephrosis in either\nkidney. The ureters are symmetric in their course to the bladder.\n\nBOWEL:  There is a small hiatal hernia. The small bowel is normal in caliber. \nThe large bowel is unremarkable.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: There is a large amount of subcutaneous gas in the soft tissues of the\nanterior abdominal wall and left inguinal canal, minimally increased from the\nprior examination done at outside facility on ___.  There is a\npartly walled-off fluid collection noted in the presacral space on the right.\nAdditionally, there is an ill-defined enhancing mass to the left of the rectum\n(series 2, image 74) suggestive of tumor. There is a gas containing cavity\nalong the perineum (Series 2, image 82) and a large soft tissue defect\nassociated with the recent debridement procedure. There is a small amount of\nascites within the pelvis.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: No suspicious osseous lesions are seen. \nWithin the soft tissues of the anterior abdominal wall is increased\nsubcutaneous gas, increased fat stranding however no focal fluid collection is\nidentified.",
            "output": "1. Increased gas within the soft tissues of the anterior abdominal wall and\nleft inguinal canal as well as increased fat stranding of the anterior\nabdominal wall soft tissues compared to the most recent prior exam on ___. On going deep soft tissue infection cannot be excluded although the\ntiming of gas accumulation is uncertain aside from increase since preoperative\nimaging.\n2. No discrete fluid collection is identified in the abdomen or pelvis. There\nis a partly walled-off, but very small fluid collection noted in the presacral\nspace on the right.\n3. Small amount of new simple, free fluid in the pelvis.\n\nNOTIFICATION:  Findings discussed with Dr. ___ telephone at 18:27\non ___ 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 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 2.1 cm simple renal cyst in the interpolar right kidney.  There is\nno evidence of solid 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.\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 metastases in the abdomen or pelvis.  No bone metastases."
        },
        {
            "input": "CHEST:  The lung bases are clear.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is normal and without gallstones.\n\nThe spleen and adrenal glands are unremarkable. The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder. There is no evidence of renal abscess.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening. The appendix is not visualized but\nthere are no secondary signs of appendicitis in the right lower quadrant.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is distended.  There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute intra-abdominal process. No evidence of renal abscess or CT evidence\nof pyelonephritis."
        },
        {
            "input": "LOWER CHEST: Trace right greater than left pleural effusions with mild\nadjacent atelectasis.  Subsegmental atelectasis in the visualized lungs. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout\nsuggesting 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.  No evidence of laceration. \nSubcentimeter hypodensities suggest cysts.  Geographic regions of\nhypoattenuation in the lower aspect likely reflect contrast mixing.\n\nADRENALS: The right and left adrenal glands 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.  Both kidneys contain cysts.  A 1.2 cm\nhyperdense cyst in the interpolar region of the right kidney measures 113\nHounsfield units and is new from ___ (2:60).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Large hiatal hernia containing the majority stomach.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  There is wall thickening of the rectum\nwith surrounding stranding suggesting proctocolitis.  Additional fat stranding\nsurrounds sigmoid colon deep pelvis.  No drainable fluid collection.  A 4.2 x\n3.1 cm well circumscribed pelvic air-filled cavity is surrounding by\nnon-opacified bowel loops and stranding.  A similar appearance is seen in\n___, making this unlikely to be an acute finding.\n\nPELVIS: The urinary bladder is decompressed.\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: Bones are diffusely demineralized limiting assessment for subtle\nfractures.  Within these limits, no worrisome osseous lesions or acute\nfracture is seen.  Moderate vertebral body compression deformity at L4 has\nprogressed since ___.  No surrounding soft tissue stranding to suggest that\nit is acute.  Similarly, inferior endplate Schmorl's nodes involving T12, L1,\nand L2 has progressed from ___.  Post right proximal femur surgical repair\nwith surrounding streak artifact limiting assessment of adjacent structures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Proctocolitis involving the sigmoid colon with 4.2 x 3.1 cm pelvic\nair-filled cavity well circumscribed pelvic air-filled cavity is surrounding\nby non-opacified bowel loops and stranding similar in appearance to prior CT\nin ___, making this unlikely to be an acute finding.  No evidence of\npneumoperitoneum.  No drainable fluid collection.\n2. Soft tissue stranding surrounding the gluteal cleft extends superiorly\nadjacent to the coccyx.  No abscess.  Visual inspection to evaluate for\ndecubiti ulcer recommended. Demineralized osseous structures without CT\nevidence for osteomyelitis.\n3. No evidence of acute fracture or abdominopelvic traumatic injury.\n4. Moderate vertebral body compression deformity at L4 has progressed since\n___. No surrounding soft tissue stranding to suggest that it is acute.\n5. 1.2 cm hyperdense right renal hypodense lesion is incompletely\ncharacterized.  Nonemergent renal ultrasound recommended.\n\nRECOMMENDATION(S):\n1. Clinical exam and visual inspection to assess for decubitus ulcer.\n2. Nonemergent 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 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. \nHypodensity in the upper pole of the left kidney is too small to be further\ncharacterized but statistically a cyst.  Additionally, there is a punctate\nnonobstructing stone seen in the left kidney.  In the right ureterovesicular\njunction, there is a 3 mm stone.  Subsequently, there is mild\nhydroureteronephrosis.  An additional nonobstructing 3 mm stone is seen in the\ninterpolar region of the right 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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple prominent but not pathologically enlarged mesenteric\nlymph nodes seen.  There is no retroperitoneal lymphadenopathy.  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": "Obstructing 3 mm stone at the right ureterovesicular junction with mild right\nhydroureteronephrosis.  Additional small bilateral nonobstructing renal\ncalculi, one on each side."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, ___, renal and\niliac arteries and their major branches are patent with no signs of occlusive\nor aneurysmal disease. The portal system including SMV, splenic and portal\nveins is patent. The renal veins, iliac veins and IVC are patent and\ndemonstrate normal caliber. There is minimal calcium burden in the abdominal\naorta 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 decreased 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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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, suspicious renal lesions, or hydronephrosis. \nThere are numerous simple cysts bilaterally and other ovoid hypodensities with\nthin septa and a few with thin calcifications, which fall under ___\ncategory 1 and 2 and do not require followup.  Other smaller ovoid\nhypodensities bilaterally are too small to characterize.  There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.  There is scarring and parenchymal loss in the right kidney which\nmay be due to prior insult or treatment.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis mild-to-moderate pancolonic diverticulosis.  There is minimal haziness of\nthe fat surrounding the cecum.  Appendix contains air, has normal caliber\nwithout evidence 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 a posterior uterine hypodense mass which may\nrepresent a fibroid.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is moderate degenerative change in the imaged spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No gastrointestinal bleeding identified.\n2. Minimal inflammatory change surrounding the cecum may represent 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\nThere is an irregular mass abutting the inferior surface of the right\nhemidiaphragm which extends inferiorly to the liver dome (series 2, image 5). \nA focal blush of contrast between the liver and the mass is compatible with\nhyperemia.  However, a thin fat plane separating the mass from liver is noted,\nbest demonstrated on sagittal reformats (series 602, image 34).  This mass is\ncompatible with a peritoneal metastatic implant.\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.  1.8 cm accessory spleen is noted at the hilum\n(series 2, image 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 with normal nephrogram. \n8 mm stone is seen in the inferior pole of the left kidney (series 601, image\n56).  There is no evidence of focal renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is present.  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: Postoperative changes of total hysterectomy with\nbilateral salpingo-oophorectomy are present.\n\nLYMPH NODES: Nodularity and hazy appearance of the mesentery in the upper\nabdomen may reflect omental caking (series 2, image 19).  Prominent inguinal\nnodes, measuring up to 1.0 cm on the left (series 2, image 78).\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: Postoperative changes are present in the soft tissues of the\nanterior low abdomen.",
            "output": "1.  Large volume ascites and new irregular right subdiaphragmatic mass,\nconcerning for peritoneal implant and malignant ascites.\n2.  Nodularity and hazy appearance of the omentum in the upper abdomen may\nreflect omental caking.\n3.  Nonobstructing left renal stone measuring up to 3 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: Again seen is a 6.1 x 4.5 cm irregular hypoattenuating mass\nalong the inferior surface of the right hemidiaphragm abutting and exerting\nmass effect on the right hepatic lobe (4; 38).  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.  There 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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  An 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.  A 1.1 cm cyst\nis seen in the interpolar region of the right kidney.  2 nonobstructing stones\nmeasuring up to 7 mm are seen in the lower pole of the left kidney.  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 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 patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Similar to prior again seen is a\nhazy/nodular stranding of the upper abdominal mesentery concerning for omental\ndisease (4; 50, 51).\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  There is grade 1\nanterolisthesis of L5 on S1\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. 6.1 cm right diaphragmatic soft tissue density lesion is similar to prior\nand concerning for a peritoneal implant.\n2. Hazy nodularity in the upper abdomen is concerning for metastatic omental\ncaking.\n3. Small volume ascites, decreased compared to prior.\n4. Stable 7 mm nonobstructing left renal calculus."
        },
        {
            "input": "LOWER CHEST: Epicardial fat lymph node is minimally enlarged in size,\npreviously measuring 4 mm currently 6 mm.  Please refer to separate report of\nCT chest performed on the same day for further description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere has been interval decrease of the liver surface lesion, currently\nmeasuring 3.2 x 4.2 by 1.8 cm, previously 6.1 x 5.7 x 3 cm.  No hepatic focal\nlesions are seen.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is surgically absent.  Stable amount of\nsmall to 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.  Accessory spleen 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.  A\nnonobstructive 5 mm stone is seen in the midpole of the left kidney.  1 cm\nhypodensity in the interpolar region of the right kidney is unchanged.  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.\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: There is no retroperitoneal or mesenteric lymphadenopathy.  Inter\nto caval lymph nodes measure up to 8 mm, unchanged.  Redemonstrated stranding\nof the omentum (02:59).  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. \nStable grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: Supraumbilical ___ hernia again noted.  A 1.2 x 1.8 cm\nenhancing nodule in the right vulva is again seen.",
            "output": "1. Interval decrease in size of liver surface metastatic implant at the\nhepatic dome.\n2. Unchanged small volume of ascites.\n3. Omental stranding haziness of the omentum as before without discrete\nnodules.\n4. 1.2 x 1.8 cm enhancing nodule in the right vulva is again seen, and\nunchanged compared to the prior exam.  Correlate with physical exam.\n5. Please refer to separately reported chest CT performed the same day for\nsupradiaphragmatic 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.\n\nThere has been interval decrease in size of the hepatic dome lesion, currently\nmeasuring 3.5 x 3.5 x 1.8 cm, previously 3.2 x 4.2 x 1.8 cm (series 5, image\n40) on the study dated ___.  There are no new focal lesions. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is surgically absent.  There has been interval decrease in the\namount of 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.  There is a 2 cm accessory splenule in 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. \nSmall focal cortical scarring the inferior pole of the right kidney.  There is\na 1 cm parapelvic cyst in the right kidney, likely representing a benign renal\ncyst and is unchanged since ___.  There are two 6 mm nonobstructive\nrenal calculi in the inferior pole of the left kidney.  There is no evidence\nof a solid 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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding to suggest diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ndecreased free fluid in the pelvis in comparison to most recent prior.  The\npelvic floor is situated below the pubococcygeal line.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.  Fiducial markers are seen at the region of the\ncervical cuff.  There is no soft tissue mass at the site of the cervical cuff\nto suggest local recurrence.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nAortocaval lymph nodes measure up to 8 mm, unchanged from most recent prior\n(series 5 image 60).  There has been interval improvement in the omental\nstranding in comparison to most recent prior.\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. \nStable grade 1 anterolisthesis of L4 on L5.  Incidental note is made of a\ntransitional lumbosacral vertebra.  Mild degenerative change of the bilateral\nsacroiliac joints.\n\nSOFT TISSUES: Supraumbilical midline Richter hernia is again noted through a\n5.5 cm midline abdominal wall defect, containing a small portion of the\ntransverse colon.  There is a 5 mm soft tissue mass in the subcutaneous tissue\nof the left upper abdominal wall (series 5, image 50), stable comparison to\nmost recent study.  The previously visualized enhancing nodule in the right\nvulva was not imaged on this study.",
            "output": "1. Interval decrease in the size of the liver surface metastatic implant at\nthe hepatic dome now measuring 3.5 x 3.5 x 1.8 cm.  No new hepatic lesions. \nNo evidence of soft tissue mass or local recurrence in the pelvis.\n2. Interval decrease in the small volume of ascites in the perihepatic space\nand pelvis.\n3. Two 6 mm nonobstructive renal calculi in the inferior pole of the left\nkidney.\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:\nHEPATOBILIARY: A rim enhancing surface lesion at the hepatic dome has\nincreased in size, measuring 6.1 x 2.9 cm, previously 3.5 x 3.3 cm.  No\nadditional hepatic lesions are seen.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is a ventral hernia\ncontaining nonobstructed loops of colon.  Colonic diverticulosis without\nevidence of diverticulitis is present.  There is small volume ascites, which\nis increased from the prior study.\n\nPELVIS:  Small volume nonhemorrhagic free fluid is present.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  No adnexal mass.\n\nLYMPH NODES: Para-aortic lymph nodes measuring up to 6 mm are similar (3:69).\nNo new or increasing abdominopelvic lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a ventral hernia containing nonobstructed loops of\nlarge bowel. There is a 1.5 cm thick-walled cystic lesion along the anterior\nabdominal wall (3:83).  There is a small amount of soft tissue in the\numbilical hernia, similar to prior (3:88).  A third soft tissue nodule\nsuperior to the umbilicus is similar (3:76).",
            "output": "1. Interval increase in the size of a surface lesion at the hepatic dome\nmeasuring 6.1 x 2.9 cm, previously 3.5 x 3.3 cm.\n2. Soft tissue nodules along the anterior abdominal wall midline are\nindeterminate, but have increased in size making tumor implants a concern. \nContinued attention on follow-up is warranted.\n3. Interval increase in small volume nonhemorrhagic ascites.\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 slightly heterogeneous attenuation,\nparticularly throughout the right hepatic lobe, but is likely transient\nperfusion anomaly.  A knownright subdiaphragmatic metastatic lesion along the\nhepatic dome is decreased in size, and less conspicuous on current exam\n(601:30, 25).  Trace perihepatic ascites.  There is no evidence of new\nconcerning focal lesions. 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.  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. \nAgain demonstrated are nonobstructing bilateral renal calculi.  There is a\nstable right parapelvic cyst.  Otherwise, there is no evidence of solid 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. Mild colonic\ndiverticulosis without evidence of acute diverticulitis.  Moderate colonic\nstool load.  The rectum is within normal limits.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace pelvic\nfree fluid, decreased compared to prior.\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.  Minimal atherosclerotic\ndisease is 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: Again demonstrated, is an upper abdominal wall mesh hernial\nrepair with residual hernia containing anterior portions of the transverse\ncolon.  Small fat containing umbilical hernia, unchanged.  Interval resolution\nof a supraumbilical soft tissue nodule.  A tiny 1.3 cm soft tissue nodule\nabutting the midline anterior abdominal wall approximately 5.5 cm from the\numbilicus, is similar to prior (2:38).",
            "output": "1. No acute abdominopelvic process.\n2. Interval decrease in size of hepatic dome capsular lesion.\n3. Interval resolution of supraumbilical midline abdominal soft tissue nodule.\nStable more superior 1.3 cm midline anterior abdominal soft tissue lesion.\n4. Trace perihepatic and pelvic ascites."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural effusion.  Trace pericardial fluid is likely physiologic.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver dome is excluded from the field of view.  Mild\nheterogeneous enhancement of the liver is similar to prior.  The known right\nsubdiaphragmatic metastatic lesion is partially visualized, with interval\ncalcification, which may represent post treatment changes (2; 3).  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 a stable right parapelvic cyst.  There is no evidence of solid 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 or fat\nstranding. 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: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.  Fiducial markers are seen in the pelvis.\n\nLYMPH NODES: Prominent aortocaval lymph nodes measuring up to 8 mm in short\naxis is similar to prior (2; 52).  There is no mesenteric lymphadenopathy. \nThere 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. \nThere is grade 1 anterolisthesis of L4 on L5, likely degenerative and similar\nto prior.\n\nSOFT TISSUES: There is redemonstration of a midline ventral hernia status post\nrepair with residual hernia containing portion of the transverse colonic wall\n(2; 44).  A 1.9 cm hypodense focus in the umbilicus (2; 101) appears slightly\nmore prominent compared to prior but measures fluid in attenuation.  A 6 mm\nsubcutaneous enhancing lesion in the left anterior upper abdominal wall is\nsimilar to prior (2; 45).\nPreviously noted soft tissue nodule abutting the midline anterior abdominal\nwall appears less conspicuous compared to prior (2; 75).",
            "output": "1. No evidence of acute intra-abdominal process or small-bowel obstruction.\n2. The known right subdiaphragmatic metastatic lesion is partially visualized\nbut demonstrates interval calcification which may represent post treatment\nchanges.\n3. There is interval decreased prominence of the previously seen midline\nanterior abdominal soft tissue lesion.\n4. Interval increase in 1.9 cm hypodense focus in the umbilicus, more\nprominent compared to prior but measures fl"
        },
        {
            "input": "CHEST:\n\nPlease see the separate dedicated chest CT report dictated by the\ncardiothoracic imaging section.\n\nABDOMEN:\n\nThe liver is normal in appearance and without focal suspicious lesion.\nRedemonstrated is a stable, 8 mm hypodensity seen anterior to the left portal\nvein, too small the characterize. The portal venous system is patent. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder, pancreas, spleen, and bilateral adrenal glands are normal. The\nkidneys enhance symmetrically and are without suspicious solid mass.  A 6 mm\nhypodensity within the upper pole of the right kidney is too small to\ncharacterize, but unchanged from prior examination.\n\nThe patient is status post a proctectomy and sigmoid colectomy, and the\nterminal colostomy is seen within the left lower quadrant appearing patent and\nwithout evidence of obstruction.  A peristomal hernia is seen extending\nadjacent to the colostomy without evidence of obstruction. The stomach, small\nbowel, and proximal large bowel are grossly normal in caliber and without\nevidence of wall thickening.  There is no retroperitoneal lymphadenopathy by\nCT size criteria. There is no free abdominal fluid or pneumoperitoneum. The\naorta and iliac branches contain calcifications and are normal in course and\ncaliber. The celiac trunk and SMA are grossly patent.\n\nPELVIS:\n\nThe patient is status post abdominoperineal resection with residual\npostoperative changes. There is no evidence of abscess formation. Evidence of\nuterine and inferior bladder prolapse into the lower pelvis are best\nappreciated on the sagittal reformats (9:36), and are likely secondary to the\npatient's prior surgery. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:  No focal lytic or sclerotic lesion concerning for\nmalignancy.  Redemonstrated is grade 1 anterolisthesis of L4 on L5.",
            "output": "1.  No evidence of recurrent or metastatic disease within the abdomen or\npelvis.\n\n2.  Status post proctectomy and sigmoid colectomy with patent end colostomy.\n\n3.  Interval development of uterine and bladder prolapse.\n\n4.  Stable, 8 mm hypodensity within the left hepatic lobe."
        },
        {
            "input": "Lung Bases:  Central venous catheter extends into the right cavoatrial\njunction.  The heart appears within normal limits though there is a small\npericardial effusion again noted.  Unchanged right basal atelectasis with tiny\nright pleural effusion noted as well as right pleural calcification. Mild left\nbasal atelectasis noted.\n\nAbdomen: The unenhanced appearance of the liver, spleen, splenule, pancreas,\nadrenals is normal.  A nonobstructing right renal upper pole stone is noted. \nThere is an area of cortical scarring in the right renal upper pole. \nOtherwise the kidneys appear normal.  There is mild aortic atherosclerosis\nwithout aneurysmal dilation.  No retroperitoneal adenopathy.  A\ngastrojejunostomy tube is in place, entering the stomach and extending to the\nlevel of the proximal jejunum.  No signs of complication.  The stomach is\ndecompressed.  The duodenum appears normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  No\nfree air or free fluid is seen.  The appendix is normal.  The colon contains a\nmild fecal load.  No signs of colitis or bowel obstruction.  A suprapubic\ncatheter is in place.  The urinary bladder is only mildly distended.  No\npelvic sidewall or inguinal adenopathy.\n\nBones: Bones are diffusely demineralized.\n\nSoft tissues:  Infiltrated contrast is noted within the right upper arm best\nseen on series 2, image 19.  Extensive atrophy of the body wall is noted\nrelated to immobilized status.",
            "output": "No acute findings to account for symptoms of abdominal pain.\n\nStudy was complicated by IV contrast infiltration with approximately 60 cc of\ncontrast. Patient reports no pain at this site. Attention to this area is\nadvised as potential complications include skin necrosis and compartment\nsyndrome. D/w Dr ___."
        },
        {
            "input": "Lung bases: Partially imaged lung bases are clear. There is no pleural\neffusion.\n\nCT abdomen: A 2.6 x 3.3 cm hypodensity at the dome of the liver with\nperipheral nodular discontinuous enhancement which is compatible with a\nhemangioma. An additional hypodensity in the right lobe of the liver abutting\nthe middle hepatic vein is too small to characterize. There is no biliary\ndilatation. Gallbladder, spleen, pancreas, and adrenal glands are within\nnormal limits.\n\nThe left kidney demonstrates delayed enhancement and lack of excretion of\ncontrast in comparison with the right kidney. There is also mild adjacent fat\nstranding and mild hydroureteronephrosis. A 0.7 x 2.0 cm stones present in the\nmajor calyx however no obstructing stone is detected in the pelvis or along\nthe course of the left ureter. A 2 cm simple cyst is present in the lower pole\nof the right kidney. No suspicious renal mass identified.\n\nStomach is partially decompressed and nondilated loops of small and large\nbowel are within normal limits.  Appendix is normal. There is no mesenteric or\nretroperitoneal lymphadenopathy. Abdominal aorta is of normal caliber\nthroughout. There is no intra-abdominal free air or fluid.\n\nCT pelvis: Partially distended bladder is unremarkable. Prostate is enlarged\nmeasuring 7.2 cm TRV. There is no pelvic free fluid or lymphadenopathy.\n\nBone window: Degenerative changes in the spine are noted. No concerning lytic\nor sclerotic osseous lesion is identified.",
            "output": "Mild left perinephric stranding with delayed enhancement and excretion,\nprobably related to mild left hydroureteronephrosis. The differential includes\na recently passed stone or other obstructing stone/lesion that is not readily\nidentified on today's exam. Large nonobstructing calculus within the left\nrenal pelvis."
        },
        {
            "input": "LOWER CHEST:  Bilateral small pleural effusions are noted with associated\natelectasis. There is no evidence of pericardial effusion.  There is moderate\ncardiomegaly.\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. A 2.0 x\n4.1 x 2.7 cm hyperdense fluid collection is noted within the surgical bed\nadjacent to the termination of a JP drain (series 2, image 32).\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 right kidney appears normal. The left kidney is edematous and\nmildly enlarged with a delayed nephrogram and heterogeneous enhancement.\nPerinephric stranding and urothelial thickening is noted involving the left\nkidney and ureter, respectively.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix has\nnormal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries. There is no evidence of clot\nwithin the main portal vein, splenic vein and SMV.\n\nPELVIS: There is a moderate amount of air within the urinary bladder. There is\nno evidence of pelvic or inguinal lymphadenopathy. The uterus is enlarged.\nAdnexae appear within normal limits.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. There is midline diastasis of the anterior abdominal wall and a small\nfat containing ventral hernia. Surgical staples are noted in the anterior\nabdominal wall. There is a small amount of subcutaneous air and edema within\nthe superficial soft tissues, likely secondary to instrumentation.",
            "output": "1. The left kidney is enlarged with a delayed nephrogram and heterogeneous\nenhancement, concerning for acute pyelonephritis.  Early microabscess\nformation cannot be excluded.\n\n2. A 4 cm hyperdense fluid collection consistent with hematoma is noted in the\nsurgical bed /gall bladder fossa adjacent to the termination of the patient's\nJP drain.\n\n3. Bilateral, small pleural effusions.\n\n4. A moderate amount of air is noted within the urinary bladder, likely\nsecondary to prior instrumentation.\n\n5. Moderate cardiomegaly."
        },
        {
            "input": "Calcified pleural plaques within the lung bases again demonstrated, consistent\nwith asbestos related pleural disease. RCA calcification. Please refer to\nchest CT report for further details.\n\n1.3 x 1.8 cm hypodense capsular soft tissue lesion of segment 4 a,\nincompletely characterized. Patent portal veins.  Tiny calcification of\npancreatic tail. Pancreas otherwise unremarkable.\n\nNormal spleen and adrenals. Fat containing left diaphragmatic hernia.\n\n1.1 x 0.7 cm upper pole renal hypodensity, likely cyst.  No hydronephrosis.\n\nPossible small lower esophageal pulsion diverticulum. Contrast within stomach.\nContrast and stool within colon.  Mild mural thickening of the left colon\nsigmoid anastomosis, likely representing postoperative changes.  Sigmoid and\nleft colonic diverticulosis. Normal caliber appendix with tip appendicolith,\nsimilar to prior.  No small bowel dilatation.  Unremarkable right lower\nquadrant ileostomy.\n\nPostoperative changes with mild generalized mesenteric stranding are noted.\nPost repair of the anterior midline abdominal wall, which appears open below\nthe umbilicus with 1.9 cm transverse dimension opening. Tiny focus of gas\nwithin the anterior abdominal wall. Multiple small bowel loops abutting the\ntransversalis fascia, possible adhesions.\n\nHeavy mixed plaque of abdominal aorta with small infrarenal ectasia of 3 cm,\nsimilar to prior.  No abdominal adenopathy.\n\nDecompressed bladder. No free pelvic fluid.  No pelvic adenopathy.\n\nPossible enchondroma left iliac bone, similar to prior. Degenerative changes\nof the spine.  Grade 1 anterolisthesis of L5 on S1 with bilateral pars\ndefects.",
            "output": "-No abdominal pelvic collection.\n-Postoperative changes of the abdomen post midline dehiscence repair. Probable\nadhesions with multiple loops of small bowel abutting the anterior abdominal\nwall. Mild thickening at the colonic anastomosis, likely postoperative change.\n-Incompletely characterized hypodense 1.8 cm liver lesion. Liver MRI is\nrecommended for further characterization.\n-Heavy mixed plaque of abdominal aorta with infrarenal ectasia of 3 cm.\n-Grade 1 anterolisthesis of L5 on S1 with bilateral pars defects.\n-Other findings as detailed above."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal aorta and great abdominal arteries.  There is no evidence of\nintramural hematoma however at the level of the diaphragm, a focal outpouching\nof the aorta is noted (03:29, 601B:68) and may represent a penetrating\natherosclerotic ulcer or small aneurysm.\n\nThe major intra-abdominal arteries are patent.  There is narrowing of the\nceliac artery ostium as well as the origins of both renal arteries however the\nvessels are well opacified.  There is no evidence of contrast extravasation\nwithin the bowel, mesentery or retroperitoneum.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  A dense tubular\nstructure is noted in the left posterior lower lobe (601B:92) and may reflect\nan impacted airway.  There is no pleural or pericardial effusion.  The heart\nis enlarged.  There is mild hypoattenuation of the blood pool relative to the\nmyocardium, suggestive of anemia.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 cm hypodensity is noted in the lower pole of the right kidney, and\nalthough is indeterminate, likely reflects a cyst.  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:  There is a large hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis left-sided colonic diverticulosis without evidence of diverticulitis.  The\ncolon and rectum are otherwise within normal limits.  The appendix is not\nvisualized.  There 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.  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. \nMultilevel degenerative changes of the lumbar spine are present including a\ngrade 1 retrolisthesis of L1 on L2 and grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Diverticulosis without evidence of diverticulitis.\n2. No evidence of active contrast extravasation within the bowel.\n3. Extensive fatty and calcified atherosclerotic disease of the abdominal\naorta.  Protrusion of the aorta at the level of the diaphragm is noted without\nevidence of an intimal flap or intramural hematoma and may reflect a\npenetrating atherosclerotic ulcer.\n4. Large hiatal hernia."
        },
        {
            "input": "LOWER CHEST:  Evaluation of the lung bases demonstrates moderate centrilobular\nemphysema.  No pleural effusions.  There is a 2.9 x 1.2 cm soft tissue density\nalong the posterior aspect of the right lower lobe containing calcifications\n(2:7) that dates back to at least ___, and may represent a sequela of\nprior infection or inflammation.  Heart size is normal, without 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: Right kidney is atrophic.  Left kidney is normal in size.  There are\ninnumerable bilateral renal cysts, the largest of which is a simple cyst\nmeasuring 3.6 x 3.8 cm in the interpolar region of the right kidney.  The\ndominant left renal cyst is present within the upper pole and measures 2.5 x\n2.8 cm.  A 2.0 x 3.1 cm hemorrhagic or proteinaceous exophytic cyst arising\nfrom the left upper pole (2:14) is not significantly changed from ___\nwhere it measured 2.1 x 2.8 cm.  There are also a few smaller sub-cm cysts\nthat are too small to characterize.  A 6 mm non-obstructing stone is seen in\nthe lower pole of the right kidney.  No nephrolithiasis on the left.  No\nhydronephrosis.  No perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is extensive colonic\ndiverticulosis, without evidence of diverticulitis.  Colon and rectum are\notherwise within normal limits.  Normal appendix.\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 heavy calcification of the abdominal aorta and bilateral\niliac branches.  There is an infrarenal abdominal aortic aneurysm that\nmeasures 4.5 x 4.2 cm TV x AP (2:32), little changed from ___ where it\nmeasured 4.4 x 4.1 cm comparatively.  However, it has increased in size since\ncompared to ___ where it measured 4.1 x 3.6 cm (3:47, prior study).\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There are severe multilevel degenerative changes including a\ncompression deformity at L5 which is unchanged.  The abdominal and pelvic wall\nis within normal limits.",
            "output": "1. A 4.5 x 4.2 cm infrarenal abdominal aortic aneurysm is little changed from\n___, although slightly enlarged from ___.\n2. Non-obstructing 6 mm right lower pole renal stone, measuring 457 Hounsfield\nUnits.\n3. Innumerable bilateral renal cysts, including a hemorrhagic/proteinaceous\nleft upper pole cyst that has remained stable since ___.\n4. Colonic diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "Optimal evaluation of organ pathology and vasculature is limited without the\nbenefit of intravenous contrast.\n\nLOWER CHEST:\nThere is moderate bilateral lower lobe emphysema.  Chronic atelectasis is seen\nin the right lower lobe with foci of calcification within it.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  Within limitations of a non contrast-enhanced scan, no focal\nhepatic lesions identified.\nThe gallbladder is distended and likely demonstrates presence of layering\nsludge within it..\nPANCREAS: The pancreas is mildly at trophic without main duct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No nodules.\nURINARY:  There are multiple bilateral renal cortical hypodensities including\nan unchanged 3.0 x 2.4 cm hyperdense, likely hemorrhagic cyst arising from the\nupper pole of the left kidney.  No hydronephrosis on either side.  There is\nunchanged severe right renal cortical parenchymal thinning.  5 mm\nnonobstructive calculus is seen in the lower pole of the right kidney.\nGASTROINTESTINAL:  There is a small hiatus hernia.  Extensive colonic\ndiverticulosis with a large amount of fecal loading throughout the colon\nwithout bowel obstruction.\nLYMPH NODES: Within limitations of a non contrast-enhanced scan, there are no\nenlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Extensive atherosclerotic calcification of the abdominal aorta and\nits branches noted.  The known infrarenal abdominal aortic aneurysm measures\napproximately 4.6 x 4.2 cm in maximum transaxial ___ (series 3, image\n31) unchanged compared to ___.  Both common iliac arteries\ndemonstrate atherosclerotic calcification without aneurysmal dilation.\n\nPELVIS:\nThe bladder is distended, unremarkable.  Reproductive organs are unremarkable.\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes of the lumbar spine with no concerning osseous\nlesions.  Chronic superior endplate compression of L5 is present.",
            "output": "1. 4.6 x 4.2 cm infrarenal abdominal aortic aneurysm has not changed\nsignificantly since CT dated ___.  Extensive atherosclerotic\ncalcification of the abdominal aorta and its branches noted, limited\nevaluation for presence of thrombus and patency of vessels in the absence of\nintravenous contrast.\n2. Nonobstructing 6 mm right renal lower pole calculus.  Numerous bilateral\nrenal cortical cysts, including a hemorrhagic cyst in the upper pole of the\nleft kidney overall unchanged.  Limited evaluation for a solid enhancing renal\nmass in the absence of intravenous contrast.  No hydronephrosis.\n3. Extensive colonic diverticulosis and large fecal loading throughout the\ncolon without bowel obstruction.\n4. Chronic subsegmental atelectasis in the right lower lobe with foci of\ncalcification has not changed in size or appearance dating back to ___."
        },
        {
            "input": "VASCULAR:\n\nThere has been slight interval increase in the large fusiform infrarenal\nabdominal aortic aneurysm that extends to the aortic bifurcation, which\nmeasures up to 5.8 x 5.6 cm in greatest axial dimension, previously 5.5 x 5.6\ncm (___).  Patent internal lumen measures up to 3.1 x 3.4 cm at the\nupper portion of the aneurysm (05:35), 2.4 x 2.3 cm in the midportion (05:48),\nand 1.5 x 1.7 cm in the inferior portion (5:67).  There is unchanged complete\nocclusion of the left common and external iliac arteries arising from the\naneurysm sac dating back to at least ___ with distal reconstitution of flow\nat the level of the common femoral artery from collateralization of the\ninferior epigastric artery and branches within the left body wall. \nAtherosclerotic disease is otherwise extensive and severe, with moderate to\nsevere focal stenosis at the origin of the celiac artery with poststenotic\ndilatation (08:32).  The SMA is widely patent.  Mild to moderate stenoses of\nbilateral renal arteries are noted.  The ___ is not visualized.  There are\nmultifocal areas of high grade stenosis with the right common and external\niliac arteries, similar to the prior study.  The bilateral internal iliac\narteries are completely occluded.\n\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 a slightly delayed nephrogram,\nsimilar to multiple prior studies.  There is a 7 mm nonobstructing right lower\npole renal stone (03:34).  Numerous simple cysts are present bilaterally,\nsimilar to prior studies.  A hyperdense cyst is noted arising from the left\nupper pole, unchanged and previously evaluated by ultrasound.  There is no\nsuspicious solid renal lesion.  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.  There is extensive\ncolonic diverticulosis without evidence of diverticulitis.  The appendix is\nunremarkable.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter and the\ndistal ureters are unremarkable.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There 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. \nModerate degenerative changes of the lumbar spine are similar to the prior\nstudy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Slight interval increase in size of the fusiform infrarenal abdominal\naortic aneurysm when compared with the recent prior study in ___, now\nmeasuring to 5.8 x 5.6 cm.\n2. Unchanged complete occlusion of the left common and external iliac arteries\ndating back to ___, with reconstitution of flow distally at the level of the\ncommon femoral artery.\n3. Multifocal areas of high grade stenosis with the right common and external\niliac arteries, similar to the prior study.\n4. Nonobstructing right lower pole nephrolithiasis.\n5. Extensive diverticulosis."
        },
        {
            "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 liver is consistent with\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.  Scattered calcifications are suggestive 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: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. Scattered sigmoid diverticula are noted\nwithout evidence of diverticulitis.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of the left hip are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Status\npost umbilical hernia repair.",
            "output": "1. No acute abdominal process.  No findings to account for left lower quadrant\npain.\n2. Hepatic steatosis.\n3. Mild sigmoid diverticulosis.\n4. Severe degenerative changes of the left hip."
        },
        {
            "input": "LOWER CHEST: Unchanged small bilateral pleural effusions and lower lobe\natelectasis.  Please refer to separate report of CT chest performed on the\nsame ___ 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 biliary dilation.  The CBD\nmeasures 1.1 cm (3:80) with smooth tapering to the level of the ampulla,\nsimilar to prior examination, however the gallbladder is progressively more\ndistended than on ___, without evidence of stones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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.  Anterior accessory spleen is again noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  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: Stomach is distended with oral contrast.  Oral contrast is\nalso seen in distal loops of small bowel.  Anastomosis from partial small\nbowel resection in the left lower quadrant is unremarkable.  Patient is status\npost ileostomy and mucous fistula in the right lower quadrant.  Bilateral\nlower quadrant surgical drains are in place.  There is small volume ascites\nsurrounding loops of the small bowel.  Status post sigmoidectomy with\ncolorectal anastomosis.  No evidence of gastrointestinal leak.\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 masses.\n\nLYMPH NODES: Few mesenteric and retroperitoneal lymph nodes are noted but not\npathologically enlarged.\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: Diffuse body wall anasarca and ventral midline defect in keeping\nwith history of laparotomy and right lower quadrant ileostomy.  A hyperdensity\nnoted in the deep aspect of the abdominal wall incision has been present and\nunchanged in the past 3 studies and does not correspond to a leak.",
            "output": "1. Progressive gallbladder distension with mild dilation of the CBD without\nevidence of stones.  Given the noncontrast nature of the study, gallbladder\nwall thickening cannot be assessed.  Consider gallbladder ultrasound and\npercutaneous drainage for decompression.\n2. Small volume ascites.\n3. No evidence of gastrointestinal leak.\n4. Sm"
        },
        {
            "input": "LOWER CHEST: Moderate left pleural effusion with complete atelectasis of the\nleft lower lobe.  Small right-sided pleural effusion dependent atelectasis of\nthe right lower lobe.  Mild pulmonary edema is noted in the lower lung zones\nbilateral.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of suspicious focal lesions.  Hamartomas/cyst in the\nright lobe is unchanged.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is slightly less distended compared to\nprior imaging, but the gallbladder wall appears irregular with areas of\nnonenhancement concerning for cholecystitis and associated necrosis\n(gangrenous cholecystitis).  Contained perforation cannot be excluded.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Wedge-shaped peripheral hypodensity in the superior aspect of the\nspleen is concerning for a splenic infarct.  Other small rounded splenic\nhypodensities are indeterminate.\n\nADRENALS: The 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 noted is a parapelvic cyst in the right kidney and a cyst/possible\ncaliceal diverticulum in the upper pole of the right kidney.  No\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Status post multiple\nsurgeries.  Ileostomy seen in the right lower quadrant.  No evidence of bowel\nleak.  Small amount of free intra-abdominal fluid in close association with\nsmall-bowel loops is nonspecific.  Multiple surgical drains present in the\nabdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Air is\nlikely secondary to catheterization.\n\nREPRODUCTIVE ORGANS: Patient is status post total 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Midline abdominal incision is noted with a covering dressing.",
            "output": "1. Findings concerning for acute gangrenous cholecystitis\n2. No good evidence of bowel leak.  Small amount of free fluid in relation to\nthe small bowel loops are nonspecific.  No well-formed abscess/drainable\ncollection.\n3. Suspected small splenic infarct.\n4. Moderate left and small right-sided pleural effusion with collapse of the\nleft lower lobe and partial atelectasis of the right lower lobe.\n5. Mild pulmonary edema.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 suspicious focal lesion.  There is a 9 mm hypodense lesion in the\nright hepatic lobe, which is too small to further characterize but likely a\ncyst or biliary hamartoma, which is unchanged compared to prior exam dated ___. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is decompressed around a cholecystostomy tube.\n\nPANCREAS: The pancreas has normal attenuation throughout without pancreatic\nductal dilatation.  In the body of the pancreas, there are two cystic lesions,\nwhich measure 10 mm (series 5, image 46) and 5 mm (series 5, image 36) and are\nincompletely characterized on this exam but unchanged compared to CT dated ___.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is incidental note of a 1.1 cm accessory\nspleen seen in the hilum (series 5, image 28).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is redemonstration of hypodense right renal lesions, measuring up to 3.4\ncm (series 5, image 55).  There are additional subcentimeter hypodensities,\nwhich are too small to further characterize but likely cysts.  There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nbladder wall is mildly thickened, which may be due to incomplete distension;\nhowever, cannot exclude acute cystitis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\nileocolectomy and end ileostomy.  As before, there are multiple small bowel\nloops, which appear adherent to the anterior abdominal wall.  Additionally,\nthe rectum is stool-filled and demonstrates mild wall thickening and\nhyperenhancement, suggesting mild proctitis.  The appendix is not visualized.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of a 1.3 x 1.1 cm anterior abdominal\ndefect, which communicates a small anterior abdominal collection (series 5,\nimage 81).  The collection a drain, which does not appear significantly\nchanged in positioning compared to prior exam dated ___. \nSurrounding the drain, there is soft tissue thickening but no large fluid\ncollection.  There is redemonstration of a 2.0 cm left lower quadrant omental\ninfarction (series 7, image 27).",
            "output": "1. Redemonstration of a 1.3 x 1.1 cm anterior abdominal defect, which\ncommunicates with a very s"
        },
        {
            "input": "Trace bilateral pleural effusions with passive atelectasis.\n\nScattered small hepatic hypodensities are noted within the right lobe, too\nsmall to characterize, possible cysts. Nondistended gallbladder. No\nsignificant biliary dilatation.  Patent portal veins.  Normal appearance of\nthe pancreas without main ductal dilatation.  Normal spleen and adrenals.\n\nNo hydronephrosis or suspicious renal lesions.\n\nDecompressed stomach.  Contrast and stool within colon.  No significant\ncolonic mural thickening or edema.  Normal contrast filled appendix.  Normal\nTI.  No small bowel dilation.\n\nNormal caliber abdominal aorta.  There is a small amount of ill-defined soft\ntissue within the retroperitoneum, periaortic region, most prominent just\ninferior to the left renal vein (2, 68) in addition to mild prominence of\nsubcentimeter retroperitoneal nodes.  No significant mesenteric adenopathy.\n\nNo free pelvic fluid. No focal bladder wall thickening.  Anteflexed uterus.\n\nNo suspicious osseous lesions.",
            "output": "-Small amount of ill-defined soft tissue within the retroperitoneum, as\ndescribed above, in addition to mild prominence of subcentimeter\nretroperitoneal nodes. Nonspecific finding, which may be seen in the setting\nof SLE.\n-Normal appearance of the small and large bowel."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate mild dependent atelectasis. \nThere is no evidence of pleural or pericardial effusion.  Heart size is normal\nwith minimal coronary artery calcifications demonstrated.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic ductal\ndilatation is due to prior cholecystectomy, unchanged.  There is no\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: Spleen remains enlarged measuring up to 15.3 cm.  The spleen shows\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: Distal esophageal wall appears circumferentially thickened. \nThe stomach is unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  Minimal colonic diverticula are\nnoted without acute diverticulitis.  The colon and rectum are otherwise 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 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: Severe compression deformity of the L4 vertebral body with retropulsion\ninto the spinal canal by approximately 4 mm appears unchanged.  Compression\ndeformities of the T11 and T12 vertebral bodies are also similar to the prior\nexam.  There is no evidence of worrisome osseous lesions or new fracture.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.",
            "output": "1. No acute abnormality identified to account for the patient's symptoms.  No\ncolitis or bowel obstruction.\n2. Colonic diverticula without diverticulitis.\n3. Distal esophageal wall thickening suggests esophagitis which may be from\nrecent vomiting.\n4. Splenomegaly, similar to prior exam.\n5. Redemonstration of severe compression fracture of the L4 vertebral body\nwith unchanged 4 mm of retropulsion into the spinal canal.  Additional\nunchanged compression deformities involving the T11 and T12 vertebral bodies.\n6. Mild coronary artery calcifications."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  Mild central intrahepatic biliary duct\ndilation is likely related to prior cholecystectomy, unchanged.  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.  Accessory spleen 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. \nThere is no evidence of solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement.  There is wall thickening and\nsurrounding fat stranding of the descending and proximal sigmoid colon.  The\nappendix is not visualized, with no secondary signs of acute appendicitis..\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.0 cm in the\ntransverse dimension.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Again seen are severe compression fractures of L3 and L5 with minimal\nretropulsion of fracture fragments, grossly unchanged from the prior exam. \nAlso seen is a moderate compression deformity of T11 and mild compression\ndeformity of T12, grossly unchanged.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia..  There is a\nfat containing right inguinal hernia.",
            "output": "1. Wall thickening and surrounding fat stranding of the descending and\nproximal sigmoid colon.  Findings are consistent with colitis - infectious,\ninflammatory, or less likely ischemic in etiology.\n2. Severe compression deformities of L2 and L4 with retropulsion of fracture\nfragments, stable from prior examination.  Also noted is moderate compression\ndeformity of T11 and mild compression deformity of T12, also stable."
        },
        {
            "input": "LOWER CHEST: There is dependent atelectasis bilaterally.  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. \nThe CBD is mildly distended likely reflective of post cholecystectomy status.\n\nPANCREAS: The pancreas demonstrates mild stranding and fluid adjacent to the\ntail.  A pancreatic duct stent is present extending from the body through the\nsecond portion of the duodenum.  No upstream pancreatic ductal dilatation.  No\npancreatic calcifications are seen.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left 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 a 1.3 cm simple cyst in the posterior\ninterpolar region of the right kidney.  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\ntrace free pelvic fluid.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  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.  There is median arcuate ligament affect on the celiac 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. Mild stranding and fluid adjacent to the pancreatic tail reflects acute\ninterstitial pancreatitis.\n2. No free air to suggest bowel perforation.  No other acute intra-abdominal\nabnormality visualized."
        },
        {
            "input": "LOWER CHEST:  The visualized lung bases demonstrate small bilateral pleural\neffusions with adjacent atelectasis. ___ opacities are noted\nin the right middle lobe and left lower lobe. Please refer to separate report\nof CT chest performed on the same day for description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense liver lesions are seen, the largest measuring 3.5 x 3.5 cm\nin segments VIII/V. These are incompletely characterized on this single phase\nCT.  There is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThe gallbladder is surgically absent.\n\nSPLEEN:  The spleen is enlarged to 16.8 cm craniocaudally.  A 1.4cm\nhypodensity in the spleen is noted (8:16).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nADRENALS:  A 9-mm indeterminate nodule in the right adrenal gland is noted\n(5:56, 8:27). The left adrenal gland is thickened without a discrete nodule.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis. Multiple hypodensities are seen in the kidneys\nbilaterally, some of which are too small to characterize and others of which\nare simple cysts measuring up to 3.2 cm small left renal upper pole.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits.\n\nMESENTERY AND RETROPERITONEUM: Subcentimeter retroperitoneal lymph nodes are\nnot enlarged by CT size criteria. A porta hepatic node measures up to 2.4cm\n(5:62). There is trace perihepatic ascites. No free air.\n\nVASCULAR:  The abdominal aorta is normal in caliber with focal chronic\ndissection and mural thrombus in the mid portion (5:75). There are moderately\ndense atherosclerotic calcifications along its course. Atherosclerotic\ncalcifications are seen at the origin of the celiac axis and SMA, but\nevaluation for significant stenosis is limited by phase of contrast. The main\nportal vein, splenic vein and SMV are patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Small intermediate density\nfree fluid in the pelvis is nonspecific. The prostate is enlarged.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  A non-aggressive appearing lesion is noted in the right iliac wing\nwith sclerotic borders. Abdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple indeterminate liver lesions. MRI is recommended for further\nevaluation.  An indeterminate 9-mm right adrenal nodule and a splenic\nhypodensity can be assessed at the time of MRI.\n2.  Enlarged porta hepatic lymph node. Splenomegaly in keeping with known CLL.\nWithout prior imaging in our system, evaluation for progression cannot be\nassessed.\n3.  CT Chest reported separately.\n\nNOTIFICATION:  The findings and recommendations were discussed by Dr. ___\n___ with Dr. ___ on the telephone on ___ at 10:35pm,\nupon attending review."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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. Adjacent to the\nmid descending colon in the left mid abdomen, there is a 1.9 cm pericolic fat\ndensity lesion with adjacent fat stranding, consistent with epiploic\nappendagitis.  (Series 2:47 and series 601:35).  There is possible mild\nthickening of the colonic wall in this area, likely reactive.  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 and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Findings consistent with epiploic appendagitis of the mid descending colon\nin the left mid abdomen.\n2. No other acute process within the abdomen or pelvis."
        },
        {
            "input": "There is mild dependent atelectasis in the right base. No pleural or\npericardial effusion is seen.\n\nLIVER: Scattered hypodensities in segments 7, 8, and 2, the largest measuring\nup to 3 mm in segment 2, are too small to characterize but likely represent\nbiliary hamartomas or hepatic cysts. The portal vein is patent.The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without peripancreatic stranding or fluid\ncollection.  A tiny fat-containing lesion in the uncinate process of the\npancreas may represent a lipoma or interposed fat.\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:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized.Multiple inflamed diverticula with associated wall thickening,\ninflammation, and surrounding fat stranding of the sigmoid colon is consistent\nwith acute multifocal diverticulitis.  There is no evidence of free air or\nmacroperforation.  Wall thickening of adjacent bowel is likely related.\n\nRETROPERITONEUM: The aorta is normal in caliber, without atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid. An\nIUD is noted within the uterus.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. Acute multifocal sigmoid diverticulitis without evidence of\nmacroperforation.\n2. Scattered hypodensities within the liver, too small to characterize but\nlikely representing biliary hamartomas or hepatic cysts.\n3. A fat-containing lesion in the uncinate process of the pancreas may\nrepresent a lipoma or interposed fat."
        },
        {
            "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 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 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.  Normal appendix.\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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES:  There are serpiginous areas of subchondral sclerosis in the bilateral\nfemoral heads, which is new from ___, although known by MRI a\nperformed ___\n\nSOFT TISSUES:  There is a small fat containing left inguinal hernia.The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal process.\n2. Hepatic steatosis.\n3. Known bilateral femoral head avascular necrosis is again visualized."
        },
        {
            "input": "LOWER CHEST: Bibasilar dependent atelectasis is present.  Bilateral metastases\nare re-demonstrated and unchanged, including a left hilar mass measuring up to\n3 cm (7:1), a left lower lobe nodule measuring 1.7 cm (07:12), and a right\nlower lobe nodule measuring 12 mm (7:7).  No pleural or pericardial effusion. \nA central venous catheter terminates in right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: Innumerable hepatic metastases are re-demonstrated.  Severe\nintrahepatic biliary dilation is similar to prior.  The common bile duct is\nonce again noted to be dilated to the level of the pancreatic head, where it\nis abruptly obstructed by the large pancreatic head mass.\n\nPANCREAS: A hypoattenuating pancreatic head mass is again seen, measuring 5.1\nx 5.0 cm, similar to 5 days prior.  The mass continues to contact the main\nportal vein near the confluence, and the SMV.  Nonocclusive thrombus is seen\nin the SMV and the main portal vein (11:69, 59 respectively).  The SMA and\nceliac axis are not directly contacted.\n\nSPLEEN: The spleen shows normal size and 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 surgically absent.  The left kidney is\nunremarkable.  There is no hydronephrosis or suspicious focal lesion.\n\nGASTROINTESTINAL: There is high-density material in the third and fourth\nportion of the duodenum, as well as the jejunum on the noncontrast scan. \nPostcontrast arterial and delayed phase images demonstrate no difference in\nthis high density material, although its presence on the noncontrast phase\nmakes evaluation for active extravasation very difficult.  Within this\nlimitation, no definite discrete focus of active extravasation seen.\n\nRETROPERITONEUM/LYMPH NODES: There is extensive retroperitoneal\nlymphadenopathy, with soft tissue encasing the bilateral common iliac\narteries, and also pelvic lymphadenopathy (for example 11:122).  A right\nexternal iliac node measures 1.6 cm (11:35).\n\nVASCULAR: There is nonocclusive thrombus in the left common femoral vein, with\nthrombus extending into the iliac vein and probable occlusion of the left\ncommon iliac vein (11:152, 124).  There is also nonocclusive thrombus in the\nleft external iliac vein extending into the common iliac vein which is also\nlikely occluded (11:20).\n\nHepatic arterial anatomy is conventional.\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\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. High-density material in the duodenum and jejunum on the noncontrast study\nlimits evaluation for active contrast extravasation in this area. Within this\nlimitation, the amount and extent of hyperdense material in the duodenum and\njejunum remains essentially unchanged on all contrast phases, and no definite\npoint of active contrast extravasation is seen.\n2. Re-demonstrated 5 cm pancreatic head mass which obstructs the common bile\nduct and main pancreatic duct.  There is redemonstration of severe intra and\nextrahepatic biliary dilation related to this mass.\n3. Extensive hepatic metastases, retroperitoneal/pelvic lymphadenopathy, and\npartially imaged pulmonary metastases as before.\n4. Nonocclusive thrombosis of the superior mesenteric and main portal vein.\n5. Nonocclusive thrombus within the left common femoral and external iliac\nvein, as well as right external iliac vein. Occlusive thrombus is present in\nthe bilateral common iliac veins, with patency of the inferior vena cava."
        },
        {
            "input": "The partially imaged lung bases are notable for a small radial atelectasis in\nthe lingula. There is no pleural effusion.\n\nCT abdomen: The liver enhances homogeneously without concerning lesions or\nbiliary dilatation. Gallbladder is surgically absent. Spleen, pancreas, and\nadrenal glands are within normal limits. Kidneys enhance and excrete\nsymmetrically. Mild right hydroureteronephrosis is unchanged. There is no\nhydronephrosis on the left.\n\nThe stomach is largely decompressed and nondilated loops of small bowel do not\nshow wall thickening or signs of obstruction. Colon is unremarkable. There is\nno intra-abdominal free air or fluid. There is no mesenteric or\nretroperitoneal lymphadenopathy. Abdominal aorta is of normal caliber\nthroughout. Note is made of a small ventral hernia to the left of midline\ncontaining omentum and a small amount of fluid but no bowel loops. There is\nalso evidence of mesh surgery along the anterior abdominal wall. Postsurgical\nstranding is again noted in the subcutaneous tissues along the lower anterior\nabdominal wall without an organized or rim enhancing collection.\n\nCT pelvis: The bladder is decompressed. Predominantly on the left side of the\nvaginal cuff there is are two heterogeneous area of hypodensity with mild rim\nenhancement measuring approximately 1.7 x 2.0 cm and 1.0 x 1.9 cm (6:68,\n6:70), corresponding to locations of prior abscesses although the degree of\norganization and rim enhancement is less prominent. There is no pelvic free\nfluid or lymphadenopathy.\n\nBone window: Degenerative changes are seen throughout the spine. No concerning\nlytic or sclerotic osseous lesion is identified.",
            "output": "1. In the location of previous abscess in the vaginal cuff, two small\nill-defined heterogeneous hypodensities are present measuring 1.7 x 2.0 cm and\n1.0 x 1.9 cm with less prominent rim enhancement and may represent residual\nphlegmon or recurrent/developing abscess.\n\n2. Mild right hydroureteronephrosis is unchanged. No obstructing lesion is\nclearly identified."
        },
        {
            "input": "THORAX: Supradiaphragmatic structures will be evaluated on concurrent CT\nchest.\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 mildly distended.\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:  A 2.3 x 1.7 cm hyperdense in the upper pole of the right kidney does\nnot meet the criteria for a simple cyst and is high in attenuation.  This was\nevaluated on the recent ultrasound demonstrated to reflect a hyperdense cyst. \nThere is trace nonspecific stranding around both kidneys, greater on the left.\nThere is no evidence of hydronephrosis in either kidney.\n\nBOWEL: An enteric tube terminates within the first portion of the duodenum. \nThe small bowel is normal appearing with no evidence of obstruction.  The\nlarge bowel is filled with stool and is normal.  There is no free air or free\nfluid in the abdomen or pelvis.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta.  The aorta\nand its major branches are patent.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: A Foley catheter is seen within the urinary bladder.  A rectal tube is\nnoted.  There is no pelvic sidewall lymphadenopathy.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.  There is a small fat\ncontaining left inguinal hernia.",
            "output": "No acute intra-abdominal or intrapelvic process.  No free air or free fluid in\nthe abdomen or pelvis.\n\n2.3 cm hyperdense right upper pole renal cyst as characterized on the previous\nultrasound."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions.  Linear atelectasis in the\nleft lower lobe.  Air trapping in the medial right lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Mild intrahepatic and extrahepatic\nbiliary duct dilatation, with the CBD measuring up to 8 mm.  There is\npneumobilia.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows 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 is detected.\n\nURINARY: Native kidneys are atrophic with subcentimeter hypodensities\nbilaterally.  No hydronephrosis.\n\nTransplant kidney in the right lower quadrant demonstrates mildly\nheterogeneous enhancement and surrounding fat stranding.  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.\n\nPELVIS: The bladder is collapsed.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are mildly enlarged retroperitoneal/left para-aortic lymph\nnodes measuring up to 13 mm (series 2, image 41).  There is no mesenteric\nlymphadenopathy.  There is no pelvic lymphadenopathy.  A prominent 1.8 x 1.0\ncm right inguinal lymph node (series 2, image 75) is likely reactive.\n\nVASCULAR: The abdominal aorta and IVC are normal in course and caliber.  No\natherosclerotic disease is seen.\n\nBONES: Mild diffuse sclerosis of the bones is nonspecific, but could suggest\nrenal osteodystrophy.  There is no suspicious osseous lesion.\n\nSOFT TISSUES: There is a 4.8 x 2.5 cm irregularly marginated, rim enhancing\nfluid collection in the right inguinal region, which could represent abscess\nor hematoma.  There is anasarca of the body wall.",
            "output": "1. Normal adrenal glands, without evidence of mass.  No evidence of\nparaganglioma in the retroperitoneum, noting that evaluation is somewhat\ndifficult due to the presence of mildly enlarged retroperitoneal lymph nodes. \nIf there is continued clinical concern, further evaluation with a nuclear\nmedicine MIBG scan could be performed, as this is a more sensitive study.\n2. Intra- and extrahepatic biliary duct dilatation should be correlated with\nLFTs and results of prior ERCP.  Pneumobilia is compatible with prior biliary\nintervention.\n3. 4.8 x 2.5 cm rim enhancing fluid collection in the right inguinal region,\nwhich could represent abscess or 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. \nThere is 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 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 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 renal lesions or hydronephrosis.  Bilateral\nsubcentimeter renal hypodensities are too small to characterize but\nstatistically likely cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Status post total colectomy\nwith end ileostomy.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. No evidence of acute Crohn's flare.\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. \nRight vasectomy clips are noted.  The previously seen left vasectomy clips are\nnot imaged.\n\nLYMPH NODES: Prominent lymph nodes in the hepatic hilum have increased in size\nsince prior, measuring up to 1.7 cm in short axis.  No new retroperitoneal or\nmesenteric lymphadenopathy.  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: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. No acute intra-abdominal process.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Borderline splenomegaly.\n4.  Please refer to separate report on same-day CT chest for complete\ndescription of the thoracic findings."
        },
        {
            "input": "PELVIS: Rectally administered contrast opacifies the rectum extending\nproximally to the level of the right lower quadrant stoma.  Some of the\ncontrast is visualized within the ostomy pouch.  There is no evidence of bowel\nobstruction or extravasation of contrast.  Patient is undergone recent trans\ngluteal drainage of a collection in the left piriformis muscle.  The drainage\ncatheter tip is well positioned and there is no significant adjacent\ncollection within the left piriformis muscle.  However, residual collections\nare noted within the presacral space best seen on series 6, image 31 measuring\n7.0 x 1.5 x 2.6 cm, previously 10.0 x 1.9 x 3.6 cm.  Additionally, the\ncollection in the right piriformis muscle appears slightly smaller though 2\nsmall collections persist best seen on series 3, image 20 measuring 21 x 14 mm\nand 25 x 14 mm best seen on series 3, image 20.  At least 1 of these\ncollections appears to communicate with the presacral collection, best seen on\nseries 5 images 21 and 22.  There is no enteric contrast within these\ncollections.\n\nThe uterus and adnexal regions appear normal.  The urinary bladder is mostly\ndecompressed.  No pelvic free fluid.  No pelvic sidewall or inguinal\nadenopathy.\n\nBones: Unremarkable.",
            "output": "Interval drainage of left piriformis collection without evidence of residual\ncollection at this site.  Persistent though smaller collections in the\npresacral space and right piriformis muscle, likely communicating.  Consider\nadditional percutaneous drainage.  No evidence of enteric contrast within\nthese collections to suggest fistula."
        },
        {
            "input": "PELVIS: Noncontrast image demonstrated enteric contrast within the lower\nrectum.  A pigtail drainage catheter is again seen in the area of the previous\nleft piriformis collection.  After the administration of contrast through the\ndrainage catheter, a small amount of contrast is seen around the drain at the\nleft pelvic collection and contrast is seen crossing the midline and filling\nthe pre sacral soft tissue on the right.  The size of these collections are\nnot significantly changed from ___.  Additionally, compared to the\nnoncontrast image, new contrast is seen within a tubular structure just\nanterior to the sacrum, likely representing a fistulous connection to the\nbowel (compare series 2, image 27 with series 3, image 27).  The urinary\nbladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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.  There is communication of the left piriformis collection with the right\npresacral collections.  Additionally,  there is new contrast within a tubular\nstructure in front of the sacrum which likely represents a fistulous\nconnection with bowel.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:43 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 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.  The patient is status post\nileocecectomy and diverting loop ileostomy.  A pigtail drainage catheter is\nagain seen in the area of the previous left piriformis collection.  The\ncatheter tip is well positioned and there is no significant adjacent\ncollection within the left piriformis muscle.  Residual collections are again\nnoted in the presacral space best demonstrated on series 2: Image 135\nmeasuring up to 2.5 cm x 1.1 cm.  Additional smaller collections are\ndemonstrated inferiorly.  The superior extent is unchanged.  Of note, the\ncollection in the right piriformis muscle (series 2: Image 130) now extends\nmore laterally, is more conspicuous than prior exams, and measures\napproximately 5 cm x 1 cm.  These collections were demonstrated to be\ncommunicative on prior 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 and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent presacral space and right piriformis muscle collections which\nare now more organized in appearance and marginally larger than prior exam. \nThe right piriformis collection now extends more laterally and measures\napproximately 5 cm x 1 cm.  Of note, these collections were demonstrated to be\ncommunicative on prior CT dated ___.\n2. Stable appearance of left piriformis pigtail catheter with no significant\nadjacent collection.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\n___ at 10:35 am, 2 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 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: There is a small amount of simple fluid within the\npelvis.  There is a large left adnexal cystic mass measuring 7.1 x 5.2 x 6.6\ncm (2:69 and 61:29), better appreciated on the same day pelvic ultrasound,\ncompatible with likely hemorrhagic cyst versus endometrioma.  A small right\novarian cyst is better appreciated on 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. No evidence of appendicitis.\n2. Left ovarian cystic lesion measuring up to 7.1 cm with a small amount of\nsimple free fluid within the pelvis is better assessed on same day US as\nprobable hemorrhagic cyst (versus endometrioma).  Smaller right ovarian cystic\nlesion also thought to represent a hemorrhagic cyst is better assessed on\npelvic US.  Recommend follow-up pelvic ultrasound in 6 weeks to assess for\nresolution.\n\nRECOMMENDATION(S):  Follow-up pelvic ultrasound in 6 weeks to assess for\nresolution."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: Patient is status post supracervical hysterectomy. \nOvaries are unremarkable.\n\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: Postsurgical changes to the lower abdominal wall from resection\nof endometrioma.  No focal fluid collection or evidence of other complication.",
            "output": "No acute intra-abdominal abnormality.  Normal appendix.  Expected postsurgical\nchanges in the right lower quadrant from prior resection."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is a moderate\namount of free fluid within the pelvis.\n\nLYMPH NODES: There are no pathologically enlarged pelvic or inguinal lymph\nnodes.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES:  Numerous injections a granulomas are noted overlying the left\nlower abdominal wall.  Diffuse anasarca is noted.  Overlying the right gluteal\nmusculature, there is a mixed density lesion measuring 3.0 x 2.8 x 4.2 cm\n(4:97, 6:91), of unknown chronicity but likely a hematoma relating to the\npatient's given history of trauma.",
            "output": "1.  No acute fracture.\n2.  Age-indeterminate, mixed density soft tissue lesion overlying the right\ngluteal musculature.  In the setting of known trauma, findings likely\nrepresent a hematoma.  Recommend follow-up ultrasound in ___ weeks to document\nimprovement or resolution, and to exclude underlying soft tissue mass.\n3.  Diffuse anasarca and moderate free pelvic fluid.\n\nRECOMMENDATION(S):  Follow-up ultrasound in ___ weeks to document\nimprovement/resolution of a right gluteal subcutaneous hematoma."
        },
        {
            "input": "The visualized lung bases are clear. The heart is normal in size.\n\nABDOMEN:\n\nLIVER: The liver is homogeneous with no focal lesions. There is no biliary\nductal dilatation.\n\nGALLBLADDER: The gallbladder is normal in appearance.\n\nPANCREAS: The pancreas is normal in appearance.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS:  The kidneys are normal in appearance.\n\nGI: The stomach is mild-to-moderately distended with food but is otherwise\nunremarkable. The duodenum and intra-abdominal loops of bowel are normal in\ncaliber and unremarkable.\n\nRETROPERITONEUM:  There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR:  The abdominal aorta is normal in appearance.\n\nPELVIS:\n\nBowel wall thickening is seen in the distal sigmoid and rectum with mild\nadjacent fat stranding, consistent with a flare of ulcerative colitis. The\nuterus is normal in appearance. Cysts are noted in the bilateral ovaries,\nincluding 1 prominent cysts on the right ovary measuring up to 3.5 cm in\ndiameter. The distal ureters and bladder are normal. There is no pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo focal lytic or sclerotic osseous lesions suspicious for infection or\nmalignancy are seen.",
            "output": "1.  Bowel wall thickening is seen in the distal sigmoid and rectum with mild\nadjacent fat stranding, consistent with a flare of ulcerative colitis.  No\nother acute findings.\n\n2.  Mild to moderate distention of stomach with food."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  There is mild calcium burden\nin the abdominal 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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is contains stones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.  The largest\nstone measures up to 1.7 cm (3:67).\n\nPANCREAS: 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 up to 12.7 cm.  No focal\nsplenic lesions are identified.\n\nADRENALS: Bilateral adrenal glands are normal in size and shape.\n\nURINARY: Incidental note is made of a horseshoe kidney configuration, with\nfusion of the bilateral lower poles.  Bilateral renal cortical hypodensities,\nsome which are too small to fully characterize, measure up to 1.3 x 1.2 cm in\nthe right mid pole, consistent with a simple renal cyst (3:96).  There is mild\ncortical thinning and prominence of the medullary pyramids of the left\ninferior lower pole kidney (for example 601:69, 602:110).  Findings may\nreflect sequelae of prior insult.  No evidence of hydronephrosis.  No\nnephrolithiasis.  No perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Mild colonic diverticulosis.  The descending\ncolon is decompressed.  No convincing evidence to suggest colitis.  The rectum\nis unremarkable.  No evidence of bowel obstruction.  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: The prostate and seminal vesicles are grossly\nunremarkable.\n\nBONES: Moderate right hip degenerative changes are noted.  There is a\nsclerotic appearance of the right greater trochanter with adjacent heterotopic\nbone.  No aggressive osseous lesions are identified.  No acute fractures.\n\nSOFT TISSUES: Small bilateral fat containing inguinal hernias.",
            "output": "1. No convincing evidence of colitis.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Incidental note is made of a congenital horseshoe kidney with scarring of\nthe left inferior lower pole."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no significant calcium burden\nin the abdominal aorta and great abdominal arteries.  There is a anatomic\nvariant with the a left hepatic artery providing from the left gastric artery.\n\n The inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 4 main perforators on the\nright and 3 perforators on the left.\n\nThe perforators on the right measure: lateral 2 mm (series 3;91) ,\nintermediate 2 mm (series 3;103), medial 1.5 mm (series 3;11).\nThe perforators on the left measure: lateral 1 mm (series 3;126),\nintermediate1 mm (series 3;135), medial 2 mm (series 3;97).\n\nNotes: 1. The diameter of the perforators is measured at the level of the\nfascia as the perforators exit the rectus muscle.\n2. The number of perforators varies you need to comment only on the ___\nlargest on each side and refer to them as lateral, intermediate and medial\n(right and left) by their relation to one another on the axial images.\n3. On the sagittal MIP that is part of each study, please place an arrow on\nthe largest perforator on each side and save as a significant image.\n\nLOWER CHEST: Unremarkable.  Right breast prosthesis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is not cirrhotic.  There is no focal lesion with the\nlimitation that this is a arterial phase. 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 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. \nFew scattered subcentimeter hypodensity in both kidneys too small to be\ncharacterize but possibly related to cysts.  No hydronephrosis.\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. There is no\nevidence of pelvic or inguinal lymphadenopathy. Trace of free fluid in the\npelvis physiological.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere is a intrauterine device.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is intermediate and measures 2 mm. The largest perforator on the\nleft is medial and measures 2 mm."
        },
        {
            "input": "LOWER CHEST: Please see separately submitted Abdomen and Pelvis CT report for\nfindings above the diaphragm..\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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post bypass gastrectomy.  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 uterus and right ovary are not visualized.  The left\novary is unremarkable, noting a 2.5 cm left ovarian 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.  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 evidence of abdominopelvic malignancy or an acute abdominopelvic\nabnormality"
        },
        {
            "input": "Lungs and Heart: Of note, the chest portion of this examination will be\ndictated under other clip number.\n\nLiver, Gallbladder: The liver is normal in size and attenuation with no focal\nlesions identified. There is no intra or extrahepatic biliary ductal\ndilatation.  The hepatic and portal veins are patent. Again seen is\ncholelithiasis and choledocholithiasis with no evidence of cholecystitis.  Of\nnote, the possibility of Mirizzi syndrome should be considered in this patient\nwith both cholelithiasis and adjacent choledocholithiasis.\n\nThe patient is status post distal pancreatectomy, splenectomy and subtotal\ncolectomy and ileostomy.\n\nKidneys, Adrenals: The bilateral adrenal glands are normal.  There is a small\nhypodensity in the lower pole of the right kidney, which is unchanged. The\npatient is also status post left nephrectomy and partial diaphragm removal.\n\nStomach, Bowel: There is no evidence of hiatal hernia. The small bowel is\ngrossly normal appearing and shows no evidence of dilatation.  There is no\nevidence of free fluid in the abdomen.  An ileostomy is again seen and is\nunchanged.  Surgical clips are seen in the left lower quadrant and are\nconsistent with prior surgeries as described.\n\nVessels: There is moderate mural calcification of the abdominal aorta, however\nthe abdominal aorta is normal in caliber and its major branches appear patent.\n\nLymph Nodes: There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes by CT size criteria.\n\nPelvis: The rectum and sigmoid are unremarkable. There is no evidence of\npelvic free fluid.  The uterus is surgically absent.\n\nOsseous Structures: There are no suspicious lytic or blastic lesions\nidentified in the visualized skeleton.",
            "output": "1. No evidence of disease recurrence in the abdomen or pelvis.\n2. Cholelithiasis and adjacent choledocholithiasis are again seen and the\npossibility of Mirizzi syndrome should be considered given this finding.\nConsider MRCP for further evaluation when clinically appropriate."
        },
        {
            "input": "VASCULAR:\n\nPatent mesenteric and hepatic vasculature.  The right hepatic artery\noriginates directly from celiac trunk coursing behind the portal vein (3:47,\n46).  The left hepatic artery originates from the proper hepatic at the origin\nof the GDA.  Of note, a division of the right renal artery is in close\nproximity to the posterior aspect of the second portion the duodenum at the\nlevel of the duodenal mass (3:72).  There is no abdominal aortic aneurysm. \nThere is minimal calcium burden in the abdominal aorta and great abdominal\narteries.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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: Redemonstrated the second portion of the duodenum is an oval\nwell-circumscribed hypodense mass that measures approximately 1.7 x 1.6 cm\ncorresponding to findings on prior MRI (3:70).  There is no evidence local\ninvasion or obstruction.  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.  An\naortocaval lymph node measures 6 mm in short axis, not pathologically enlarged\n(3:63).\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 within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Redemonstrated well-circumscribed duodenal mass as seen on prior MRI.\n2. No evidence of local invasion, bowel obstruction, lymphadenopathy, or\nmetastasis.\n3. Variant hepatic vascular anatomy. The right hepatic artery originates from\nthe celiac axis and courses behind the main portal vein similar to the\nexpected course of a replaced right hepatic artery of the SMA.\n4. Right renal artery division courses in very close proximity to the\nposterior wall of the duodenum at the level of the mass."
        },
        {
            "input": "LOWER 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 hypoattenuating focus in segment 7 of the liver (5:59), is\nunchanged compared to prior study and likely represents a cyst or biliary\nhamartoma.  Additional ill-defined subcentimeter hypodensities, are grossly\nunchanged compared to prior and too small to fully characterize.  There is no\nevidence of focal suspicious lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nPANCREAS: There is a soft tissue enhancing mass, arising from the pancreatic\nhead, now measuring 2.0 x 1.6 cm (5:61, 8:27), which previously measured 3.1 x\n3.2 cm.\nIn the pancreatic body there is a hypodense well-defined cystic-appearing\nlesion, that measures 2.2 cm in maximum dimension (5:55) that may represent an\nIPMN, slightly more conspicuous than on prior study likely due to differences\nin technique.\nThe pancreatic parenchyma appears atrophic, with coarse calcifications\nprojecting in the head and uncinate process, which may represent changes of\nprior pancreatitis.\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 with normal nephrogram. \nThere is a 1.2 cm exophytic right upper pole simple cyst (5:65).  There is no\nevidence of solid 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 colonic\ndiverticula.  The remainder of 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 a prominent portacaval lymph node measuring 0.9 cm in\nshort axis (5:62), previously 1 cm.\nIn the right lower quadrant there is ill-defined mesenteric stranding, where\npreviously a 1.8 cm soft tissue nodule was visualized (8:33).\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.\n\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.  Small left fat containing inguinal hernia.",
            "output": "1. Interval decreased size of the likely metastatic pancreatic head mass, now\nmeasuring 2 cm in maximum dimension, previously 3.2 cm.\n2. At site of previously visualized 1.8 cm right lower quadrant mesenteric\nsoft tissue nodule, there is now mesenteric fat stranding, in keeping with\nhistory of excisional biopsy.\n3. No new metastases in the abdomen or pelvis.\n4. 2.2 cm pancreatic body cystic lesion, slightly more conspicuous than on\nprior study, likely due to differences in technique, may represent an IPMN. \nSee below recommendations for follow-up.\n\nRECOMMENDATION(S):  For pancreatic cysts measuring more than 1.5cm, patients\nshould be referred to the pancreas cyst clinic for consultation. These\nreferrals can be made by emailing ___\nor by calling ___.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable 1.5 cm right hepatic lobe cyst.  Less conspicuous hypoenhancing\nsubcentimeter lesion in hepatic segment VII is too small to characterize but\nstable.  Areas of hyperenhancement in the right and left hepatic lobes appears\nstable and likely represent perfusional change (3:56, 3:63).  No new or\nsuspicious focal 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: Redemonstrated heterogeneously hyperenhancing mass in the upper pole\nthe right kidney which measures 3.8 x 3.1 x 3.4 cm, previously 3.8 x 3.0 x 3.4\ncm, stable given differences in measurement but slowly growing since ___\nwhen it measured 3.5 x 2.6 x 3.1 cm (3:64, 601:34).  It does not extend to the\nrenal sinus fat.  No new masses are seen in either kidney.  No hydronephrosis\nor 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: Single bilateral renal arteries and veins are patent. Large\natherosclerotic plaque at the origin of the right renal artery does not cause\nsignificant stenosis. there is no abdominal aortic aneurysm.  Extensive\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are present in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 3.8 cm right upper pole renal mass, again concerning for clear cell renal\ncell carcinoma, is not appreciably changed since ___, slowly growing\nsince ___.  Single bilateral renal arteries and veins.\n2. No evidence of metastasis in the abdomen and pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThe patient is status post aorto bi-iliac stent placement, without evidence of\nendoleak.  The calcified infrarenal abdominal aortic aneurysm sac measures\napproximately 4.2 cm, similar to prior.  Severe calcium burden is seen within\nthe abdominal aorta.  The celiac axis is severely narrowed, new from the prior\nstudy, with severely diminutive hepatic and splenic arteries and associated\ndecreased perfusion of these organs.\nAn SMA stent is in place, which appears patent.  Atherosclerotic disease is\nseen at the origin of the right renal artery, which appears patent.  An\naccessory left renal artery is well opacified (05:36), while the main left\nrenal artery is suboptimally opacified (05:38), which suggests possible\nstenosis of the ostium.  A left femoral approach catheter is partially imaged.\n\nLOWER CHEST: Moderate bilateral pleural effusions, left greater than right,\nwith adjacent compressive atelectasis.  The previously seen lesion within the\nright lower lobe is obscured by the pleural effusion and atelectasis. \nModerate centrilobular emphysema.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged and appears mottled.  Multiple\nhypoattenuating hepatic metastatic lesions are better assessed on the most\nrecent prior study.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Small locules of air are seen within the left hepatic\nlobe (for example, 05:35), which could reflect small volume portal venous gas,\nlikely from recent procedure.  No pneumatosis, mesenteric or free\nintra-abdominal air.  The gallbladder is decompressed, limiting evaluation.\n\nPANCREAS: Pancreas demonstrates differential enhancement with the tail being\nmarkedly hypoenhancing, the body demonstrates enhancement, and the head\nintermediate enhancement.  No evidence of focal lesions or pancreatic ductal\ndilatation.  No peripancreatic stranding.\n\nSPLEEN: The spleen demonstrates normal size, although appears diffusely\nhypoenhancing.\n\nADRENALS: The right and left adrenal glands are normal in size and shape, but\nappear mildly hyperenhancing.\n\nURINARY: The kidneys are of normal and symmetric size.  Multiple, bilateral,\nwedge-shaped hypodensities are new, concerning for renal infarcts. \nSubcentimeter left renal hypodensities are too small to characterize.  There\nis no evidence of stones or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A portion of the gastric wall is diffusely hypoenhancing. \nMultiple segments of small bowel appear hypoenhancing, concerning for\nischemia, for example, in the terminal ileum (5:100).  Multiple areas of\ncolonic hypoenhancement in the splenic flexure (05:37) as well as parts of the\nsigmoid, descending and transverse colon (05:81).  No evidence of pneumatosis\nor free intraperitoneal air.  Sigmoid diverticulosis, without evidence of\nacute diverticulitis.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium is mildly thickened, measuring 8 mm.  The\nuterus is otherwise unremarkable for age.  No adnexal masses.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLevoconvex curvature of the lumbar spine.  Multilevel degenerative changes of\nthe thoracolumbar spine.\n\nSOFT TISSUES: Multiple surgical clips are seen within the bilateral inguinal\nregions. Mild diffuse subcutaneous edema.",
            "output": "1. Interval, new severe narrowing of the celiac axis, compatible with near\ncomplete occlusion as well as extremely diminutive appearance of the hepatic\nand splenic arteries, with a mottled appearance of the liver and\nhypoenhancement of the spleen, gastric wall, and pancreatic tail concerning\nfor ischemia.\n2. Multiple wedge shaped hypodensities of the bilateral kidneys, likely\nreflecting renal infarcts, possibly from embolic etiology.\n3. Hypoenhancement of multiple bowel segments (small and large bowel)\nconcerning for bowel ischemia (may also be embolic).  No evidence of\npneumatosis or free intraperitoneal air.\n4. Status post aorto bi-iliac stent placement, without evidence of endoleak. \nNo substantial change in size of the infrarenal abdominal aortic aneurysm sac,\nmeasuring 4.2 cm.\n5.   Suspected hepatic metastasis were better visualized on prior study. \nSmall locules of air seen within the left hepatic lobe which likely represent\nsmall volume portal venous gas, from recent procedure as there is no evidence\nof pneumatosis, mesenteric venous air locules or free intra-abdominal air.\n6. Moderate bilateral pleural effusions, with adjacent compressive\natelectasis.  The right pleural effusion and atelectasis obscures the right\nlower lobe lesion, better characterized on prior CT.\n7. Mildly thickened endometrium, measuring 8 mm.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:50 pm, 1 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: There are a few pulmonary nodules within the lungs including a 4\nmm nodule at the right lower lobe (series 5, image 12) and a 6 mm nodule at\nthe left lower lobe (5, image 9).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 or\nextrahepatic biliary dilatation.  There are nonobstructing gallstones within\nnondistended gallbladder.  The largest measures approximately 1.9 cm in\ndiameter.\n\nPANCREAS: There multiple side branch IPMNs measuring up to 4.8 cm in diameter.\nThese are unchanged from prior imaging.  There is no ductal dilatation.  There\nis no peripancreatic stranding.\n\nSPLEEN: There is a small hypodensity within the spleen which is most likely\nbenign based on prior MRI.  The spleen shows normal size and attenuation\nthroughout.\n\nADRENALS: There is nodular thickening of left adrenal gland.  There appears to\nbe left myelolipoma that is stable.  The right adrenal gland is unremarkable.\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.\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 or fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a multi fibroid uterus.  Reproductive organs are\notherwise unremarkable.\n\nLYMPH NODES: There are a few prominent portacaval, periaortic and mesenteric\nnodes.  There is no lymphadenopathy by size criteria.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are compression fractures of the T12 and L1 vertebral bodies. \nThere is 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": "1. Again seen are cystic lesions within the pancreas consistent with side\nbranch IPMNs.  These are similar in size to prior imaging.\n2. Colonic diverticulosis without evidence of diverticulitis.\n3. Fibroid uterus.\n4. Stable compression deformities of the T12 and L1 vertebral bodies.\n5. There are no suspicious findings within the abdomen/pelvis concerning for\nmalignancy.  No lymphadenopathy.  No abdominopelvic abscess or organized 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 is markedly hypoattenuating throughout, consistent\nwith hepatic steatosis.  There is no evidence of focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Gallstones are\nseen within the gallbladder, without overt signs 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 focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post gastric bypass, without evidence of\ncomplication.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement 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\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nTampon is seen within the 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.  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. Cholelithiasis without hydropic distension of the gallbladder or convincing\nevidence for acute cholecystitis.  Given laboratory findings, ultrasound is\nrecommended for further evaluation.\n2. Hepatic steatosis.\n\nRECOMMENDATION(S):  Given laboratory findings, ultrasound is recommended for\nfurther evaluation."
        },
        {
            "input": "LOWER CHEST: Unchanged micronodule in the right lower lobe (02:39). There is\nmild bilateral dependent atelectasis, right greater than left.  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.  Air is noted throughout much\nof the small bowel.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. There is a large amount of stool\nthroughout the colon.  The appendix is normal (401:44).\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": "There is a large amount of stool throughout the colon, as well as air\nthroughout the small bowel.  Otherwise, no acute intra-abdominal findings."
        },
        {
            "input": "For findings within the chest, please refer to the separate report for the CT\nchest performed earlier on the same visit.\n\nAssessment of the solid visceral structures of the abdomen and pelvis is\nlimited without IV contrast.\n\nABDOMEN:\n\nThe liver is homogeneous in attenuation, without focal lesion. The segment\nVIII subcentimeter hypodensity noted on the prior examination is not well seen\non this noncontrast examination. The fluid contents within the gallbladder is\nrelatively dense, suggestive of stones or sludge.  There is gallbladder wall\nedema, which is nonspecific in the setting of diffuse anasarca.  The pancreas,\nspleen, and adrenal glands are normal. The kidneys are without stones,\nconcerning solid lesion (within the limitation of non-contrast technique), or\nhydronephrosis.  The stomach and duodenum are normal.  The small bowel and\nlarge bowel are normal in caliber.  The appendix is normal (601b:25).  There\nis no intra- or retroperitoneal lymphadenopathy. There is a small volume\nascites, along with diffuse stranding of the subcutaneous and mesenteric fat. \nThere is no fluid collection or pneumoperitoneum.  There is no hemo peritoneum\nor retroperitoneal hematoma.  The abdominal aorta is normal caliber.\n\nPELVIS:\n\nThe rectum is normal.  The urinary bladder is collapsed around a Foley\ncatheter balloon and cannot be adequately assessed.  There is no pelvic or\ninguinal lymphadenopathy.  The prostate is mild to moderately enlarged.\n\nMUSCULOSKELETAL:\n\nThere is a mild compression deformity of L2, which has progressed by 2 mm from\n___ (602b:40). The T12 compression fracture, which has also\nprogressed, is discussed on the chest CT report.  Diffuse heterogeneity of the\nimaged spine is concerning for metastatic disease and has worsened markedly\nsince the prior study.",
            "output": "1. No evidence hemoperitoneum or retroperitoneal hematoma.\n2. No evidence of acute inflammatory process in the abdomen or pelvis, within\nthe limitation of noncontrast technique.\n3. Anasarca with small to moderate volume ascites.\n4. Progression of T12 and L1 compression fractures from ___.\n5. Diffuse heterogeneity of the imaged skeleton is concerning for metastatic\ndisease, markedly increased since the 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: 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\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.  Retroaortic left renal vein\nis incidentally noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Trace free fluid in the pelvis, not physiologic in a male though no underlying\netiology to explain this finding.\nOtherwise unremarkable CT scan without findings to explain symptoms.  Normal\nappendix."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. Hepatic arterial anatomy is\nconventional.  There are bilateral accessory renal arteries.  There is mild\ncalcium burden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: 0.5 cm left lower lobe pulmonary nodule (series 3, image 10) is\nlikely unchanged there to ___.  2 additional 0.3 cm pulmonary nodules\nin the right lower lobe also likely unchanged compared to ___. \nOtherwise the lung bases are clear.  No pleural or pericardial effusions.\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 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, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of stone or hydronephrosis.  1.8 cm simple cyst is seen\nin the lower pole of the right kidney.  There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is diverticulosis of the sigmoid and\nascending colon.  Otherwise the remaining colon and rectum are within normal\nlimits.  Appendix contains air, 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\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 unremarkable.  No adnexal mass.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are mild.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.\n\n The inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 3 perforators on the right\nand 3 perforators on the left.\n\nThe perforators on the right measure: lateral 2 mm, intermediate 3 mm, medial\n1 mm.  The intermediate perforators (series 605, image 36) demonstrates\nrelatively short course through the rectus muscle.\n\nThe perforators on the left measure: lateral 3 mm, intermediate3 mm, medial 2\nmm.  The intermediate perforator (series 605, image 54) demonstrates short\ncourse through the rectus muscle.  The lateral and medial perforators\ndemonstrate elongated and oblique course through the rectus muscle",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is intermediate and measures 3 mm. The largest perforator on the\nleft is intermediate and measures 3 mm.\n2. No acute process within the abdomen or pelvis.\n3. Bilateral lower lobe pulmonary nodules, likely stable compared to ___ given technique differences, and therefore no follow-up is required."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 moderately well distended and grossly\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThe appendix is air-filled and normal in appearance, without adjacent fat\nstranding (601b:21, 2:48).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\ntrace amount of free fluid in the pelvis, likely physiologic.\n\nREPRODUCTIVE ORGANS: A 1.5 cm fibroid is identified in the superior aspect of\nthe uterus (601b:30).\n\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.  Mild degenerative changes of the lumbar spine are present,\nand most pronounced at L2-L3, where there is endplate sclerosis and disc space\nnarrowing.  The abdominal and pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain.  Normal appendix without adjacent fat stranding."
        },
        {
            "input": "Lung bases clear.\n\nNo focal liver lesions.  Nondistended gallbladder.  Normal appearance of\npancreatic parenchyma. No significant biliary dilatation. Normal spleen and\nadrenals.\n\nNo hydronephrosis or suspicious renal lesions.  Partially duplex right-sided\ncollecting system.\n\nContrast within stomach.  Mild colonic diverticulosis. Stool throughout colon.\nNo intraperitoneal gas.  Normal appearance of small bowel loops.\n\nMild calcification of normal caliber abdominal aorta.  No retroperitoneal or\nmesenteric adenopathy. Fat containing periumbilical hernia.\n\nNo focal bladder wall thickening. No free pelvic fluid. No pelvic adenopathy.\n\nNo suspicious osseous lesions.",
            "output": "-Normal abdominopelvic CT.   No colonic perforation, intraperitoneal free air\nor other explanation for abdominal pain."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar dependent atelectasis, the lung\nbases 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 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 at the right superior polar too small to\ncharacterize.  There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The presence of fecalized\nmaterial in multiple small bowel loops may be related to ileocecal valve\nincompetence.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is marked mural edema and hyperenhancement\nof the distal transverse colon extending through the entire descending colon. \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 gland 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 fracture. \nModerate degenerative disc disease at L3-L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Mural edema and mucosal hyperenhancement involving the distal transverse and\nentire descending colon is compatible with colitis.  This could be infectious,\ninflammatory or ischemic."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 the right hepatic lobe is again seen and is\ntoo small to characterize, may represent a cyst or biliary hamartoma.  There\nis mild extrahepatic biliary ductal dilation likely secondary to\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: A small hiatal hernia is noted.  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: An IVC filter is noted at superior tip at the level of the renal\nveins in appropriate position.  No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an approximately nonenhancing 6.3 x 6.1 x 5.1 cm\nill-defined fluid collection in the left inguinal region with associated\nsubcutaneous stranding and edema the extends upwards overlying the left\nlateral abdomen",
            "output": "1. A 6.3 cm nonenhancing ill-defined fluid collection along with extensive\nsubcutaneous edema and stranding is present in the left inguinal region. \nImaging findings are most consistent with a subacute hematoma\n2. IVC filter at superior tip at the level of the renal veins in appropriate\nposition."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nThere is an accessory left hepatic artery arising from the celiac axis.\n\nThere is a large right-sided retroperitoneal hematoma with a fluid fluid level\nand evidence of at least 3 sites of active contrast extravasation from\nperipheral retroperitoneal lumbar branch arteries. 1 of the branches courses\nthrough the psoas muscle.  Overall, the retroperitoneal hematoma is\napproximately 11.6 x 12.3 x 12.8 cm.  This extends from the posterior para\nrenal space inferiorly any anterior to the iliopsoas. There is also and\niliacus hematoma which extends towards the lesser trochanter. This measures\napproximately 2.9 x 8.0 x 10.8 cm. There is also a small focus of active\ncontrast extravasation on the venous phase at the level of the iliac crest\n(4B: 970).\n\nA left femoral central line is in situ with tip in the right atrium.  A right\nfemoral venous line is in situ with tip in the right common iliac vein.\n\nLOWER CHEST: Minimal bilateral atelectasis. Small bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nGeographic areas of hypodensity surrounding the falciform ligament, which may\nbe perfusional versus focal fat.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is within normal limits and\ncontains contrast, without gallbladder wall thickening.\n\nPANCREAS: The pancreas has normal attenuation throughout. The main pancreatic\nduct is not dilated. There is a 0.6 cm hypodensity in the uncinate process\nwhich may represent a fat lobule versus side-branch 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: Native kidneys are atrophic, with poor enhancement. There is no\nevidence of hydronephrosis.  Transplant kidney is appreciated within the right\nlower quadrant and pelvis containing multiple small cysts, as well as to\nslightly larger cysts. There is hypertrophy of the renal sinus fat. No\nevidence of hydronephrosis.  The bladder is decompressed with a Foley catheter\nin situ.  A peritoneal dialysis catheter is seen along the anterior pelvic\nwall.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. Small\nvolume ascites.  There is high density fluid with hematocrit level in the\npelvis, representing extension of hemorrhage.\n\nBONES: There 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 right-sided retroperitoneal hematoma mainly anterolateral to the\npsoas muscle, as well as a right-sided intramuscular iliacus hematoma.\nMultiple sites of active contrast extravasation, at least 3 in the\nretroperitoneal hematoma from lumbar arteries, and 1 slow flowing/venous bleed\nin the iliacus hematoma.\n2. Small to moderate hemorrhagic ascites.\n3. Bilateral nonhemorrhagic pleural effusions.\n4. Atrophic bilateral native kidneys. Right lower quadrant transplant kidney\ncontaining multiple cysts, normal nephrogram, with hypertrophied renal sinus\nfat.  Peritoneal dialysis catheter with tip against the anterior pelvic wall."
        },
        {
            "input": "Lung Bases: The imaged lung bases are clear aside from minimal basal dependent\natelectasis.  The imaged portion of the heart is unremarkable. There is a\nsmall hiatal hernia.\n\nAbdomen: The liver enhances normally without concerning focal liver lesion. \nGallbladder is moderately distended though appears unremarkable.  No biliary\nductal dilation.  The pancreas appears normal.  The spleen is normal in size. \nNodular thickening of the left adrenal gland is noted.  The kidneys enhance\nsymmetrically.  No concerning renal lesion or hydronephrosis.  The abdominal\naorta is mildly calcified and normal in course and caliber.  No\nretroperitoneal adenopathy.  Stomach is decompressed.  The duodenum is normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is normal.  The colon contains a large fecal load.  There is bowel\nwall thickening involving the rectum and sigmoid colon and the distal aspect\nof the descending colon concerning for colitis.  There is associated\npericolonic stranding most notable along the distal descending colon.  Mural\nirregularity and distortion along the proximal sigmoid colon raises potential\nconcern for an underlying mass and a colonoscopy is recommended once the acute\nsymptoms resolve to further assess.  There are small adjacent lymph nodes in\nthe sigmoid mesocolon measuring up to 8 mm in short axis, series 2, image 58. \nNo free air or drainable fluid collection.  Urinary bladder is moderately\ndistended.  Right-sided bladder diverticula noted.  Clips are noted in the\nregion of the prostate gland.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Acute colitis involving the descending colon, sigmoid and rectum, likely\ninfectious or inflammatory.\n2. Relative distortion involving the proximal sigmoid colon which warrants a\nnonemergent colonoscopy to exclude underlying neoplasm.  Several mildly\nprominent lymph nodes along the sigmoid mesocolon noted.\n3. Diverticulosis without diverticulitis.\n4. Normal appendix."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings including the increasing moderate\nto large bilateral pleural effusions and severe bibasilar atelectasis.\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 adrenal gland is normal in size and shape. Left adrenal\nnodules appears stable measuring 2.0 cm in the lateral limb and 1.5 cm\ninvolving the body (02:56).\n\nURINARY: The kidneys are of 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 stomach.  The stomach is\ndistended and small bowel loops are dilated with air-fluid levels scattered\nthroughout.  The right lower quadrant there is fecalization of small bowel\nloops suggesting slow transit.  There is an abrupt transition to very\ndecompressed small bowel as it exits the right anterior abdomen at the\nileostomy (2:90).  There is stranding and mild fluid in the mesentery without\norganized fluid collection or large pneumoperitoneum. There has been interval\ncolectomy with improving minimal inflammation around the rectal pouch. A\nrectal tube is present.\n\nPELVIS: Stable right bladder diverticulae. The bladder slightly decompressed.\n\nREPRODUCTIVE ORGANS: Fiducials are present in the right prostate and the\nprostate appears nodular.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Anasarca.  Postsurgical changes in the anterior abdominal wall. \nNo abscess.",
            "output": "1. Small bowel dilation  with transition point at the ileostomy exit from the\nright anterior abdominal wall. This may either represent bowel obstruction or\nileus.  No evidence of ischemia or perforation.\n2. Post colectomy with expected postsurgical changes.  No abscess.\n3. Left adrenal nodules measuring up to 2.0 cm are incompletely characterized.\nNon urgent MRI or Adrenal protocol CT may be performed to better characterize\nthem.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings including the increasing moderate to\nlarge bilateral pleural effusions and severe bibasilar atelectasis.\n\nRECOMMENDATION(S):  Please see impression No 3\n\nNOTIFICATION:  The findings were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 3:18 pm, 10\nminutes after discovery of the findings."
        },
        {
            "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: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nTrace abdominal ascites is demonstrated throughout the abdomen, tracking into\nthe 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 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: Two left adrenal nodules are re-demonstrated measuring 2 cm in the\nlateral limb in 1.5 cm in the body, unchanged from prior.  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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post colectomy with interval decrease\nin minimal inflammation around the rectal stump, compared to prior.  Again\nseen are multiple distended loops of small bowel throughout the abdomen with a\ndecompressed loop of small bowel demonstrated as it trans its the right\nanterior abdominal wall the ileostomy site, though degree of distension is\nmildly improved from prior.  No findings identified to suggest active bleeding\nthrough the ostomy site.  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: A small right bladder diverticulum is re-demonstrated otherwise the\nbladder is under.  There is no evidence of pelvic or inguinal lymphadenopathy.\nThere is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fiducials within the prostate are again seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes in the anterior abdominal wall\nre-demonstrated.",
            "output": "1. Small bowel dilatation with transition point at the ileostomy site which\ncould represent obstruction or ileus, though mildly improved from prior study.\n2. Status post colectomy with mild interval decrease in inflammatory changes\naround the rectal stump.  No abscess 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:\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 normal in size, with no\nradiodense stones demonstrated.  There is pericholecystic fluid, but this\nappears to be related to mild generalized ascites in the flanks and between\nmesenteric loops.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no significant\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Nodular thickening of the left adrenal gland measuring up to 1.2 cm\nis unchanged.  This can be re-evaluated at next follow-up CT.  The right\nadrenal 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\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach contains a weighted feeding tube.  There is a\nright lower quadrant ileostomy.  The residual small bowel is contrast\nopacified with no evidence of obstruction.  Mild wall thickening is likely\npostsurgical.  The patient is status post colectomy.  The rectal stump is\nagain fluid-filled but appears intact.\n\nThere is a thin residual rim enhancing collection in the left anterior abdomen\nbetween the small bowel and deep abdominal wall.  This measures approximately\n11.5 x 5.8 x 1.0 cm, previously approximately 21.5 x 17.5 x 3.5 cm.\n\nThere is are traces of free-fluid as mentioned above but there is no\nextraluminal contrast or air aside from a tiny locule of gas just deep to the\nright abdominal wall near midline (2:72), which is likely residual from recent\nsurgery.\n\nPELVIS: The bladder wall is diffusely, mildly thickened.  There are\nright-sided bladder diverticulae.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged and diffusely nodular.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 an open midline surgical wound containing packing\nmaterial.",
            "output": "1. No evidence of bowel obstruction or leak.\n2. Small residual rim enhancing collection in the left anterior peritoneal\ncavity, decreased from prior study and not drainable.\n\nNOTIFICATION:  The findings were discussed with the nurse practitioner on the\ncolorectal surgery team by ___, M.D. on the telephone on ___ at\n3:15 pm, 30 minutes after discovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. No active extravasation of IV contrast\nis identified.  There is moderate calcium burden in the abdominal aorta and\ngreat abdominal arteries.\n\nLeft accessory renal artery is noted.\n\nIVC filter is identified.\n\nLOWER CHEST: 9 mm ground-glass opacity in right lung base is likely a minimal\ninfectious/inflammatory change.  Atelectasis is minimal in bilateral lung\nbases.\n\nABDOMEN:\nThere is no ascites.\n\nHEPATOBILIARY: Liver demonstrates homogeneous attenuation.  Tiny\nhyperenhancing foci near the dome may represent areas of altered perfusion or\nflash filling hemangiomas.  Intra and extrahepatic bile ducts are not dilated.\nGallbladder is unremarkable.\n\n\nPANCREAS: Pancreas demonstrates homogeneous attenuation throughout.  There is\nno pancreatic duct dilation.\n\nSPLEEN: Spleen is not enlarged.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: Punctate radiodensity in mid right kidney may be a nonobstructing\nstone.  25 mm hypodensity in left kidney upper pole is consistent with a renal\ncyst.  Several subcentimeter hypodensities in right kidney are too small to be\nfully characterized.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Small and large bowel loops are\nnormal caliber.  Extensive colonic diverticulosis is noted.  Appendix is\nunremarkable.\n\nPELVIS: Bladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is noted.  5 mm calcification in the right\nadnexa is nonspecific.  Pessary is in place.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nBONES: No suspicious bone lesion is identified.\n\nSOFT TISSUES: Fat containing umbilical hernia is small.",
            "output": "1. No evidence of intestinal bleeding is identified.\n2. Colonic diverticulosis."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Mild eventration of the right\nhemidiaphragm.  Lung bases, visualized pleural spaces, and lower mediastinal\nstructures otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Patient is status-post cholecystectomy.  No\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Interdigitating fat within the pancreatic parenchyma.  Pancreas\notherwise unremarkable.  No focal parenchymal lesions.  No main duct\ndilatation.\n\nSPLEEN: Spleen is not enlarged (10 cm).\n\nADRENALS: Adrenal glands are normal.  Tiny calcification within the left\nadrenal gland.\n\nURINARY: The right kidney is atrophic relative to the left kidney.  There are\nno focal parenchymal lesions.  No perinephric fat stranding.  In the left\nkidney, there is a 3 mm calculus at the upper pole of the left kidney, and two\nadditional 2-3 mm calculi at the interpolar region of the left kidney.  There\nis no evidence of hydronephrosis or hydroureter.  In the right kidney, there\nis a 4 mm calculus at the lower pole of the right kidney.  No evidence of\nhydronephrosis or hydroureter.  No ureteric or bladder calculus.\n\nGASTROINTESTINAL: Normal appearance of the large and small bowel. No mural\nthickening.  A large duodenal diverticulum is noted no luminal distention. \nAppendix in the right lower quadrant normal.\n\nPELVIS: Unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: Unremarkable prostate gland and seminal vesicles. \nNon-specific tiny penile calcifications.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, mesenteric, or periportal\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta nonaneurysmal.  Mild atheromatous calcification of\nthe aortoiliac vasculature.\n\nBONES: No acute or focal destructive osseous lesions.  Multilevel degenerative\ndisc disease throughout the visualized spine, most pronounced at L4-L5.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.\n\nPERITONEUM: No free-fluid.",
            "output": "1.  bilateral non-obstructive nephrolithiasis.  The largest calculus measures\n4 mm in diameter and is seen at the lower pole of the right kidney.  No\nureteric or bladder calculus.\n2.  Large duodenal diverticula"
        },
        {
            "input": "LOWER CHEST: Numerous nodules in the imaged lung bases measure up to 2.0 cm in\nthe left lower lobe.  Please refer to separate report of CT chest performed on\nthe same day for a detailed description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is diffuse hepatic steatosis.  A few scattered\nsubcentimeter hypoattenuating lesions in the liver (05:47, 50, 63) are\nunchanged.  No new focal mass lesions are identified.  No biliary dilatation. \nThere is cholelithiasis, without evidence of cholecystitis.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: A small left renal cyst is unchanged.  The kidneys are otherwise\nunremarkable.\n\nGASTROINTESTINAL: Small and large bowel loops are normal in caliber. \nExtensive colonic diverticulosis, most notable in the sigmoid colon, is again\ndemonstrated.  Normal appendix (09:21).  No ascites.\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: No pathologically enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Re-demonstration of\nnoncalcified plaques along the posterior abdominal aorta (05:59).  Ectasia of\nthe left common iliac artery up to 1.5 cm (5:76) is unchanged.\n\nBONES: Extensive osseous metastatic disease in the form of mixed lytic and\nsclerotic lesions involving the thoracolumbar spine, pelvis and left lesser\ntrochanter are similar.  No new focal lesions are identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive osseous metastatic disease involving the thoracolumbar spine,\npelvis and left lesser trochanter appear similar to ___.\n2. No specific evidence of new metastatic disease in the abdomen or pelvis.\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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstration multiple subcentimeter hypodense lesions, which appear\nunchanged compared to prior CT.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.\n\nPANCREAS: Mild fatty replacement of the 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 upper pole of the left kidney. There is\nno evidence of a concerning focal renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach appears normal.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Extensive\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Re-demonstration of multiple mixed lytic and sclerotic lesions\ninvolving the thoracolumbar spine, pelvis, and left lesser trochanter, which\nappear more sclerotic compared to prior CT dated ___.  No new focal\nlesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Re-demonstration of multiple lytic and sclerotic lesions involving the\nthoracolumbar spine, pelvis, and left lesser trochanter.  Compared to prior\nCT, these findings appear more sclerotic.  No new concerning lesions\nidentified."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Dense mitral annular calcifications are\nnoted as well as probable aortic valve and coronary artery calcifications.\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 contains stones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.  There is\nhowever significant stranding adjacent to the gallbladder neck, more fully\ndescribed below.  A 5 mm slightly dense focus is identified in the distal CBD\n(2:30, 6018:69) which may reflect a stone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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 1.8 x 1.2 cm peripherally calcified lesion is\nidentified near the splenic hilum is felt to represent a partially thrombosed\nsplenic heart aneurysm.\n\nADRENALS: The 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 millimetric hypodensities in bilateral kidneys are too small to be\ncharacterized, likely cysts.  There is no hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:  A 2.2 x 0.9 cm focal outpouching of the proximal duodenal\nis noted suspicious for diverticulum (02:28, 601 a 59).  Surrounding fat\nstranding is identified centered around the outpouching and extending to the\ngallbladder neck and pancreatic head.  Extensive colonic diverticulosis is\nnoted without diverticulitis.  Appendix is not visualized.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR:  Mild to moderate atherosclerotic calcifications noted throughout\nthe abdominal aorta which is normal in caliber.\n\nPELVIS: Foley catheter is in the bladder.  There is no evidence of pelvic or\ninguinal 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. A 2.2 x 0.9 cm duodenal diverticulum in the first portion of the duodenum\nis inflamed with the inflammatory changes extending to the gallbladder neck\nand pancreatic head.\n2. Probable 5 mm gallstone is identified in the distal common bile duct. \nIntra and extrahepatic bile ducts are normal in size. Cholelithiasis.\n3. Extensive colonic diverticulosis.\n4. A 1.8 x 1.2 cm peripherally calcified lesion near the splenic hilum likely\nis a partially thrombosed splenic artery aneurysm."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: In the right lower quadrant there is a 1.6 cm linear fat\ndensity with surrounding fat stranding concerning for epiploic appendagitis\n(series 2, image 89).  Patient is status post PEG tube placement.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement. The colon\nand rectum are within normal limits. The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.3 cm with central\nlucency which could represent a TURP defect.\n\nLYMPH NODES: Prominent mesenteric in the right lower quadrant and\nretroperitoneal lymph nodes are noted without evidence of enlargement by CT\nsize criteria.  No evidence of pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Multilevel degenerative changes of the lumbar spine with osteophyte\nformation and endplate sclerosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right lower quadrant 1.6 cm linear fat density with surrounding fat\nstranding is concerning for epiploic appendagitis.  Prominent mesenteric lymph\nnodes in the right lower quadrant are noted.\n2. Unremarkable PEG tube.\n3. Prostatomegaly.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:56 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nA focal dissection of the celiac artery is re-demonstrated just prior to the\ncommon hepatic artery stent (04:46), unchanged.  A proper hepatic artery stent\nis also re-demonstrated, with similar focal narrowing between the sequential\nstents.  There is unchanged aneurysmal dilatation of the distal proper hepatic\nartery, measuring up to 10 mm (04:35), as well as unchanged aneurysmal\ndilatation of the proximal right hepatic artery, measuring up to 8 mm (04:32).\nEmbolization material is again seen in the splenic artery and vein and left\nupper quadrant varices, with streak artifact limiting evaluation in this\nareas.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\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 is\nresected.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: Measures 11.6 cm craniocaudal, unchanged to 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 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 normal.\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: Prior midline abdominal incision.",
            "output": "1. No acute intra-abdominal process to explain the patient's symptoms.\n2. Unchanged size of aneurysmal dilatation of the distal proper hepatic artery\nmeasuring up to 10 mm and of the proximal right hepatic artery measuring up to\n8 mm.\n3. Unchanged focal dissection of the distal celiac artery prior to the common\nhepatic artery stent."
        },
        {
            "input": "RETROPERITONEUM :\nThere is a moderate to large amount of high-density fluid which tracks from\nthe perihepatic and perisplenic regions along the pericolic gutters into the\npelvis.  This is increased from CT abdomen pelvis ___.  There is\nno evidence of active extravasation.  Please note, the left perinephric space\nin the region of embolization coils demonstrates severe beam hardening\nartifact related to the coil material which obviates visualization for active\nextravasation at this site.\n\nVASCULAR:\nThere is active extravasation of contrast from a perihepatic vessel as seen on\nseries 4B, image 229/series 600b, image 36.\nThe abdominal aorta appears normal without evidence of stenosis, aneurysm, or\ndissection.  The celiac axis, SMA, ___, and bilateral renal arteries are\npatent. There is minimal calcium burden in the abdominal aorta and great\nabdominal arteries.  There is sequelae of portal hypertension including\nesophageal varices and dilated spleno-renal varices.  Embolic material seen\nwithin the splenorenal varices.  There is an expansile near occlusive thrombus\nwithin the distal splenic vein (series 600b, image 36).\n\nLOWER CHEST: There is moderate right-sided dependent atelectasis and mild\nleft-sided dependent atelectasis. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation with nodular\nborders compatible with cirrhosis.  There is no intra extrahepatic biliary\ndilatation.  There are no arterial enhancing lesions within the liver with\nwashout concerning for HCC.There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Contrast is seen within the distended\ngallbladder suggestive of vicarious excretion 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: The spleen is enlarged, unchanged from comparison study.  There is no\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.\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.  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. Moderate to large amount of high-density fluid compatible with hemorrhage\nin the abdomen and pelvis which is significantly increased in size since CT\nabdomen pelvis ___.\n2. There is active extravasation of contrast in the right perihepatic space\nfrom a capsular arterial branch located in the perihepatic space at this site\nas described in detail above.  The patient subsequently had a conventional\nangiogram on the same day.\n3. Cirrhotic morphology of the liver, splenomegaly, sequela of portal\nhypertension, near occlusive thrombus within the distal splenic vein are\nadditional findings unchanged compared to the prior exam.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 6:16 AM, 5 minutes after discovery\nof the findings.  The additional and changed reading as noted on impression 2\nwas discussed subsequently with ___, MD taking care of the patient by\n___, MD on ___ at 14:14"
        },
        {
            "input": "LOWER CHEST:  Refer to concomitantly performed CT of the chest for evaluation\n\nABDOMINAL FINDINGS:\n\n\nSmall amount of perihepatic and perisplenic free fluid.  Perihepatic ascites\nis of slightly increased attenuation, which may represent diluted blood\nproducts.  There is a moderate amount of simple appearing free fluid in the\npelvis.\n\nHEPATOBILIARY:  Morphologic changes of cirrhosis.  Nodular contour the liver\nis also consistent with cirrhosis.  Heterogeneity at the posterior aspect of\nthe right hepatic lobe is likely perfusional. Intrahepatic and extrahepatic\nbile ducts are not dilated. Gallbladder contains hyperdense material, similar\nto before.  Gallbladder wall is thickened, this is a is nonspecific finding in\nthe setting of cirrhosis.  No calcified gallstone is noted.\n\nInterval placement of a TIPS, which extends from the right portal vein to the\nright hepatic vein.  It is difficult to evaluate the TIPS for patency on this\nphase of contrast enhancement however it appears at least partially patent.\nFurther evaluation with a Doppler ultrasound is recommended.\n\nPANCREAS: Pancreas is of normal bulk and homogeneous throughout without main\npancreatic duct dilation.  No focal lesion.\n\nSPLEEN: Enlarged spleen measures 16.8 cm in the coronal plane.  Normal\nattenuation.  No focal lesion.\n\nADRENALS: Bilateral adrenal glands are unremarkable in morphology, size, and\nattenuation.  No nodularity\n\nURINARY: Bilateral nephrograms are symmetric.  No focal lesion is identified. \nThere is no hydronephrosis.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Loops of small bowel are normal in\ncaliber.  Colon and rectum are within normal limits.  There are no surrounding\ninflammatory changes.\n\nLYMPH NODES:  Enlarged periportal and upper abdominal lymph nodes, likely\nreactive in the setting of cirrhosis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.  Again seen is radiodense material within\nthe splenorenal varices from the prior embolization procedure, unchanged.\n\nThrombus is present in the splenic vein slightly expanding the splenic vein\nand extending to the confluence of the SMV and the splenic vein.  It appears\nthat the SMV is patent without thrombus.  The main portal vein is patent but\nappears somewhat attenuated in size at the porta hepatis when compared to ___.  This may represent nonocclusive thrombus and a Doppler\nultrasound is recommended for further evaluation.\n\nThe left portal vein is not well seen proximally and the distal visualized\naspect is also somewhat attenuated when compared to ___. The\nproximal aspect of the right portal vein is patent but appears somewhat\nattenuated when compared to ___ and the right portal vein is not\nwell seen distal to the TIPS.  These findings may also represent nonocclusive\nthrombus and a Doppler ultrasound is recommended for further evaluation. \nHepatic veins are patent.  Duplicated IVC.\n\nRight renal vein is patent.  There is apparent partial filling defect within\nthe left renal vein at the renal hilum which may represent nonocclusive\nthrombus versus mixing contrast artifact.  Recommend Doppler ultrasound for\nfurther evaluation\n\nBONES: No suspicious bone lesion is identified.\n\nSOFT TISSUES: Mild diffuse subcutaneous tissue edema is noted.",
            "output": "1. Since ___ there has been a TIPS placed from the right portal\nvein to the right hepatic vein.  It is difficult to evaluate the TIPS for\npatency however it it appears at least partially patent.  Further evaluation\nwith a Doppler ultrasound is recommended.\n\n2.  Thrombus is again seen within and expanding the splenic vein.  The\nthrombus extends to the confluence of the SMV and splenic vein.  The SMV\nappears free of thrombus.  The main portal vein appears patent however it is\nsomewhat attenuated in size at the porta hepatis when compared to ___.  This may represent nonocclusive thrombus.  In addition, the proximal\nleft portal vein is also not well seen proximally and somewhat attenuated in\nsize distally when compared to ___, this may also represent\nnonocclusive thrombus.  The proximal right portal vein is patent but also\nappears somewhat attenuated when compared to its size from ___ and\nthe right portal vein distal to the TIPS is not well seen.  These findings may\nalso be due to nonocclusive thrombus.  Doppler ultrasound is recommended for\nfurther evaluation.\n\n3. Liver cirrhosis with portal hypertension\n\n4.  Apparent partial filling defect within the left renal vein may represent\nmixing of contrast and venous blood or nonocclusive renal vein thrombosis. \nDoppler ultrasound of the kidneys is recommended for further evaluation\n\n\nRECOMMENDATION(S):  Doppler ultrasound of the liver to evaluate the patency of\nthe TIPS as well as the portal venous system\n\nDoppler ultrasound of the kidneys is recommended to evaluate for possible\nnonocclusive left renal vein thrombosis versus mixing artifact\n\nNOTIFICATION:   The findings regarding the TIPS and portal venous system as\nwell as the findings on the CT chest were discussed with Dr. ___. by\n___, M.D. on the telephone on ___ at 11:14 ___, 25\nminutes after discovery of the findings.\n\n The findings regarding the possible left renal vein thrombosis were discussed\nwith Dr. ___. by ___, M.D. on the telephone on\n___ at 9:05 AM, 10 minutes after discovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. Hepatic arterial anatomy is\nconventional. There is minimal calcium burden in the abdominal aorta and great\nabdominal arteries.\n\nThe main portal vein is diminutive, but the main, right, and left portal veins\nare patent.  There are extensive paraesophageal and perigastric varices, as\nwell as a large splenorenal shunt in the left upper abdomen.  Mesenteric\nvarices are also noted in the left lower quadrant.  Incidentally noted is a\ndouble IVC.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation, with a nodular contour\ncompatible with cirrhosis.  An ill-defined focus of hyper enhancement on\narterial phase in the left lobe (3A: 24) has no correlate on subsequent\nsequences, and may represent a flash filling hemangioma. The gallbladder is\nwithin 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 is mildly enlarged, measuring 12.9 cm. There is no focal\nlesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric and normal in size, demonstrating normal\nnephrograms and excreting contrast promptly. There is no stone, concerning\nmass, or hydronephrosis.  No perinephric abnormality is identified.\n\nGASTROINTESTINAL: The stomach is decompressed, but there is no obvious wall\nthickening or mass. Small bowel is normal in caliber, without wall thickening\nor evidence of obstruction.  The colon rectum appear normal.  A normal\nair-filled appendix is visualized. Scattered mesenteric lymph nodes are\nprominent, but not pathologically enlarged by CT size criteria.\n\nRETROPERITONEUM: Periaortic lymph nodes are visualize, but not pathologically\nenlarged by CT size criteria.\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: There is no concerning focal lytic or sclerotic osseous lesion to\nsuggest neoplasm or infection.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Nodular hepatic contour, compatible with cirrhosis.  Ill-defined left lobe\nfocus of hyperenhancement on arterial phase, likely representing a flash\nfilling hemangioma or regenerative nodule.\n2. Extensive periesophageal, perigastric, and mesenteric varices.  Large\nsplenorenal shunt.  Incidentally noted double IVC.\n3. Splenomegaly."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis and scarring.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nTIPS is in place.  While this study is not tailored to evaluate for portal\nvein patency, the main portal vein is patent, with flow within the.  The right\nand left portal veins are more difficult to assess, but appear grossly patent\nas well.  Thrombosed, enlarged varices are left upper quadrant, similar to the\nprior.  There is stable intrahepatic biliary ductal dilatation and prominence\nof the common bile duct, measuring up to 1.1 cm.  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 enlarged, measuring up to 15 cm, unchanged the prior\nexamination.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Incidentally noted is a duplicated 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. No definite evidence of infection in the abdomen or pelvis.\n2. No definite CT findings consistent with pancreatitis, though correlation\nwith laboratory values and clinical symptoms is recommended.\n3. Stable intra and extrahepatic biliary ductal dilatation."
        },
        {
            "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 and its splenic\nand left gastric branches are widely patent.  There is only a thin wisp of\nenhancement in the expected location of the common hepatic artery.  At the\njunction of the proper hepatic artery via the gastroduodenal artery is a\nbulbous focus of contrast opacification measuring 7 mm which may represent the\ndistal most portion of the common hepatic artery presumably close to the\nanastomosis (301:45).  The right and left hepatic arteries are well opacified.\nThe superior mesenteric artery and bilateral renal arteries are within normal\nlimits.\n\nLOWER CHEST: There is a small to moderate nonhemorrhagic right pleural\neffusion with adjacent atelectasis.  The visualized lung bases are otherwise\nclear.\n\nABDOMEN:\n\nHEPATOBILIARY: There are interval postsurgical changes of liver\ntransplantation.  Several wedge-shaped areas of hypodensity along periphery of\nthe right hepatic lobe superiorly are consistent with small infarcts.  The\ngallbladder is absent.  Hyperintense fluid in the gallbladder fossa and\ntracking along the inferior edge of the liver measuring approximately 31 x 56\nmm could be related to postsurgical changes (301:41).  The common bile duct is\nslightly more prominent measuring 13 mm in diameter but tapers normally to the\nampulla.  There is mild central intrahepatic biliary dilatation.  There is\nmoderate focal narrowing of the portal vein at the porta hepatis (303:43). \nThe intrahepatic portal vein branches 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: There is mild splenomegaly, similar to the prior study.  There is\ndense embolization material inferior to the spine, and as before there is\nextensive streak artifact limiting evaluation of this region.\n\nADRENALS: The right and left adrenal glands 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: Redemonstrated are numerous gastric and esophageal varices. \nThe stomach and partially imaged loops of small large bowel are otherwise\nwithin normal limits.  There is a linear radiodensity seen within the duodenal\nlumen, of unclear etiology but may reflect a migrated biliary stent.\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: Postsurgical changes are noted along the anterior abdominal\nwall.",
            "output": "1. The patient is status post liver transplantation.  There is severe\nattenuation of the common hepatic artery with a bulbous area of contrast\nenhancement at the junction of the proper hepatic artery radius radial artery\npresumably representing the terminal portion of the common hepatic artery at\nthe anastomosis.\n2. Multiple wedge-shaped areas of hypoenhancement along the periphery of the\nright hepatic lobe are suggestive of infarcts.\n3. Hyperdense fluid in the gallbladder fossa tracking along the inferior edge\nof the liver may represent postoperative change.\n4. Moderate focal attenuation of the portal vein at the porta hepatis\nsurrounded by the collection in this region.\n5. A slightly increased caliber of the common bile duct measuring 13 mm since\nthe preoperative CT scan and mild central intrahepatic biliary dilatation.\n6. Mild splenomegaly and numerous gastric and esophageal varices as a result\nof prior cirrhosis and portal hypertension.\n7. Small to moderate nonhemorrhagic right pleural effusion\n8. Linear radiodensity within the duodenal lumen is of unclear etiology but\nmay reflect a migrated biliary stent.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:23 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  Extensive atherosclerotic\ncalcifications are identified throughout the abdominal aorta.  There are\nbilateral common iliac artery grafts.  Of note, there is occlusion of the left\ncommon iliac graft (3:66), extending into the left external iliac portion\n(3:106, 5:39).  There is reconstitution at the level of the left common\nfemoral artery (3:120).  The left internal iliac artery is patent, although\nthere are dense calcifications along the course of both internal iliac\narteries.\n\nLOWER CHEST: 1.3 cm spiculated left lower lobe nodule, 3.9 cm spiculated left\nlower lobe mass, 1.2 cm right lower lobe nodule, and 1.6 cm right lower lobe\nnodule are concerning for metastases, given the provided history of metastatic\npancreatic cancer.\n\nABDOMEN:\n\nHEPATOBILIARY: Several predominantly hypodense hepatic lesions are concerning\nfor metastatic disease.  The largest of these measures approximately 2.6 x 2.1\ncm in hepatic segment VIII (3:29).  A percutaneous cholecystostomy tube is in\nplace within the collapsed gallbladder.\n\nOn noncontrast imaging, a 6 mm hyperdensity in the region of the duodenum may\nrepresent a small stone (2:34).\n\nPANCREAS:\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): Approximately 2.6 x 2.0 cm (5:36, 3:50)\nLocation:  Head/uncinate\nPancreatic duct narrowing/abrupt cutoff with upstream dilatation: present\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\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\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: 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: suspicious\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: aortocaval (3:38)\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nSPLEEN: The spleen is normal in size.  A subcentimeter splenic hypodensity is\ntoo small to characterize, but likely a small cyst (3:32).\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.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis.  There\nis 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.\n\nLYMPH NODES: There is a 1.1 cm aortocaval node.  There is no evidence of\nretroperitoneal 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: Small fibroid identified in the uterus.\n\nBONES: There is grade 1 anterolisthesis of L4 and L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Hypoattenuating pancreatic head/onset mass measuring approximately 2.6 cm,\nwith specific details as above.  Possible 6 mm stone in the region of the\nduodenum, seen only on noncontrast imaging.\n\n2.  Metastatic disease involving the liver and bilateral lung bases.\n\n3.  Incidental note of occlusion of the left common iliac arterial graft into\nthe left external iliac artery, which reconstitutes at the level of the left\nfemoral artery.  The right common iliac artery graft is patent."
        },
        {
            "input": "LOWER CHEST: Mild left basilar 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Mild submucosal thickening at the pylorus is nonspecific. \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: A couple of subcentimeter right ileocolic lymph nodes are\nnonspecific.  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 definite findings explaining the patient's left lower quadrant pain.\n2.   No evidence of diverticulitis.  The appendix is normal."
        },
        {
            "input": "ABDOMEN:\n\nLung Bases: There are small bilateral pleural effusions with associated\nbibasilar atelectasis.\nHepatobiliary: The liver demonstrates homoenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is surgically absent.\nPancreas: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\nSpleen: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nAdrenals: There are stable bilateral adrenal nodules.\nKidneys: There are multiple bilateral renal hypodensities, the low majority of\nwhich are too small to accurately characterize but likely represent cysts. \nThere is no hydronephrosis.\nBowel: There is persistent severe wall thickening circumferentially involving\nthe sigmoid colon. New from the previous exam is a small gas and fluid\ncontaining collection interposed between the sigmoid colon in the bladder dome\nmeasuring 2.7 x 2.4 cm concerning for a small developing abscess. Again\ndemonstrated are multiple foci of air along the left lateral aspect of the\nproximal sigmoid which may be intramural or immediately extramural along the\nserosal surface. A few new foci of gas are now seen on the medial aspect of\nthe proximal sigmoid colon some of which are likely communicating with the\npresumed developing abscess collection.  The remainder of the visualized small\nand large bowel loops are unremarkable.\nRetroperitoneum: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVascular: The abdominal vasculature appears patent.\n\nPELVIS:\n\nThe bladder is decompressed and not well evaluated, but the wall does appear\nthickened most notably at the bladder dome adjacent to the inflammatory\nprocess in the pelvis.  The uterus is absent.. There is no significant pelvic\nor inguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "Unchanged severe circumferential wall thickening involving the sigmoid colon.\nHowever, there has been interval development of multiple new foci of air along\nthe medial aspect of the proximal sigmoid colon which appear to communicate\nwith a small developing 2.6 cm abscess cavity interposed between the sigmoid\nand the bladder dome.  This is not amenable to percutaneous drainage."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: 10 mm hypodensity within segment III demonstrates a focus of\nperipheral hyperenhancement, likely representing hemangioma.  Additional\nhypodensity within liver is too small to characterize.  Otherwise,\nunremarkable.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable.\n\nGASTROINTESTINAL: The appendix is dilated and fluid-filled measuring 10 mm\n(series 602, image 22).  There is a moderate amount of mucosal\nhyperenhancement and surrounding fat stranding/fluid, compatible with acute\nappendicitis.  No appendicolith.  No bowel obstruction.\n\nPELVIS: The uterus and adnexa are unremarkable for age per\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: The hepatic vasculature is patent.\n\nBONES: No worrisome osseous lesion.\n\nSOFT TISSUES: The abdominopelvic wall is within normal limits.",
            "output": "Acute appendicitis."
        },
        {
            "input": "VASCULAR:\n\nPatient is status post coil embolization a of gastroduodenal artery, with\nstreak artifact limiting local evaluation.  There is no evidence active\nextravasation within the first/second portion of the duodenum.  The celiac\nartery is patent.  The right and left hepatic arteries are unremarkable.  The\nSMA, and ___ are unremarkable.\n\nArising from the right common femoral artery, a multilobulated, complex pseudo\naneurysm is seen measuring approximately 3.1 cm TRV by 1.2 cm AP by 1.6 cm cc,\nwith a surrounding bilobed inguinal hematoma measuring approximately 5.1 cm\nTRV by 4.8 cm AP by at least 16.8 cm CC with extension into the scrotum.\n\nThe bilateral common, external, and internal iliac arteries are otherwise\nunremarkable.  The left femoral artery is unremarkable.\n\nLOWER CHEST: Bases of lungs demonstrate loculated pleural effusions as well as\nextensive atelectasis.  Mild interstitial thickening is seen which may be\nsecondary to pulmonary edema.  There is a small 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 mildly distended.\n\nPANCREAS: Assessment of the pancreas is limited secondary to adjacent streak\nartifact from the celiac coils, however there is no definite evidence of\npancreatic ductal dilatation.  Mild surrounding fluid is seen.\n\nSPLEEN: Patient is status post splenectomy with small residual 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.  A Foley catheter seen in place.\n\nGASTROINTESTINAL: A gastrostomy/jejunostomy tube appears to be in place. \nWithin the first/second portion the duodenum, there does not appear to be any\nevidence of extravasation.  Scattered diverticula are again noted within the\nsigmoid colon.  The appendix is not definitively visualized.\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: Heterogeneous hematoma is seen tracking into the scrotum.\nExtensive scrotal soft tissue thickening is seen.\n\nBONES: An old left ninth rib fracture seen.  No suspicious sclerotic or\nblastic lesions are seen.\n\nSOFT TISSUES: There is extensive soft tissue anasarca.",
            "output": "1. No evidence of recurrent bleeding within the duodenum, status post coiling\nof the gastroduodenal artery.\n2. Large complex multilobulated pseudo aneurysm measures up to 3.1 cm arising\nfrom the right common femoral artery.  A surrounding bilobed hematoma\nmeasuring up to 17 cm in craniocaudal dimension appears to extend into the\nscrotum.\n3. Small pleural and pericardial effusions appears to have slightly progressed\ncompared to the prior exam from ___.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 6:30 am, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "VASCULAR: There is occlusive thrombosis in the left external iliac vein\nextending to the common femoral vein.  The left common iliac vein is patent.\nThere is minimal compression of the left common iliac vein against lumbar\nvertebral by left common iliac artery (series 4, image 92), however may Turner\nsyndrome can not be adequately diagnosed or excluded based on this exam.\n\nThere is no abdominal aortic aneurysm.\n\nLOWER CHEST: Lung bases are clear with 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 contains stones, without\nevidence of gallbladder 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 is enlarged measuring 13.5 cm with no focal lesion 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 thickness\nand enhancement throughout. Colon and rectum are within normal limits. There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is underdistended.  There is no evidence of pelvic\nor inguinal lymphadenopathy.  Bilateral ovarian follicular cysts are seen. \nThere is trace volume free from 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Occlusive thrombosis in the left external iliac vein extending to the\ncommon femoral vein. Patent left common iliac vein.  ___ Turner syndrome can\nnot be adequately diagnosed or excluded based on this exam.\n2. Cholelithiasis.\n3. Splenomegaly."
        },
        {
            "input": "VASCULAR:\n\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 3 perforators on the left.\n\nLEFT:\nBranching pattern: Type 1\nPerforators:\n1 mm, 58 mm to the left and 25 mm below the umbilicus, (series 604, image 49)\n1.5  Mm, 58 mm to the left and 25 mm below the umbilicus, (series 604 image\n57)\n2 mm, 32 mm to the left and 10 mm above the umbilicus, (series 604, image 52)\n\nRIGHT:\nBranching pattern: Type 1\nPerforators:\n1 mm, 56 mm to the right and 10 mm above the umbilicus, (series 604 image 32)\n1 mm, 18 mm to the right and 7 mm above the umbilicus, (series 604 image 41)\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 liver demonstrates homogenous attenuation throughout. \nThere is a 11 x 17 mm cyst in segment VII (series 2, image 41).  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.  Pancreas divisum 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nThere are collaterals extending from the left renal vein into a left\npara-lumbar draining vein.\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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is unremarkable.  Fibroid uterus measures 7.7 x\n4.3 x 5.8 cm.  There is a 4.6 x 4 cm right adnexal cyst.  No ascites.  There\nis a 1.7 x 1 cm fluid structure surrounding the right lateral aspect of the\nurethra likely representing a Skene duct cyst.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is lateral and measures 1 mm. The largest perforator on the left is\nmedial and measures 2 mm.\n2. Right hepatic lobe cyst.\n3. Fibroid uterus."
        },
        {
            "input": "There are numerous small, well-circumscribed nodules in bilateral lung bases,\nthe largest of which measures up to 1 cm in short axis, for which short-term\nfollowup with a dedicated chest CT is recommended. Additionally, there is an\narea of increased opacity in the right lower lobe posterior basal segment,\nconsistent with early pneumonia at this location. There is bilateral pleural\nthickening. There is no pleural or pericardial effusion.\n\nLIVER: The liver is without focal lesion or intrahepatic biliary duct\ndilation. There are several large non-obstructing gallstones noted in an\notherwise normal gallbladder.  These appear stable from the prior exam dating\nback to ___.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: No renal stones are visualized in the right kidney. In the left\nkidney there is a nephroureteral stent in place with expected postoperative\nchanges including mild perinephric subcutaneous emphysema and adjacent fat\nstranding. There is a residual 0.4 cm renal stone in the upper pole (2b:32). 3\nsmall stones are seen within the bladder (2b:71, 73, 75). There is no focal\nlesion or hydronephrosis.\n\nGI: The stomach is mildly distended without obvious intraluminal mass or wall\nthickening. The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction.A normal appendix is visualized.There is\ncolonic diverticulosis without evidence of diverticulitis.  There is a small\numbilical hernia.\n\nRETROPERITONEUM: The aorta is normal in caliber, with numerous atherosclerotic\nvascular calcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.  3 small bladder stones are\nvisualized. No pelvic wall or inguinal lymph node enlargement by CT size\ncriteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES: There are severe degenerative changes of the lumbar spine,\nwith a dextroscoliosis centered at L3, exuberant multilevel marginal\nosteophyte formation, intervertebral disc space loss, and subchondral\nsclerosis, most prominently at L2-L3.No focal lesion suspicious for malignancy\npresent.",
            "output": "1. 0.4 cm residual left upper pole renal stone, as well as 3 small bladder\nstones.\n2. Numerous pulmonary nodules for which dedicated chest CT is recommended.\n3. Early right lower lobe pneumonia.\n4. Severe degenerative changes of the lumbar spine."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable,\nnoting a right lower quadrant colostomy. The urinary bladder and 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 pathologic pelvic or inguinal lymphadenopathy. \nMesenteric fat stranding in the lower abdomen is unchanged and nonspecific.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: There is a large, expansile, lytic soft tissue lesion invading the\nentire medial and anterior walls of the left acetabulum and almost the entire\nlength of the left superior pubic ramus.  This lesion also invades the left\npsoas, iliopsoas, and iliacus muscles.  This lesion has scattered\ncalcifications throughout and measures approximately 11.6 x 8.6 x 6.2 cm. \nThere are numerous linear lucent lines, some with sclerotic borders,\nthroughout the adjacent bone suggesting pathologic fractures of varying\nchronicities.  Additionally, there is a separate lucent line with adjacent\nsclerosis through the inferior pubic ramus suggesting a healing subacute to\nchronic insufficiency fracture.\n\nSOFT TISSUES:  Excluding muscular tumoral invasion described above, the\nproximal left adductor musculature appears prominent.  There is moderate\nsubcutaneous fat stranding in the proximal left leg and mild subcutaneous\nstranding in the proximal right leg suggesting edema.  There is a large\nventral hernia containing loops of nonobstructed small bowel.  There is a\nsmall, fat containing inguinal hernia.",
            "output": "1. There is a large expansile, lytic, soft tissue mass involving the anterior\nand medial walls of the acetabulum and most of the left superior pubic ramus. \nThere are numerous lucent lines within the adjacent bone likely reflecting\nfractures of varying chronicity.  This mass appears to invade the ipsilateral\npsoas, iliopsoas, and iliacus muscles.\n2. Prominence of the left adductor musculature likely represents a combination\nof tumor involvement, hemorrhage, and/or edema.\n3. There is a healing, separate, subacute to chronic left inferior pubic ramus\nfracture.\n4. Large ventral hernia containing nonobstructed loops of small bowel.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:38 AM, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "The patient is status post right nephrectomy, and cystoprostatectomy.  The\nleft kidney is atrophic, and there is moderate hydronephrosis and hydroureter,\nwith focal caliber change of the ureter at the level of the surgical clips,\nwhich are seen at the level of the aortic bifurcation. Ileal conduit is again\nnoted.\n\nThere is no small or large bowel dilatation present. The ileocolonic\nanastomotic suture line is unchanged from the prior exam. 14 mm circumscribed\nfat density focus anterior to the sigmoid colon is again noted likely\nreflecting epiploic appendagitis.\n\nThere is no free intraperitoneal fluid or free air.\n\nStranding in the jejunal mesentery, with lymph nodes measuring up to 4 mm is\nunchanged from the prior exam. There is a large midline ventral hernia\ncontaining small bowel measuring 12.9 x 6.0 cm. Additional fat containing\nright abdominal wall hernia is noted measuring 3.6 x 3.8 cm.\n\nAssessment of the solid organs is limited without intravenous contrast.\nAllowing for this the liver and gallbladder unremarkable. The spleen it is\ndiminutive in size. There is no pancreatic mass or ductal dilatation. The left\nadrenal gland is unremarkable. There is atheromatous calcification involving\nthe abdominal aorta and iliac arteries.\n\nThere is abnormal soft tissue density in the region of the prostatectomy bed,\nmeasuring 4.0 cm transverse by 2.8 cm AP x 4.3 cm craniocaudal. Rounded\nincreased density nodule is noted in the right aspect of the lesion measuring\n2.3 cm in maximal dimension.\n\nThere are multiple mixed density centrilobular nodules in the right middle\nlobe measuring 5 mm or less. A larger right middle lobe nodule measuring 1.6\ncm demonstrates irregular margins. 7 mm nodule is noted in the lateral basal\nsegment of the right lower lobe, and there are nodular foci in the anterior\nbasal segment of the right lower lobe measuring up to 5 mm. There is no\nosseous lesion present. Degenerative disc changes are noted at L5-S1.",
            "output": "1. Soft tissue density mass in the anteroinferior aspect of the pelvis\nmeasuring 4.3 cm in maximal dimension concerning for local tumor recurrence of\nprostate or bladder carcinoma. The lesion would be amenable to CT-guided\nbiopsy if management would be altered.\n2. Status post right nephrectomy and cystoprostatectomy. The left kidney is\natrophic with moderate hydronephrosis and hydroureter again demonstrated.\n3. Features of mesenteric panniculitis.\n4. Interval development of right middle and right lower lobe nodules as\ndescribed. The dominant nodule within right middle lobe measures 1.6 cm.\nAlthough the distribution is suggestive of an infectious/inflammatory process,\nneoplasia is also a consideration, particularly with respect to the dominant\nright middle lobe nodule. Ongoing followup is advised."
        },
        {
            "input": "CHEST:\n\nThe lung bases are clear. The previously described patchy opacities have\nresolved\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homoenous attenuation throughout. No\nfatty infiltration: 57 ___. There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains numerous 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. There\nis a dominant cyst in the lower pole of the left kidney (2.6 ___ measuring 3.4\ncm\n\nRETROPERITONEUM/ MESENTERY:  There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy.\n\nVASCULAR:  The abdominal aorta demonstrates severe atherosclerosis and there\nis extensive therosclerotic calcification throughout the wall of the arteries\nin the abdomen pelvis no aneurysm.\n\nGI TRACT: There is no small or large bowel dilatation.  No obstructing lesion\nin the colon there are several hyperdense diverticular in the sigmoid colon\nwithout CT signs of diverticulitis .\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. \nThe uterus is normal\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.\n\nLIMITATION :\n\nCT without contrast has decreased accuracy in detecting inflammatory\nintraparenchymal disease including the liver in the liver, of the pancreas,\nboth kidneys, and the GI tract",
            "output": "Cholelithiasis.\n\nExtensive atherosclerotic calcification (is the patient diabetic)\n\nNo large obstructing lesion that could produce GI bleed."
        },
        {
            "input": "New very small bilateral pleural effusions are noted with adjacent areas of\nminor atelectasis.  In addition several new pulmonary nodules are noted at the\nright lung base, measuring up to 5-6 mm in diameter. Coronary calcifications\nare noted.  The aortic valve is heavily calcified.  The patient is status post\ncoronary artery bypass surgery.\n\nABDOMEN:\n\nThe liver is mildly enlarged and the caudate lobe is prominent, nonspecific\nbut which may correlate with chronic liver diease. The portal venous system is\npatent. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  There is cholelithiasis without evidence of cholecystitis. The\npancreas, spleen, and bilateral adrenal glands are normal.  An incidental left\n9 mm angiomyolipoma is noted, stable from the prior examination.  A 4.5 cm\ninferior pole left renal cyst is noted.  The spleen measures up to 12.0 cm in\nlength, not enlarged.\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\nair-filled and normal in appearance. Diffuse chronic diverticulosis is noted\nthroughout the descending and sigmoid colon.  Mild wall thickening and minimal\nfat stranding is seen surrounding the sigmoid colon in the region of the\npatient's previous acute diverticulitis (2:68).  There is no evidence of\nperforation or abscess formation.\n\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum. The aorta and iliac branches contain\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\n\nPELVIS:\n\nThe bladder and rectum are grossly unremarkable. There is no pelvic side-wall\nor inguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  Grade 1 anterolisthesis L5 on S1\nis noted with bilateral pars defects, stable from prior examination and likely\ndegenerative in nature. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Mild residual fat stranding and wall thickening within the sigmoid colon,\nin the region of the patient's prior episode of acute diverticulitis. Findings\nmay represent resolving old, or potentially early new, diverticulitis. No\nevidence of perforation or abscess formation.\n2.  Cholelithiasis.\n3.  Trace bilateral pleural effusions with adjacent atelectasis.\n4.  Multiple pulmonary nodules measuring up to 5-6 mm.  Recommend correlation\nwith subsequent chest CTA.\n5.  Mildly prominent liver, including caudate enlargement; clinical\nsignificance uncertain but correlation regarding possibility of chronic liver\ndisease suggested."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is common origin of the celiac\ntrunk and SMA. There is extensive atherosclerosis of the abdominal aorta and\ngreat abdominal arteries, but the celiac trunk, SMA, and ___ appear well\nopacified without evidence of filling defects.\n\nLOWER CHEST:  Patchy airspace disease and consolidation is seen in the lower\nlobes bilaterally.  A small left pleural effusion is noted.\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.  Small stones are seen within the gallbladder\nbut the wall of the gallbladder is not thickened and the gallbladder is not\ndistended.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A 4 mm hypodensity is seen in the pancreatic\nhead (image 3b:254), unchanged compared to previous.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  A fat attenuation lesion measuring 1 cm is seen in the left adrenal\ngland likely representing a benign myelolipoma.\n\nURINARY: The kidneys are mildly atrophic. A 4.3 cm simple cyst is seen in the\ninferior pole of the left kidney.  Bilateral ureters demonstrate mild\nincreased urothelial enhancement without hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is moderate sigmoid diverticulosis without\ndiverticulitis.  Appendix contains air, has normal caliber without evidence of\nfat stranding.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: A 1 cm short axis diameter left para-aortic lymph node (image\n3a: 82) is unchanged compared to previous.\n\nPELVIS: The bladder wall is mildly thickened with increased urothelial\nenhancement.  There is no evidence of pelvic or inguinal lymphadenopathy.  A\nsmall amount of free fluid is seen in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild anterolisthesis of L5 on S1.\n\nSOFT TISSUES: Soft tissue nodularity is seen in the pannus, likely\nrepresenting injection granulomas.",
            "output": "1. Extensive atherosclerosis of the abdominal aorta and great arteries without\nevidence of vascular occlusion or thrombus.  There is no evidence of bowel\nwall thickening or abnormal enhancement to suggest ischemic bowel.\n2. Extensive bilateral lower lobe airspace disease, concerning for pneumonia\nor aspiration.\n3. Mild wall thickening of the urinary bladder with mild increased urothelial\nenhancement of the bladder and ureters.\n\nRECOMMENDATION(S):  Correlate clinically for urinary tract infection."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is extensive calcium burden in\nthe abdominal aorta and great abdominal arteries.  A common origin of the\nceliac trunk and SMA demonstrates significant atherosclerotic calcifications\nwith mild (less than 50%) stenosis.  The left gastric artery arises\nindependently off of the aorta cranial to the SMA/celiac trunk.  Significant\natherosclerotic calcifications are also noted at the origins of the renal\narteries, but the renal arteries are too small for adequate assessment.  An\naccessory left renal artery is noted.  There is no evidence of filling\ndefects.\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 contains stones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A 4 mm hypodensity is again seen within the\npancreatic head, unchanged compared to previous.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A small myelolipoma is again seen in the left adrenal gland.  The\nright adrenal gland is unremarkable.\n\nURINARY:  Both kidneys are atrophic with normal nephrograms.  There is no CT\nevidence of pyelonephritis or renal abscesses.  A 4.5 cm simple cyst is again\nseen in the inferior pole of the left kidney.  There is no evidence of\nhydronephrosis or perinephric abnormality.  There is increased left urothelial\nenhancement with mild periureteric fat stranding.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is sigmoid diverticulosis without evidence\nof diverticulitis.  The appendix is unremarkable.  There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: A 1.1 x 1.7 cm left para-aortic lymph node (3:72) is not\nsignificantly changed compared to previous.\n\nPELVIS: The bladder wall is mildly thickened with increased urothelial\nenhancement.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are seen within the uterus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is anterolisthesis of L5 on S1 secondary to bilateral pars defects.\n\nSOFT TISSUES: Multiple subcutaneous nodules are again seen in the anterior\nabdominal wall, likely representing injection granulomas.",
            "output": "1. Extensive atherosclerotic disease of the abdominal aorta and its major\nbranches without evidence of vascular occlusion.  There is heavy calcification\nat the common origin of the celiac artery and SMA without hemodynamically\nsignificant stenosis.\n2. Mild wall thickening of the urinary bladder and increased urothelial\nenhancement of the left ureter with mild periureteric stranding, consistent\nwith the patient's known UTI.  There is no CT evidence of pyelonephritis or\nabscesses."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 scattered simple hepatic cysts.  Additional sub-centimeter\nhypodensities are too small to characterize but statistically also likely\nreflect 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable within the limitations of CT. \nThe small bowel is fluid-filled throughout with normal wall enhancement. \nThere are several mildly dilated loops without focal transition points or\ndefinite evidence of obstruction.  No collapsed loops of small bowel are seen.\nThe colon is normal in appearance with a moderate colonic stool burden.  The\nappendix is not definitively seen however there is no right lower quadrant or\ncecal fat stranding.  No free fluid in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace high density free fluid in the pelvis within the pelvic cul-de-sac\nmeasuring approximately 40 Hounsfield units.\n\nREPRODUCTIVE ORGANS: There is a 2.5 cm peripherally enhancing left adnexal\ncyst.  The uterus demonstrates a somewhat heterogeneous enhancement pattern.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. Mildly prominent and fluid-filled small bowel loops without evidence of\nobstruction. This finding is nonspecific but could be seen in setting of\nenteritis.\n2. 2.5 cm corpus luteal left adnexal cyst with a small amount of high density\nfluid within the pelvic cul-de-sac. This could represent sequelae of cyst\nrupture."
        },
        {
            "input": "LOWER 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 suspicious focal lesion.  There are multiple subcentimeter\nhypoattenuating lesions the liver consistent with 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.  There is a punctate calcification in the pancreatic tail (series\n3, image 67).\n\nSPLEEN: The spleen shows normal size 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 bilateral cortical atrophy.  There is a 1.0 cm\nhypoattenuating lesion in the interpolar region of the right kidney consistent\nwith a. There are multiple subcentimeter hypoattenuating lesions throughout\nthe kidneys bilaterally, too small to characterize but likely represent benign\nrenal cysts.  The urinary bladder is unremarkable.  There is no hydronephrosis\nor hydroureter.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nThere is a right perianal mass with heterogenous enhancement consistent with\nthe known anal carcinoma.  The enhancing mass extends to the level of the\nsphincters, approximately 6 cm from the anal verge.  This is better evaluated\non the recent MRI of the rectum from ___.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged (5.3 cm in transverse diameter),\nextending into the bladder base.  The seminal vesicles appear normal.\n\nLYMPH NODES: Again seen is a 1.3 cm right inguinal lymph node, not\nsignificantly changed compared to study from ___.  There is no\nretroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  The celiac axis and superior mesenteric artery share a\ncommon origin.  There are calcifications at the origin of the renal arteries\nbilaterally.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes in the thoracolumbar spine.  There is\nmultilevel degenerative disc disease with disc space narrowing most severe at\nL1-L2 and L4-L5.  Degenerative changes are seen in the bilateral sacroiliac\njoints and hip joints.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Soft tissue thickening involving the anus, consistent with known anal\ncarcinoma that was better characterized on recent MR of the rectum from ___..\n2. Enlarged right inguinal lymph node, similar to the prior study from ___.\n3. No evidence 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: There are bilateral small pleural effusions with associated\ncompressive atelectasis.  No suspicious pulmonary nodule or mass in the\nbilateral lung bases.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nsuspicious focal hepatic lesion.  3-5 mm right hepatic lobe hypodensities are\nincompletely characterized but unchanged compared to ___ there is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.  Trace pericholecystic fluid is noted\nadjacent to the gallbladder fundus.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic 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 bilateral adrenal glands are unchanged compared to\nprior studies.  No focal nodularity.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  Scattered\nmillimetric hypodensities in the right kidney are too small to characterize,\nlikely representing cyst, unchanged.\n\nGASTROINTESTINAL: The stomach is distended by enteric contrast with an enteric\ntube in place.  The patient is status post abdominal peroneal resection with\nand an end colostomy in the left lower quadrant.  There is diffusely dilated\nsmall bowel loops are doing from the mid jejunum with smooth tapering in the\ndistal ileum.  No transition point identified.  Consideration of finding is\nconsistent with ileus.  Mild wall thickening of the distal ileum and terminal\nileum in the setting of relative decompression may be secondary to infection\nor inflammation from recent surgery.  No colonic wall thickening.  No free\nair.  Soft tissue density in the pelvis superior to the urinary bladder and\nposterior to the prostate is consistent with flap reconstruction (series 602,\nimage 80).\n\nPELVIS: There is a Foley catheter in situ.  Foci of air within the urinary\nbladder is consistent with instrumentation.  There is small amount of\npresacral free fluid measuring approximately 5.3 x 1.7 x 7.2 cm (TV by AP by\nCC) without rim enhancement, which could be postoperative.  Posttreatment\nchanges of the right in S is noted.  There is a pelvic drain in situ.\n\nREPRODUCTIVE ORGANS: The prostate is moderately enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  No\npelvic lymphadenopathy.  There is a 2.2 x 1.8 cm right inguinal lymph nodes,\npreviously 1.5 x 1.10 cm (series 2, image 178 closed.  No additional enlarged\ninguinal lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Major tributaries of the abdominal aorta and portal venous system\nare patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are moderate.\n\nSOFT TISSUES: There is a midline wound vac with skin staples.  A subcutaneous\ndrainage catheter is noted coursing along the midline 2 right-sided abdomen.",
            "output": "1. Diffusely dilated small bowel loops starting from the mid jejunum with\nsm"
        },
        {
            "input": "PELVIS:  Redemonstration of an unremarkable left lower quadrant end colostomy.\nPostoperative changes from prior abdominal perineal resection.  Previously\nseen right inferior approach drainage catheter extending into the presacral\nspace removed since ___.  Compared to prior exam from ___, there is\nincreased focal soft tissue along the right gluteal fold (2:90) measuring 1.6\nx 1.9 cm.  This area was FDG avid on recent PET.\n\nThe partially visualized small and large bowel are otherwise unremarkable. \nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged, likely consistent with\nbenign prostatic hyperplasia.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy where visualized. \nThere is a necrotic right inguinal node measuring 2 x 1.2 cm (2:64), similar\nto prior.  Ventral and slightly caudal to this, a conglomerate of necrotic\nright inguinal node measures 4.6 x 4.2 cm (2:79), similar prior PET-CT.  A\nfiducial marker is seen within (2:80).  Further distal to this, a 1.5 cm right\ninguinal necrotic lymph node is not substantially changed from prior (2:97).\nIn the left inguinal region, a 3.5 x 2.3 cm similar-appearing necrotic node\nhas increased in size (2:81), previously up to 2.8 cm.\n\nVASCULAR: 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. Redemonstration of a conglomerate of necrotic right inguinal lymph nodes,\nmeasuring up to 4.6 cm in the largest axial dimension.  This is overall\nsimilar in size from prior PET-CT in ___.  Additional right inguinal\nlymph nodes are also not substantially changed.\n2. Interval increase in size of a left inguinal necrotic node, now measuring\nup to 3.5 cm, previously up to 2.8 cm.\n3. Unremarkable left lower quadrant end colostomy.\n4. Soft tissue nodule along the right gluteal fold which had demonstrated FDG\navidity, suspicious for metastatic disease as well.\n5. Mild prostatomegaly."
        },
        {
            "input": "LOWER CHEST: Bibasilar segmental atelectasis.  Otherwise, visualized lung\nfields are within normal limits.  There is no evidence of pleural or\npericardial effusion.  There are extensive partially imaged coronary artery\ncalcifications.  Cardiac device leads are partially imaged within the heart.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain demonstrated, is a stable 2.2 cm left hepatic lobe cyst.  Otherwise,\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.  Again\ndemonstrated, is a moderate to large colonic stool load.  Otherwise, the colon\nand rectum are within normal limits. The appendix is not definitely\nvisualized, however no secondary signs of acute appendicitis.\n\nPELVIS: There is marked dilation of the urinary bladder, similar to CT scan\nfrom ___.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate demonstrates multiple calcifications and\ncentral hypodensity which may reflect changes from prior TURP.  The seminal\nvesicles 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.  Extensive atherosclerotic\ndisease is 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, including multilevel spondylolisthesis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Marked urinary bladder dilation.  Foley catheterization is recommended.\n2. Otherwise, no other acute abdominopelvic process.\n3. Moderate to large colonic stool load."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  There is a small right pleural\neffusion.  There is no evidence of pericardial effusion.  Coronary artery\ncalcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is severe central intrahepatic\nand mild-to-moderate peripheral biliary dilatation with dilatation of the\ncommon bile duct up to 1.5 cm.  The gallbladder is surgically absent.  There\nis trace perihepatic ascites with capsular retraction of the liver (2; 11).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  There is mild dilatation of the pancreatic duct measuring up\nto 5 mm in the pancreatic head (302; 33).  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Simple cysts\nare seen in bilateral kidneys measuring up to 4.3 cm in the upper pole of the\nright kidney.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The distal esophagus is dilated and fluid-filled the stomach\nis markedly distended.  There is a small 1.4 cm mural nodule is seen within\nthe second portion of the duodenum (3 6; 30).  There is bulging of the ampulla\nof Vater.  There is mural thickening and enhancement of several loops of small\nbowel in the right lower quadrant with mild mesenteric edema suggestive of\nenteritis.  Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is normal.  Trace free fluid\nis seen in the right pericolic gutter.\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 contains central\ncalcifications.  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 are seen in the lumbar spine.  The patient is\nstatus post right hip total arthroplasty.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Severe central intrahepatic and mild extrahepatic biliary dilatation with\nmild pancreatic ductal dilatation and a bulging papilla.  Differential would\ninclude cholangiocarcinoma, choledochocele, obstructing stone, or ampullary\nneoplasm.  Duodenal mural nodule may be related to this primary disease\nprocess or represent a polyp.  Further evaluation can be performed with ERCP.\n2. Mural thickening of loops of small bowel with mesenteric edema is\nsuggestive of enteritis.\n3. Small volume ascites and trace right pleural effusion."
        },
        {
            "input": "LOWER CHEST: There is a trace right pleural effusion with adjacent\natelectasis. The remainder of the visualized lung bases are clear. Coronary\nartery calcifications in the LAD, right coronary artery and left circumflex\nartery of unknown unknown hemodynamic significance. No pericardial effusion.\n\nCT ABDOMEN:  Evaluation of the intra-abdominal organs is limited without\nintravenous contrast. The unenhanced liver, spleen, pancreas and bilateral\nadrenal glands are normal. Layering gallstones are seen within the gallbladder\nwithout wall edema or pericholecystic fluid. There is no hydronephrosis, renal\nstone or contour altering renal mass.\n\nThe small and large bowel are normal in course and caliber without\nobstruction. There is moderate colonic fecal loading. The appendix is\nvisualized and is normal (601:28). No ascites. Moderate amount of air within\nthe right retroperitoneum is likely related to the recent spine surgery\nperformed on ___. The abdominal aorta is normal in caliber with\nmild atherosclerotic calcifications along its course.\n\nCT PELVIS: The rectum is normal. Scattered diverticula are seen in the sigmoid\ncolon without inflammatory changes. The bladder and prostate are unremarkable.\nThere is no free fluid. Retroperitoneal air tracks into the inguinal canal and\nto the scrotum.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Postsurgical changes with posterior fusion rods are noted at L3\nthrough S1 with an L3-L4 intervertebral disc spacer, pedicle screws at L4 and\nL5, and intervertebral disc spacer at L5-S1. A fractured anterior osteophyte\nis seen at the L4 superior endplate (602b:43).\n\nThe study is performed with Valsalva. No abdominal wall hernia is identified.\nSmall foci of subcutaneous air and stranding in the right flank subcutaneous\ntissues and abdominal wall muscles (02:44) are likely postsurgical.",
            "output": "1.  No evidence of right abdominal wall hernia.  No acute intra-abdominal\nabnormality identified on this non-enhanced study.\n2.   Free air in the right retroperitoneum extending into the right scrotal\nsac is likely postsurgical.  No intra-peritoneal free air.  No bowel wall\nabnormality on this NECT.\n3.  Cholelithiasis.\n\nNOTIFICATION:  The preliminary findings were discussed by Dr. ___\nwith Dr. ___ (medicine consult) on the telephone on ___ at\n2:39 ___."
        },
        {
            "input": "Please refer to the dedicated CT chest report from the same date for the\nthoracic findings.\n\nLIVER: There has been an interval decrease in size of the dominant segment V,\nVIII lesion from 3.2 x 3.2 cm to 2.4 x 2.5 cm on today's study (02:56).  The\nlesion inferior to the dominant one measures 1.5 x 1.1 cm, also decreased\n(2:60).  There has also been a decrease in the lesion along the anterior\nmargin of the dominant, now measuring 12 x 9 mm, previously 14 x 12 mm\n(02:55).\n\nThe segment VI/VII lesion measures 1.8 x 1.7 cm, smaller compared with the\nprior when it measured 2.8 x 3.1 cm (02:56).\n\nIn segment VIII, the previously described 2.4 x 2.3 cm lesion now measures 1.9\nx 1.7 cm (02:51), with no change in the 10 x 8 mm segment VII lesion (02:51).\nThe portal vein is patent.The non-distended gallbladder is within normal\nlimits, without wall thickening or pericholecystic fluid.\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: The right adrenal glands is unremarkable.  Patient is status post\nleft adrenalectomy.\n\nKIDNEYS: The left kidney is surgically absent. The right kidney is normal in\nappearance, without suspicious masses or hydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.  There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith no significant atherosclerotic calcifications. There is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.\n\nBONES: Sclerotic lesions in T4, T10 and L3 are stable.  In addition, the\nsclerotic lesions in the left iliac wing (2:98) and right iliac wing (2:95)\nare unchanged.  There is a stable right superior pubic ramus lesion (2:116).",
            "output": "1.  Interval decrease in the size of the multiple hepatic lesions, suggesting\nresponse to treatment.\n\n2. Unchanged osseous lesions in the vertebral bodies, left iliac wing, right\niliac wing, and right superior pubic ramus.\n\n3. Status post left adrenalectomy and nephrectomy, with expected postsurgical\nchanges.\n\n4. Please see the dedicated CT chest report from today's date for the thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Partially visualized are intracardiac device leads.  There are\nmild atherosclerotic calcifications in the aortic valve.  There is anterior\nand apical myocardial thinning suggestive of prior myocardial infarction. \nThere is no evidence of pleural or pericardial effusion. Tiny peribronchial\nnodules in the right lower and right middle lobes as well as traction\nbronchiectasis and mucous plugging in the left lower lobe are suggestive of\nsmall airways disease.\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.  Incidentally noted is a 6 mm accessory spleen\nlocated laterally.\n\nADRENALS: The right and 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 1.6 cm simple cyst in the left mid kidney.  Additional\nsubcentimeter hypodensities bilaterally are too small to characterize, but\nstatistically likely represent simple cysts.  There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no perinephric 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. There is an 8 mm nodule posterior\nto the cecum (4:60) which may represent a small lymph node or an appendiceal\nstump.  Punctate calcifications in the mid abdomen are likely due to sequela\nof prior omental infarct.\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 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 to severe multilevel degenerative changes in the\nthoracolumbar spine including loss of intervertebral disc space height,\nendplate sclerosis, subchondral cystic change, vacuum phenomena and facet\nhypertrophy.\n\nSOFT TISSUES: Probable bilateral inguinal plugs are present, denoting prior\nhernia repair.  There is a small 4.2 x 1.3 cm intramuscular lipoma in the\nright anterolateral abdominal wall.  Otherwise, the abdominopelvic wall is\nwithin normal limits.",
            "output": "1.  No acute intra-abdominal or intrapelvic pathology to explain the patient's\npain.\n2.  Evidence of small airway inflammation in the lung bases.\n3.  Re-demonstration of a moderate sized hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Redemonstrated is a 6 mm right lower lobe nodule (02:05) and a 5\nmm left lower lobe nodule (02:20), which remains stable in size dating back to\nat least ___.  There is no pleural or pericardial effusion.  The heart is\nnormal in size.\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.  Surgical clips are again seen along the lateral aspect of the\nanterior right lobe.  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.  Previously seen\npancreatic lipoma is not well evaluated due to lack of intravenous contrast. \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 an\napproximately 1.0 x 0.8 cm calcified lesion in the upper pole of the right\nkidney, which was previously characterized as a complex cyst, which is grossly\nunchanged in size.  Subcentimeter hypodense lesions are seen bilaterally which\nare too small to characterize but likely represent 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.  No stones\nare identified.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexa are grossly normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nare few prominent pelvic sidewall lymph nodes which are not 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. \nThere are mild multilevel degenerative changes of the lumbar spine, worst at\nL5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n.",
            "output": "1. No nephrolithiasis, hydroureteronephrosis, or other acute abdominopelvic\nabnormality.\n2. Stable bilateral pulmonary nodules, unchanged since ___.\n3. Grossly stable appearance of 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 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 bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The wall of the descending colon\nappears mildly thickened, which may be secondary to underdistention versus\nmild colitis.  No bowel obstruction 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 visualized reproductive organs are unremarkable.  The\nbilateral ovaries are symmetric in size and appearance measuring up to 3.3 cm\non the left and 3.8 cm on the right without evidence of free fluid within 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.  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 apparent thickening of the descending colon, which may be secondary to\nunderdistention versus mild colitis.  No drainable fluid collection or\nextraluminal gas.\n2. Normal appendix."
        },
        {
            "input": "LOWER CHEST: Mild left basilar atelectasis.  No pleural or pericardial\neffusion.  Small hiatus hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  There is focal fat\ndeposition at the falciform ligament.  No focal parenchymal lesions otherwise.\nPortal and hepatic veins patent.  Gallbladder is decompressed.  There is no\nintrahepatic or extrahepatic bile duct dilatation.\n\nAgain redemonstrated is a cystic lesion along the right paracolic gutter,\nabutting the inferior right lobe of the liver and the adjacent ascending\ncolon.  This lesion does not appear to arise from the liver.  This lesion\nmeasures approximately 4.4 x 2.1 cm in AP and transverse dimension.  On the\nremote CT performed in ___ it measured approximately 3.2 x 1.5 cm, and the\nmore recent CT performed in ___, it measured approximately 4.3 x 2.0 cm. \nThere is no evidence of perceptible wall enhancement nor is there enhancement\ninternally.  No surrounding fat stranding.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  There are\nno focal pancreatic parenchymal lesions.  No pancreatic calcifications.  No\nmain duct dilatation.  No peripancreatic fat stranding.\n\nSPLEEN: The spleen is not enlarged (8 cm).  There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Kidneys are normal.  No focal parenchymal lesions.  No\nhydronephrosis.  No nephrolithiasis.\n\nGASTROINTESTINAL: Normal stomach and small bowel.  Unremarkable large bowel. \nNo mural thickening.  No luminal distention.  A long, retrocecal, air-filled\nappendix is identified in the right lower quadrant (series 2, image 105).\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nLYMPH NODES: There is a mildly bulky left external iliac lymph node which\nmeasures up to 9 mm in short axis (series 2, image 138).  This lymph node\nmeasured up to 8 mm in short axis on the remote study performed in ___.  No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy otherwise.\n\nVASCULAR: Abdominal aorta is normal in caliber.  Origins of the celiac axis,\nSMA, renal arteries, and ___ appear patent, although there is some\natherosclerotic plaque at the origin of the ___ (series 2, image 56).  There\nis mild background atherosclerotic plaque overall.  Of note is a circumaortic\nleft renal vein.\n\nPELVIS: Urinary bladder is largely decompressed and otherwise unremarkable.\n\nREPRODUCTIVE ORGANS: Fibroid uterus, with multiple calcified fibroids.  The\ncalcification is new from ___.\n\nBONES: Bones are mildly osteopenic.  There is degenerative facet arthropathy\nand mild degenerative disc disease of the lumbar spine, and thoracolumbar\njunction.  There is grade I anterolisthesis of L4 on L5.  There is disc\neffacement and calcification at L5-S1.  No acute or focal destructive osseous\nlesions.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Normal CT appearance of the pancreas.  No acute intra-abdominal pathology\n2. Left paracolic gutter duplication cyst.\n3. 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. 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:  Both kidneys enhance homogeneously throughout.  Left kidney appears\nlarger than the right.  The left collecting system appears duplex, but can\nonly be traced to the level of the mid left ureter.  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.  A\nventriculoperitoneal shunt terminates in the pelvis, with multiple surrounding\nloculated fluid collections.  There is apparent wall thickening and\npericolonic fat stranding involving a segment of the sigmoid colon abutting\nthe dominant fluid collection (601b:34).  Based on these imaging findings\nalone, it is difficult to determine whether this represents primary colitis\nwith adjacent abscess formation or secondary colitis.  Similarly, the appendix\nis fluid-filled and most likely secondarily inflamed (2:64). It measures\napproximately 5 mm in diameter. However, given the close association of the\nfluid collections with the distal catheter tip, CSF pseudocyst is of primary\nconcern.\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 lesions are\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 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": "Multiple loculated fluid collections in the right hemipelvis closely\nassociated with the distal VP shunt catheter tip, concerning for CSF\npseudocyst.  The appendix and sigmoid colon are likely secondarily inflamed."
        },
        {
            "input": "LOWER CHEST:\n\nThere is a small amount of linear atelectasis in the right lung base (2:4), as\nwell as tiny areas of subpleural thickening bilaterally (2:7, 02:18).\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  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.\n\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "No evidence of acute pathology in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The hepatic parenchyma enhances homogeneously.  A small\nportion of the hepatic dome has not been included on this scan.  The portal\nvein is patent.\nThe gallbladder is surgically absent.\nPANCREAS: The pancreatic parenchyma enhances homogeneously with no main duct\ndilation.\nSPLEEN:  The native spleen is surgically absent.  Again visualized is a 4.3 x\n3.1 cm splenule in the left upper quadrant (series 2, image 8).\nADRENALS:  No adrenal nodules.\nURINARY:  No hydronephrosis or solid enhancing renal masses.  Unchanged 10 x 6\nmm cyst within the right renal midpole cortex (series 2, image 27).\nGASTROINTESTINAL:  The patient is post gastrectomy for gastric cancer.  There\nis no bowel obstruction.  A moderate amount of stool is present throughout the\ncolon.  There is a normal appendix in the right lower quadrant.\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.  Normal size\nretroperitoneal lymph nodes are seen.\nVASCULAR: The abdominal aorta and its branches are normal in caliber.  There\nis no significant atherosclerotic calcification within the abdominal aorta.\n\nPELVIS:\nThe bladder is distended, unremarkable.  The uterus appears appropriate for\nthe age of the patient.  Both ovaries are present, CT has limited sensitivity\nin evaluating the ovaries accurately.  The right ovary measures approximately\n3.7 x 1.5 cm compared to a prior measurement of 2.2 by 0.9 cm on the scan\ndated ___.  There is no large pelvic mass or free fluid in the\npelvis or pelvic lymphadenopathy.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.\nDegenerative disc disease at L5-S1 level noted.  No interval change in 4 mm\nsclerotic lesion within the left ischial tuberosity (series 2, image 82).",
            "output": "1. Post gastrectomy for gastric cancer with no evidence of local recurrence in\nthe upper abdomen or metastatic disease in the abdomen or pelvis.\n2. No abdominal or pelvic lymphadenopathy, large pelvic mass or free fluid in\nthe pelvis.\n3. The uterus appears age-appropriate, however CT is limited sensitivity in\nevaluating the ovaries which are present and a dedicated pelvic ultrasound may\nbe considered given the history of pelvic pain.\n4. No ascites, bowel obstruction or acute intra-abdominal or pelvic process\nidentified.\n\nRECOMMENDATION(S):  A dedicated pelvic ultrasound may be obtained to evaluate\nboth ovaries which are present and the right ovary appears slightly enlarged\ncompared to the prior scan from ___, which in a postmenopausal\npatient needs further evaluation."
        },
        {
            "input": "LOWER CHEST: There is trace left pleural effusion with adjacent compressive\natelectasis.  There is no right pleural effusion.  There is no evidence of\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in morphology.  There is a heterogeneous\nmass in segment II/III measuring approximately 3.5 x 3.5 x 4.2 cm (02:13),\nwhich invades the pancreatic body, likely corresponding to the known\ncholangiocarcinoma.  There multiple, ill-defined hypoattenuating lesions\nscattered throughout the liver measuring up to 3.1 x 1.1 cm in the posterior\nright hepatic lobe (2:21, 601:36), likely metastases.  A well-circumscribed\nhypoattenuating lesion in the left hepatic lobe measures 3.5 x 2.9 cm is\nincompletely characterized, but could represent a cyst or metastasis.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is not visualized.\n\nPANCREAS: There is moderate diffuse atrophy of the pancreas.  As above, there\nis invasion of the pancreatic body by the left hepatic lobe mass.  There is no\nmain ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is normal in size.  Two splenic hypodensities measuring up\nto 1 cm may also represent metastases.\n\nADRENALS: The right and 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 mm nonobstructing stone in the left lower pole.  A few scattered\nsubcentimeter hypodensities bilaterally are too small to characterize.  There\nis no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is diffuse mural edema the gastric antrum, body and\nduodenum.  Small bowel loops are normal in caliber.  There is also mural edema\nof the descending colon.  The colon is otherwise unremarkable.\n\nThere is extensive peritoneal nodularity, for example a 2.3 x 1.3 cm nodule in\nthe right paramidline anterior mid abdomen (2:36), 4.6 x 2.6 cm nodule in the\nleft lower quadrant (601:17), and a 3.1 x 1.4 cm nodule in the right lower\nquadrant (02:39).  There is moderate volume ascites with peritoneal\nthickening.  Findings are compatible with peritoneal carcinomatosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nmoderate volume ascites.\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. 3.5 x 3.5 x 4.2 cm heterogeneous mass in the left hepatic lobe which\ninvades the pancreatic body, likely corresponding to the known\ncholangiocarcinoma.  Other scattered hypoattenuating lesions throughout the\nliver likely represent metastases.\n2. Two small splenic lesions may also represent metastases.\n3. Extensive peritoneal carcinomatosis and moderate volume ascites.\n4. Mural edema of the gastric body/antrum, duodenum, and descending colon may\nbe reactive and/or third spacing of fluids.  No bowel obstruction.\n5. Trace left pleural effusion.\n6. 3 mm nonobstructing renal stone in the left lower pole."
        },
        {
            "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 nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\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: 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:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening. Again seen is a right inguinal hernia, containing small bowel\nwithout evidence of ischemia or obstruction. The small and large bowel are\notherwise within normal limits, without wall thickening or evidence of\nobstruction.A normal, air-filled appendix is visualized.\n\nRETROPERITONEUM: The aorta is normal in caliber, with moderate atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid. \nBilateral hydroceles are noted.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. No findings to explain the patient's acute right upper quadrant pain.\n2. Redemonstration of a right inguinal hernia, containing small bowel without\nevidence of ischemia or obstruction and unchanged since ___."
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nThe liver is normal in attenuation with focal hypodensity adjacent to the\nfalciform ligament (02:43), likely representing focal fat. The portal vein is\npatent. There is no intrahepatic biliary dilatation. The gallbladder is within\nnormal limits, with no stones. Pancreas is normal in attenuation with no duct\ndilatation. Spleen is normal in size and attenuation with no lesions. Within\nthe left adrenal gland, there is a 3.1 x 2.6 cm hypoenhancing (with comparison\nto the adrenal gland) lesion which splays the medial and lateral limbs. The\nright adrenal gland is normal. The kidneys enhance and excrete contrast\nsymmetrically without hydronephrosis or suspicious lesions.\nThe enteric tube terminates in the stomach. The small-bowel is diffusely\nmildly dilated. The large bowel is decompressed and the appendix is normal.\nThere is no mesenteric or retroperitoneal lymphadenopathy. No intra-abdominal\nfree air or free fluid.\n\nPELVIS:  The uterus contains an IUD in satisfactory position. There is a small\namount of free fluid in the pelvis, which is likely physiologic. The urinary\nbladder contains a Foley catheter. There is no pelvic lymphadenopathy.  Right\npelvic corpus luteal cyst is noted.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. 3.1 x 2.6 cm intermediate-density left adrenal mass.  Further evaluation\nwith CT adrenal mass protocol or MRI could be performed, otherwise direct\nsampling could be obtained under EUS or CT-guidance.\n2.  Diffuse small bowel dilatation without evidence of obstruction.  This may\nrepresent an ileus."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Minimal atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Large soft tissue defect overlying the right gluteal region\nspans of length of approximately 10.2 cm there is stranding of the underlying\nfat which extends the level of the gluteus musculature.  No fluid collection. \nNo underlying bony changes to suggest osteomyelitis.",
            "output": "Large soft tissue defect overlying the right gluteal region with surrounding\nfat stranding which extends to the right gluteus musculature.  No underlying\nbony changes to suggest osteomyelitis."
        },
        {
            "input": "LOWER CHEST: Bilateral small pleural effusion are noted with secondary\natelectasis.\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 5.5 cm left upper pole cyst as well as a 2.6 cm left cyst at the\ninferior pole of the left kidney.  No new kidney lesion.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Few uncomplicated\ncolonic diverticulosis are noted.  The appendix is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is trace of ascites in the pelvis and in right lower\nquadrant.  There are new few subcentimeter peritoneal nodules in the right\nlower quadrant (series 5, image 49).  No abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  There is a common trunk to the celiac artery and SMA there\nis mildly ectatic measuring 12 mm.\n\nBONES: There 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 small pleural effusion.\n2. Trace of free fluid in the pelvis (around small bowel loops) and in the\nright lower quadrant.\n3. Few peritoneal nodules in the right lower quadrant are new from prior. \nAttention on future follow-up."
        },
        {
            "input": "LOWER CHEST: Motion artifact limits evaluation lung bases however there is\nminimal bibasilar atelectasis.  The heart is enlarged.  No pericardial\neffusion.\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 measures up to 8 mm.  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. \nBilateral renal parenchymal atrophy, left greater than right.  Bilateral renal\nhypodensities are too small to accurately characterize but likely represent\ncysts.  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 sigmoid\ndiverticulosis without inflammatory changes to suggest diverticulitis.  The\nappendix is normal.\n\nPELVIS: Circumferential thickening of the urinary bladder is likely related to\nunderdistention.  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.  Moderate atherosclerotic\ndisease is noted.  There is soft tissue stranding surrounding the right\nfemoral artery (3:137) which remains opacified and is likely from a recent\nintervention.  The IVC and major abdominopelvic veins are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes of the visualized spine.  Superior\nendplate compression deformity of the L2 vertebral body, age indeterminate.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No CT evidence of deep venous thrombosis within the abdomen or pelvis.\n2.  Prominence of the CBD measuring up to 8 mm and mild intrahepatic biliary\nductal dilatation may be related to post cholecystectomy status.  The\npatient's liver function test were reviewed and are normal at this time."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar atelectasis.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Subcentimeter hypodensity in the right hepatic lobe is too\nsmall to characterize (2:25).  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: Again seen is a heterogeneous right adrenal mass measuring 3.3 x 2.2\nx 4.4 cm with foci of bulk fat, suggesting a myelolipoma (2:21), unchanged. \nThe left adrenal gland is unremarkable.\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.\n\nGASTROINTESTINAL: A small hiatal hernia is present.  Small bowel loops are\nnormal in caliber.  Again demonstrated is extensive pancolonic diverticulosis.\nThere is no sign of associated inflammation to suggest diverticulitis.  There\nis no fluid collection, free fluid, or 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 not visualized.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of the bilateral hips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No acute findings in the abdomen or pelvis.\n2.  Extensive pancolonic diverticulosis without evidence of acute\ndiverticulitis.\n3.  Redemonstration of a 4.4 cm heterogeneous right adrenal mass with foci of\nbulk fat, suggesting a myelolipoma, unchanged."
        },
        {
            "input": "Bibasilar atelectasis. No pleural effusions.\n\nSubcentimeter segment 7 hypodense liver lesion is again seen, stable over\nmultiple prior studies.  No new liver lesions.  Decompressed gallbladder. \nPain portal veins.  Normal appearance of the pancreas without main ductal\ndilatation.  Normal spleen and left adrenal.  2.8 x 3.2 cm right adrenal\nnodule is similar to multiple prior studies.\n\nNo hydronephrosis.  Single bilateral renal arteries.\n\nNormal appearance of stomach containing VoLumen.  A focal coarse calcification\nis present within the third segment of duodenum, present on multiple prior\nstudies.  Marked colonic diverticulosis, most prominently involving sigmoid.\nStool is noted throughout the colon. No appreciable colonic thickening or\npericolonic stranding.  Small bowel loops are distended with VoLumen, without\nsignificant mural thickening. There is no evidence of fold reversal.  The\nterminal ileum is decompressed. No abdominal adenopathy.\n\nNormal caliber abdominal aorta. Patent SMA supplying common hepatic and\nsplenic arteries.\n\nStreak artifact affects the pelvis secondary to body habitus. No free pelvic\nfluid. No focal bladder wall thickening. Small anteverted uterus. No pelvic\nadenopathy.\n\nNo suspicious osseous lesions.",
            "output": "-Unremarkable appearance of small bowel without fold reversal, significant\nmural thickening or adjacent inflammation. No abdominal adenopathy.\n-Marked colonic diverticulosis without apparent diverticulitis.\n-A focal coarse calcification is present within the third segment of duodenum,\npresent on multiple prior studies, of uncertain significance."
        },
        {
            "input": "LOWER CHEST:\n\nSubsegmental dependent atelectasis is present in the bilateral lung bases.\nThere is no pleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout.  A\nsub cm hypodensity in the posterior right hepatic lobe (02:27) is unchanged. \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:  A 3.5 x 2.2 cm right adrenal nodule is not significantly changed\ncompared to multiple prior studies.  The left adrenal gland is unremarkable.\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 hiatal hernia (02:20) An enteric tube\nterminates in the distal aspect of the stomach. There are proximal loops of\nsmall bowel, which are distended with fluid, measuring up to 4 cm in maximal\ndiameter in the left abdomen (601B: 25), and more distal anterior abdominal\nsmall bowel loops filled with air (02:43), with two likely transition points\nidentified in the left upper quadrant (601b:30, 601b:22). There is severe\ndiverticulosis throughout the colon, as described previously, with no evidence\nof diverticulitis. The appendix is not clearly visualized.\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.\n\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Distended gas and fluid-filled small bowel loops, with 2 transition points\nthe left upper quadrant, raising concern for closed loop small bowel\nobstruction. No evidence of abdominopelvic free fluid or free air.\n2. Severe colonic diverticulosis, with no evidence of diverticulitis.\n3. Stable right adrenal nodule.\n\nNOTIFICATION:   The above findings and addition to the original wet read were\ndiscussed via telephone by Dr. ___ with Dr. ___ resident) on\n___ at 3:53 ___, 15 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar dependent atelectasis.  No pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 8 mm hypodensity in segment ___ (02:28), which is too small to\ncharacterize, but may represent 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: There is a 2.7 x 2.4 cm right adrenal nodule, unchanged from ___.  Left adrenal nodule 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.  Multiple dilated loops of\nsmall bowel are noted on the left, measuring up to 3.8 cm in diameter\n(601b:38), consistent with a small bowel obstruction.  There is a transition\npoint in the left abdomen (601b:35).  There is adjacent mesenteric fat\nstranding, without frank edema.  No evidence of ischemia or perforation. \nColonic loops are still moderately distended, particularly in the ascending\ncolon, suggesting either an early or partial small bowel obstruction.  No\nascites.  No pneumoperitoneum.\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.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 and nodularity\n(2:66) is likely related to injections.",
            "output": "1. Partial or early small bowel obstruction, with a transition point in the\nleft abdomen.  No evidence of ischemia or perforation.\n2. 2.7 x 2.4 cm right adrenal nodule, stable from ___."
        },
        {
            "input": "LOWER CHEST: There is a small right and trace left nonhemorrhagic pleural\neffusion with adjacent compressive atelectasis.  Streak artifact from a device\nin the heart limits evaluation of surrounding structures.\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 enlarged and contains hyperdense layering\nsludge or stones.  However, there is no pericholecystic fat stranding or\nfluid.  Therefore, this likely reflects a fasting state.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 5 mm nonobstructive left renal stone (2:31). \nSymmetric thickening of the bilateral anterior pararenal fascia, right greater\nthan left, likely due to rehydration on top of chronic kidney disease.\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 a Foley catheter in a small focus of air.\nDistal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small calcification 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 no evidence of worrisome osseous lesions.  A defect in the\nanterior-mid superior endplate of L1 is age-indeterminate (602b:43).  Chronic\nrib fractures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to correlate with fever.\n\n2.  Non-obstructive 5 mm left renal stone; 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 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 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. 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 grossly 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 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": "Normal abdomen and pelvis study.  Specifically, no evidence 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: There are small cysts in the right and caudate lobes of the\nliver.  There is a 3 mm hypodensity in the left lobe of the liver that likely\nrepresents a cyst but is too small to accurately characterize.  The liver\ndemonstrates otherwise homogenous attenuation throughout.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  There is a\nheterogeneous, rounded, 14 mm structure along the anterior wall of the\ngallbladder likely representing a gallstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 small cysts in the right kidney and lower pole of the left\nkidney.  There also subcentimeter hypodensities in each kidney consistent with\ncysts but too small to characterize.  In addition, there is a complex,,\nheterogeneous, largely exophytic 4.2 x 3.5 x 4.3 cm lesion in the interpolar\nright kidney that contains coarse calcification at its periphery.  Cortical\nscarring is noted in the left kidney.  The kidneys are of normal and symmetric\nsize with normal nephrogram.  There is no hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A moderate axial hiatal hernia is present.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThere are multiple sigmoid diverticula.  Hazy density in the perirectal fat as\nimproved.  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: There is an enlarged fibroid uterus containing multiple\ncoarse calcifications.  A pigtail catheter has been inserted, terminating in\nthe region of the previously demonstrated abscess cavity extending from the\nuterine fundus into the left pelvic adnexa.  There is no apparent residual\nfluid collection in this location.  There are also bilateral pelvic adnexal\ncysts, the larger measuring 2.6 cm on the right, unchanged.\n\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 with disc space narrowing in the spine. \nDegenerative changes are present in the hips as well.  There is a hemangioma\nof bone in the L3 vertebral body.  There is no concerning osteolytic or\nosteoblastic lesion.  There is grade 1 anterior spondylolisthesis L5 on S1.\n\nSOFT TISSUES: A moderate-size, fat containing, periumbilical hernia is\nre-demonstrated.",
            "output": "1. Satisfactory drainage of pelvic abscess.\n2. There are persistent bilateral necks all cysts that likely represent\novarian cysts.\n3. Enlarged fibroid uterus.\n4. 4.2 cm complex right renal mass consistent with neoplastic disease, which\nis been reported previously.  Has this been characterized prior outside\nexaminations?\n5. Hepatic and renal cysts.  Also subcentimeter hypodensities in the liver and\nkidneys that likely represent cysts but are too small to accurately\ncharacterize.\n6. Filling defect in the gallbladder that likely represents a gallstone, but\nis nonspecific in character.  This could be further characterized by\nsonography.  Has this been evaluated on prior outside studies?\n7. Colonic diverticulosis.\n8. Hiatal hernia.\n9.  Interval improvement in findings consistent with proctitis.\n10. Degenerative change in the spine with grade 1 anterior spondylolisthesis\nof L5 on S1.  Hemangioma of bone L3."
        },
        {
            "input": "VASCULAR:\n\nThe abdominal aorta is mildly calcified and normal in caliber.  Patent\niliofemoral arterial vasculature which is normal in caliber.  Major proximal\ntributaries are patent.  Specifically, patent celiac axis.  Patent proximal\nleft gastric artery and common hepatic artery.  Embolization material from\nrecent splenic artery embolization is noted near the splenic hilum.  Patent\nSMA.  Patent renal arteries.  Patent ___.\n\n LOWER CHEST: There is minimal lung base atelectasis.  No pleural or\npericardial effusion.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: There is focal fatty infiltration near the falciform ligament\n(03:39).  The liver otherwise enhances homogeneously without concerning focal\nlesion.  Patent hepatic veins.  Patent portal vein, SMV, and proximal splenic\nvein; the distal splenic vein is not well seen due to hardware artifact from\nsplenic artery embolization material.  No intra or extrahepatic biliary ductal\ndilation.  Gallbladder is unremarkable.\n\nPANCREAS: Imaged portions of the pancreas including the head, neck, body,\nproximal tail enhance homogeneously.  No ductal dilation.  Portions of the\npancreatic tail near the splenic hilum are obscured due to hardware artifact.\n\nSPLEEN: New from prior exam is a wedge-shaped hypoenhancing portion of the\nhepatic parenchyma involving the central to slightly anterior and mostly\ninferior splenic parenchyma, consistent with new splenic infarct (see series\n___, and 601:11).  The volume of infarcted spleen likely represents\nslightly under half of spleen volume.  No perisplenic fluid collection.  No\nfocal splenic lesion elsewhere.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The kidneys enhance normally and symmetrically.  There is no\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach and duodenum are unremarkable.  Non-dilated\nsmall bowel loops are normal in course and caliber without evidence of wall\nthickening or obstruction.  The colon is unremarkable.  The appendix is\nnormal.\n\nMESENTERY AND LYMPH NODES: No mesenteric or retroperitoneal lymphadenopathy. \nNo free intraperitoneal air or ascites.\n\nCT PELVIS:\nThe visualized portions of the bladder internal ureters are within normal\nlimits.  Calcifications within the left fundal uterus likely represent\ncalcified fibroids.  No concerning focal uterine or adnexal abnormality.  No\npelvic or inguinal lymphadenopathy.  No free pelvic fluid.\n\nMUSCULOSKELETAL: No focal abnormality in the soft tissues of the\nabdominopelvic wall.  No concerning focal lytic or sclerotic osseous lesions.",
            "output": "1. New splenic infarct likely involving slightly under half of the volume of\nthe spleen.  No perisplenic fluid or fluid collection.\n2. Calcified uterine fibroids.  Other incidental findings, as above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:45 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: Liver again is shrunken in size with a nodular contour and\nheterogeneous attenuation compatible with known cirrhosis.  There is no\nevidence of focal lesions. There is no evidence of intrahepatic biliary\ndilatation.  Persistent mild dilatation of the common bile duct to 8 mm is\nunchanged with normal tapering distally.  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 is borderline enlarged measuring up to 12.4 cm.  The spleen\nhas 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.\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: Portal venous system is patent with a patent paraumbilical vein. \nThere is no abdominal 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. No acute abnormality identified to account for the patient's symptoms. \nSpecifically, no small bowel obstruction or abscess.\n2. Cirrhosis with borderline enlarged spleen and patent paraumbilical vein."
        },
        {
            "input": "LOWER 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 in comparison to\nthe spleen suggesting hepatic steatosis.  There is no evidence of focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is contracted and not well 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. \nMultiple well-circumscribed hypoattenuating lesions are demonstrated are the\nbilateral renal cortices too small to fully characterize but statistically\nlikely renal cysts.  There is no evidence of solid renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Moderately-sized 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. 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 grossly 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.  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. No acute abdominopelvic pathology to explain patient symptoms.\n2. Diffuse hypoattenuation of the liver suggests hepatic steatosis."
        },
        {
            "input": "CTA: Again demonstrated is a 1.2 cm aneurysm in the celiac artery just\nproximal to the bifurcation (3:33). The SMA, renal arteries, and ___ are\npatent. Hepatic arterial anatomy is conventional. The abdominal aorta is\nnormal in caliber throughout its length.\n\nABDOMEN:\n\nThe only focal liver lesion is a 0.8 x 0.7 cm hypodensity in segment VI/VII,\npreviously demonstrated on MRI and most likely a biliary hamartoma (3:30).\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder, pancreas, spleen, and bilateral adrenal glands are normal. The\nkidneys enhance symmetrically and are without suspicious solid mass.  Tiny\nsimple cysts in both kidneys are better shown on prior MRI.\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\nnormal. Colonic diverticulosis is present without evidence of diverticulitis.\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable.  The seminal\nvesicles and urinary bladder are normal. However incidentally noted, is a 0.9\nx 0.8 cm soft tissue density just adjacent the left seminal vesicle (3:132).\nThere is no pelvic side-wall or inguinal lymphadenopathy by CT size criteria.\nNo free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:\n\nMultilevel, multifactorial degenerative changes are seen within the visualized\nthoracolumbar spine. No focal lytic or sclerotic lesion concerning for\nmalignancy.  Incidental note is made of a hemangioma in the T12 vertebral\nbody.",
            "output": "1.  1.2 cm celiac artery aneurysm. No additional aneurysm in the abdomen or\npelvis.\n\n2.  0.9 cm soft tissue lesion adjacent to the left seminal vesicle could\nrepresent a lymph node. However followup is recommended in ___ months to\nensure stability.\n\nNOTIFICATION:  Suggest either followup CT or MRI of the pelvis in ___ months\ngiven the presence of an unusually prominent pelvic lymph node of uncertain\nsignificance."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. A\n4mm calcification adjacent to the left greater trochanter with mild adjacent\nstranding may suggest calcific tendinitis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nCalcific tendinitis",
            "output": "1. No acute fracture or dislocation in the pelvis.\n2. Punctate calcification adjacent to the left greater trochanter with mild\nadjacent stranding may suggest calcific tendinitis."
        },
        {
            "input": "CHEST:   The bases of the lungs are clear.\nABDOMEN:  The liver is normal without evidence of focal lesions or\nintrahepatic biliary ductal dilatation. The patient is status post\ncholecystectomy. The portal vein is patent. The splenic vein is patent. The\nSMV is patent. The adrenal glands bilaterally are normal. An 8 mm hypodensity\nin the midpole the left kidney is too small to characterize by CT but likely\nsecondary to a simple renal cyst. The kidneys otherwise bilaterally are normal\nwithout evidence of focal lesions concerning for malignancy or hydronephrosis.\nThe pancreas is normal without evidence of focal lesions or pancreatic duct\ndilatation.\n\nThe stomach, duodenum, and small bowel are normal without evidence of wall\nthickening or obstruction. There is no retroperitoneal or mesenteric\nlymphadenopathy.\n\nThe tip of the appendix is dilated, measuring up to 1.4 cm series 601b, image\n31. There is periappendiceal fat stranding as well as prominent local lymph\nnodes, although none are enlarged by CT size criteria. The colon is normal.\nThere is no evidence of an adjacent abscess or rupture.\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.\nBONES AND SOFT TISSUES:  There is no evidence of worrisome lesions.",
            "output": "Acute appendicitis, with the tip of the appendix dilated to 1.4-cm and\nperiappendiceal stranding.  No evidence of an adjacent abscess or rupture."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  Otherwise the lung fields\nare within normal limits. There is no evidence of pleural or pericardial\neffusion.A small fat containing Morgagni hernia is noted within the anterior\nmidline.\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, similar compared to the previous exam.  The\nCBD measures 10 mm at the level of the hepatic artery and tapers normally to\nthe level of the ampulla. The gallbladder is surgically absent.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. A splenule is noted at the hilum of the spleen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence or\npancreatic ductal dilatation.  A fat lobule and re- demonstrated in the head\nof the pancreas.\n\nADRENALS:  The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.  Multiple sub cm hypodensities are noted in the right\nkidney, which are too small to characterize but likely represent renal cysts.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. A few scattered diverticula are seen within the colon\nwithout evidence of active inflammation. Otherwise the colon and rectum are\nwithin normal limits. Appendix has normal caliber without evidence of fat\nstranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\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: No bone finding suspicious for infection or malignancy\nis seen.",
            "output": "1. Colonic diverticulosis without evidence of diverticulitis.\n\n2.  Mild intrahepatic and extrahepatic biliary duct dilatation, which appears\nstable from previous examination and likely related to prior 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 parenchyma is heterogeneous.  There is no evidence of\nfocal lesions. There is mild intrahepatic biliary dilatation and the CBD\nmeasures up to 1.3 cm, however this is unchanged when compared to prior scan\nfrom ___ and likely secondary to 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 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. A short segment of\nsigmoid wall thickening, with surrounding mild fat stranding (2: 59) is\nconcerning for mild diverticulitis.  The rectum is 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 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": "Mild uncomplicated sigmoid diverticulitis."
        },
        {
            "input": "LOWER CHEST: There is trace bibasilar atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a subcentimeter hypodensity in the liver which is too small to\ncharacterize, however which likely represents a hepatic cyst or biliary\nhamartoma.  A 1 cm enhancing lesion in the right hepatic lobe (02:15) is\nunchanged compared with CTA chest ___, likely a hemangioma.  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.  There is a tiny accessory spleen adjacent to the\npancreatic tail.\n\nADRENALS: The right and 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 new 2.2 cm heterogeneously enhancing mass arising from the\ninterpolar region of the right kidney (02:32; 601:44).  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 is\nnormal limits.  There is a large amount of stool in the rectum.  The appendix\nis normal (02:53).  Haziness at the root of the mesentery is unchanged.\n\nPELVIS: The bladder is collapsed with a Foley catheter present.  The distal\nureters are unremarkable.  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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There are multilevel degenerative changes in the lumbar spine,\nprogressed compared with ___.  L3 limbus vertebra is incidentally 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": "1. No acute process in the abdomen or pelvis.\n2. Large amount of stool in the rectum.\n3. New 2.2 cm heterogeneously enhancing right kidney mass, highly concerning\nfor renal cell carcinoma.  Outpatient urologic consultation recommended.\n\nRECOMMENDATION(S):  Outpatient urologic consultation."
        },
        {
            "input": "LOWER 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 CBD stent and right main hepatic duct stent are unchanged in\nposition.  The heterogeneously enhancing mass along the common hepatic duct is\nslightly increased in size in axial dimension, measuring 2.3 x 4.5 cm (04:38),\npreviously 2.0 x 3.9 cm.  Intraluminal tumor is re-demonstrated proximally\n(04:40).  There is a similar degree of mild to moderate intrahepatic biliary\nductal dilatation.\n\nA 2.7 cm hypoenhancing lesion in the left hepatic lobe is unchanged (5:105),\nconsistent with treated satellite lesion.  A fiducial marker is again seen in\nthe inferior left hepatic lobe.  There is decreased conspicuity of previously\nseen hypodensities in the right hepatic lobe thought to represent micro\nabscesses, though with persistent hyperenhancement.  No new hepatic lesions\nare demonstrated.\n\nThe gallbladder 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.  A 1.8 cm right renal cyst is unchanged.  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 and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Borderline enlarged porta hepatis lymph nodes measuring up to 1.2\ncm in short axis are unchanged (04:31), as is a 1.0 cm aortocaval lymph node\n(04:52).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is unchanged chronic occlusion of the left portal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes of the spine are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Slight interval increase in size of obstructing intraductal mass involving\nthe common hepatic duct, now measuring 4.5 x 2.3 cm in axial dimension,\npreviously 3.9 x 2.0 cm, with similar extension into the hepatic confluence\nand unchanged intraluminal component.\n2. Unchanged moderate intrahepatic biliary ductal dilatation.\n3. Persistent heterogeneous hyperenhancement along the posterior peripheral\nright hepatic lobe consistent with cholangitis.  Previously seen hypodensities\nthought to represent micro abscesses are less conspicuous, though direct\ncomparison is difficult due to differences in bolus timing.\n4. Unchanged appearance of 2.7 cm hypoattenuating lesion in the left hepatic\nlobe consistent with treated satellite lesion.  No new hepatic lesions are\ndemonstrated.\n5. Unchanged chronic occlusion of the left portal vein.\n6. Unchanged borderline enlarged porta hepatis and aortocaval lymph nodes."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases are clear.  There is no pleural or\npericardial effusion.  The tip of a Port-A-Cath is seen at the cavoatrial\njunction.  There are severe coronary calcifications involving the LAD.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is atrophy of the left hepatic lobe, in keeping with\nposttreatment sequelae of Y-90 radioembolization.  A 1.9 x 1.5 cm satellite\nlesion in the left hepatic lobe (series 9, image 148) is unchanged to\nminimally decreased in size compared to CT of the abdomen/pelvis from ___, previously 2.1 x 1.8 cm.  A mass in the hepatic hilum, in keeping with\nknown hilar cholangiocarcinoma, is not significantly changed in size,\nmeasuring 3.7 x 2.5 cm, previously 3.8 x 2.8 cm. A new 1.9 x 1.1 cm\nsubcapsular hypodense focus with mild rim enhancement along the medial margin\nof the right hepatic lobe (series 9, image 162) is suspicious for abscess.  No\nother discrete abscesses are seen.  Mild diffuse intrahepatic biliary ductal\ndilatation is similar in degree to prior.  There are two stents extending from\nright anterior hepatic duct to the duodenum.  There is air within stents, but\nno pneumobilia in the liver.\n\nThe gallbladder is collapsed and contains a stone.\n\nPANCREAS: 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 length.\n\nADRENALS: The right and left 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 a 1.9 cm cyst in the lower pole of the\nright 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 is\nlargely collapsed and grossly unremarkable.  The appendix is mildly dilated,\nmeasuring up to 9 mm, decreased from prior, previously 14 mm.\n\nPERITONEUM: There is moderate volume abdominopelvic ascites, increased from\nprior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable. \nThere are dense calcifications of the vas deferens bilaterally.\n\nLYMPH NODES: Mildly enlarged periportal lymph nodes measuring up to 12 mm in\nshort axis are unchanged from prior.  There is no other 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 are small paraesophageal varices.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes of the lumbar spine with multilevel\nendplate sclerosis and vacuum phenomenon.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild diffuse intrahepatic biliary ductal dilatation is similar in degree to\nprior CT of the abdomen/pelvis from ___.  Two stents extending from\nright anterior hepatic duct to the duodenum. New 1.9 x 1.1 cm subcapsular\nhypodense focus with mild rim enhancement along the medial margin of the right\nhepatic lobe is suspicious for abscess.  No other discrete abscesses seen.\n2. Atrophy of the left hepatic lobe, in keeping with posttreatment sequelae of\nY-90 radioembolization.  1.9 x 1.5 cm satellite lesion in the left hepatic\nlobe is unchanged to minimally decreased in size.\n3. Mass in the hepatic hilum, in keeping with known hilar cholangiocarcinoma,\nis not significantly changed in size, measuring 3.7 x 2.5 cm.\n4.  Moderate volume abdominopelvic ascites, increased from prior.\n\nNOTIFICATION:  The impression above was entered by Dr. ___ on\n___ at 15:58 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST:\nPlease refer to same day chest CT report for subdiaphragmatic findings.\n\nABDOMEN AND PELVIS:\n\nHepatobiliary: Atrophic left hepatic lobe following Y-90 radioembolization. \nUnchanged appearance of the 1.9 x 1.5 cm lesion in the left hepatic lobe\n(8:76).  The mass in the hepatic hilum consistent with the known\ncholangiocarcinoma is relatively unchanged in size and appearance measuring\n3.6 x 2.5 cm, previously 3.7 x 2.5 cm.  The lesions suspicious for an abscess\nseen in the right hepatic margin (8:79) is less well-defined and slightly\nsmaller when compared to prior, now measuring 1.9 x 0.7 cm.  Mild intrahepatic\nbiliary dilation is still seen, relatively unchanged from prior.  2 biliary\nstents are unchanged in position.  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 again mildly enlarged measuring 13.0 cm in length.\n\nAdrenals: The right and left adrenal glands are normal in size and shape.\n\nUrinary: The kidneys are normal and symmetric in size with normal nephrogram.\nThere is no evidence of hydronephrosis.  Stable simple cyst in the right\ninferior pole (08:17) measuring up to 2.1 cm.  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 rectum\nare within normal limits. Unchanged appearance of the mildly dilated appendix.\n\nPelvis: The urinary bladder and distal ureters are unremarkable. Large\nintra-abdominal ascites is again noted, now with mild enhancement of the\nperitoneum in the paring hepatic region.\n\nReproductive Organs: The prostate and seminal vesicles are unremarkable.\n\nLymph Nodes: Again noted are multiple mildly enlarged periaortic lymph nodes,\nthe largest measuring 1.2 cm in the periportal station (8:88), unchanged. \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. \nModerate lumbar spondylosis.\n\nSoft Tissues: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable appearance of the hepatic hilum mass in keeping with known hilar\ncholangiocarcinoma.\n2. Unchanged atrophic left hepatic lobe, post treatment sequela of Y 90\nradioembolization, with a stable hypodense satellite lesion.\n3. Central biliary stents are unchanged in position associated to stable mild\ndilation of the biliary tree in the right hepatic lobe.\n4. Previously mentioned lesion suspicious for an abscess along the right\nhepatic margin is slightly smaller currently.\n5. Stable periportal lymphadenopathy, presumably metastatic.\n6. Large volume ascites with new peritoneal enhancement concerning for\nperitonitis.  In the absence of clinical symptoms of infection, differential\ndiagnosis would include metastatic involvement.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 16:26 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: Again seen is an atrophic left hepatic lobe following Y 90\nradioembolization.  The previously noted lesion in the left hepatic lobe has\nincreased in size, now measuring 2.9 x 2.4 cm, increased from 1.9 x 1.5 cm on\n___.  The mass in the hepatic hilum consistent with known\ncholangiocarcinoma is also increased, now measuring 3.8 x 3.4 cm, increased\nfrom 3.6 x 2.5 cm.\n\nThe lesions previously suspicious for an abscess in the right hepatic margin\nremain less well-defined and progressively decreased in size from ___, now measuring 1.8 x 0.4 cm (series 303, 106).  There continues to be\nmild intrahepatic biliary ductal dilatation.  There are 2 biliary stents which\nremain in place.  The gall bladder has nonobstructing stones without wall\nthickening or distension.\n\nThere is mild perihepatic ascites, markedly 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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 is a simple cyst of the inferior pole of the right kidney.  There is no\nevidence of solid 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 well visualized on\ntoday's study.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There has\nbeen near complete resolution of previously noted intra dominant ascites. \nThere is mild residual stranding and free fluid within the abdomen.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again seen are a few prominent periaortic and mesenteric lymph\nnodes.  There is no lymphadenopathy by size criteria. 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The lesion in the left hepatic lobe is increased in size, now measuring up\nto 2.9 cm in diameter.  The mass in the hepatic hilum is also slightly\nincreased in size.  These findings are suggestive disease progression.  There\nis no associated lymphadenopathy.\n2. Again seen is a trophic left hepatic lobe after Y 90 treatment.\n3. Decreased size of the previously noted intra-abdominal ascites with\nresidual perihepatic ascites, mesenteric stranding and trace intra-abdominal\nfluid.\n4. The previously noted possible abscess in the right hepatic lobe is grossly\nunchanged from ___ and could represent scarring.\n5. Central biliary stents are unchanged from prior imaging."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Left lobe atrophy is noted.  The mass in the left lobe of the\nliver is smaller in size now measuring 2 x 1.6 cm compared with 2.9 x 2.4 cm\non the prior study (series 5, image 106).  The common hepatic duct mass is\nsmaller in size now measuring 2.5 x 2.2 cm compared with 3.8 x 3.4 cm (series\n5, image 118).  Two biliary drains are unchanged in position.  There is\npersistent mild intrahepatic biliary dilatation in both lobes of the liver.\n\nThe gallbladder is contracted and contains a nonobstructing calculi.\n\nNear complete resolution of perihepatic ascites.  There are extensive\nesophageal perigastric and omental 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: The spleen is enlarged measuring 14 cm.  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 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. The colon and\nrectum are within normal limits. Appendix is not well visualized, with some\nfluid around likely related to diffuse third spacing.\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 are multiple subcentimeter periportal lymph (series 5,\nimage 117) stable from the prior scan.  Retroperitoneal nodes also measuring\nunder 1 cm in short axis dimension are unchanged.  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. Interval regression in size of segment 2 mass which now measures 2 x 1.6 cm\ncompared with 2.9 x 2.4 cm on the prior study.\n2. Interval regression in size of common hepatic duct mass which now measures \n2.5 x 2.2 cm compared with 3.8 x 3.4 cm\n3. Persistent bilobar biliary dilatation.  There are 2 biliary stents in-situ.\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: Fiducial markers are noted within left hepatic lobe segment 3,\nwith atrophy and relative ___ of the entire left hepatic lobe as\nnoted previously.  There is a heterogeneous early arterial enhancement of the\nanterior left hepatic lobe with background biliary ductal ectasia (series 4,\nimage 33), the segment 2 lesion measures 2.9 x 1.7 cm, not substantially\nchanged compared to the prior study when measured in a similar plane.\n\nNear the common hepatic duct, there is an area of heterogeneous enhancement\nmeasuring approximately 3.4 x 2.4 cm (series 9, image 46), also not\nsignificantly changed compared to the prior study.  2 biliary drains within\nthe right anterior and right posterior biliary trees are unchanged in\nposition.  There is persistent intrahepatic biliary ductal dilatation\ndiffusely.\n\nWithin the right hepatic lobe, there is a new area of early arterial\nenhancement within segment 8 measuring 1.8 cm (series 4, image 38), which does\nnot demonstrate washout on 15 minutes delayed images.\n\nThere is cholelithiasis in a nondistended gallbladder with mild gallbladder\nwall edema which is likely due to third spacing.\n\nInterval increase in mild perihepatic ascites which is nonhemorrhagic.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Redemonstration of mild splenomegaly without evidence of 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 solid renal lesions.   There is no perinephric\nabnormality.  There is a right inferior pole parapelvic cyst measuring 2.2 cm.\nThere is no hydronephrosis or hydroureter.  The urinary bladder is\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement.  There is a small amount of\ninterloop ascites.  The colon and rectum are within normal limits. The\nappendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is generalized haziness of periaortic and aortocaval soft\ntissue and nodes, with a aortocaval conglomerate of hazy soft tissue measuring\napproximately 3.1 x 1.8 cm, however this is not substantially changed compared\nto the prior study in could be accentuated by third-spacing (series 5, image\n122).\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\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 substantial interval change in appearance of multifocal treated\ncholangiocarcinoma.  Similar heterogeneously enhancing appearance of the\natrophic left hepatic lobe.\n2. Persistent bilobar biliary dilatation with dual biliary stents in similar\nposition.  Unchanged appearance of ill-defined aortocaval nodes with adjacent\nsoft tissue haziness.\n3. Slight interval increase in ascites.\n4. Cholelithiasis.\n5. Please refer to the separately dictated chest CT 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 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 solid renal lesions or hydronephrosis.  There is a 2.4\ncm cyst in the upper pole of the right kidney on series 7 ___ 31 measuring 14\n___.  This is increased in size.  A subcentimeter hypodense lesion in the upper\npole of the right kidney on series 7 ___ 25 sulcal minimally increased too\nsmall to characterize but likely represents a cyst.  A subcentimeter lesion in\nthe lower pole of the right kidney on series 7 ___ 36 is also too small to\ncharacterize but likely represents a cyst.  In the left kidney there is a 0.9\ncm lesion in the upper pole on series 7 ___ 30.  This is minimally increased\nfrom prior study.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticula are identified in the colon.  There is no evidence for\ndiverticulitis.  The appendix is not definitely seen.\n\nPELVIS: The urinary bladder and distal ureters are unchanged.  There is a 1.4\ncm calcification at the base of the bladder on series 7 ___ 76.  This is\nunchanged..  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: The abdominal and pelvic wall is within normal limits.  A sacral\nnerve stimulator is identified on series 7 ___ 61",
            "output": "1. No etiology for the patient's pain identified\n2. Stable calcification in the bladder wall at the base is most consistent\nwith surgical material related to prior uropexy"
        },
        {
            "input": "Examination is severely limited due to lack of intra-abdominal fat and enteric\ncontrast.\n\nLOWER CHEST: There is minimal bibasilar dependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered 2-3 mm hypodensities throughout the liver are too small to\ncharacterize.  There is mild intrahepatic biliary ductal prominence, not\nsignificantly changed since prior examination.  The common bile duct measures\nup to 8 mm in diameter, not significantly changed since the prior examination,\nlikely related to cholecystectomy.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  The pancreatic duct\nis minimally prominent, but not dilated similar to 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: There is bilateral moderate hydronephrosis and hydroureter.  The\ndilated ureters extend all the way up to the bladder.  Compared to the prior\nexam dated ___, there is interval increase in hydronephrosis on both\nsides.  There is uniform enhancement of the ureteral walls with periureteral\nthickening and stranding, either related to reflux and chronic ureteritis or\nunderlying urinary tract infection.  There is mild thinning of the renal\ncortical parenchyma, right greater than left which is new relative to the\nprior scan from ___ and is likely related to chronic obstruction.  No\ndefinite evidence of pyelonephritis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There are a few fluid\ndistended loops of jejunum in the left upper quadrant without a definite\ntransition point and are likely related to localized ileus than a mechanical\nobstruction.  Extensive fecal loading throughout the colon.  A normal appendix\nis not visualized discretely.\n\nPELVIS: The urinary bladder is thick walled and trabeculated.  Diverticula\nappears to be present.  This is similar to findings on prior examination.  The\npatient has a reported history of a colovesicular fistula.  Dedicated imaging\nto evaluate for this fistula is not performed.  There is no fecal material or\nfree air within the bladder to suggest the same on today's exam.  .\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable.  The ovaries are not\nvisualized.\n\nLYMPH NODES:  There is no definite retroperitoneal lymphadenopathy.  Prominent\nretroperitoneal lymph nodes are noted, measuring up to 7 mm in short axis.\n\nVASCULAR: There is no 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 stool throughout the colon without bowel obstruction.\n2. Fluid distended loops of jejunum in the left upper quadrant without a\ntransition zone less likely represent mechanical obstruction.\n3. Interval progression of bilateral hydronephrosis with thinning of the right\nrenal cortical parenchyma.  There is bilateral hydroureter, the ureters are\ndilated and tortuous and are likely obstructed at the ureterovesical junction\nby a markedly thickened and trabeculated bladder wall.  Uniform enhancement of\nthe ureteric walls with periureteral soft tissue stranding along with\nextensive enhancement and thickening of the bladder wall may reflect presence\nof underlying urinary tract infection and chronic ureteritis, possibly related\nto infection or chronic reflux.  Please note that evaluation for any localized\nbladder wall masses is limited given the extent of diffuse bladder wall\nthickening.\n4. Known colovesicular fistula.  However on today's exam there is no material\nor free air within the urinary bladder to suggest presence of the same. \nDedicated imaging to look for the same has not been performed.\n5. No localized intra-abdominal fluid collection present."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 unremarkable.  Main\nportal 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, not well assessed on CT.  There\nis no small bowel obstruction.  There is a 3.1 x 4.4 x 4.6 cm simple fluid\ndensity cystic lesion adjacent to the ascending colon, possibly a duplication\ncyst (2:46, 601:23).  Colon and rectum are otherwise unremarkable.  The\nappendix is normal.  No free 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: Uterus is enlarged and heterogeneously enhancing\ncompatible with uterine fibroids as seen on the prior pelvic CT.  Several of\nthese fibroids appear to be relatively hypoattenuating compatible with\ndegeneration, new from prior but incompletely evaluated.  No definite adnexal\nabnormality.\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 suspicious osseous lesion or acute fractures.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.Abdominopelvic\nwall is otherwise within normal limits.",
            "output": "1. No acute intra-abdominal process.  Specifically, no urolithiasis or\nhydroureteronephrosis.\n2. Fibroid uterus.  In comparison to prior, some of the fibroids now appear to\nbe degenerating, incompletely evaluated on the current modality.  Further\nevaluation with pelvic ultrasound could be performed as clinically indicated.\n3. Probable duplication cyst in the right lower quadrant as described above."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.  The appendix is within normal limits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Very mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is minimal dystrophic calcification anterior to the right iliac bone\njust superior to the right acetabulum of uncertain clinical significance.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.  No inguinal\nhernias are identified.",
            "output": "1. No acute intrapelvic process.  No inguinal hernias identified.\n2. Small fat containing umbilical hernia.\n3. Minimal dystrophic calcification anterior to the right iliac bone just\nsuperior to the right acetabulum of uncertain clinical significance.  If site\nof patient pain, consider MRI for further assessment."
        },
        {
            "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.  The cecum appears slightly distended\nand for that a portion with edema of the sacrum under the liver. This may\nsuggest a long cecal mesocolon and potential for intermittent bascule.\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 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: Post hysterectomy.  Both ovaries are seen. The right\novary appears normal. The left contains a 1.6 x 3.5 cm cyst and another\nsmaller enhancing cyst likely corpus luteum\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "Likely long cecal mesocolon and potential for a cecal bascule which may cause\nRLQ discomfort/pain\nPost hysterectomy.  3.5 cm left ovarian cyst."
        },
        {
            "input": "A 4 mm subpleural right lower lobe pulmonary nodule is noted (2:10), stable\nfrom the prior examination. The visualized lung bases are otherwise clear. The\nheart is normal in size and there is no evidence of pericardial effusion.\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, spleen, and bilateral adrenal glands are\nnormal.  The pancreas demonstrates fatty atrophy. The right kidney enhances\npromptly and is without solid suspicious mass. A 2.3 cm simple renal cyst is\nnoted within the interpolar region, and multiple additional subcentimeter\nhypodensities are too small characterize. The left kidney is absent, likely\ncongenital, as the left adrenal gland has a 'pancake' configuration.\n\nThe distal esophagus demonstrates wall thickening. The stomach is distended\nwith gastric contents. Within the abdomen, there are multiple loops of fluid\nfilled small bowel dilated up to 3.7 cm. A single transition point is noted\nwithin the right lower pelvis (2:62), with fecalization of the small bowel\nimmediately proximal to this point. The distal small and large bowel are\nrelatively collapsed and grossly unremarkable.  The appendix is not\nvisualized. There is no evidence of bowel perforation, free intra-abdominal\nfluid, or pneumoperitoneum. There is no retroperitoneal lymphadenopathy by CT\nsize criteria.  The aorta and iliac branches contain calcifications and are\nnormal in course and caliber. The celiac trunk and SMA are grossly patent.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable.  The left\nseminal vesicle is also congenitally absent. There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Multiple, dilated, fluid-filled loops of adjacent small bowel compatible\nwith a small bowel obstruction. A single transition point is identified in the\nright lower pelvis. There is no evidence of free intra-abdominal fluid or\npneumoperitoneum.\n2. 4-mm right lower lobe subpleural nodule, stable for ___ year and no longer\nrequiring followup imaging.\n3. Congenitally absent left kidney and left seminal vesicle.\n4.  Distal esophageal thickening may be related to esophagitis from recent\nvomiting and clinical correlation is recommended.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___ telephone\nat 22:24 on ___."
        },
        {
            "input": "LOWER CHEST: Small left greater than right pleural effusions are stable or\nslightly smaller.  There is moderate to severe adjacent atelectasis in the\nleft lung base.  Right lung base pulmonary embolus redemonstrated (5:3).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout\ncompatible with steatosis. A calcified granuloma is present in hepatic segment\nIV. 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 left adrenal gland is normal in size and shape. A 1.4 cm fat\ncontaining left adrenal nodule is compatible with a myelolipoma measuring -44\n___ units (07:31).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of hydronephrosis.  Bilateral renal cysts appear simple\nand measure up to 7.1 cm in the right kidney.  Bilateral subcentimeter\nhypodensities are too small to characterize but suggest cysts.  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 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: An infrarenal IVC filter appears appropriately positioned.  Bolus\ntiming limits assessment of infrarenal and lower extremity veins, however\nthere is no asymmetry or surrounding stranding to suggest venous abnormality. \nThe abdominal arterial vasculature is widely patent.  There is no abdominal\naortic aneurysm. Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes are worst in the lumbar spine with fusion of\nL4-L5, dextroscoliosis, extensive osteophyte formation.  Minimal bilateral hip\nosteoarthritis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominopelvic or hip abnormality.\n2. Severe lumbar spine degenerative change.\n3. Appropriately positioned IVC filter. Contrast bolus timing limits\nassessment of the IVC in the extremity veins. No asymmetry or stranding to\nsuggest venous abnormality. If persistent concern, evaluation for extension of\nthe previously seen left popliteal deep venous thrombosis could be pursued\nwith ultrasound.\n4. 1.4 cm left adrenal myelolipoma.\n5. Small bilateral pleural effusions with moderate to severe left basilar\natelectasis.\n6. Redemonstrated pulmonary embolus in the right lung base, partially\nvisualized."
        },
        {
            "input": "There is mild bibasilar atelectasis, the lung bases are otherwise clear. \nThere is a stable appearing triangular soft tissue nodule in the right middle\nlobe (5:5).  There is no pleural or pericardial effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The patient is status post Whipple procedure, with expected atrophy\nof the remaining pancreatic tail. There is no evidence of recurrence of the\nsurgical bed.\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: The stomach is decompressed without obvious intraluminal mass or wall\nthickening. The patient is status post Whipple procedure. Stable postsurgical\nchanges are seen in the abdomen. There are no abnormally dilated loops of\nlarge or small bowel.  The anastomotic sites appear patent. The appendix is\nnot definitively visualized, but there is no fat stranding or free fluid in\nthe right lower quadrant to suggest acute appendicitis.There is colonic\ndiverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with atherosclerotic\ncalcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. No CT evidence of infectious etiology.\n2. Stable postsurgical changes.\n3. No evidence of IPMN recurrence 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. 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 mildly atrophic with probable compensatory\nhypertrophy of the left kidney.  The kidneys demonstrate a normal nephrogram. \nThere is no evidence of focal renal lesions 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\ndiverticulosis of the sigmoid colon without evidence of acute diverticulitis. \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: 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. \nPars defect at L4-L5 results in 7 mm of anterolisthesis of L5 on S1.  At\nL5-S1, there is associated height loss, vacuum phenomenon and endplate\nsclerosis.  Mild multilevel degenerative changes are also noted in the\nthoracic spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic process.\n2. Extensive colonic diverticulosis without evidence of acute diverticulitis.\n3. Pars defects at L4-L5 with resultant anterolisthesis of L5 on S1."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day.\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 patient is status post subtotal gastrectomy with\nRoux-en-Y reconstruction.  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.\n\nVASCULAR: There is no 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 for metastatic disease in the abdomen and pelvis\n2. Please refer to chest CT report from the same day for description of\nintrathoracic findings"
        },
        {
            "input": "VASCULAR:\n\nPatient is status post aorta bi-iliac endovascular aortic repair with renal,\nsuperior mesenteric and celiac artery stents.  Graft remains patent.  There\nhas been interval resolution of the previously seen type 2 endoleak.  Overall,\nthe aneurysm sac is grossly unchanged in size as described below.\n\nPOST EVAR EVALUATION\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 10.9 x 9.9 cm\nDiameter (Center-line): 10.6 x 11.2 cm\nVolume:\n\nAneurysm: 874.6 ml, previously 879 mL\n\nENDOLEAK: no\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 7.6 cm; compared to 7.7 cm.\nLength distal graft to iliac bifurcation:  Right: 4.9 cm, compared to 4.5 cm;\nLeft: 1.2 cm, compared to 1.3 cm.\n\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. \nSubcentimeter hypodensity in the right hepatic lobe is unchanged, and there is\nsuggestion of peripheral contrast pooling, suggesting hemangioma.  There is no\nevidence of other focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is 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. \nSeveral renal cysts are again noted in the right kidney, the largest in the\nright upper pole measuring 8.4 cm.  These are unchanged.  There is no evidence\nof stones, suspicious renal lesions, or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  A duodenal diverticulum is noted.  Colon\nextensive diverticulosis of the descending and sigmoid colon is noted without\nevidence of diverticulitis.  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.  Trace stranding in the left\nhemipelvis is likely related to prior procedure..\n\nREPRODUCTIVE ORGANS: The prostate gland and seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is grade 1 anterolisthesis of L4 on L5 with moderate lumbar degenerative\nchanges.\n\nSOFT TISSUES: A large ventral hernia containing nonobstructed loops of small\nbowel is noted.  An evolving postoperative hematoma in the left inguinal\nregion is stable to slightly decreased from prior (3:157).",
            "output": "Status post endovascular aortic repair and treatment of type 2 endoleak\nwithout evidence of a persistent endoleak. The aneurysm sac is grossly\nunchanged in size."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. A\nright-sided pelvic kidney is demonstrated and is atrophic but unchanged in\nappearance from CT on ___.  There is a 2.2 cm nonobstructing stone\ndemonstrated within a right extrarenal pelvis, similar in appearance to the\nprior exam.  There there is no evidence of hydronephrosis within the right\nkidney.  The left kidney is not visualized.  Additional subcentimeter\nnonobstructing renal calculi are seen in the right kidney, unchanged from the\nprior CT examination.  The bladder is within normal limits. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: Lumbar spine fusion hardware is partially imaged.  No suspicious\nosseous lesions are identified.  Marked lumbar levoscoliosis is re-\ndemonstrated.  Irregularity of the right acetabulum is unchanged from the\nprior examination and may reflect prior surgery in that area.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 2.2 cm nonobstructing stone within a right extrarenal pelvis unchanged in\nsize and position from ___.  Multiple nonobstructing renal calculi\nwithin the right kidney are re- demonstrated and unchanged.  No evidence of\nhydronephrosis involving the right kidney, an extrarenal pelvis is present.  ."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nGI:  There is a large amount of free air in the intraperitoneum, more than\nexpected at postop day 5. Contrast is seen extending down to the cecum, with\nno evidence of oral contrast leakage. The bowel loops are within normal\nlimits, without evidence of wall thickening, diverticuli, or obstruction.\n\nThe patient is status postcholecystectomy. There is no fluid collection within\nthe gallbladder fossa or in the subcapsular space. The liver parenchyma is\nhomogeneous without evidence of focal lesion. The spleen and pancreas are\nwithin normal limits.\n\nGU: The adrenal glands are unremarkable. The kidneys demonstrate symmetric\nnephrograms and excrete contrast promptly. There is no focal lesion or\nhydronephrosis. The urinary bladder appears normal.\n\nRETROPERITONEUM: The aorta is normal in caliber There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS:  The uterus and ovaries are normal appearing. No pelvic wall or\ninguinal lymph node enlargement by CT size criteria is seen. There is trace\npelvic free fluid.\n\nSOFT TISSUE/BONY STRUCTURES:  Small focus of soft tissue gas is also seen in\nthe subcutaneous tissue of right upper abdomen and ___, likely\nresidual air from laparoscopic surgery. No focal bony lesion suspicious for\nmalignancy present.",
            "output": "1. Large amount of pneumoperitoneum, more than expected given postop day 5. No\nsource is identified.  Trace pelvic free fluid, but no large amount of free\nfluid.\n2. Bowel loops are of normal caliber without evidence of wall thickening or\nobstruction"
        },
        {
            "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 examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of liver, spleen,\nkidneys, and pancreas are unremarkable. The patient is status post\ncholecystectomy. Postoperative pneumobilia is noted.\n\nAgain seen, is massive intra-abdominal free air, overall similar to the prior\nstudy.  The most concentrated foci of air are noted in the left upper quadrant\nin the region of the splenic flexure.  Oral contrast extends through the\nrectum.\n\nThere are linear areas of high density material seen within the left upper\nquadrant that track inferiorly, these were also seen on the prior study from\nthe same day (series 2, image 25). The overall density of this material is\nsomewhat less than that of oral contrast. It is unclear if these findings\nrepresent extravasated oral contrast or more likely mesenteric vessels.\n\nSince prior, there is new mild thickening of the descending colon. No\nintra-abdominal free fluid is seen.\n\nThe noncontrast appearance of the abdominal aorta and its major branches is\nunremarkable. There is no retroperitoneal or mesenteric adenopathy.\n\nPELVIS: The bladder is well distended and normal. The uterus is unremarkable.\nThere is no pelvic free fluid. There are no pelvic sidewall or inguinal lymph\nnodes that are enlarged by CT size criteria.\n\nOSSEOUS STRUCTURES. There are no concerning lytic or sclerotic bony lesions.",
            "output": "1.  Linear hyperdense material within the left upper quadrant, seen and\nunchanged from the prior study, ___ represent of mesenteric vessel or may be\nartifactual, this as a source of oral contrast extravasation is unlikely.\n2.  Large intraperitoneal free air unchanged from the prior study.\n3.  New thickening of the descending colon is a nonspecific finding and could\nbe seen as a consequence of serosal inflammation following perforation or in\ndeveloping inflammation primary to the colon itself."
        },
        {
            "input": "LOWER CHEST:  There are small bilateral pleural effusions.  A hiatal hernia\ncontaining stomach, colon, small bowel as well as pancreas are noted.  This is\nincompletely 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.  A cecum\ncontaining right inguinal hernia is seen.  The hernia does not appear to\ncontain the appendix. No definite small bowel is seen within.  There is no\nevidence of bowel obstruction.  Fat stranding and small free fluid surrounds\nthe contained bowel.  There is large fecal load.   The appendix is not\ndefinitively visualized, however there are no secondary signs of appendicitis.\n\nPELVIS:  The bladder is low lying consistent with pelvic floor descent.  Small\npelvic free fluid is noted.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  No adnexal masses 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:  Lumbar lordosis is exaggerated with mild anterolisthesis of L4 on L5. \nMultilevel degenerative changes are seen throughout the lower thoracic and\nlumbar spine, particularly involving L 1 and T12.  Vertebral body height loss\nat these levels is age indeterminate, but likely chronic.\n\nSOFT TISSUES: A right-sided inguinal hernia is seen, containing colonic wall,\nas described above.",
            "output": "1. Right inguinal hernia containing the inferior pole of the cecum.  No\nresultant bowel obstruction.\n2. Large hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nVASCULAR: Mild poststenotic dilatation of the celiac trunk is noted.  The\nceliac axis and its major branches remain patent. The superior mesenteric,\nbilateral renal, inferior mesenteric, bilateral common iliac arteries and\ntheir major branches are patent.\n\nLIVER: There are innumerable hypoattenuating lesions scattered throughout the\nliver, which are new from ___, with representative measurements as\nfollows:\n\n-1.7 cm lesion in the left hepatic lobe (4:84)\n-3.0 cm lesion in the left hepatic lobe (4:84)\n-2.9 cm lesion in the right hepatic lobe (4:74)\n-2.8 cm peripherally enhancing lesion at the right liver dome (4:57)\n-2.4 cm lesion in the right hepatic lobe (4:85)\n\nBILIARY: There is no biliary dilatation.  Cholelithiasis is noted.  A small\nfocal hypoattenuating area at the fundus (4:103) likely reflects\nadenomyomatosis.\n\nPANCREAS: The mass at the junction of the pancreatic neck and body measures is\nlarger, now measuring 2.1 x 2.0 x 2.3 cm (AP by TV by SI) (4:85, 7:24),\npreviously up to 1.1 cm.  This mass is noted to extend to the gastrohepatic\nligament, measuring up to 1.9 cm in that area (4:79), new from prior.  The\nmass is in close proximity to the portal splenic confluence, abuts the\nproximal common hepatic and splenic arteries and encases the proximal gastric\nduodenal artery.\n\nThere is dilatation of the main pancreatic duct up to 1.0 cm, with an abrupt\ncutoff of the mass (4:86).  The distal pancreatic body and tail are atrophied.\n\nThere is a 2.1 x 1.2 x 2.3 cm (AP by TV by SI (4:92, 7:24) cystic lesion in\nthe pancreatic head, likely representing an IPMN.\n\nSPLEEN: Heterogeneous appearance of the spleen is likely related to contrast\ntiming.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: There is scarring and atrophy involving a segment of the right upper\npole (7:50), likely reflecting sequela of prior injury.  There is a 1.7 cm\nsimple cyst in the right lower pole.  Additional bilateral subcentimeter\nlesions are too small to characterize.  There is a 4 mm nonobstructing stone\nin the left interpolar region (3:25).  No hydronephrosis\n\nGASTROINTESTINAL: There is no gastrointestinal obstruction.  No\nintraperitoneal free fluid or air is seen.\n\nLYMPH NODES: There are stable, nonspecific omental nodules measuring up to 0.4\ncm (4:108).  A 0.5 cm porta hepatis node is also noted (4:86).  There is no\nevidence of pelvic or inguinal lymphadenopathy.\n\nPELVIS: There is no free fluid in the pelvis. The uterus and bilateral adnexae\nare within normal limits.\n\nBONES: There are no new aggressive appearing osseous lesions.  Bilateral\nsacroiliitis is noted.  Grade 1 anterolisthesis of L4 on L5 is unchanged.",
            "output": "1. Interval progression of disease with numerous new hepatic metastases and\ngrowth of the pancreatic mass, as detailed above.\n2. 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 the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Numerous metastatic low-density lesions in the liver have\nslightly improved and are smaller than prior exam except for 2 lesions in the\nright hepatic lobe measuring 1.9 cm (series 601, image 56, previously 1.3 cm) \nand 1.4 cm (series 601, image 55, previously 1.0 cm)  which are larger and\nmore conspicuous today, and unlike the lesions which are smaller, demonstrate\na peripheral rim of enhancement.  The intrahepatic biliary ductal dilatation\nis unchanged.  The gallbladder is contains stones, without evidence of\ngallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreatic head/neck mass is ill-defined but appears grossly\nstable, measuring 1.8 x 1.3 cm.  There is a stable upstream duct dilatation. \nCystic lesion in the pancreatic head is similar to prior exam measuring 1.3 x\n2.2 cm likely IPMN.\n\nVASCULAR: Pancreatic mass encases the common hepatic artery with associated\nthickening and narrowing of the common hepatic artery unchanged..  Pancreatic\nmass also abuts the gastroduodenal artery main portal vein, distal SMV and\ndistal splenic vein similar to prior exam.  There is no thrombosis.\n\nSPLEEN: Hypodense metastatic foci in the spleen measuring up to 1.0 cm, are\nunchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys unremarkable expect for few bilateral low-density lesions\nmeasure up to 1.6 cm and cortical scars.\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.\n\nThere is interval improvement of diffuse mesenteric 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 small volume of\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits. Early enhancement of the left gonadal vein and periuterine vasculature\nmay be from retrograde filling, and could be associated with pelvic congestion\nin the appropriate clinical presentation.\n\nBONES: Multiple lytic and sclerotic lesions in the axial skeleton are slightly\nmore prominent compared to prior exam suggestive of worsening metastatic\ndisease for example lytic lesion on L4 vertebral body with rim of sclerosis\nmeasuring 1.2 cm.  There is stable anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval worsening of osseous metastases.\n2. Mixed response of metastatic liver lesions to the treatment as described.\n3. Stable splenic metastases.\n4. New free fluid in the pelvis, nonspecific."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates decreased attenuation throughout.\n\nThere are 5 hyperenhancing hepatic lesions, some of which appear stable to\nminimally increased compared to ___, and slightly increased in size\ncompared to ___.\n\n-The segment V 2.3 cm lesion is similar compared to ___, but appears\nincreased in size compared to ___ when it measured 2.1 cm (303:39).\n-The 1.8 cm segment VII lesion appears minimally increased compared to ___ and slightly increased compared to ___ which measured 1.2 cm\n(301:39).\n-The more superior segment VII 1.9 cm lesion appears minimally increased\ncompared to ___ and ___ which measured 1.2 cm (301:27.\n-The peripheral segment VII 9 mm lesion appears similar to ___ but\nincreased in size compared to ___ (301:34).\n-There is a 9 mm arterially hyperenhancing lesion in segment II which is\ndifficult to accurately compared to prior but appears slightly increased\n(301:19, 601:59).\n\nThere is no definite new concerning hepatic lesion compared to ___.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: Again demonstrated, is a 1.6 cm hyperenhancing area in the tail of\nthe pancreas, unchanged and indeterminate (303:44).  The remaining pancreas\nhas normal attenuation throughout, without evidence of new 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 a stable right simple renal cyst.  Otherwise, there is no evidence of\nsolid renal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient status post right\nhemicolectomy and resection of a mid abdominal neuroendocrine tumor arising\nfrom the small bowel with a surgical clip demarcating the surgical bed\n(303:69).  Small soft tissue nodule immediately superior to the surgical clip\nabutting the third part of the duodenum measures 1.9 x 0.7 cm (series 3 of 5,\nimage 67) is indeterminate, however most likely representing postsurgical\nchange.  Attention on follow-up.  The remaining small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nPatient status post right hemicolectomy with postsurgical changes in the mid\nabdomen as well as reactive lymph nodes (series 303, image 85).  Colonic\ndiverticulosis without evidence of acute diverticulitis.   Otherwise, the\nremaining 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 uterus and bilateral adnexae are grossly within\nnormal limits.  Again noted is a polypoid soft tissue lesion in relation to\nthe cervix measuring 2.0 x 1.5 x 1.4 cm and correlation with Gyne ultrasound\nis advised.\n\nLYMPH NODES: There are few mildly prominent, mildly hyperenhancing mesenteric\nlymph nodes in the lower anterior abdominal cavity, likely reactive from\nrecent surgery.\n\nVASCULAR: There is no 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 cm left posterior subcutaneous nodule which appears\nnew compared to ___ and more coalesced compared to ___.  This\nis nonspecific in indeterminate but may represent fat necrosis.  There is a\nsurgical scar over the midline abdomen.  Otherwise, the abdominal and pelvic\nwall is within normal limits.",
            "output": "1. Please note that the hepatic lesions were better characterized on prior MRI\n(___) and MRI would be the investigation of choice for accurate\ncomparison.\n2. 5 hepatic metastatic lesions appear similar to minimally increased compared\nto prior CT abdomen done ___, but definitely slightly increased\ncompared to ___ (as well as prior MR done ___.  No\nnew lesions are identified.\n3. Status post right hemicolectomy and resection of mid abdominal\nneuroendocrine tumor.  Small soft tissue nodule immediately superior to the\nsurgical clip is indeterminate, but most likely postsurgical.  Attention on\nfollow-up imaging.\n4. Indeterminate left posterior subcutaneous nodule appears more coalescent\nand is nonspecific. This may represent fat necrosis, however a metastatic\nlesion cannot be entirely excluded. Attention on follow-up imaging is\nrecommended.\n5. Stable focus of increased enhancement in relation to the pancreas tail is\nnonspecific, may represent fatty sparing.  Attention on follow-up imaging.\n6. Polypoid soft tissue lesion in relation to the endocervix for which\ncorrelation with gynecological ultrasound is advised\n7. Hepatic steatosis.\n\nRECOMMENDATION(S):  Please note that MRI of the liver would be more accurate\nfor direct comparison of hepatic metastatic lesions.\n\nNon urgent gynecological 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.\n\nThe patient is status post radiofrequency ablation of hepatic lesions in\nsegment V and VII.  Post-radiofrequency ablation changes are demonstrated in\nsegment V measuring up to 3.7 cm in diameter.  There is a focus at the center\nof this which is isodense to the liver and does not enhance.  There are two\nsimilar foci of post-radiofrequency ablation changes in segment VII.  The more\ninferior focus measures 4.8 cm in greatest dimension.  In the more superior\nfocus measures up to 5.7 cm.  Each of these also contains a region which is\nisodense to the liver and does not enhance.\n\nThe arterially hyperenhancing lesion in segment II measures 9 mm, unchanged\nfrom prior exam.\nThere are no definite new or concerning hepatic lesions compared to ___.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: Again demonstrated is a multifocal, hyperenhancing area in the tail\nof the pancreas measuring 1.6 mm as before, unchanged and indeterminate.  The\nremaining pancreas has normal attenuation throughout, without evidence of new\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 right simple renal cyst.  There is also a stable left lower\npole renal simple cyst.  Otherwise, there is no evidence of solid renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\nright hemicolectomy and resection of a mid-abdominal neuroendocrine tumor\narising from the small bowel with a surgical clip demarcating the surgical\nbed.  Small soft tissue nodule immediately superior to the surgical clip\nmeasures 1.6 x 0.7 mm, similar to prior.  This likely represents postsurgical\nchange, however attention on follow-up is recommended.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\n\nThe patient is status post right hemicolectomy with postsurgical changes in\nthe mid abdomen as well as reactive lymph nodes.  Colonic diverticula are\npresent without evidence of acute diverticulitis.  Otherwise, the remaining\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 uterus and bilateral adnexae are grossly within\nnormal limits.  Again noted is a polypoid soft tissue lesion in relation to\nthe cervix measuring 1.9 x 1.7 x 1.7 cm, similar to prior.  Correlation with\ngynecologic ultrasound is advised.\n\nLYMPH NODES: There are few mildly prominent, mildly hyperenhancing mesenteric\nlymph nodes in the lower anterior abdominal cavity, likely reactive from\nrecent surgery, unchanged from prior.\n\nVASCULAR: There is no 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 2.6 cm left posterior subcutaneous nodule which\nappears similar to prior in morphology but has increased in size, previously 2\ncm.  This may represent fat necrosis however is a nonspecific and\nindeterminate finding.  There is a surgical scar over the midline abdomen,\notherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. The arterially hyperenhancing segment II lesion is unchanged in size. \nAttention on follow-up is recommended.  Please note that the hepatic lesions\nwere better characterized on prior MR (___). MRI is the\ninvestigation of choice for accurate comparison.\n2. Post radiofrequency ablation changes are noted in the segment V and VII. \nThere is no enhancement at the sites of the previous lesions than the lesion\nin segment V and VII. No new lesions are identified.\n3. Status post right hemicolectomy and resection of midabdominal\nneuroendocrine tumor.  Small soft tissue nodule immediately superior to the\nsurgical clip is indeterminate but most likely postsurgical.  Attention on\nfollow-up imaging is recommended.\n4. Indeterminate left posterior subcutaneous nodule has increased in size from\n2.0 cm to 2.6 cm.  This finding is nonspecific but may represent fat necrosis,\nhowever metastatic lesion cannot be entirely excluded.  Attention is\nrecommended on follow-up imaging.\n5. Again seen is a multifocal, hyperenhancing area in the pancreatic tail\n(stable from prior) which is indeterminate, but may represent fatty sparing\nhowever attention is recommended on follow-up imaging.\n6. Polypoid soft tissue lesion in relation to the endocervix is again seen. \nGynecologic ultrasound is recommended.\n\nRECOMMENDATION(S):  Please note that MRI of the liver be more accurate for\ndirect comparison of hepatic metastatic lesions.\n\nNon urgent gynecologic ultrasound is recommended for characterization of\npolypoid soft tissue lesion of the endocervix."
        },
        {
            "input": "LOWER 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 15 mm subcapsular hypodense lesion in segment VII (series 10, image\n77). A 19 mm hypodense lesion in segment IVB (series 10, image 89) and an\nadditional 1 cm lesion at the base of segment VII (series 10, image 87) are\nalso noted.  These lesions were hardly seen on prior CT but were present on\nrecent MRI of ___.\n\nThere is a faint new 8 mm hypodense lesion in segment II (series 13, image 33)\nnot well imaged on prior studies.\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 unremarkable besides a 14 mm right interpolar cyst as\nwell as a 12 mm left upper pole cortical cyst measuring 12 mm.  No\nhydronephrosis.\n\nGASTROINTESTINAL: Again noted is mild wall thickening of the terminal ileum\n(series 10, image 131).  The mesenteric partially calcified soft tissue mass\nis unchanged measuring 2.5 x 1.6 cm and there is tethering of the terminal\nileum, inferior portion of the duodenum as well as the cecum.  No bowel\nobstruction.\n\nAdditional subcentimeter lymph node in right mesentery are also noted (series\n10, image 127 and 125).\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: No retroperitoneal adenopathy.  No peritoneal disease.  There is\nmild stranding in the right flank likely related to recent postoperative\nchanges.\n\nVASCULAR: There is no 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. Overall hepatic lesions are unchanged from prior MRI. There is a faint\nhypodense lesion in segment II concerning for a new hepatic metastasis.  To be\nfurther characterized by MRI.\n2. Unchanged small-bowel carcinoid tumor with adjacent metastatic lymph nodes.\n3. Please refer to separate chest CT done the same day for thoracic findings.\n\nRECOMMENDATION(S):  Abdominal MRI to further characterize left hepatic\nhypodensity."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Allowing for differences in technique, 1.9 cm and 1.4 cm\narterially hyperenhancing lesions in segments IVb (06:33) and VII (06:27),\nrespectively, are stable, previously measuring 1.9 cm and 1.5 cm.  The segment\n4b lesion is hypoattenuating in the portal venous phase while the segment VII\nlesion becomes isodense to the parenchyma in the portal venous phase.  The\npreviously identified hypodense segment II lesion is not clearly seen on\ntoday's study.  No new lesions are seen.  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: An area of ill-defined portal venous phase enhancement in the\npancreatic tail (10:103) is stable from prior and is nonspecific but may\nrepresent fatty sparing.  The pancreas otherwise has normal attenuation\nthroughout, without pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 and 1.2 cm simple cysts in the interpolar region of the right kidney and\nupper pole of the left kidney, respectively, are unchanged.  There is no\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Enhancement of the terminal\nileum is not significantly changed (10:127).  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\nA 2.3 x 1.4 cm partially calcified soft tissue mesenteric mass (10:126) is\nunchanged, previously measuring 2.5 x 1.6 cm.  Tethering to the junction of\nthe second and third portions of the duodenum (10:127) and the terminal ileum\n(10:128) is unchanged.\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\nseen.\n\nLYMPH NODES: Prominent subcentimeter right mesenteric lymph nodes are stable\ncompared to prior (10:123).  There is no retroperitoneal lymphadenopathy.\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: Postsurgical changes of the midline ventral abdominal wall are\nagain seen.  Patchy subcutaneous soft tissue densities with nearby vessels\nextending from the gluteal muscles in the posterior left lower abdominal wall\nis nonspecific and potentially secondary to injections.",
            "output": "1. No significant change in hepatic lesions concerning for metastasis.  No new\nhepatic lesions.  Of note, the previously described lesion within segment II\nis not clearly seen on today's study.  However, agree with prior\nrecommendations for additional evaluation with MRI.\n2. Unchanged small bowel carcinoid tumor with adjacent metastatic lymph nodes.\nNo new lymphadenopathy.\n3. Stable focus of portal venous phase enhancement in the pancreatic tail is\nnonspecific but may represent fatty sparing. Attention on follow-up studies\nrecommended.\n4. Subcutaneous soft tissue densities in the posterior left lower abdominal\nwall are nonspecific but potentially related to injections.  Clinical\ncorrelation and attention on follow-up recommended.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 1.9 x 1.5 cm\nLocation (head right of SMV, body left of SMV): Superior aspect of the\npancreatic head\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent; dilatation up to 6mm\nBiliary tree abrupt cutoff with or without upstream dilatation: Present; CBD\nupto 1.4cm with stent in situ\n\nArterial evaluation\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nOf note, patient has a diminutive gastroduodenal artery which is not clearly\nvisualized.\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: absent\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: Few sub-cm portocaval measuring upto 8mm are\nnon-specific\nOther extrapancreatic disease (invasion of adjacent structures): Abuts the\nadjacent duodenum\n\n\nLOWER CHEST: Few non-specific ___ opacities may relate to aspiration. \nNo discrete pulmonary mass/nodule is identified.  There is no pleural effusion\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is moderate intra and\nextrahepatic biliary dilatation, mildly improved since examination of ___.  There has been interval placement of a biliary stent which is in\nadequate position.\n\nThe gall bladder is collapsed\n\nThe hepatic and portal veins are patent without evidence of thrombosis.\n\nPANCREAS: Suspected hypodense pancreatic head carcinoma as described above. \nThere is diffuse pancreatic duct dilatation, up to 6mm.  A couple of dilated\nside branches are also noted (series 3, image 40 and 43).  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  A few splenules are noted in the region of the\nhilum.\n\nADRENALS: There is mild nonspecific thickening of bilateral adrenal glands.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nFocal scarring is noted along the posterior-lateral right kidney.  A 1.3 cm\nlow-density lesion in the right kidney likely represents a small 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. There is moderate colonic diverticulosis\nwithout evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  Streak artifact from left hip arthroplasty slightly\nobscures intrapelvic structures.\n\nREPRODUCTIVE ORGANS: Prostate gland and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Subcentimeter portacaval lymph nodes are nonspecific\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Osseous structures show diffusely decreased bone mineral density. \nThere is grade 1 anterolisthesis of L5 over S1 and L4 over L5.  There is mild\ncompression deformity of the superior endplate of L4.  No suspicious appearing\nlytic or sclerotic lesion is identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Ill-defined hypoattenuating mass in the pancreatic head is concerning for\npancreatic adenocarcinoma.  Presumptive staging as above (resectable).\n2.  There is dilatation of the pancreatic and common bile duct, with interval\nplacement of a CBD stent.  Mild interval decrease in intra and extrahepatic\nbile duct dilatation\n3. No evidence of metastatic disease in the abdomen or pelvis.\n4. Colonic diverticulosis without associated acute inflammation.\n\nRECOMMENDATION(S):  Correlation with EUS with or without FNA.\nPancreatic surgery consult.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with\nDr. ___ on the telephoneon ___ at 8:09 pm, 10 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: A small hiatal hernia is demonstrated.  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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No findings of intra-abdominal or pelvic malignancy identified.\n2. Prostatomegaly.\n3. Please refer to same-day CT chest for characterization of intrathoracic\nfindings."
        },
        {
            "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 enhances homogenously without focal abnormality. The portal venous\nsystem is patent. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is not distended, and there are no gallstones\nnoted.  The pancreas, spleen, and bilateral adrenal glands are visualized and\nwithin normal limits.  The kidneys enhance symmetrically, excrete contrast\npromptly, and show no evidence of suspicious solid mass.  A retro-aortic left\nrenal vein is noted.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in 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 aorta and iliac branches are normal\nin course and caliber. The celiac trunk and SMA are grossly patent.\n\nPELVIS:\n\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. An\nintrauterine device is positioned satisfactorily within the uterus. There is\nno pelvic side-wall or inguinal lymphadenopathy by CT size criteria. No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES:\n\nNo focal lytic or sclerotic lesion concerning for malignancy. Again visualized\nwithin the left rectus femoris muscle is a 1.9 x 1.5 cm hypodense lesion with\nan internal attenuation of -31 Hounsfield units, most likely representing a\nlipoma, which is unchanged from the prior study (2:126).  The scattered\nsclerotic lesions within the lower thoracic and lumbar spine are unchanged in\nappearance from the prior exam.",
            "output": "1.  The previously described subcentimeter left lobe hypodensity is no longer\nvisualized.\n\n2. Stable sclerotic lesions in the thoracolumbar spine.\n\n3. A 1.5 x 0.9 cm hypodense lesion within the left rectus femoris muscle,\nlikely representing a lipoma, is again visualized. This is unchanged in\nappearance from the prior study."
        },
        {
            "input": "LOWER CHEST: No significant abnormalities identified in lung bases. Please see\nreport from dedicated CT of the chest for supradiaphragmatic 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:  An IUD is seen within the endometrial canal.  Adnexae\nappear grossly 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.  Incidentally noted is a retroaortic left renal vein.\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 metastatic 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 is no evidence of focal renal lesions 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 of and distal ureters are unremarkable.  There is\nno free 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. Minimal atherosclerotic\ndisease is noted.  A retro-aortic left renal vein is incidentally noted.\n\nBONES: A stable lucent lesion of L2, inferior and lateral, (08:28) is\nunchanged from prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence new intra-abdominal or pelvic metastatic disease.\n2. Please see same-day chest CT for additional details."
        },
        {
            "input": "Chest:  Multiple pulmonary nodules are identified at the lung bases.  The\nlargest appears to measure up to 6 mm within the right lower lobe (2:9). \nGround-glass opacity within the right lower lobe appears progressed since\nprior study.  There is no pleural effusion. There is no pericardial effusion.\n\nAbdomen: Evaluation limited in the absence of intravenous or oral contrast.\nNumerous hypodensities throughout the liver measure up to 3.2 cm within the\nright hepatic lobe, compatible with liver metastasis. Relative to prior\nexamination, the gallbladder appears distended measuring 5.1 cm in axial\ndimension (2:40).  There is no gallbladder wall thickening or stone\nidentified. Relative to prior examination, central intrahepatic biliary ductal\ndilatation is more pronounced.\n\nEvaluation of the pancreatic mass is limited in the absence of intravenous\ncontrast.  A mass within the pancreatic tail is again identified and measures\n3.4 cm, mass significantly changed in appearance though appears to have\nincreased in size relative to prior study dated ___. Additional\nhypodensities just superior to the pancreatic head are noted, the largest 3.4\nx 3.6 cm (2:22), likely pancreatic in origin.  There is no pancreatic ductal\ndilatation.\n\nThe spleen is unremarkable.  The right adrenal gland is unremarkable.  The\nleft adrenal gland appears bulky, though unchanged.\n\nBilateral kidneys are lobulated in appearance with multiple ill-defined\ncortical hypodensities, similar in appearance to prior examination though\nincompletely characterized. The largest within the lower pole of the right\nkidney measures 4 cm in largest dimension. There is no hydronephrosis or\nnephrolithiasis.\n\nOral contrast fills loops of nonobstructive small bowel. Scattered diverticula\nare noted throughout the colon without evidence to suggest diverticulitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. In the\nabsence of intravenous contrast, assessment for abdominal lymphadenopathy is\nlimited though enlarged retroperitoneal nodes within the right paraaortic\nstation appears largely unchanged.\n\nPelvis: The bladder is moderately well distended and grossly unremarkable.\nThere is no pelvic free fluid. There is no inguinal or pelvic sidewall\nadenopathy.\n\nOsseous structures: Multilevel degenerative changes are noted throughout the\nvisualized spine with anterolisthesis of L3 on L4.  No suspicious lytic or\nblastic lesion is identified.",
            "output": "1.  Known pancreatic masses incompletely characterized on current examination\nin the absence of contrast. Not significantly changed is metastatic disease\ninvolving the lungs, liver, retroperitoneal adenopathy, and possibly bilateral\nkidneys. As previously recommended, MRI would be helpful to further\ncharacterize renal lesions.\n\n2.  Relative to prior examination, there appears to be increased intrahepatic\nbiliary ductal dilatation as well as distention of the gallbladder. There is\nno gallbladder wall thickening, edema,  or radiopaque cholelithiasis to\nsuggest acute cholecystitis. Constellation of findings likely reflective of\nobstruction at the level of the pancreatic head. Correlate with lab values\nadvised.  Alternatively, remote last meal may additionally cause distended\ngallbladder."
        },
        {
            "input": "LOWER CHEST: The heart is mildly enlarged.  There is no pericardial effusion\nor wall thickening.  There are bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 2 cm hyperdense lesion in hepatic segment 7,\nincompletely characterized at the current study.  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 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. 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 well visualized likely 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.  Diastasis\nrectus.",
            "output": "1. No acute intra-abdominal or intrapelvic pathology explaining the patient's\nabdominal pain.\n2. Incidental findings described as in above including indeterminate\nhypervascular liver lesion.  Differential diagnosis may include hemangioma,\nfocal nodular hyperplasia or possibly adenoma.  In a high risk patient\nhypervascular metastasis could be considered but this is very unlikely.\n\nRECOMMENDATION(S):  Follow-up multi phasic CT or preferably MR is recommended\nto evaluate a liver lesion.  Alternatively, an attempt could be made to see if\nit is likely a hemangioma on ultrasound as a first although ultrasound might\nnot be definitive in characterization."
        },
        {
            "input": "CHEST: There is a calcified granuloma at the right lung base. Mild left\nbasilar atelectasis is noted. There is a large hiatus hernia containing nearly\nthe entire stomach, a portion of transverse colon and fat. The heart is normal\nin size with no pericardial effusion. No pleural effusion is seen.\n\nABDOMEN: The liver and gallbladder are normal. The spleen and adrenal glands\nare unremarkable. The pancreas is normal with no surrounding stranding. The\nkidneys enhance and excrete contrast normally.  Small bowel is decompressed\nwith no evidence of obstruction. The appendix is normal and there a normal\namount of colonic stool.\n\nPELVIS:  There is fat stranding adjacent to the proximal sigmoid colon in the\nregion of several diverticula, with no adjacent fluid collection or evidence\nof macro perforation. Findings are compatible with uncomplicated acute\ndiverticulitis.  Adjacent bowel wall thickening is likely reactive. Urinary\nbladder is normal appearing. The uterus and adnexae are unremarkable. There is\nno free fluid in the pelvis.\n\nVESSELS: The aorta demonstrates mild atherosclerotic calcification without\naneurysmal dilatation and its major branches are patent.\n\nOSSEOUS STRUCTURES: There is moderate to severe facet arthropathy in the lower\nlumbar spine, with mild leftward scoliosis of the lumbar spine.  No concerning\nosseous lesions are seen.",
            "output": "1.  Uncomplicated acute sigmoid diverticulitis. Given the presence of bowel\nwall thickening, consider colonoscopy once the acute symptoms resolve to\nexclude underlying mass.\n2.  Large hiatal hernia containing the entire stomach and a small portion of\ntransverse 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 no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is notable for thickening at\nthe fundus likely due to 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.  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 3.4 cm left adnexal cyst.  IUD noted in the\nuterus.  Right 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.  Circumaortic left renal vein\nis incidentally noted.\n\nBONES: 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, no findings to explain patient's symptoms. \nNormal appendix."
        },
        {
            "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN AND 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 is within normal limits.\n\nPancreas: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSpleen: The spleen shows normal size and attenuation throughout, 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 with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGastrointestinal: The stomach, duodedum, jejunum and ileum are normal in\ncaliber, with no parietal edema.  Terminal ileum shows questionable mucosal\nhyperenhancement relative to adjacent loops, but particularly since it is\ncollapsed, assessement is difficult.  Robust fatty infiltration along the\ncecum, ileocecal value and even the appendix is moderately striking, and\nunchanged.  The lower sigmid shows questionable wall thickening but again\ndifficult to assess due to collapsed state.\n\nPelvis: The urinary bladder is mildly decompressed and unremarkable.  There is\nno free fluid in the pelvis.\n\nReproductive Organs: The uterus is normal in size and shape and has an\nindwelling intrauterine device.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVascular: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.  No evidence of arterial obstructions in the abdominal aorta or its\nimmediate 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. Normal vasculature.\n2. Suspected underlying chronic bowel pathology although mild active ileal\nand/or sigmoid inflammation is possible.  A prior study from ___\nshowed severe ileitis and colitis, which almost fully resolved at that time in\nonly 3 days on follow-up imaging.  More recent study from ___\narguably showed lower sigmoid wall thickening, which is difficult to assess on\nthis study.  Possibilities may include Crohn's disease, or alternatively,\nvasculitis or angioedema might be considered, although there is not\nnecessarily an active process on imaging at this time.  It is also possible\nthat the striking abnormalities on the initial CT from ___ may have been due\nto acute infectious enterocolitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within 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 or\nextrahepatic biliary dilatation.  Focal adenomyomatosis of the gallbladder\nfundus.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal 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 remains borderline dilated at 7 mm, however\nsimilar to previous, and fluid-filled.  There remains no mucosal\nhyperenhancement, abnormal wall thickening, periappendiceal fat stranding, or\nadenopathy to suggest acute inflammation.  No appendicolith.  Areas of\napparent thickening of the terminal ileum, likely due to incomplete\ndistention/peristalsis at the time of exam.  No abnormal stricturing,\nmesenteric comb sign/congestion, or fecalization.  There remains fatty\ninfiltration of the cecum, likely representing sequela of remote colitis from\n___.\n\nThe stomach is unremarkable.  Small bowel loops within the left upper quadrant\nare mildly distended but appear similar in caliber to prior.  No evidence of\nobstruction.  There is suggestion of mucosal hyperenhancement involving the\nterminal ileum (2:59), similar in extent to prior.  Elsewhere, small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThe distal descending and sigmoid colons are decompressed.  The colon and\nrectum are otherwise unremarkable.  The appendix is mildly dilated up to 8 mm\n(2:61) and fluid-filled with mild mural enhancement.  No definite\nperiappendiceal inflammation.  No free fluid are intraperitoneal free air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD in situ.  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.\n\nBONES: Left iliac bone islands.  No Findings of sacroiliitis.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.  Injection\ngranuloma left abdominal wall.",
            "output": "1.  The appendix remains borderline dilated with fluid, but given this is\nsimilar in appearance to prior, without other secondary inflammatory changes,\nthis is overall not convincing for acute appendicitis, however for clinical\ncorrelation.\n2.  There is sequela prior remote colitis of the cecum, but no evidence of\nactive colitis or terminal ileitis.  If there remains persistent clinical\nconcern for Crohn disease, this may be better assessed by MR enterography."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  There is no\nevidence of obstruction.  The colon and rectum are within normal limits. The\nappendix measures 6 mm in diameter without evidence of surrounding fat\nstranding or hyperemia.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No adnexal abnormalities.  A 2 cm right adnexal cyst is\nlikely physiologic.  Appropriately positioned IUD.\n\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: Left iliac bone islands.  There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.",
            "output": "No evidence of acute abdominal or pelvic abnormality.  Normal appendix."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen: The liver appears subtly nodular along its margins though otherwise\nunremarkable. Main portal vein is patent. No biliary ductal dilation. The\nspleen is surgically absent though there is accessory splenic tissue noted.\nPancreas, adrenal glands appear normal. The kidneys enhance symmetrically and\nexcrete contrast promptly without focal lesion or hydronephrosis. The\nabdominal aorta is normal in course and caliber with widely patent major\nbranches. Stomach and duodenum appear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  There is no bowel wall thickening or\nevidence of acute inflammation. Distal ureters opacify normally. The urinary\nbladder appears normal. No pelvic sidewall lymphadenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "No acute 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 asymmetric thickening and enhancement of the collapsed\ngallbladder wall adjacent to the hepatic parenchyma (4:44), which persists on\nthe 15 min delayed phase (11:28).  This enhancement extends superiorly into\nthe hepatic parenchyma, suggesting involvement (4:34).  Furthermore, this area\ncorresponds with a region of enhancement on the outside hospital MRI.  The\ncommon bile duct stent is identified extending into the duodenum. There is\npneumobilia, predominantly in the left hepatic lobe, in keeping with history\nof prior ERCP, residing CBD stent, and sphincterotomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 hypodensities are\nidentified in the left kidney (13:51,66), the largest of which measures 1.9 x\n1.4 cm in the interpolar region (13:59), consistent with a simple cyst. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Diverticulosis of the descending and sigmoid colon\nis noted, without evidence of wall thickening and fat stranding. Appendix\ncontains air, has normal caliber without evidence of fat stranding.\n\nLYMPH NODES:  A suspicious ill-defined, nodal mass is identified adjacent to\nsmall bowel loops in the left abdomen (5:138, 8:___).  Multiple adjacent\nprominent mesenteric lymph nodes are present, with surrounding misty\nmesentery, which can reflect mesenteric panniculitis.\n\nRETROPERITONEUM: In the left para-aortic region, there is a suspicious,\nenlarged 6.6 cm conglomerate nodal mass (13:57, 5:127).\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nThe left hepatic artery arises from the left gastric artery.  The right\nhepatic artery, splenic artery, SMA, and bilateral renal arteries are patent.\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: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: Multilevel moderate degenerative changes of the lumbar\nspine are identified. No focal suspicious osteoblastic or osteolytic.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Asymmetric thickening and enhancement of the collapsed gallbladder wall,\nwhich extends superiorly into the hepatic parenchyma and corresponds with an\narea of enhancement on the outside hospital MRI, is concerning for malignancy.\n\n2.  Suspicious, ill-defined conglomerate nodal mass in the left para-aortic\nretroperitoneum, concerning for metastatic involvement. If clinically\nwarranted, this site would be amenable to CT guided biopsy.\n\n3. Similarly suspicious mesenter"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 appears to contain slightly\ndense material within the gallbladder lumen which could reflect sludge or\nstones.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 left kidney are too small to characterize\nby CT, but likely are cysts.  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. There is\ncircumferential wall thickening involving the ascending colon from the cecum\nto the hepatic flexure, as well as the descending colon extending from the\nsplenic flexure to the sigmoid colon and rectum, with adjacent pericolonic fat\nstranding, mild fascial thickening, mucosal hyperemia, and small amount of\nfluid, with inflammatory changes more pronounced in the right colon than on\nthe left.  Additionally, relatively ahaustral appearance of the sigmoid colon,\nwith increased fat surrounding the sigmoid colon may reflect the sequela of\nchronic inflammatory bowel disease.  No bowel obstruction or megacolon.  The\nappendix is normal.  There is trace fluid along the right pericolic gutter.\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 are numerous mesenteric lymph nodes in the right lower\nquadrant, which do not meet size criteria for pathologic enlargement, but\nlikely reactive.  There also multiple pelvic lymph nodes, measuring up to 9 mm\nto the left of the sigmoid colon, again 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.  A\ntransitional vertebra is noted in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute proctocolitis involving the majority of the colon and rectum with\nsparing of the transverse colon, with most pronounced inflammatory changes in\nthe ascending colon.  Findings are most likely due to active inflammatory\nbowel disease, namely Crohn's colitis, as the distribution of involvement\nwould be unusual for ulcerative colitis, with infectious colitis also a\npossibility.\n2. Ahaustral appearance of the sigmoid colon with fibrofatty proliferation\nsuggests changes from chronic inflammatory bowel disease.\n3. Possible gallbladder sludge or stones."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 in segments 8 and 6 are too small to\ncharacterize (02:12, 02:20).  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. Normal appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are large intramural masses arising from the\nanterior and posterior walls of the uterine fundus, most consistent with\nfibroids.  The larger fibroid in the anterior wall measures 7.4 x 7.6 x 6.1 cm\n(2:66, 602:41).  The smaller fibroid in posterior wall of the uterus measures\n5.3 x 6.1 x 4.3 cm (02:53).  The fibrods exert mass effect on the bladder.  In\naddition, there is a polypoid, enhancing focus in the fundal endometrium\nmeasuring approximately 2.3 x 1.0 cm (602:45).  A corpus luteum is present on\nthe 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: There is a small fat containing umbilical hernia.",
            "output": "1. Large intramural uterine fibroids, and a possible endometrial polyp versus\nsubmucosal fibroid.  These could be further investigated with a nonemergent,\noutpatient pelvic ultrasound.  Please note that the fibroids are causing mass\neffect and compressing the bladder.\n2. Otherwise, no acute intraabdominal process.\n\nRECOMMENDATION(S):  Nonemergent, outpatient 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: There is mild pancreatic duct dilation within the head, neck, and\nbody measuring 5 mm in diameter without obstructing mass or lesion evident. \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: 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is stool\nseen diffusely within the ascending and transverse colon.  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 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.  There\nare scattered calcifications within subcutaneous tissue which are nonspecific.",
            "output": "1. There is no suspicious mass or lesion to suggest lymphoma.\n2. There is dilation of the pancreatic duct without evidence of obstructing\nmass or lesion.  This is most likely related to age, but has developed since\n___ and should be clinically correlated with pancreatic enzymes and symptoms.\nIf enzymes are normal or there are symptoms referable to the pancreas, MRCP\nwould be recommended."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions have increased in size since 4\nmonths prior.  There is adjacent relaxation atelectasis.  There are numerous\npunctate calcified granulomas.  There is partially imaged ground-glass\nopacification in the left upper lobe (series 5, image 1).  A central venous\ncatheter tip is located in the upper right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: There is mild peribiliary edema.  No focal lesions.  Distal\nbranches of the right and left portal vein within segment IV in the\ninferomedial aspect of segment V are not clearly patent with adjacent\nheterogeneous hypoenhancement.  The proximal intrahepatic and extrahepatic\nportal veins are patent.  Superior mesenteric, splenic, and inferior\nmesenteric veins are patent.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is distended.  No\ngallbladder wall edema appreciable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 reflecting simple cysts.  There is no evidence of solid\nrenal lesions.   There is no perinephric abnormality.  There is no\nhydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is severe pancolonic\nmural edema, most prominent extending between the mid transverse colon and\nrectum with an imaging appearance somewhat classic for Clostridium difficile\ncolitis.\n\nPELVIS:  There is trace pelvic free fluid.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  No adnexal mass identified.\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 are chronic appearing rib fractures.  There are minimal\ndegenerative changes in the spine.\n\nSOFT TISSUES: There are extensive subcutaneous calcifications most notably in\nthe bilateral gluteal regions and proximal thighs.  There is severe soft\ntissue edema.",
            "output": "1. Severe pancolitis, morphology highly concerning for Clostridium difficile\ncolitis.\n2. Suspect distal intrahepatic portal venous branch thrombosis within segment\nIV and the inferomedial aspect of segment V.\n3. Severe anasarca including small volume ascites and small bilateral pleural\neffusions..\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:41 pm, approximately 15\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions have enlarged slightly when compared\nto the prior study and there is adjacent atelectasis similar to prior.  There\nare calcified granulomas in the lung bases.  The tip of the Port-A-Cath\nterminates 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 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 suspicious lesions.  Tiny peripheral calcification, similar\nto 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 suspicious\nrenal 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 is not well assessed\non this study but there is likely mural thickening affecting the descending\nand sigmoid colon.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is now\na moderate volume ascites in the abdomen and pelvis which is increased when\ncompared to the prior study.\n\nREPRODUCTIVE ORGANS: Hysterectomy 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. \nOld left rib fractures noted.  Thoracolumbar scoliosis noted.\n\nSOFT TISSUES: Unchanged extensive calcifications affecting the subcutaneous\nsoft tissues in the bilateral gluteal regions and proximal thighs.  Severe\nanasarca noted.",
            "output": "1. Increase in the volume of ascites in the abdomen and pelvis and the\nextensive anasarca.\n2. Suboptimal assessment of the large bowel but there appears to be ongoing\nmural thickening affecting the descending and sigmoid colon, which is\nconcerning for colitis.  No pneumatosis or extraluminal air.\n3. Slight increase in the 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\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.  No stones are seen in the kidneys or collecting\nsystem bilaterally on the non-contrast images.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. The appendix\nis visualized and is normal (04:50, 601b:23).\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 without\natherosclerotic calcifications. The main portal vein, splenic vein and SMV are\npatent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable with bilateral\nureteral jets seen. There is no evidence of pelvic or inguinal\nlymphadenopathy.  Trace free fluid in the pelvis is within the physiologic\nrange. Uterus is of normal size and enhancement.  The ovaries are normal\nbilaterally with a physiologic 1.7 cm left ovarian follicle.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Abdominal and pelvic wall is within normal limits.",
            "output": "Normal CT abdomen and CT pelvis. Specifically, normal appendix and normal CT\nappearance of the ovaries.  No stones in the kidneys or ureters bilaterally."
        },
        {
            "input": "LOWER 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 7\nmm ill-defined hypodensity in segment ___ (6:22) is unchanged.  No new focal\nlesions are identified.  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 remains enlarged measuring up to 15.6 cm AP, similar to\nprior.  However, it demonstrates normal attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Although only partially visualized, there is similar wall\nthickening and fat stranding surrounding the distal esophagus.  A right lower\nparaesophageal lymph node measures up to 6 mm in short axis, and is unchanged.\nThe stomach is unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  There is a large colonic stool\nburden.  Otherwise, 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: A prominent left external iliac node measures 8 mm in short axis\n(6:139).  While not pathologically enlarged by CT size criteria, this\npreviously measured 4 mm in ___.  Attention on follow-up is recommended.\nThere is no retroperitoneal or mesenteric lymphadenopathy.  There is no\ninguinal 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. \nRedemonstrated is a healing fracture in the posterolateral left tenth rib.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.",
            "output": "1. Partially visualized circumferential wall thickening in the distal\nesophagus appears similar to prior.  However, please refer to dedicated CT\nchest performed on same date for description of intrathoracic findings.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Stable splenomegaly"
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  An esophageal stent has been\nplaced and there is partially visualized circumferential wall thickening,\ngreater in the ___ o'clock position.  An adjacent paraesophageal lymph node\nmeasures 6 mm in short axis, similar to prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  An 8\nmm hypodense lesion in the right lobe (06:14) is unchanged across multiple\nprior exams.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is contracted but otherwise unremarkable.\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 remains enlarged measuring approximately 15 cm in AP\ndimension.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is a large amount of\nstool throughout the entirety of the colon, progressive since ___.  No evidence of pneumatosis or free air.  No colonic wall thickening.  1\nThe appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Chronic nondisplaced fracture of the lateral aspect of the left tenth\nrib which dates back to at least ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings in the abdomen or pelvis.\n2. Large amount of stool in the colon, progressive since CT from 12 days ago.\n3. Please see separate chest CT report from today for details regarding the\nintrathoracic findings.\n4. Persistent splenomegaly."
        },
        {
            "input": "Chest is reported separately.\n\nSubcentimeter hypodense focus at the junction of segments VII and VIII is\nunchanged, again measuring up to 7 mm in diameter, too small to characterize\nbut doubtful in significance.  There is no biliary dilatation.  The\ngallbladder is mostly empty.  The pancreas appears normal.  The spleen\nmeasures up to 15.4 cm in length.  It was even larger in ___, measuring up to\n17.5 cm in length at that time.  The adrenals appear normal.  No evidence for\nstones, solid masses, or hydro nephrosis involving either kidney.\n\nStomach is not particularly distended.  Small bowel appears normal.  The\nappendix is unremarkable.  Quantity of stool in some portions of the large\nbowel is mildly prominent.  There are a few scattered colonic diverticula.\n\nProstate is normal in size.  Seminal vesicles and bladder appear normal. \nMajor vascular structures appear widely patent.  There is no lymphadenopathy\nor free fluid.\n\nThere are no suspicious bone lesions.",
            "output": "Mild splenomegaly.  Otherwise unremarkable.\n\nThe chest is reported separately include presence of very large esophageal\nmass."
        },
        {
            "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nnonspecific 7 mm hypoattenuating lesion in the right hepatic lobe is likely\nbenign as it is unchanged since ___\n (series 5, image 9).  No other hepatic lesions identified.  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 is splenomegaly measuring 16.4 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 with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: A large circumferential mass in the distal thoracic\nesophagus is partially imaged, not appreciably changed since the most recent\nprior examination.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. 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 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: Since 2 weeks prior, there are numerous small, newly appreciated lytic\nosseous lesions, some of which clearly scallop the adjacent cortex.  The\nlargest lesion measures 8 mm in the left iliac wing series 5, image 9).\n\nSOFT TISSUES: There is a small, fat containing umbilical hernia.",
            "output": "1. There are numerous small, newly appreciated lytic osseous lesions\npredominantly located in the pelvic, but also located in the partially imaged\nspine.\n2. A large circumferential mass in the distal thoracic esophagus is partially\nimaged, not appreciably changed since the most recent prior examination.\n3. Splenomegaly measures 16.4 cm."
        },
        {
            "input": "LOWER CHEST: Please refer to same day chest CT report for supradiaphragmatic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable ill-defined hypodense nodule in segment ___ (5:91) measuring 7 mm. \nThere is no evidence of 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 unchanged increased size of nearly 15 cm with no\nfocal lesions 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The visualized lower esophagus appears to have improved\ncompared to prior abdominal CT from ___, chest CT from ___\nand PET-CT from ___, with less thickened walls and comparison to all\npriors, however is only partially visualized.  Please refer to same day chest\nCT report for more detailed findings.  The stomach is unremarkable.  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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Prominent mesenteric lymph node measuring 0.7 cm, not\npathologically enlarged however not clearly visualized in the prior\nexamination (5:119).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Healing linear fracture in the left tenth posterolateral rib.  No acute\nfractures.  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. Partially visualized thickening of the lower esophagus appears improved\ncompared to prior study.  Please refer to same day chest CT report for more\ndetailed description.\n2. No evidence of metastases 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.  A\n1.6 x 1.5 cm hypodensity within segment 4 day is consistent with a cyst.  An\nadditional 1.6 x 1.7 cm hypodensity in segment 5 is consistent with a cyst. \nAdditional subcentimeter hypodensities within the liver too small to fully\ncharacterize, may represent cysts or biliary hamartomas.  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 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.  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 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 mild ectasia of the infrarenal abdominal aorta.  Mild\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 evidence of metastatic disease within the abdomen or pelvis, although\nassessment is limited without intravenous contrast.  The patient reports nasal\ncongestion following intravenous contrast.  Consider premedication prior to\nintravenous contrast in the future.\n\n2. Multiple hepatic cysts.\n3. Mild ectasia of the infrarenal abdominal aorta.\n4. Please see separate chest CT report for details of intra 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 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 appear subtly heterogeneous bilaterally.  This includes\nan ill-defined hypodensity in the anterior upper pole of the right kidney,\nmeasuring 1.8 x 1.9 cm.  Correlate with urinalysis for possible\npyelonephritis.  No frank hydronephrosis is seen bilaterally.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No bowel obstruction is seen. \nThere is fatty infiltration of the submucosa of the right colon, which can be\nseen in the setting of chronic inflammation.  The appendix is normal in\ncaliber.\n\nPELVIS: The urinary bladder is relatively collapsed, but grossly unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is suggestion of a small uterine fibroid, measuring\napproximately 2 x 1.2 cm in the posterior fundal myometrium.\n\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": "Heterogeneous appearance to the bilateral kidneys, including an ill-defined\n1.8 x 1.9 cm hypodensity in the upper pole of the right kidney.  Correlate\nwith urinalysis for concern for pyelonephritis.\n\nFollow-up renal ultrasound.\n\nRECOMMENDATION(S):  Correlate with urinalysis for concern for pyelonephritis.\n\nFollow-up renal ultrasound.\n\nNOTIFICATION:  Updated findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:55 pm, 6 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 no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Post-surgical changes are appreciated compatible with\npatient's known history of total abdominal hysterectomy.  Also evidence of\npartially visualized penile reconstruction.\n\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 or diverticulitis.  Post-surgical changes\ncompatible with patient's known history of total abdominal hysterectomy are\nnoted, otherwise unremarkable CT abdomen/pelvis."
        },
        {
            "input": "Lungs: Unchanged lung bases since ___, with redemonstration of\nnonspecific 2 mm nodules in the right lower lobe, series 2, image 5 and\nperifissural, image 1.\n\nLiver: The liver is homogeneous with a smooth contour. There is an enhancing\nlesion in segment 7 of the liver, progressively filling in with contrast, most\nlikely representing a hemangioma. No suspicious liver lesion identified.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nis collapsed.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: There are sequela of prior right nephrectomy. No focal mass is seen\nwithin the surgical scar. No hydronephrosis.\n\nPelvis:\n\nAt least 5 stones are seen within the urinary bladder measuring up to 1.0 cm.\n\nThe distal ureters are unremarkable. There is no free fluid in the pelvis.\n\nThe prostate measures 4.1 cm x 5.4 cm and is mildly enlarged.\n\nGastrointestinal: Small hiatal hernia. Previous partial colonic resection. No\nevidence of bowel dilatation or obstruction.\n\nVascular: Mild to moderate atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: No suspicious bone lesion. Stable bone island in the\nleft aspect of the sacrum. Small bilateral fat containing inguinal hernias.\nRedemonstration of the umbilical hernia containing small bowel, with no\ncomplications. There is scarring in the anterior abdominal wall on the right,\nsecondary to previous repair of a right lower spigelian hernia. The\npostoperative changes have resolved compared to previously.",
            "output": "1. No evidence of focal recurrence or metastasis within the abdomen or pelvis.\n\n2. Stable tiny pulmonary nodules in the right lung base since ___.\n\n3. Interval resolution of the postoperative changes in the right anterior\nabdominal wall post spigelian hernia repair.\n\n4. At least 5 stones are seen within the urinary bladder measuring up to 1.0\ncm."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is an enhancing lesion at the dome of the liver in\nsegment 7 measuring 1.4 x 2.6 cm.  Lesion progressively enhances on delayed\nimaging, suggestive of a hemangioma.  The liver demonstrates homogenous\nattenuation throughout.  There is no evidence of focal lesions.\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: Patient is status post right lower pole renal partial nephrectomy,\nwith associated postsurgical changes.\nThe right renal pelvis is progressively increased in size from ___, now measuring 2.5 x 1.7 cm, previously 1.4 x 1.4 cm likely due to prior\nstone passage.  There is no evidence of stones. There is no wall thickening. \nLeft kidney appears within normal limits.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There are\npostsurgical changes from colonic resection.\n\nPELVIS: There are bilateral fat containing inguinal hernias.  The urinary\nbladder and distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged, measuring 5.4 cm in diameter. \nThe visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are multiple enlarged portocaval nodes measuring up to 1.4\ncm in diameter (series 4, image 53) and to 1.0 cm in diameter (series 4, image\n63).  These lymph nodes have increased in size since ___.  There\nis a 1.2 cm density in the pelvis which is stable dating back to ___\nand likely related to scarring. 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. No evidence for tumor recurrence\n2. New mild lymph adenopathy in the porta hepatis can be seen in the setting\nof hepatitis, The location is unusual for metastatic disease.\n3. Enhancing lesion within the liver is consistent with a hemangioma on prior\nMRI."
        },
        {
            "input": "The patient has had prior cholecystectomy. 8 mm enhancing lesion is\ndemonstrated in segment 5 of the liver (series 5, image 20). No additional\nhepatic lesion is demonstrated. The portal vein is patent. No intra or\nextrahepatic biliary dilatation is present.\n\nThe spleen is normal size. There is no pancreatic mass or ductal dilatation.\nThe adrenal glands are unremarkable.  There is cortical scarring involving the\nupper pole of the right kidney.\n\nThe patient has had previous hysterectomy.  There is no free fluid in the\npelvis.\n\nNo small or large bowel dilatation is present. There is no abdominal or pelvic\nlymphadenopathy.  The appendix is unremarkable.  Normal appearance of the\nbladder.\n\nThere is posterior fusion of L5 and S1, with 8 mm anterolisthesis of L5 on S1.\nNo osseous lesion is demonstrated.  The lung bases are clear.",
            "output": "1. Cause for the patient's pelvic pain not identified.\n2. 8 mm enhancing lesion in segment 5 of the liver, not well characterized on\nthis single phase exam but most in keeping with hemangioma or FNH."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases are clear.  No pleural effusion.\nThe visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\nThe liver is homogeneously hypodense consistent with hepatosteatosis. No focal\nlesion identified.No intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal without calcified gallstones. The portal vein, SMV, and\nsplenic vein are patent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. Subtle fat stranding\naround the gastroduodenal junction and duodenal bulb with mild mucosal hyper\nenhancement is noted. (2: 21). No intramural abscess.  Possible 0.4 cm ulcer\nalong the medial portion of the duodenum best seen on coronal images\n(601b:39). No extraluminal air. A 1.7 x 2.2 cm (2: 29) enhancing soft tissue\nlesion along the second portion of the duodenum is similar in appearance to\nprevious examination and consistent with normal pancreatic tissue. The stomach\nis otherwise grossly unremarkable in appearance. The small bowel is normal in\ncaliber without wall thickening. The large bowel is normal in caliber without\nwall thickening, fat stranding, or focal mass lesion. The appendix is normal\nwithout evidence of acute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  The iliac arteries are normal in\ncourse and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. The prostate and seminal vesicles are within normal limits.\n\nOSSEOUS STRUCTURES:  Sacralization of L5 is noted. Stable grade 1\nanterolisthesis of L5 on S1 with bilateral spondylolysis at L5. No focal lytic\nor sclerotic lesion concerning for malignancy.Mild anterior wedging of\nvertebral at the lumbosacral junction is likely developmental.",
            "output": "1.  Subtle fat stranding around gastroduodenal junction and duodenal bulb with\nmild mucosal hyperenhancement and apparent mural edema is consistent with mild\ngastritis/duodenitis. No extraluminal air.  Possible 0.4 cm ulcer along medial\nportion of the duodenum.  Recommend dedicated upper endoscopy for further\nevaluation.\n2.  Hepatosteatosis.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 9:48 AM."
        },
        {
            "input": "LOWER CHEST: Moderate right-sided nonhemorrhagic pleural effusion is unchanged\ncompared to CT abdomen and pelvis from ___.  There is associated\ncompressive atelectasis of the right lower lobe.  There is dependent\natelectasis in the left lower lobe.  Atherosclerotic calcification of the left\nanterior descending coronary artery is severe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in morphology.  There is a small,\nill-defined area of hypoattenuation in the posterior aspect of segment III\n(02:31), decreased in size compared to prior CT from ___,\nnonspecific in etiology.  There is no biliary ductal dilatation.  The patient\nis status post hepaticojejunostomy.  The gallbladder is surgically absent.\n\n\nPANCREAS: Postsurgical changes from ___ procedure noted.  There is a small\namount of fluid with punctate locules of gas just posterior to the\npancreaticojejunostomy, which mildly attenuates the portal-splenic confluence,\nsimilar prior (02:38).  Remnant pancreas is unremarkable without main ductal\ndilatation or focal lesion.  Fiducial markers are noted adjacent to the\npancreatic neck and downstream body.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in contour.  There is thickening\nof the left adrenal gland, unchanged from prior.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is there is a 1.2 cm simple cyst in the interpolar region of the right\nkidney (2:53).  There is no hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes from Whipple procedure noted.  Mild\nwall thickening of the gastric antrum is similar to prior, likely reactive. \nOral contrast progresses through the gastrojejunostomy, to the mid small\nbowel.  There is no extraluminal oral contrast indicate leak.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThe colon and rectum are within normal limits.\n\nThere is a small amount of perihepatic and right lower quadrant non-organized\nascites, decreased from prior.\n\nPELVIS: There is near complete resolution of the fluid collections in the\nanterior and deep pelvis, status post drainage with two pigtail catheters. \nThere is a trace residual fluid collection the right pelvis measuring 3.7 x\n1.3 cm (2:80).  The pre-existing left paramidline anterior approach pigtail\ncatheter terminates in the anterior pelvis, and the intervally placed right\nanterolateral approach pigtail catheter terminates more inferiorly in the\nright pelvis.\n\nAir in the anti-dependent bladder is likely due to recent Foley catheter.\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.  An IVC filter is in situ, with tip chest below the level of the\nrenal veins.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild multilevel endplate degenerative changes with Schmorl's nodes\nof the visualized lower thoracic and lumbar spine.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia.",
            "output": "1. Near complete resolution of the fluid collections in the anterior and deep\npelvis, status post drainage with two pigtail catheters.  Trace residual fluid\ncollection the right pelvis measuring 3.7 x 1.3 cm.\n2. Small amount of perihepatic and right lower quadrant non-organized ascites,\ndecreased from prior.\n3. Small ill-defined area of hypoattenuation in segment III of the liver has\ndecreased in size compared to the prior CT from ___, nonspecific in\netiology.\n4. Postsurgical changes from Whipple procedure.  Small amount of fluid with\npunctate locules of gas just posterior to the pancreaticojejunostomy, which\nmildly attenuates the portal-splenic confluence, similar to prior."
        },
        {
            "input": "LOWER CHEST: There is interval resolution of the right pleural effusion. \nThere is mild right basilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post hepaticojejunostomy with expected\npostsurgical anatomy.  The liver demonstrates homogenous attenuation\nthroughout.  There is no evidence of focal lesions.  The previously seen\nhypoattenuating lesion in segment 3 is not visualized on this study.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure with expected\npostsurgical anatomy.  There is soft tissue density and stranding with\ninterval resolution of the fluid collection posterior to the\npancreaticojejunostomy, compatible with postsurgical changes (05:26).  The\nremaining pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.  Fiducial markers are again noted in the pancreatic neck.\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\nunchanged thickening of the left adrenal gland.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.1 cm right midpole cyst, unchanged from prior study (05:42). \nThere is no evidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post gastrojejunostomy with expected postsurgical\nanatomy.  No extraluminal contrast to suggest leak.  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: There is interval resolution of the small right pelvic fluid\ncollection.  There is interval removal of the left paramidline anterior\npigtail catheter.  The right paramidline anterior pigtail catheter is in\nstable position.  The urinary bladder and distal ureters are unremarkable. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged and unchanged\n\nLYMPH NODES: There is no 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 infrarenal IVC filter is in stable position.\n\nBONES: Mild multi level degenerative changes with Schmorl's nodes are again\ndemonstrated in the thoracolumbar spine.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of soft tissue nodules along the right\nanterior abdominal wall measuring up to 2.2 x 1.0 cm (05:50, 05:36, 05:48),\nmildly decreased from prior study and likely reflecting inflammatory changes.",
            "output": "1. Interval resolution of the right pelvis fluid collection with right pigtail\ndrainage catheter remaining in place.\n2. Soft tissue nodularity along the right anterior abdominal wall, mildly\ndecreased from prior study and compatible with inflammatory changes.\n3. Soft tissue density and stranding posterior to the pancreaticojejunostomy\nwith interval resolution of the previously seen fluid collection, compatible\nwith postsurgical changes."
        },
        {
            "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. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: Patient is known for biopsy-proven pancreatic neuroendocrine tumor\nand a metastatic lymph node.  There is a 2.1 x 2.4 cm mass (series 2, image\n54) arising from the head of the pancreas which is isodense with the pancreas,\nat the level of which the main pancreatic duct is abruptly terminating,\nalthough not dilated.  On the left lateral margin of this lesion, there is a\n2.8 x 2.7 cm nodule (series 2, image 52) abutting the posterior aspect of the\npancreas that could represent the lymph node that was biopsied.  On the\nposterior margin of this nodule there is a an 8 mm lymph node that remains\nstable when compared with previous (series 2, image 50).  The celiac artery,\nthe splenic artery, hepatic artery, and the SMA are not surrounded by this\nlesion.  These 2 nodules are narrowing the confluence of the SMV and portal\nvein, of note the splenic vein is seen coursing inferiorly to the posterior\npancreatic mass.   The assessment of the venous structure is limited by the\nfact that we only have an angiographic study.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable.  Left adrenal gland\ncontains a 5 mm hypodense nodule, nonspecific as well as hyperplasia.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis.  Bilateral cysts, largest on\nthe right measuring 21 mm.  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.  2.2 cm diverticulum to the second portion of the\nduodenum.  Colonic diverticulosis. There is no evidence of mesenteric\nlymphadenopathy.\n\nLYMPH NODES AND RETROPERITONEUM: Minimal enlargement of a gastrohepatic lymph\nnode (series 2, image 21) measuring 8 mm (6 mm previously).  A retrocrural\nlymph node is better seen today (series 2, image 27) measuring 15 x 5.5 mm\ncompared with 13 x 5 mm previously.  2 adjoining newly developed 19 mm soft\ntissue lesions anteriorly at the upper pole the right kidney, (series 2, image\n55) could be suspicious for metastatic deposit, although post biopsy changes\nsuch as hematomas can also be of concern.  Stable 8 mm lymph node behind the\nmass arising from the body of the pancreas.\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. Biopsy-proven pancreatic neuroendocrine tumor with metastatic lymph node. \nThese lesions are creating a narrowing of the confluence of the SMV and portal\nvein.\n2. Newly developed bilobed lesion anteriorly to the upper pole of the right\nkidney which could be suspicious for lymph nodes/implants, to be reassessed\nwith MRI.\n3. Small gastrohepatic lymph node minimally enlarged when compared with\nprevious.\n4. Left adrenal nodule, could be reassessed by MRI.\n\nRECOMMENDATION(S):  MRI Abdomen\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:00 pm into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "Patchy airspace consolidation within the right lung lower lobe is concerning\nfor pneumonia versus aspiration.  The left lung base is clear. The heart is\nenlarged in size and there is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the unenhanced appearance of the liver, gallbladder,\npancreas, spleen, and bilateral adrenal glands are unremarkable.\n\nAgain noted, are atrophic kidneys with multiple exophytic low density lesions,\nincompletely characterized on this noncontrast study. No renal stones are\nidentified.\n\nThe stomach, small bowel, and large bowel are unremarkable in appearance\nwithout dilation or wall thickening. The appendix is not visualized. There is\nmild fecal loading of the colon.\n\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nThere is no free abdominal fluid or pneumoperitoneum. The aorta and its major\nbranches contain calcifications. There is no abdominal aortic aneurysm.\n\nPELVIS:\n\nA Foley catheter is seen within the bladder. Air within the bladder is likely\nfrom catheterization. Again noted, are prominent bilateral inguinal lymph\nnodes as well as scattered enlarged pelvic sidewall lymph nodes, which\ndemonstrate normal morphology. The largest node measures approximately 4.6 x\n3.0 cm in the right inguinal region (2:96) and is essentially unchanged from\n___. Left inguinal lymph nodes, while still enlarged have decreased in size\nfrom ___ with the largest measuring 2.3 cm, previously 2.9 cm (2:97). No free\npelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Severe multilevel multifactorial degenerative changes are\nnoted in the lumbar and thoracic spine as is dextroscoliosis, overall\nunchanged from ___. Grade 1 anterolisthesis of L5-S1 is with stable. No focal\nlytic or sclerotic lesion concerning for malignancy.\n\nSOFT TISSUES: There is symmetric thickening within the groin. There is no free\nair in this region to suggest Fournier gangrene.",
            "output": "1. Symmetric skin thickening in the groin. No evidence of subcutaneous gas to\nsuggest Fournier's gangrene.\n2. Right lower lobe consolidation concerning for pneumonia.\n3. No acute intra-abdominal abnormality. No evidence of bowel obstruction.\n4. Prominent lymph nodes in the pelvis and inguinal region likely reactive,\nsimilar to prior exam.\n5. Stable severe degenerative disease of the lumbar spine."
        },
        {
            "input": "Lower Chest: Mild ground-glass opacities in the right middle lobe are stable\nsince CT chest from yesterday.  .  No lung consolidation.  No effusion. \nCentral line tip at the cavoatrial junction.\n\nAbdomen and Pelvis:\n\nHepatobiliary: No hepatic abnormality.  No pericholecystic fluid.\n\nSpleen: Normal\n\nAdrenals: Normal\n\nKidneys, Bladder, Ureters: Normal kidneys.  No hydronephrosis.  No stones\nnormal bladder.  Pelvic phleboliths.\n\nPancreas: Normal, no inflammatory changes\n\nGastrointestinal: Normal stomach, small, large bowel.  No diverticulitis.  No\nevidence of colitis on noncontrast exam.  No evidence of appendicitis.\n\nLymph Nodes: No adenopathy.\n\nPelvis: No fluid in the pelvis.\n\nReproductive Organs: No abnormality\n\nVascular: No abnormalities\n\nSoft Tissues: 1.7 cm round cystic structure in the upper gluteal cleft has\nmildly decreased compared with 2.2 cm on prior, surrounding inflammatory\nchange has improved.  2 air bubbles medial buttock, likely injection site,\nclinically correlate.\n\nBones: Degenerative changes spine, sacroiliac joints, hips",
            "output": "Improved upper gluteal cleft abscess, improved surrounding inflammatory\nchanges"
        },
        {
            "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 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 appendix is\nnormal.  There is moderate fecal loading of the right colon.  Of note, the\ncecum is located just deep to the umbilicus.  Distal colon is unremarkable.\n\nPELVIS: Tiny focus of air is noted within the bladder which is otherwise\nunremarkable.  There is no 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Abdominal and pelvic walls are within normal limits.  A left\nflank fat containing hernia is noted.",
            "output": "1. Normal appendix.\n2. Moderate fecal loading of the right ___ contribute to symptoms of\ndiscomfort.\n3. Fat containing left flank hernia."
        },
        {
            "input": "LOWER CHEST: Again seen are mild thickening of the middle lobe bronchi.  No\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: In the interim, a common bile ducts metallic stent was placed\nin the left biliary duct.  Left pneumobilia is seen.  Persistent of right\nintrahepatic biliary ductal dilatation.  As previously described, the\ngallbladder is still distended with a mass near its body invading the right\nliver lobe with no significant change since the prior exam.  The hepatic veins\nand portal veins are patent.  No new hepatic lesion suspicious for an abscess.\n\nPANCREAS: Interval mild increase in the diameter of the main pancreatic ducts\nreaching up to 6.5 mm with peripancreatic stranding. No drainable 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: Bilateral renal cysts with the dominant 1 measuring 2 cm in the\ninferior pole of the right kidney is again seen.  18 mm cyst at the upper pole\nof the left kidney.  Other subcentimeter hypodensities are too small to\ncharacterize.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The colon\ncontains steatorrhea.\nWe again see the 3 peritoneal implants in the right hemi-abdomen unchanged in\nsize measuring up to 3 cm.\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": "-Known gallbladder carcinoma invading the liver with abdominal tumor deposit.\n-Status post metallic stent in the CBD with persistent right biliary ductal\ndilatation.  No hepatic abscess.\n-New mild pancreatic ductal dilatation with the peripancreatic stranding\nconsistent with acute pancreatitis.\n\nRECOMMENDATION(S):  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:57 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  The celiac, SMA and\nbilateral renal arteries are widely patent.  There is a 1 cm right renal\nartery aneurysm (601:61) is unchanged.  Incidental note is made of an\naccessory left renal artery.  There is at least moderate narrowing of the\norigin of the ___, however, this remains patent.\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. \nSince ___, there has been significant interval increase in size and\nnumber of multiple hypodensities scattered throughout the liver, consistent\nwith metastatic disease.  The largest conglomerate adjacent to the gallbladder\nfundus measures 8.6 x 5.0 cm, previously 4.0 x 4.7 cm (03:50).  There are new\nlesions throughout the liver as well.  A common bile duct stent is in similar\nposition.  There is a moderate amount of debris within the stent, however,\nthis remains patent.  There is persistent mild intrahepatic biliary ductal\ndilatation, unchanged, as well as a small amount of expected pneumobilia in\nthe left hepatic lobe.  Re-demonstrated is an invasive mass arising off the\ngallbladder fundus.  The gallbladder remains significantly distended, similar\nto prior.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There has been\nslight interval decrease in dilatation of the main pancreatic duct, currently\nmeasuring up to 4 mm, previously 6.5 mm.  There is no significant\nperipancreatic stranding.  Slight atrophy of the pancreas noted in the\ninterim.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 are multiple bilateral renal hypodensities measuring up to 2.0\ncm in the right midpole and 1.7 cm in the left upper pole, which likely\nrepresent simple cysts.  Additional subcentimeter bilateral hypodensities are\ntoo small to characterize.  There is a punctate hyperdensity in the right\ninterpolar kidney which likely represents a small nonobstructing renal\ncalculus.  There is no hydronephrosis.  There are no urothelial lesions in the\nkidneys or ureters. 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. There\nhas been significant interval increase in size and number of multiple\nperitoneal implants.  For example, 2 lesions measuring 1.6 x 1.3 cm and 0.7 cm\nin the right mid abdomen are new (3:109).  A peritoneal implant in the lateral\nright hemiabdomen currently measures 4.5 x 2.3 cm, previously 2.9 x 1.7 cm. \nThe largest peritoneal implant measures 7.6 x 3.9 cm, previously 2.9 x 2.4 cm\njust inferior to the gallbladder fossa (3:81).  No drainable intra-abdominal\nfluid collection is identified.\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: Fiducial markers are again seen in the prostate gland.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are mild.\n\nSOFT TISSUES: Small bilateral fat containing inguinal hernias are noted.",
            "output": "1. No evidence of bowel ischemia, bowel obstruction or pneumoperitoneum.  No\ndrainable intra-abdominal fluid collections.\n2. Significant interval increase in metastatic disease burden throughout the\nabdomen and pelvis.  For example, there has been significant interval increase\nin size and number of multiple hepatic metastases.  Additionally, there is\nbeen significant interval increase in size and number of multiple peritoneal\nimplants.  The largest measures up to 7.6 cm, previously 2.9 cm inferior to\nthe gallbladder fossa."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation.  There is very mild dilation of the common bile duct,\nup to 7 mm, which is nonspecific in the setting of the cholecystectomy (5:22).\nThe portal vein is patent.The gallbladder surgically absent with clips in the\ngallbladder fossa. Two dropped clips are seen in the right abdomen (7:31,32).\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is a 4 mm hypodensity in the upper pole of the left kidney,\ntoo small to characterize on the current exam, but likely a cyst. There is no\nhydronephrosis.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction.A normal, nondistended appendix is\nvisualized.There is no intra-abdominal free air or fluid.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith minimal atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.An enhancing focus in the retroverted\nuterus is likely a fibroid (5:66).\n\nBONES: No focal lesion suspicious for malignancy.",
            "output": "1. Nonacute CT of the abdomen and pelvis, without a correlate for the\npatient's abdominal pain.\n\n2. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Minimal bibasilar dependent atelectasis.  No pleural effusions. \nHeart is top-normal in size, without a pericardial effusion.  Note is made of\naortic valvular and mitral annular 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.  There is cholelithiasis, without abnormal\nluminal distention or pericholecystic 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 focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:  Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  Patient is status post\npartial colectomy.  Moderate fecal loading throughout the colon. Remaining\ncolon and rectum are otherwise unremarkable.  Normal appendix.  No ascites. \nNo pneumoperitoneum.\n\nPELVIS: The urinary bladder is moderately distended, without evidence of wall\nthickening.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized.  No adnexal masses are\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.  Incidental note is made of a retro-aortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nCompression fractures at T11 and T12 are not significantly changed compared to\n___.\n\nSOFT TISSUES: There is a small fat containing ventral left mid abdominal wall\nhernia (02:39), new from the prior CT in ___.",
            "output": "1. No acute intra-abdominal process.  Specifically, no bowel obstruction.\n2. Cholelithiasis.\n3. Small fat containing ventral hernia, new from ___.\n4. Aortic valvular calcifications.\n\nNOTIFICATION:   The findings were discussed with ___ (medical\nstudent caring for the patient) by ___, M.D. on the telephone on\n___ at 10:53 ___, 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: There is an ill-defined area of enhancement adjacent to the\ngallbladder without mass effect, most compatible with transient hepatic\nattenuation difference (series 2, image 24).  Otherwise, the liver\ndemonstrates homogenous attenuation throughout.  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: There is a soft tissue density ___: 47) lesion within the pancreatic\nbody, measuring 9 mm in the greatest dimension (series 2, image 26).  This is\nmost compatible with an intraductal papillary mucosal neoplasm (IPMN). \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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 grossly 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. The celiac origin appears to\ncome off the SMA.  Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic degenerative changes to the lumbar spine, most prominent at the L4\nlevel.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Diverticulosis without evidence of diverticulitis.\n2. 9 mm soft tissue density within the pancreatic body, most compatible with\nIPMN.\n\nRECOMMENDATION(S):  Further evaluation of suspected IPMN with 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 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. \n2 circumscribed hypodensities in the right kidney measure up to 3 cm in the\nupper pole correspond to simple cyst.  There is no evidence of focal\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. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  The right uterus is slightly\nlarger than the left with minimal urothelial enhancement, which could be\nreactive.  Left ureter is normal.\n\nREPRODUCTIVE ORGANS: Bulky and globally hypodense uterus containing an IUD. \nThe IUD placement cannot be confirmed on CT.  No gas seen within the\nendometrium.  Tubular fluid filled heterogeneous structure in the right adnexa\nwith hyperenhancing walls.  The right ovary is not seen.  There is mild fat\nstranding and small amount of free fluid in the pelvis with enhancement of the\nposterior aspect of the pelvic wall (2:66).\n\nLYMPH NODES: No abdominal or pelvic lymphadenopathy there is no pelvic or\ninguinal 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. Complex tubular fluid-filled structure in the right adnexa with\nhyperenhancing walls and surrounding inflammatory changes in the pelvis\nincluding small amount of fluid within area of wall enhancement in the\nposterior pelvic wall is concerning for salpingitis/pyosalpinx.  Enhancement\nin the posterior wall of the pelvis could represent early peritonitis or\nphlegmonous changes.  No drainable fluid collections.\n2. Boggy and hypodense uterus without visible endometrial lining and with an\nIUD in place.  This is of unclear significance.  No uterine gas seen.  Edema\nor involvement of the uterus from pyosalpinx cannot be excluded.  Correlate\nwith history of discharge.\n3. Unable to determine if IUD is within the endometrium on this study, however\nit is relatively centrally located.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:23 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are clear aside from mild bibasal\natelectasis.  The left ventricle is dilated.  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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are right renal cysts as seen on prior ultrasound ___, with\ncomplex features better seen by ultrasound.  These can be followed up as\nrecommended in the ultrasound report.  The larger cyst at the right upper pole\nmeasures 3.4 cm, similar to the prior ultrasound.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is some\ntethering of the sigmoid colon and appendix with mild inflammatory changes in\nthe right lower quadrant/pelvis, likely secondary to the right adnexal\ninflammatory process.\n\nPELVIS AND REPRODUCTIVE ORGANS:\n\nThe uterus is again diffusely bulky and heterogeneous, which may be related to\ninflammation.  IUD has been removed.  There is again a tubular fluid-filled\nstructure with mural enhancement in the right adnexal region along with\nill-definition of the right ovary, which could reflect ___. \nOverall this appears decreased slightly in size and measures approximately 8.6\nx 2.7 cm (4:67), previously 9.2 x 3.2 cm.  There is multiloculated fluid in\nthe posterior cul-de-sac with progressive rim enhancement.  The largest\nindividual pocket on the right measures 4.5 x 3.1 cm (4:70), previously 3.8 x\n2.9 cm.  The largest pocket on the left measures 3.2 x 2.3 cm (4:72),\npreviously 2.8 x 1.4 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing periumbilical hernia.",
            "output": "1. Progressive organization and minimal size increase of pelvic fluid\ncollections.  The larger collection measuring 4.5 x 3.1 cm would be amenable\npercutaneous drainage if indicated.\n2. Slight improvement of right adnexal inflammatory changes.\n\nNOTIFICATION:  The findings were discussed with the on-call OB/GYN resident by\n___, M.D. on the telephone on ___ at 7:03 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lungs: The visualized lung bases are within normal limits, except for\nsubsegmental atelectasis.\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 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: Stable known complex cyst in the upper pole of the right kidney\nmeasuring 3.3 cm, for which a 6 months to ___ year follow-up was recommended on\nthe renal ultrasound from ___.\n\nAnother hypodensity is seen in the midpole of the right kidney, consistent\nwith cortical cyst seen on the previous ultrasound.\n\nThere is no hydronephrosis.\n\nPelvis: The urinary bladder is unremarkable. The distal ureters are\nunremarkable. There is no free fluid in the pelvis.\n\nInterval insertion of a drainage catheter in the cul-de-sac fluid collection,\nin correct position. The residual fluid component measures 2.3 cm x 1.4 cm,\npreviously 4.5 cm x 3.1 cm, and has also significantly improved.\n\nThere is redemonstration of the previously described tubular structure with\nmural enhancement in the right adnexal region. This measures 5.3 cm x 1.6 cm,\npreviously 8.6 cm x 2.7 cm, and has significantly improved.  Surrounding\ninflammatory changes have significantly improved as well.\n\nUnchanged bulkiness of the uterus. The intrauterine device has been removed.\n\nGastrointestinal: The bowel is within normal limits. There is no evidence of\nbowel 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. Moderate\ndegenerative disc disease at L5-S1.",
            "output": "1. Interval insertion of a drainage catheter in the rectouterine fluid\ncollection, with a residual fluid component measuring 2.3 cm x 1.4 cm,\npreviously 4.5 cm x 3.1 cm.\n\n2. Interval improved appearance of the right fallopian tube, measuring 5.3 cm\nx 1.6 cm, previously 8.6 cm x 2.7 cm.\n\n3. Stable known complex cyst in the upper pole of the right kidney measuring\n3.3 cm, for which a 6 months to ___ year follow-up was recommended on the renal\nultrasound from ___.\n\nNOTIFICATION:  The findings were discussed with ___, nurse by ___\n___, M.D. on the telephone on ___ at 9:21 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. \nThere is no suspicious focal lesion.  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 several regions of focal cortical thinning, likely representing\nscarring from prior insult.  Redemonstration of several rounded hypodense\nstructures within the bilateral kidneys, likely representing renal cysts, with\nthe largest measuring up to 3.3 cm in the upper pole the right kidney.  There\nis no evidence of solid renal lesions.   There is no perinephric abnormality. \nThere is no hydronephrosis or hydroureter.  The urinary bladder is\nunremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is continuous\ncircumferential wall thickening of the distal sigmoid colon and rectum with\nadjacent fat stranding, consistent with proctocolitis.  The distal transverse\nand descending colon is also thick walled with subtle surrounding fat\nstranding, which may represent additional regions of colitis.  The appendix is\nnormal and retrocecal in position.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality is seen.\n\nLYMPH NODES: There are several prominent, but not pathologically enlarged\nlymph nodes within the mesocolon, likely reactive.  There is no\nretroperitoneal or mesenteric lymphadenopathy.   There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Continuous circumferential wall thickening of the distal sigmoid colon and\nrectum with adjacent fat stranding, consistent with proctocolitis, which may\nbe secondary to an inflammatory or infectious etiology.\n2. The distal transverse and descending colon is also thick walled with\nsurrounding fat stranding, concerning for additional segments of colitis.\n3. Fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrates mild dependent bibasilar\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 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 right extrarenal pelvis is demonstrated and unchanged from prior.  There is\nmild left ureteral and pelvic fullness without hydroureter or urolithiasis. \nThere is no evidence of hydronephrosis bilaterally.  There is no perinephric\nabnormality.\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 prostate is minimally enlarged and 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.  Extensive atherosclerotic\ndisease is noted.  A vascular stent is demonstrated in the left common iliac\nartery.\n\nBONES: Extensive degenerative changes are visualized throughout the imaged\nportion of the thoracolumbar spine in addition to post laminectomy changes of\nL4 and L5.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Wires are demonstrated in the soft tissues overlying the sacrum.\nThe abdominal and pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal or pelvic abnormality identified to correlate with\npatient's symptoms.  Specifically, no findings of a left inguinal hernia."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis, otherwise visualized lung\nfields are within normal limits.  There is moderate calcified atherosclerosis\ninvolving the coronary arteries, most pronounced at the right coronary artery.\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 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.  There are\nmultiple foci of calcifications throughout the spleen which may represent\nsequela of prior granulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: A simple cyst is seen in the inferior pole of the right kidney. \nThere is no evidence of solid 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 extensive diverticulosis without evidence of wall thickening or 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 is enlarged.  The seminal vesicles 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.  Extensive atherosclerotic\ndisease is noted.  There is moderate narrowing of the proximal celiac axis,\n(series 602, image 45) by calcified atherosclerosis.  Mild narrowing of the\nsuperior mesenteric artery is demonstrated due to calcified atherosclerosis,\n(series 2, image 28).  There is fusiform aneurysmal dilation of the left\ninternal iliac artery measuring up to 20 mm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate multilevel degenerative changes of the thoracic and lumbar spine. \nMild retrolisthesis of L2 on L3 is likely disc degenerative.  The patient is\nstatus post median sternotomy with the visualized lower sternal wires intact.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute abdominopelvic pathology.\n2. Extensive colonic diverticulosis without evidence of diverticulitis.\n3. Calcified atherosclerosis results in moderate narrowing of the proximal\nceliac artery and mild narrowing of the proximal superior mesenteric artery.\n4. Fusiform aneurysmal dilation of the left internal iliac artery, measuring\nup to 20 mm."
        },
        {
            "input": "PELVIS:  Oral contrast fills visualized portions of the small and large bowel,\nwhich are normal in caliber without evidence of obstruction.  The urinary\nbladder and distal ureters are unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis. Visualized\niliac vessels are unremarkable.  There is no calcium burden in the abdominal\naorta and great abdominal arteries.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:  The presacral area is clear, without evidence of\ndrainable fluid collection or fat stranding.  There is no evidence of\nworrisome osseous lesions. Abdominal and pelvic wall is within normal limits.",
            "output": "The soft tissues in the presacral area and adjacent to the coccyx are\nunremarkable, without drainable fluid collection, fat stranding, or evidence\nof abscess.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 11:00 on ___, 5 min 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. \nSubtle ill-defined hypodensity along the falciform ligament, likely focal\nfatty sparing.  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 (02:55).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: IUD, partially embedded in the right knee a medium,\nslightly more pronounced than on the CT from ___.  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.  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. IUD partially embedded within the right uterine myometrium, slightly more\npronounced than on the exam 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.  The\nhepatic parenchyma hypoattenuating relative to the spleen, suggestive of\nhepatic steatosis, but not optimally evaluated on a contrast enhanced study. \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 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. The colon and\nrectum are within normal limits. The appendix is not definitely visualized,\nhowever 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: There has been interval removal of the previously seen\nIUD.  The uterus and bilateral adnexae are grossly 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 seen.  The celiac artery, left gastric artery and splenic artery have\nseparate origins from the aorta, an anatomic variant.\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 acute abdominopelvic abnormality.\n2. Interval removal of previously seen IUD.\n3. Suggestion of hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate no focal consolidation or\npleural effusion..  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\ndilatation.  The common bile duct is mildly dilated.  No intraductal\nradiopaque stones are noted.  The gallbladder is mildly distended, without\nwall thickening or pericholecystic fluid.\n\nPANCREAS: There is a cystic lesion in the body of the pancreas measuring 4.8 x\n4.1 cm (series 2, image 24). Also seen on prior CT of the L-spine.  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: Bilateral renal cysts, the largest measuring up to 4.3 cm in the\nupper pole of the left kidney.  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: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is diffuse\ncolonic wall thickening with mucosal enhancement compatible with colitis, most\nnotably involving the ascending and rectosigmoid, where there is pericolonic\nstranding and trace fluid.  There is no evidence of bowel obstruction or\norganized fluid collections. The appendix 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 diminutive but\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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes of the thoracolumbar spine are noted. \nThere is a likely hemangioma in the L1 vertebral body.  Otherwise, there is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Diffuse colonic wall thickening with mucosal enhancement compatible with\ncolitis, most notably involving the ascending colon and rectosigmoid.\n2. No evidence of bowel obstruction or organized fluid collections."
        },
        {
            "input": "Bones are diffusely demineralized though there is no acute fracture or\nworrisome bony lesion.  No significant arthritis at the hips and in the SI\njoints.  Calcifications noted at the level of the hamstrings insertion at the\nischial tuberosities bilaterally.\n\nThere is a moderate sized fat containing umbilical hernia.  There is\nmild-to-moderate vascular calcification.  Imaged bowel loops are unremarkable.\nThe uterus is surgically absent.  No adnexal masses seen.  No free air or free\nfluid.  No hematoma.",
            "output": "No 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 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. \nTiny hypodensity at the lower pole the left kidney is too small to\ncharacterize though statistically a cyst.  There is no evidence of focal\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. 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 2.4 cm right adnexal cyst, likely physiologic.\nUterus and adnexae 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: An umbilical hernia containing fat is noted.",
            "output": "A 2.4 cm right adnexal cyst, to be correlated with patient's symptoms. \nOtherwise, no acute intra-abdominal process.  No findings to explain\nabnormality in the left upper quadrant."
        },
        {
            "input": "LOWER CHEST: Moderate bibasilar atelectasis.  No pleural effusion.  No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The superior most portion of the right hepatic dome is excluded\nfrom the images.  Otherwise 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 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 large hiatal hernia.  No bowel obstruction.  No\nsuspicious focal wall thickening.  Liquid stool seen throughout the small\nlarge bowel.  There is diverticulosis without evidence of diverticulitis.  The\ncecum is in the left mid abdomen.  No free fluid.  No free air.\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\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 anterolisthesis of L5 over S1 which is mild.  No fractures. \nNo suspicious osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic findings.\n2. Liquid stool seen throughout the large and small bowel could reflect\nenteritis.\n3. Diverticulosis without evidence of diverticulitis.\n4. Large hiatal hernia.\n5. Fibroid uterus.\n6. Anterolisthesis of L5 over S1 is mild."
        },
        {
            "input": "LOWER 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. \nStable aspect of multiple scattered hypoattenuating lesions throughout of 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 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 hyperplastic.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  Bilateral\nrenal stones are noted, largest measuring 4 mm on the left.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Changes of prior\nsigmoidectomy is noted.  There is presacral soft tissue thickening measuring\n19 mm of anteroposterior dimension, which is more prominent than on prior\nstudy (15 mm).\n\nThe appendix is normal.\n\nPELVIS: The urinary bladder contains a punctate calcification on the left wall\n(series 5, image 102).  The distal ureters are unremarkable.  There is no free\nfluid 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. \nBony degenerative changes are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The patient is status post sigmoidectomy.  There is a mild increase in\npresacral soft tissue thickness which should be reassessed with PET-CT to rule\nout any active disease.\n2. Punctate calcification is seen within the bladder, attention follow-up.\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. \nMultiple hypoattenuating lesions scattered throughout both hepatic lobes were\ncharacterized as cysts or biliary hamartomas on the MRE from ___, and\nare unchanged.  There is no evidence of suspicious 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 solid renal lesions or hydronephrosis.  3 mm\nnonobstructive right renal stone is again noted.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Changes from\nsigmoidectomy are re-demonstrated.  Similar presacral soft tissue thickening.\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.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post sigmoidectomy.  Stable presacral soft tissue thickening.  No\nevidence of metastatic disease in the abdomen or pelvis.\n2. Please refer to the separately dictated CT chest from the same date 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: The liver demonstrates homogenous attenuation throughout. \nUnchanged scattered hepatic hypodensities, differentials include cysts, and\nbiliary hamartomas.  Largest is a hepatic dome hypodensity, measuring\napproximately 1.2 cm.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is partially decompressed, limiting\nevaluation.  No discrete cholelithiasis, or pericholecystic inflammatory\nchanges.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Unchanged bilaterally.\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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No abnormally dilated loops. \nPostsurgical changes of sigmoid colectomy.  Scattered colonic diverticulosis\nwithout of diverticulitis.  Presacral soft tissue thickening, similar to\nprior.  The appendix is normal in caliber.\n\nPELVIS: Partially distended urinary bladder.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: Unchanged scattered mildly prominent para-aortic lymph, not\nmeeting size criteria for lymphadenopathy.  No mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: No destructive osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post sigmoidectomy with similar presacral soft tissue thickening. \nNo CT evident metastatic disease within the abdomen and pelvis.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription 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 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: 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 proximal portion of\nthe appendix (2:63) with air seen within the midportion.  The distal appendix\nis fluid-filled and dilated to approximately 7 mm (2:69, 70, 71, 72, 73),\nabutting the right ovary.  There is mild adjacent periappendiceal fat\nstranding.  No discrete fluid collection is identified.\n\nPELVIS: The bladder is unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A fundal fibroid measures approximately 7.5 cm.  There is\nmild fat stranding surrounding the right ovary (2:72).  Cystic change of the\nright ovary could reflect follicular activity.  The left adnexal appears\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: Small, fat containing umbilical hernia.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "Fat stranding within the right lower quadrant, centered around the right\novary, with mild, likely reactive inflammation of the appendiceal tip, which\nis fluid-filled and dilated to approximately 7 mm.  These findings are most\ncompatible with inflammation of the right ovary, possibly sequela of pelvic\ninflammatory disease or ovarian torsion.  A pelvic ultrasound could be\nconsidered for further evaluation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 9:50 am, 10 minutes after discovery of\nthe findings."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is trace free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 1.1 cm cystic lesion noted in the prostate in\nthe midline; the visualized prostate is otherwise unremarkable.\n\nLYMPH NODES/SOFT TISSUE: There is right inguinal lymphadenopathy with\noverlying soft tissue stranding.  No discrete fluid collection.  No\nsubcutaneous gas.  There is no pelvic or left inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.",
            "output": "1. Right inguinal lymphadenopathy with overlying soft tissue stranding is\nconsistent with cellulitis.  No abscess.  No subcutaneous gas.\n2. Trace free fluid in the pelvis, not physiologic though nonspecific.\n3. A 1.1 cm cystic lesion within the prostate in the midline.\n\nNOTIFICATION:  The salient findings were discussed with ___, M.D.\nby ___, M.D. in person on ___ at 4:45 pm."
        },
        {
            "input": "LOWER CHEST: Small left pleural effusion has improved since ___, mild\nthickening of the pleura raises the concern for loculation.  Associated left\nbasilar atelectasis is noted.  Punctate granuloma in the left lower lobe. \nCoronary and aortic and mitral 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 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.  Punctate calcifications in the\npancreas likely reflect chronic pancreatitis.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  Large\nmultilobulated hypodense lesion with rim calcifications measuring 7.2 x 5.6 cm\nis unchanged since ___.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral atrophic kidneys without cystic lesions in keeping with\nhistory of end-stage renal disease.  No renal calculi are noted.  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. Patient is status\npost partial sigmoidectomy, with unremarkable appearance of the remaining\ncolon and rectum.  The appendix 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: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease in the peripheral vasculature.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing infraumbilical and umbilical hernias are\nstable.",
            "output": "No acute abdominopelvic findings to explain patient's symptoms."
        },
        {
            "input": "LOWER CHEST: There is a new small right pleural effusion.  There is a trace\nleft pleural effusion.  There is overlying atelectasis bilaterally,\nparticularly at the right lung base.  The heart is mildly enlarged with\natherosclerotic calcification of the coronary arteries, aortic and mitral\nvalves.  No pericardial effusion.  Evidence of prior median sternotomy.\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: Mild fatty atrophy of the pancreas which contains macro\ncalcifications consistent with chronic pancreatitis.  No peripancreatic\nstranding or pancreatic ductal dilatation.\n\nSPLEEN: A bilobed, peripherally calcified lesion within the spleen measures\n7.9 x 6.1 cm, stable from the prior study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Renal cortical atrophy is demonstrated bilaterally.  No\nhydronephrosis.  Mild perinephric stranding is stable and likely physiologic.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  A large bowel-large bowel\nanastomosis is noted along the sigmoid colon which appears intact.  There is\nbackground diverticulosis.  Otherwise the colon, rectum and appendix are\nwithin normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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 ventral hernia is again noted.  There is a\nsmall fat containing umbilical hernia also unchanged.",
            "output": "1. No bowel obstruction or acute abdominopelvic findings.\n2. New right pleural effusion with overlying relaxation atelectasis of the\nright lung base.  An overlying pneumonia is not excluded.  Persistent small\nleft pleural effusion.\n3. Redemonstration of sequela from chronic pancreatitis without evidence of\nactive inflammation.\n4. Stable appearance of a lobulated splenic cyst with peripheral\ncalcification, which could reflect prior trauma."
        },
        {
            "input": "LOWER CHEST: The heart is normal in size.  There is dense mitral valve annular\ncalcification.  There is mild atherosclerotic calcification involving the\ncoronary arteries.  There is no pericardial effusion or wall thickening. \nThere are bilateral lung small pleural effusions with associated atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in appearance.  There is no evidence\nof focal lesions within the limitations of an unenhanced scan.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  There multiple\nsmall hyperdense stones visualized at the dependent portion of the\ngallbladder.  There is no evidence of cholecystitis.\n\nPANCREAS: There are scattered calcification of the pancreas parenchyma likely\nfrom previous chronic pancreatitis.  There is no pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: There is a 8.5 x 5.4 x 7.2 cm bilobed peripheral calcified lesion in\nthe spleen grossly unchanged from previous study.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral native kidneys are atrophic.  There is a right iliac fossa\ntransplant kidney visualized with a double-J catheter visualized extending\nfrom the renal pelvis to the urinary bladder.  There is mild fullness of the\ntransplant renal pelvis.  There is mild perinephric stranding about the\ntransplant kidney.   There is a small perinephric fluid collection lateral to\nthe transplant kidney measuring 2.6 x 1.5 cm, decreased in size compared to\nthe prior ultrasound.  There is no nephrolithiasis.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber and wall thickness throughout.  There\nis an intact anastomosis at the sigmoid colon.  There are scattered colonic\ndiverticula.\n\nPELVIS: Tip of a ureteral stent is noted within the bladder.  The urinary\nbladder and distal ureters are otherwise unremarkable.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is grossly unremarkable.  Bilateral vas deferens\ncalcification suggest underlying diabetes.\n\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 mild multilevel degenerative changes of the thoracolumbar\nspine.  There is a left iliac wing chronic deformity.\n\nSOFT TISSUES: There is a dehiscent right lower abdominal wall wound containing\ngas.  There is no discrete fluid collection visualized.  There are 2\nsupraumbilical fat containing ventral hernia and a small umbilical fat\ncontaining umbilical hernia.  There are bilateral small fat containing\ninguinal hernia.  Soft tissue induration in the left anterior abdominal wall\nlikely reflects injection site.",
            "output": "1. Right lower abdominal wall wound dehiscence with gas tracking along the\nincision site adjacent soft tissue stranding.  No evidence of fluid\ncollection.\n2. Mild perinephric stranding about the transplant kidney with redemonstration\nof a perinephric fluid collection measuring 2.6 x 1.5 cm, decreased from prior\nrenal ultrasound.\n3. Peripheral calcified splenic lesion likely posttraumatic cyst.\n4. Evidence of chronic pancreatitis.\n5. Cholelithiasis without evidence of cholecystitis."
        },
        {
            "input": "LOWER CHEST: Bilateral atelectasis in both lower lobes.  No pleural effusions.\nNo pericardial effusion.  Significant atherosclerotic burden in the mitral\nannulus.\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.  Scattered\ncalcifications noted throughout the parenchyma likely from previous chronic\npancreatitis.  There is no pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen is enlarged with unchanged bilobed peripherally calcified\nlesion (2: 29) measuring approximately 8.3 x 6.2 cm.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are unchanged and atrophic bilaterally.  There is a\ntransplanted kidney in the right lower quadrant.  There is no suspicious 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.  At least 3 focal round\ndilations are noted in the jejunum with air-fluid levels (2:77, 89 and 104),\nadjacent to each other.  Remaining small bowel loops demonstrate normal\ncaliber and wall thickness throughout. Scattered colonic diverticula with no\nassociated inflammatory signs.  Anastomotic suture line in the sigmoid colon\n(2:140) from prior colectomy is patent .\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 no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Infraumbilical ventral hernia with insinuation of mesenteric fat\nand small bowel loops through a 5.7 x 4.4 cm gap (2:158, 602:84).  Epigastric\nventral hernia with insinuation of mesenteric fat through a 5.0 x 3.0 cm gap\n(2:27, 602:88).",
            "output": "1. Unremarkable appearance of the right lower quadrant transplant kidney.\n2. Focal saccular dilations of the jejunum are new compared to prior study,\nsimilar to diverticula with no associated inflammatory/infections signs.\n3. Uncomplicated cholelithiasis and colonic diverticulosis.\n4. Ventral abdominal hernias with no signs of strangulation.\n5. Stable chronic bilobed peripherally calcified lesion in the spleen."
        },
        {
            "input": "LOWER CHEST: Re- demonstration of trace right greater than left bilateral\npleural effusions with subjacent atelectasis.  Punctate calcifications at the\nright lung base are also similar.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: There is fatty atrophy of the pancreas.  There is no evidence of\nfocal lesion, within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: Redemonstration in unchanged peripherally calcified, bilobed lesion in\nthe spleen measuring 8.0 x 6.2 cm (3: 28).  The spleen measures 15 cm,\nunchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are severely atrophic bilaterally.  There are no\nsuspicious lesions within the limitations of a noncontrast study.  There is a\nright lower quadrant transplant kidney, the morphology of which is unchanged. \nThere is stranding about the transplant kidney, which appears increased\ncompared to ___.  There is no hydronephrosis.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber and wall thickness. Scattered diverticuli are noted throughout the\ndescending colon.  The patient is status post sigmoid colectomy, with\nanastomosis in the mid-pelvis.  The remaining rectum is unremarkable.  The\nappendix is normal.\n\nPELVIS: There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic calcification along the abdominal aorta, and\nextensive calcification along the proximal femoral vessels.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is diffuse osseous demineralization.  No acute fracture or\nsuspicious osseous lesion identified.\n\nSOFT TISSUES: There is redemonstration of diastasis of the rectus containing\nnonobstructed loops of bowel, as before.  Numerous fat containing small\nventral hernias are also seen.",
            "output": "1. Slightly increased stranding about the right lower quadrant transplant\nkidney is nonspecific.  There is no hydronephrosis or other abnormality\nidentified within the limitations of a noncontrast scan.  Correlate with\nurinalysis.\n2. Otherwise, no acute findings in the abdomen or pelvis.\n3. Unchanged trace bilateral pleural effusions with subjacent atelectasis."
        },
        {
            "input": "LOWER CHEST: There is redemonstration of a trace bilateral pleural effusions,\nright greater than left, with associated compressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: There is fatty atrophy of the pancreas.  Scattered calcifications\nare again noted within the pancreatic parenchyma.  There is no evidence of\nfocal lesion, within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilation or peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 15.6 cm.  There is redemonstration of\na peripherally calcified bilobed lesion in the spleen measuring approximately\n8.3 x 5.9 cm, unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is severe atrophy of the native kidneys bilaterally.  No\nsuspicious focal lesions identified within the limitations of the study.  The\nright lower quadrant transplant kidney is again seen, better characterized on\ndedicated renal transplant ultrasound dated ___. The urinary bladder\nis unremarkable.  Specifically, there is no evidence of adjacent fat stranding\nto suggest cystitis.\n\nGASTROINTESTINAL: The stomach is moderately distended and filled with a large\nvolume of ingested contents.  There is no evidence of wall thickening or\nperigastric fat stranding.  No focal gastric lesions identified within the\nlimits of a nonenhanced scan.  Small bowel loops demonstrate normal caliber\nand wall thickness. The patient is status post sigmoid colectomy.  There are\nscattered colonic diverticula without evidence of diverticulitis.  The\nremaining colon is unremarkable.\n\nPELVIS: There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  Severe atherosclerotic calcifications are again noted\ninvolving the proximal femoral vasculature.  A retroaortic left renal vein is\nincidentally noted.\n\nBONES: There is diffuse osseous demineralization.  There is a chronic\ndeformity of the xiphoid process.  Sternal cerclage wire are partially imaged.\nNo acute fracture or osseous lesions identified.\n\nSOFT TISSUES: There is diastasis of the rectus musculature with protrusion of\nnonobstructed loops of small bowel, unchanged.  Numerous fat containing small\nventral hernias are also unchanged.  Multiple subcutaneous injection\ngranulomas are again noted overlying the anterior abdomen.",
            "output": "1. Moderately distended stomach filled with a large volume of in"
        },
        {
            "input": "LOWER CHEST: Redemonstrated are bilateral trace pleural effusions, right\ngreater than left, with associated compressive atelectasis, unchanged since CT\nfrom ___.  There are mild coronary artery calcifications.  Normal heart\nsize.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has diffusely low density consistent with steatosis. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation.\n\nPANCREAS: Fatty atrophy of the pancreas with scattered calcifications\nthroughout the pancreatic parenchyma.  No evidence of pancreatic ductal\ndilatation or peripancreatic stranding.  No evidence focal lesion, within the\nlimitations of an unenhanced scan.\n\nSPLEEN: The spleen is enlarged, measuring up to 14 cm in craniocaudal\ndimension.  Redemonstrated is a 7.8 x 6.2 cm bilobed lesion with peripheral\ncalcification in the spleen, grossly unchanged in size and appearance since CT\nfrom ___ (previously measuring 8.3 x 5.9 cm) and compatible with a\nposttraumatic cyst.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral native kidneys appear atrophic.  No suspicious focal\nlesions are identified within the limitations of a nonenhanced scan.\nThe transplant kidney is located in the right lower quadrant. There is no\nevidence of suspicious focal lesions. No evidence of stones or hydronephrosis.\n The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia is noted.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber and wall thickness. The patient\nis status post sigmoid colectomy with intact colonic anastomosis in the deep\npelvis.  Scattered colonic diverticula without evidence of diverticulitis. \nThe appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.  There are calcifications in the bilateral vas deferens\nindicative of underlying diabetes.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild aortic atherosclerotic disease is present.  There is severe\natherosclerotic calcifications in the bilateral proximal femoral vasculature. \nThere is no abdominal aortic aneurysm.  A retroaortic left renal vein is again\nnoted.\n\nBONES: No acute fractures are identified.  Diffuse demineralization.  Again\nnoted is a chronic deformity of the xiphoid process.\n\nSOFT TISSUES: Redemonstration diastasis of the rectus musculature with\nprotrusion of nonobstructed loops of small bowel, unchanged in appearance\nsince CT from ___.  Multiple small fat containing ventral hernias are\nagain noted, unchanged.",
            "output": "1. No acute intra-abdominal pathology.\n2. Unremarkable appearance of the transplant kidney in the right lower\nquadrant.\n3. Liver steatosis.\n4. Cholelithiasis without cholecystitis.\n5. Stable trace bilateral pleural effusions.\n6. Splenomegaly.\n7. Diastasis o"
        },
        {
            "input": "LOWER CHEST:  The visualized lung bases are clear.  No pleural effusion is\nseen.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast. \nThere is a punctate focus of calcification in the left lobe of the liver\nunchanged from ___. The appearance of the liver is otherwise unremarkable.\nThe gallbladder is not visualized. The spleen and adrenal glands are\nunremarkable. There is fatty atrophy of the pancreas.\n\nThe native kidneys are atrophic with multiple vascular calcifications seen. A\nfailed right renal transplant is noted in the right hemipelvis. A left-sided\nrenal transplant demonstrates normal in contour.  Mild stranding surrounding\nthe transplant kidney has decreased from ___.  There is no\nhydronephrosis. No perinephric fluid is seen.\n\nMultiple surgical clips are seen in the region of the esophagus, likely from\nprior hiatal hernia repair. The distal esophagus is normal without a hiatal\nhernia. The stomach is relatively decompressed. Oral contrast extends through\nthe rectum. The small bowel is normal in caliber without wall thickening.\nThere is diverticulosis of the sigmoid colon without evidence of\ndiverticulitis. The large bowel is relatively understended without evidence of\nwall thickening. The appendix is not visualized but there are no secondary\nsigns of appendicitis in the right lower quadrant.\n\nDense vascular calcifications are noted in the abdominal aorta and its major\nbranches. There is no retroperitoneal or lymphadenopathy. There is no\nabdominal free fluid or free air.\n\nPELVIS:\n\nThe bladder is decompressed.  There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.  The\nuterus is not seen and may be surgically absent.\n\nOSSEOUS STRUCTURES/SOFT TISSUES:  The bones are diffusely demineralized with a\nmottled appearance, overall similar in appearance to ___, which can be seen\nin renal osteodystrophy. No concerning lytic or sclerotic bony lesions are\nseen. Diffuse muscle atrophy is seen.",
            "output": "No acute intra-abdominal abnormality.  Unremarkable appearance of the small\nand large bowel given lack of IV contrast."
        },
        {
            "input": "LOWER CHEST: There is new bibasilar atelectasis without pleural effusion. \nThere are extensive aortic valve calcifications and coronary artery\ncalcifications.  Cardiomegaly is unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver 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\nMultiple surgical clips are seen in the region of the esophagus, likely from\nprior hiatal hernia repair.  No hiatal hernia identified currently.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 are atrophic, with multiple unchanged\nvascular calcifications.  A failed right renal transplant is again noted in\nthe right hemipelvis containing multiple calcifications.  The known left-sided\nrenal transplant demonstrates normal contour.  Vague hypodensity extending to\nthe cortex (6:11) is 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.  The colon and\nrectum are within normal limits.  The appendix is not directly visualized,\nhowever no secondary findings to suggest acute appendicitis.\n\nPELVIS: The urinary bladder contains a small focus of air (06:34).  There is a\ntrace amount of free fluid in the pelvis (06:27).\n\nREPRODUCTIVE ORGANS: Patient appears to be 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: There is no evidence of worrisome osseous lesions.  Superior endplate\ncompression deformity of the L5 vertebral body is again seen.  T8 through T10\nvertebral body fusion vertebral body height loss is also unchanged compared to\nprior exam.  Bones are diffusely osteopenic with a mottled appearance, in\nkeeping with known renal osteodystrophy.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Vague hypodensity in the left sided transplant kidney, not seen in ___.  This may be due to an area of infection/focal lobar nephronia. \nClinical correlation with urinalysis is recommended.\n\n2.  No acute intra-abdominal or intrapelvic process to correlate with the\npatient's periumbilical pain.  No evidence of bowel obstruction.\n\n3.  Small focus of air in the urinary bladder.  Correlate for history of\nrecent instrumentation, for instance with a Foley catheter.  If there has been\nno recent instrumentation, findings are concerning for infection and again\ncorrelation with urinalysis is recommended.\n\n4.  Unchanged compression deformity of the superior endplate of the L5\nvertebral body."
        },
        {
            "input": "Depending, bibasilar atelectasis is noted. Moderate cardiomegaly. There is no\nevidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver is normal in appearance. The portal venous system is patent. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder, pancreas, spleen, and right adrenal gland are normal.  Mild\nthickening of the left adrenal gland is stable from ___. The kidneys enhance\nsymmetrically and are without suspicious 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.  A small\nduodenal diverticulum is noted.  The appendix is air-filled and normal in\nappearance. Colonic diverticulosis is present without evidence of\ndiverticulitis.  Numerous prominent mesenteric lymph nodes are noted, none of\nwhich are pathologically enlarged by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches contain\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\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.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  Mild retrolisthesis of L2 on L3\nand mild anterolisthesis of L4 on L5 are stable from ___, likely degenerative\nin nature. No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  No acute intra-abdominal process.\n2.  Colonic diverticulosis without evidence of acute diverticulitis.\n3.  Moderate cardiomegaly."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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\nintrahepatic biliary system.  The common bile duct measures 1.5 cm, likely\nnormal in the setting of 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.  Small bowel loops are\nfluid-filled and 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 pelvic\nfree-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.  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.",
            "output": "1. Mild prominence of the intrahepatic biliary system with a dilated common\nbile duct up to 1.5 cm.  Findings may reflect post cholecystectomy state,\nthough given lab abnormalities and unexplained pain, retained stone not\nexcluded.\n2. Trace pelvic free-fluid.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:05 pm, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "As seen on the prior radiographs there is a comminuted intertrochanteric right\nfemur fracture with proximal migration of the femoral diaphysis relative to\nthe femoral neck and varus angulation.  The lesser trochanter fragment is\nminimally displaced inferiorly (2:88).  Greater trochanter fragment is\nminimally displaced superiorly.  No large joint effusion seen.  Mild\ndegenerative changes in the right hip.  Moderate degenerative changes of the\nleft hip.\n\nNo additional fractures are seen.  There are moderate degenerative changes at\nthe symphysis pubis and mild degenerative changes at the bilateral sacroiliac\njoints.  There is severe disc space narrowing at L3-L4 and L4-L5 and a central\ndisc bulge at L5-S1.  Facet arthropathy in the visualized lower spine is mild.\n\nThere is extensive vascular calcification.  There is a chronic appearing\ndissection of the distal abdominal aorta measuring up to 2.8 cm.  A Foley\ncatheter is in-situ in the bladder.  Calcified fibroid in the left cornua of\nthe uterus (3:59).  There is a large amount of fecal material in the rectum\nwith mild rectal wall thickening could reflect stercoral colitis, however this\nmay also be related to pelvic floor descent (400:211).  Extensive sigmoid\ndiverticulosis without signs of diverticulitis.",
            "output": "Comminuted intertrochanteric right femur fracture.\n\nSigmoid diverticulosis without signs of diverticulitis.\n\nLarge amount of stool in the rectum with mild rectal wall thickening, raises\nthe possibility of stercoral colitis however this may also be related to\npelvic floor descent.\n\nChronic appearing dissection of the distal abdominal aorta."
        },
        {
            "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\nVP SHUNT:  The VP shunts enters the abdomen in the right upper quadrant by the\nstomach and aunts in the anterior abdomen on the left at the level of the and\numbilicus/ iliac crest.  There is no collection or other abnormality\nsurrounding the shunt.\nHEPATOBILIARY:\nThe liver demonstrates homogenous attenuation throughout.  There isevidence of\nmild steatosis: 45 ___ on non-contrast scan (normal 60-70 ___ is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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.  There is no evidence of stones,\nfocal renal lesions or hydronephrosis.\nThere are no large urothelial masses. There is no perinephric abnormality.\nGASTROINTESTINAL:\nThe stomach is not distended.  There is no abnormality in the duodenum.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  no\ndiverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nUterus is not seen, likely post hysterectomy\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. Tip of the present in the left upper quadrant anteriorly with no loculated\nor free peritoneal fluid or other abnormality."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n2\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged and demonstrates heterogenous attenuation\nthroughout which may be secondary to hepatic congestion, patchy steatosis,\nand/or ongoing liver disease.  The main portal vein and right left portal vein\nbranches are patent.  The hepatic veins are grossly patent.  Additionally,\nthere is hepatomegaly.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is surgically absent with surgical clips\nin place.  There is moderate volume ascites in the abdomen.\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 17 cm.  There is a 7 mm hypodensity in\nthe spleen, series 2, image 26, nonspecific, but on prior MRCP from ___, findings were suggestive of 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastric bypass surgery without\nevidence of bowel obstruction.  No bowel obstruction or definite bowel wall\nthickening is seen.  The appendix is normal in caliber.\n\nPELVIS: The urinary bladder is relatively collapsed, but given this, grossly\nunremarkable.  Moderate to large volume ascites seen.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae 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.  A retroaortic left renal vein is noted.\n\nBONES: 1.3 cm sclerotic focus in the medial left ilium on series 2, image 66,\nis nonspecific, but could represent a bone island or bone infarct.  The\npatient is status post posterior and interbody fixation of L4-L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Enlarged, markedly heterogeneous liver which could be due to underlying\nliver disease, hepatic congestion, underlying hepatic steatosis.  Patent main\nportal vein and right and left portal vein branches.  Hepatic veins appear\npatent.\n2. Likely sequela of portal hypertension including splenomegaly and ascites.\n3. No evidence of bowel obstruction.\n4. Status post cholecystectomy.  Status post gastric bypass surgery."
        },
        {
            "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 redemonstration of hepatomegaly.  There is no evidence\nof focal lesions within the limitations of an unenhanced scan.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  There is\ninterval decreased in the amount of ascitic fluid surrounding the liver and\nspleen, now with trace dependent fluid noted.  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: There is splenomegaly with homogeneous attenuation throughout.  There\nis redemonstration of a 5 mm hypodense lesion within the anterior aspect of\nthe spleen (2:27) that was identified as a hemangioma on the MRCP from\n___.  There also, multiple rounded calcific densities, the largest\nmeasuring 7 mm,localized in the superolateral aspect of the spleen, likely\nsecondary to previous 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass and\nAxios stenting.  The remaining small bowel loops demonstrate normal caliber\nand wall thickness 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 and left adnexa are unremarkable.  There is a\n3.2 cm left adnexal cyst, likely physiologic.\n\nLYMPH NODES: There is redemonstration of nonspecific, 1 cm porto-caval lymph\nnodes, slightly smaller in size compared to most recent study.  There is no\nretroperitoneal, pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  A retroaortic left renal\nvein is again noted.  Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes within the lower lumbar spine with posterior\nand interbody fixation at the level of L4-L5.  Sclerotic foci in the medial\nleft ilium (2:71), which remains stable compared to most recent studies and\ncould represent a bone island or bone infarct..\n\nSOFT TISSUES: There is a midline defect in the superior abdomen containing fat\nand small amount of fluid.",
            "output": "1. There is no evidence of a retroperitoneal bleed.\n2. Persistent hepatosplenomegaly reflecting underlying chronic liver disease\nand portal hypertension.\n3. Interval decrease in ascitic fluid, now with minimal amount noted.\n4. There is evidence of gastric bypass.  An AXIOS stent is redemonstrated at\nthe junction of gastrojejunostomy and the gastric remnant.  The\ngastroenterology note from ___ describes placement of this stent to\ncreate a jejuno gastric anastomosis involving the remnant stomach.  As noted\non the prior CT as well as MRI a small portion of the stent appears to\nabut/protrude outside the wall of the gastric remnant with mild soft tissue\nthickening and stranding surrounding it, without an associated abscess."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen:  There is no focal liver lesion.  However, there is focal varix of\nthe left portal vein as seen on series 2, image 15 measuring approximately 1.2\nx 1.4 cm, likely congenital.  Main portal vein is patent.  Gallbladder is\nnormal.  No intrahepatic or extrahepatic biliary ductal dilation is seen.  The\npancreas appears normal.  The spleen is normal.  Adrenal glands are normal. \nThe kidneys enhance symmetrically and excrete contrast promptly without\nhydronephrosis or focal concerning lesion.  The abdominal aorta is normal in\ncourse and caliber.  There is a retro aortic left renal vein.  There is no\nretroperitoneal lymphadenopathy.  The stomach and duodenum appear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  There is a corpus luteum in the right\novary.  There is a small volume of free pelvic fluid which is likely\nphysiologic.  The uterus appears normal.  The urinary bladder is only\npartially distended.  Visualized portions of the ureters appear normal.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Normal appendix.\n2. Incidental note of small varix of the left portal vein measuring 14 x 12\nmm, likely congenital."
        },
        {
            "input": "LOWER CHEST: Trace bibasilar atelectasis.  No consolidation or pleural\neffusion in the imaged portion of the lungs.  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: 9 mm accessory spleen is noted at the hilum (series 2, image 23).  The\nspleen shows normal size and 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. Diffuse wall edema\nand hyperenhancing mucosa is noted in the descending and sigmoid colon, which\nmay be associated with colitis.  No free air or free fluid is noted.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Punctate\nhyperdensities associated with vessels on both sides of the uterus are favored\nto represent phleboliths.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.1\n\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. Diffuse wall edema and hyperenhancing mucosa in the descending and sigmoid\ncolon, compatible with colitis.\n2. No bowel obstruction, free air, or free fluid."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nAbdomen: The liver enhances normally without focal concerning lesion.  The\ngallbladder is surgically absent.  Mild prominence of the intrahepatic biliary\ntree reflect prior cholecystectomy.  Main portal vein is patent.  The common\nbile duct appears within normal limits of size.  The pancreas, spleen and both\nadrenal glands appear normal.  Kidneys enhance symmetrically and demonstrate\nprompt excretion of contrast.  No hydronephrosis or signs of pyelonephritis. \nNo worrisome renal lesion is seen.  The abdominal aorta is normal in course\nand caliber without appreciable atherosclerosis.  The stomach and duodenum\nappear normal.  No adenopathy, free air or free fluid is seen.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix contains luminal gas though when compared with the prior CT there\nis mild mucosal hyperemia and wall thickening with the diameter measuring up\nto 9 mm.  There is no appreciable periappendiceal fat stranding.  Given focal\npain at this region, a very early appendicitis is suspected.  The colon is\nthin walled and contains a mild fecal load.  The uterus is surgically absent. \nUrinary bladder is mostly decompressed.  No pelvic sidewall or inguinal\nadenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Degenerative\ndisease in the lumbar spine is most pronounced at L4-5 level with moderate\ndisc space narrowing.",
            "output": "Mildly inflamed appearance of the appendix is concerning for early acute\nappendicitis."
        },
        {
            "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. Mild intrahepatic biliary dilatation\nand mild dilatation of the common bile duct, measuring up to 10 mm, is likely\nfollowing 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. \nA punctate 2 mm renal stone is seen within the mid right kidney (2:39).  No\nhydronephrosis.  No solid renal masses.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\ndiverticulosis, without evidence of acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS: The 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes at L4-L5.\n\nSOFT TISSUES: Tiny, fat containing umbilical hernia.",
            "output": "1. No acute intra-abdominal abnormality.\n2. Punctate, nonobstructing right renal stone.  No hydronephrosis.\n3. Colonic diverticulosis, without evidence of acute diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  Left hepatic artery arises\ndirectly from celiac artery.\n\nLOWER CHEST: Mild atelectasis is noted in bilateral lung bases.  There is no\npleural effusion.  Coronary artery calcification is moderate.\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 in the\ngallbladder wall is thickened and edematous.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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: Hiatal hernia is small.  Small and large bowel loops are\nnormal caliber.  Appendix contains air, has normal caliber without evidence of\nfat stranding.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Uterus is 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. Gallbladder wall is thickened and edematous, consistent with cholecystitis.\nGallbladder contains multiple 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 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.  There\nis trace ascites at the hepatic dome (05:17).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size 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 and\nhyperemia of several loops of distal and terminal ileum, some which\ndemonstrate a targetoid appearance.  There is also mild dilatation of distal\nileal small bowel loops up to 3.1 cm without evidence of distal decompression\nor transition point (5: 60).  There is associated fibrofatty proliferation of\nthe adjacent mesentry with trace mesenteric free fluid.  There is also mild\nthickening and hyperemia of the cecum and proximal ascending colon.  The\nremainder of the visualized colon and small bowel loops appear within normal\nlimits.  No organizing fluid collections identified.  The appendix is\nsurgically absent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized uterus is unremarkable.  A 4.8 x 4.3 cm\nright adnexal cystic structure is likely physiologic (07:28).  No left adnexal\nabnormalities identified.\n\nLYMPH NODES: No retroperitoneal lymphadenopathy.  Scattered mesenteric root\nlymph lobes not pathologically enlarged by CT size criteria (05:44, 56). \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Small sclerotic focus within the left acetabulum is unchanged compared\nto ___, compatible with a bone island (5:76).  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A 2.3 x 2.1 x 2.0 cm fluid containing lesion anterior to the\numbilicus is new compared to ___ (05:47).",
            "output": "1. Long segment thickening of the distal and terminal ileum with involvement\nof the cecum and proximal ascending colon is compatible with acute Crohn's\nflare with resultant partial bowel obstruction and small volume ascites.\n2. 4.8 cm right adnexal cyst is likely functional.  Dedicated pelvic\nultrasound may be considered if clinically warranted.\n3. 2.3 cm fluid containing structure anterior to the umbilicus is of doubtful\nclinical significance.  Recommend correlation with physical exam.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:06 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 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: There is no evidence of solid renal lesions or hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is wall thickening and\nhyperemia of several loops of distal and terminal ileum some of which\ndemonstrated targetoid appearance (series 601: Image 28).  There is associated\nfibrofatty proliferation of the adjacent mesentery with trace mesenteric free\nfluid.  In addition, a distal loop of small bowel measures up to 3 cm and\ndemonstrates an air-fluid level (series 2: Image 45).  There is no frank\ntransition point.  There is mild mucosal enhancement of the cecum, otherwise,\nthe colon and rectum are within normal limits.  The appendix is surgically\nabsent.\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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nAgain seen 2.9 x 2.4 cm fluid containing lesion anterior to the umbilicus,\noverall similar in appearance to most recent prior exam.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "Long segment thickening of distal and terminal ileum compatible with an acute\nCrohn's flare.  Distal loop of small bowel measuring up to 3 cm with air-fluid\nlevel and no transition point, consistent with a partial small bowel\nobstruction."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Patient is status post right\nmastectomy, incompletely imaged.\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 suspicious\nrenal 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 interval resolution.  There is\nstill inflammatory changes along the cecum, although probably improved.  The\ndistal ileum is more difficult to assess with this technique but is now\nprobably normal, at least for the most part, a substantial short-term change. \nPatient is status post appendectomy.  Capsule is in the lower sigmoid.\n\nPELVIS: The urinary bladder is sub maximally distended appears grossly\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.\n\nSOFT TISSUES: There is a stable fluid collection within the periumbilical\nanterior subcutaneous tissues.",
            "output": "1.  Short-term improvement in abnormal appearance of the ileum although not\noptimally assessed with this technique.  Suspicion for persistent mild\ninflammatory change along the cecum, but again not fully assessed with this\ntechnique.  Given relapsing remitting course without definite diagnosis, in\nvery rapid improvement over 2 days, angioedema should be considered.\n2.  Capsule resides in the lower sigmoid."
        },
        {
            "input": "ABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast and streak artifact secondary to the patient's arms being\non top of his abdomen.\n\nThe kidneys are irregular in contour, with several bilateral stones, with the\nlargest stone at the interpolar region of the right kidney measuring up to 1.9\ncm, however several other stones measure greater than 1 cm at the upper and\nlower poles of the right kidney. There is no right-sided hydronephrosis. The\nleft kidney contains a 1.6 x 1.5 cm stone at the lower pole, a 8 mm stone at\nthe midpole, and a third 6 mm stone at the midpole.  There is mild, chronic\nleft-sided hydronephrosis with the double-J stent beginning in the mid left\nureter, terminating in the bladder. Imaged bowel is normal in caliber without\nobstruction. No retroperitoneal and mesenteric lymphadenopathy.\n\nPELVIS: The urinary bladder is completely decompressed, with a double-J stent\nfrom the left ureter, and a suprapubic catheter. The rectum contains a\nconsiderable amount of stool. There is no pelvic free fluid or pelvic\nlymphadenopathy.\n\nVESSELS: The aorta is normal in caliber with mild calcium burden.\n\nOSSEOUS STRUCTURES: Sclerotic focus in left iliac bone is likely a bone\nisland, unchanged from ___.  No concerning osseous lesions are seen.",
            "output": "1.  Multiple bilateral renal calculi, with the largest measuring up to 1.9 cm\nat the midpole of the right kidney. No right-sided hydronephrosis.\n2.  Chronic left-sided hydronephrosis, unchanged since ___.\n3.  Left ureteral double-J stent with superior pigtail within the proximal\nureter, and inferior pigtail within the bladder."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBILATERAL LOWER EXTREMITIES TO THE KNEES:\n\nBones: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is degenerative changes of bilateral sacroiliac joints with the vacuum\nphenomenon.\n\nMuscle: There is fatty atrophy of the bilateral gluteus maximus, right greater\nthan left tensor fascia ___ muscles.  In addition there is also fatty atrophy\nof the right semitendinosus, biceps femoris long head, medial gastrocnemius,\nand more inferolateral portions of the lateral gastrocnemius muscle.  The\nremaining portions of the right calf were not included in field of view.\n\nThere is asymmetric atrophy of the left psoas muscle (series 3, image 5). \nThere is no adjacent stranding.\n\nNo fatty atrophy in the left lower extremity was noted on the axial views.\n\nSoft tissues: No evidence of hematoma or fluid collection are noted in the\nright lower extremity.  No subcutaneous edema.\n\nJoints: There is no joint effusion bilaterally.",
            "output": "1. No evidence of hematoma or fluid collections noted in the right lower\nextremity down to the knees.  However there is extensive fatty atrophy of the\nmuscles in the right lower extremity, not seen in the left, as detailed above.\n2. No CT findings directly correlating to the reported history of right lower\nextremity pain."
        },
        {
            "input": "Partially imaged lung bases are notable for minimal dependent atelectasis.\nThere is no pleural effusion.\n\nLiver enhances homogeneously without focal lesions or biliary dilatation. The\ngallbladder is not distended, contains a stone and is also notable for fundal\nadenomyomatosis.  Spleen, pancreas, and adrenal glands are unremarkable.\nKidneys enhance and excrete symmetrically without concerning lesions or\nhydronephrosis. Multiple sub cm hypodensities and bilateral kidneys are too\nsmall to characterize.\n\nA small hiatal hernia is present. The stomach is largely decompressed. Loops\nof small bowel are normal in course and caliber without wall thickening or\nsigns of obstruction. Colon is unremarkable. There is no mesenteric or\nretroperitoneal lymphadenopathy. There is no intra abdominal free air or\nfluid. Abdominal aorta is of normal caliber throughout and the portal vein,\nSMV, and splenic vein are patent.\n\nBladder and terminal ureters are within normal limits. The prostate and\nseminal vesicles are unremarkable. There is no pelvic free fluid or\nlymphadenopathy.",
            "output": "1. No acute intra-abdominal pathology."
        },
        {
            "input": "Two sub-4 mm nodular opacities are seen in the right middle and lower lobes,\nunchanged compared to ___.  There is no pleural effusion. A trivial\npericardial effusion is noted. Cardiac pacer wires are noted.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal vein is patent.The nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: Hypodensities measuring up to 6 mm within the posterior spleen are\nunchanged compared to ___. PA 20 mm hyperdense lesion within the\ninferior aspect of the spleen also appears unchanged. These findings may\nreflect hemangiomas.\n\nPANCREAS: The pancreas again demonstrates fatty infiltration, without focal\nlesion or peripancreatic stranding or fluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS: Multiple hypodensities are again seen within the bilateral kidneys,\nthe largest measuring up to 7.7 cm on the left and 3.6 cm in the right lower\npole.  Other smaller hypodensities are too small to characterize, but likely\nrepresent simple cysts as well.  A 1.0 cm hypodensity in the lower pole of the\nleft kidney appears to be somewhat complex.\n\nGI:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.\n\nRETROPERITONEUM: The aorta is normal in caliber, with minimal atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. No acute intra-abdominal process to explain the patient's symptoms.\n2. 1-cm complex cyst in the lower pole of left kidney. Further evaluation with\nultrasound on a non urgent, outpatient basis is recommended.\n3. Unchanged lesions within the spleen, likely representing hemangiomas."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Scattered subcentimeter hypodensities\nare too small to characterize by CT but likely represent 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 previous 3 mm ureteral stone on the right has moved distally and\nis now located within the distal right ureter at the ureteral vesicular\njunction (series 2:148).  There is resulting mild right hydro ureteral\nnephrosis.  An additional 4 mm stone in the lower pole of the right kidney,\nnonobstructing, is redemonstrated.  No areas of cortical hypoenhancement or\nevidence of striated 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. Incidental note is again made of a fecalith\nwithin the appendix, similar in appearance to prior.  The distal tip of the\nappendix measures 6 mm.\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. 3 mm right ureteral stone has progressed and is now near the\nureterovesicular junction, with unchanged mild right hydroureteronephrosis. \nNo finding to suggest pyelonephritis.\n2. The proximal appendix contains a fecalith and is mildly dilated at 9 mm,\npreviously 7 mm.  In the absence of periappendiceal stranding, unclear if this\nis acute.  Recommend clinical follow up."
        },
        {
            "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 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 nonobstructing stone in the right lower pole (2:38). \nAdditional nonobstructing punctate 1 mm calculus within the right interpolar\nregion is also noted (601:32).  The previously seen stone at the right\nureterovesical junction is no longer visualized.  There is no evidence of\nsolid 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 appendix is\nfluid-filled and further dilated measuring up to 1.6 cm (2:66) with hyperemic\nand thickened walls, adjacent fat stranding, mural thickening and edema at the\nbase of the cecum.  There is no periappendiceal fluid collection.  There is no\npneumoperitoneum.  The colon and rectum are otherwise 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 grossly\nunremarkable.\n\nLYMPH NODES: Multiple enlarged right lower quadrant ileocolonic lymph nodes\nare likely reactive.  There is no retroperitoneal lymphadenopathy.  There is\nno 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. Uncomplicated acute appendicitis.  No evidence of perforation or\nperiappendiceal fluid collection.\n2. Two nonobstructing right renal calculi, the largest being a 4 mm calculus\nin the right lower pole kidney.  The previously seen stone at the right\nureterovesical junction is no longer visualized.  No hydroureteronephrosis."
        },
        {
            "input": "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 and appearance.  Adrenals\nappear normal.\n\nThe right kidney shows mild hydroureteronephrosis associated with a stone at\nthe right pelvic brim measuring up to 3 mm.  Mild congestive stretched fat\nstranding about the right kidney and upper ureter.  Within the right kidney,\nand 2 mm stone is found in the upper pole and, in the lower pole an additional\n3 mm stone.  Mild medullary nephrocalcinosis on each side.  No well-formed\nstones found on the left side, however.\n\nThe stomach and small bowel are unremarkable.  Large bowel also appears\nnormal.  Incidental appendecoliths in the tip of the appendix, but no evidence\nof appendicitis.\n\nProstate is at the upper limits of normal size.  Distal ureters, seminal\nvesicles and bladder appear normal.  No lymphadenopathy or free fluid.  Aorta\nis normal in caliber.  Vascular structures are otherwise difficult to assess.\n\nVertebral body heights and interspaces are preserved in height.  No suspicious\nbone lesions.",
            "output": "Small obstructing right ureteral stone, measuring up to 3 mm."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Otherwise the lung fields are\nunremarkable.\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 solid 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 diverticulosis without diverticulitis. \nThere is no free air.  The appendix is fluid-filled and measures 8 mm with\nmild hyperemia of the wall.  Mild stranding in the adjacent fat is noted. \nDespite being decompressed, there is apparent wall thickening of the distal\ndescending colon mild surrounding stranding and thickening of the lateral\nconal fascia.\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 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. Fluid-filled borderline appendix with surrounding fat stranding are\nequivocal for appendicitis given reported polypectomy in the adjacent\nascending colon.  Close clinical follow-up is recommended.\n2. There is mild wall thickening of the descending colon with adjacent\nstranding which is most likely to related to polypectomy in this region.\n3. No free intraperitoneal air.  No other findings to explain patient's\nsymptoms."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nAbdomen: A hyperdense lesion is noted within segment 3 of the liver, series 5,\nimage 17 and series 6 image 13, measuring 12 x 18 x 15 mm, indeterminate.  A\ntiny hyperdense lesion is seen at the hepatic dome on series 6, image 33\nmeasuring 7 x 9 x 9 mm, also indeterminate.  A peripheral hypodensity is noted\nin segment 6 on series 5, image 25 measuring 8 x 14 x 13 mm, not fully\ncharacterized.  While these lesions may represent benign entities, given\nclinical history, recommend correlation with MRI.  The spleen is normal in\nsize.  Adrenals are normal bilaterally.  The pancreas enhances normally\nwithout concerning lesion or signs of inflammation.  The kidneys enhance\nsymmetrically.  No concerning lesion or hydronephrosis.  The abdominal aorta\nis mildly calcified though normal in caliber.  No retroperitoneal, or\nmesenteric adenopathy.  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 enteric contrast and appears normal. \nMild diverticulosis without diverticulitis.  No pelvic free fluid.  No pelvic\nsidewall or inguinal adenopathy.  The urinary bladder appears normal.  The\nprostate is unremarkable.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Mild\ndegenerative disc disease at L5-S1 noted.",
            "output": "3 discrete small liver lesions which can be further characterized by MRI.\nOtherwise, unremarkable CT exam."
        },
        {
            "input": "The bases of the lungs are clear. There is no large pleural or pericardial\neffusion.\n\nEvaluation of the solid organs is limited without IV contrast. Within this\nlimitation, the liver, gallbladder, spleen, pancreas, and bilateral adrenal\nglands are within normal limits.\n\nKIDNEYS: There are bilateral large exophytic lesions with simple fluid density\narising from the upper kidney poles that are likely simple renal cysts. The\nleft renal cyst measures 4.0 cm x 3.1 cm. The right renal cyst measures 4.0 cm\nx 4.0 cm. There is no hydronephrosis. There are no evidence of radio-opaque\nstones in bilateral kidneys or ureters.\n\nThe stomach, duodenum, and intra-abdominal loops of small and large bowels are\nwithin normal limits.\n\nRETROPERITONEUM: The aorta is normal in caliber with scattered calcified\natherosclerotic plaques. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal. Calcified uterine fibroids are\nagain seen. No pelvic wall or inguinal lymph node enlargement by CT size\ncriteria is seen. There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present. \nMultilevel degenerative changes are noted in the spine with mild to moderate\nneural foraminal narrowing however no evidence of high-grade spinal stenosis.\nAnterior wedging of the L4 vertebral body is again seen.",
            "output": "1. No renal stones.\n2. Simple renal cysts in bilateral upper kidney poles, unchanged since\nprevious exam on ___."
        },
        {
            "input": "LOWER CHEST: A 5 x 3.8 cm heterogeneously enhancing mass is seen at the left\nlung base.  There are scattered pulmonary nodules in the right middle and left\nlower lobes. There are small bilateral pleural effusions, left greater than\nright.  There is no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple scattered hepatic hypodensities, many of which are too\nsmall to characterize.  A 2.3 cm cyst is seen in hepatic segment VII/VIII.  2\npunctate foci of hyperenhancement are noted at the hepatic dome which are\nlikely perfusional.  There are no lesions concerning for metastatic disease.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains several stones.\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.  Multiple accessory spleens 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 with normal nephrogram. \nThere is left cortical thinning and lobulation of the cortex.  There are\nmultiple nonobstructing left renal stones measuring up to 1.2 cm.  There is no\nevidence of solid renal lesions or hydronephrosis.   Subcentimeter hypodensity\nwithin the left kidney is too small to characterize but is statistically\nlikely to be a simple cyst.  There is mild ureteral enhancement bilaterally,\nmore prominent on the left compared to the right, and likely reactive.  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 or fat\nstranding. The appendix is normal.\n\nPELVIS: The bladder wall appears thickened.  A Foley catheter is seen in situ.\n3 large stones are seen within the bladder measuring up to 2 x 3 cm.  There is\nmild dilation and enhancement of the distal ureters bilaterally.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  A 3.8 cm simple cyst is\nseen in 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.  Extensive atherosclerotic\ndisease is noted.  There is significant narrowing of the celiac axis at the\nostium, likely related to calcified atherosclerotic plaque.\n\nBONES: T9 and T10 chronic appearing compression deformities are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 5 cm left lower lobe mass with additional bilateral pulmonary nodules\nconcerning for malignancy.\n2. Thickened bladder wall with multiple bladder stones measuring up to 3 cm. \nWhile the bladder wall thickening may represent inflammatory change in the\npresence of multiple bladder stones please note that malignancy can not be\nexcluded and cystoscopy could be considered\n3. Multiple nonobstructing left renal calculi measuring up to 1.2 cm.\n4. Cholelithiasis without evidence for cholecystitis\n5. 3.8 cm left adnexal cyst. Follow-up with a pelvic ultrasound is recommended\nin 12 months to assess stability, if unchanged, no further follow up required.\n\nRECOMMENDATION(S):  Chest CT for further evaluation of lung mass and bilateral\npulmonary nodules\nCystoscopy for further evaluation of bladder wall thickening\nPelvic ultrasound in 6 months."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.  The\nappendix is normal.  The bladder wall is thickened with extensive\ntrabeculation and appears progressed compared to prior.  There are 3 large\nstone redemonstrated in the bladder, with the largest measuring up to 3.2 cm. \nRedemonstrated dilation of the left ureter is worsened compared to prior. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 2.9 cm left ovarian cyst redemonstrated.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES AND SOFT TISSUE: Skin defect and thickening overlying the coccyx,\ntowards the left consistent with ulcer.  No drainable collection.  Subtle\nunderlying coccyx osseous erosion may suggest associated osteomyelitis.",
            "output": "1. Skin ulcer with underlying coccyx subtle cortical irregularity raises\nconcern for osteomyelitis.\n2. Extensive bladder wall thickening and left ureteral dilatation has\nprogressed compared to prior, and may be secondary to inflammatory change in\nthe presence of multiple bladder stones, however underlying malignancy should\nbe considered.  Additionally, correlation with urinalysis should be performed\nto rule out infection.  Continued urology follow-up.\n3. Stable left ovarian cyst."
        },
        {
            "input": "LOWER CHEST: The previously seen bilateral lung bases consolidation has been\nimproved.  There are bilateral lower lung bases ___ opacities and\nperibronchial wall thickening which may be secondary to aspiration.  The heart\nis normal in sizes.  There is no pericardial thickening or effusion.  There is\naortic valve and mitral valve calcification.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is normal in sizes measuring 17.8 cm craniocaudally\nwith no discrete lesion.  There is no intrahepatic or extrahepatic biliary\nductal dilation.  The gall bladder is distended with no calcified stone\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: There is mild thickening of the left adrenal gland with no discrete\nlesion visualized.\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.\n\nGASTROINTESTINAL: There is a gastric tube with tip terminating in the gastric\nfundus.  The stomach is collapsed and poorly characterized.  The non-opacified\nsmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  There is a large amount of stool in the rectum.  There are\nscattered diverticula visualized in the ascending and descending colons.  The\nappendix is visualized and unremarkable.\n\nPELVIS: The urinary bladder is distended with air recanalized visiting the\nlumen likely from recent instrumentation. Please correlate clinically.\n\nREPRODUCTIVE ORGANS: The prostate is normal sized.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a 5.7 cm abdominal aorta aneurysm visualized with an\nendograft stent extending inferior to the ___ through bilateral common iliac\narteries.  There is no definite evidence of endoleak.  There is no\natherosclerotic disease is noted.\n\nBONES: There are chronic deformities involving the left sixth and seventh rib\nand the right eighth and ninth ribs.  There are moderate degenerative changes\nof the thoracolumbar spine.  There is unchanged plana deformity of the T8\nvertebral body with significant kyphosis.  There is also age indeterminate\ncompression deformity involving the L1 and L4.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.",
            "output": "1.  Bilateral lung bases ___ opacities in the peribronchial wall\nthickening which may be secondary to aspiration.\n2. Colonic diverticula.\n3.  Umbilical hernia.\n4.  A 5.7 cm evaluate abdominal aorta aneurysm with endograft covering.  No\ndefinite evidence of endoleak although evaluation is limited in the absence of\na noncontrast enhanced study.\n5.  Multiple ribs chronic deformity and vertebral body compression deformity."
        },
        {
            "input": "LOWER CHEST: There is a focal opacity involving the medial basal segment of\nthe right lower lobe.  No pleural effusions.  Extensive coronary artery\ncalcifications are present.\n\nABDOMEN:\n\nHEPATOBILIARY: A 5 mm hypodensity in the right hepatic lobe is too small to\ncharacterize by CT, but likely a cyst (2:20).  The liver otherwise\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. \nThe right kidney is mildly malrotated.  A 3.3 cm simple cyst in the right\nupper pole has enlarged since ___, when it measured 2.1 cm (2:52). \nRe demonstration of a 2.0 cm left lower pole cyst with slightly high internal\nattenuation contents, perhaps proteinaceous or hemorrhagic material.  It\ndemonstrated a similar density in ___, but was smaller at that time,\nmeasuring up to 1.2 cm.  Additional left upper pole hypodensity is too small\nto fully characterize.  There is no perinephric abnormality.  No evidence of\nhydronephrosis or hydroureter.\n\nGASTROINTESTINAL: There is a percutaneous gastrostomy catheter within the\nstomach.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Colon is unremarkable.  There is a 6.2 cm stool ball\nin the rectum, without adjacent wall thickening (2:96).  The appendix is not\ndirectly visualized, but no secondary findings of appendicitis are present.\n\nPELVIS: The urinary bladder contains a Foley catheter, and although it is not\nfully distended, appears to have hyperemic, thickened and irregular walls with\nadjacent fat stranding.  Both distal ureters demonstrate urothelial thickening\nand hyperemia.  There is fluid tracking along both ureters.  Mild presacral\nedema is noted.\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. \nGrade 1 retrolisthesis of L3 on L4 is unchanged since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Hyperemic, thickened bladder walls with adjacent fat stranding.  Fluid\ntracks along bilateral ureters, and both distal ureters demonstrates\nurothelial thickening and hyperemia.  Findings are concerning for urinary\ntract infection and cystitis, for which correlation with urinalysis is\nrecommended.\n\n2.  Focal opacity in the medial basal segment of the right lower lobe may be\ndue to atelectasis, however infection is not excluded.\n\n3.  Indeterminate 2.0 cm left lower pole renal cyst, with a slightly high\ninternal attenuation.  This may reflect hemorrhagic or proteinaceous products.\nHowever, nonemergent renal ultrasound is suggested for further\ncharacterization."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nLIVER:  The liver is normal in size and attenuation.  There is no intrahepatic\nbiliary ductal dilatation.  Of note, the liver dome is incompletely imaged.\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.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS:  The right kidney is within normal limits and shows no evidence of\nhydronephrosis.  There is mild hydronephrosis and ureteral dilatation of the\nleft kidney with a 4 mm left UPJ stone identified.  Of note, a 5.4 x 5.2 cm\nsimple renal cyst is seen originate from the upper pole of the left kidney.\n\nBOWEL: The small large bowel are normal in caliber.  There is diverticulosis\nof the colon without evidence of diverticulitis.\n\nVESSELS: The abdominal aorta is normal in caliber.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: The bladder is unremarkable.  The sigmoid colon and rectum are normal\nappearing.  There is no pelvic sidewall lymphadenopathy\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There is mild degenerative change of the\nlumbar spine particularly at L4-L5.  There are no suspicious osseous lesions\nidentified.",
            "output": "Mild left hydronephrosis and ureteral dilatation with a 4 mm left UPJ stone\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 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Interval\nincrease of the amount of free-fluid in the abdomen and pelvis, now moderate.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.\n\nLYMPH NODES: Interval mixed response.  Previously described adenopathy\nposterior to the left psoas has decreased in size now measuring 7.5 mm,\npreviously measuring 23 mm (series 4, image 85).\nInterval progression of left internal and external iliac lymphadenopathy now\nmeasuring 11 mm and 2 x 2.9 cm, previously measuring 9 mm and 8 x 6 mm (series\n4, images 102 and 100).\n\nInterval progression of a right lower quadrant mesenteric lymph node now\nmeasuring 1 cm, previously measuring 6 mm (series 4, image 83).\nProgression of an adenopathy abutting the third portion of the duodenum\n(series 4, image 73), now measuring 14 mm, previously measuring 7 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: Uncomplicated fat containing umbilical hernia.",
            "output": "1. Mixed response with interval improvement of the left posterior psoas\nlymphadenopathy however interval progression of mesenteric and left iliac\nlymphadenopathy.\n2. Interval progression of the ascites.\n3. Please refer to separate chest CT done the same day for thoracic Findings."
        },
        {
            "input": "LOWER CHEST: New, extensive peribronchovascular nodularity and ground-glass\nopacities in the imaged lung bases likely represents multifocal\ninfection/aspiration.  No pleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: There are several new peripherally hyperenhancing, centrally\nhypoenhancing lesions in the left (02:17) and right (02:18) hepatic lobes,\nmost likely representing progression of metastatic disease.\n\nMild intrahepatic biliary ductal dilatation is overall significantly improved\nfrom prior, although there appears to be focal severe dilatation of a left\nintrahepatic biliary duct (02:16) measuring up to 9 mm diameter.  An internal\nexternal PTBD is in situ, with the distal internal end terminating in the\nproximal third portion of duodenum.\n\nThere is vicarious excretion of intravenous contrast in the gallbladder lumen.\nThe gallbladder is otherwise unremarkable.\n\nPANCREAS: A 5.4 x 4.6 cm (02:36) hypoattenuating lesion in the pancreas head\nis markedly bigger, previously not well defined.  A hypoattenuating nodular\nimplant along the anterior pancreatic body is also bigger at 3.3 cm (02:33),\npreviously 2.5 cm.  There is no main pancreatic ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  A 3.1 cm hypoattenuating nodule at the splenic\nhilum is similar (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. \nThere is no evidence of focal mass lesions.  Fullness of the bilateral renal\npelvises and ureters is similar, most likely secondary to mass effects from\npelvic involvement of malignancy.\n\nGASTROINTESTINAL: The distal esophagus and stomach are markedly distended. \nThere is a transition point at the descending duodenum from the aforementioned\nlarge pancreatic head mass (601:26), with a possible component of direct\nduodenal invasion given its abnormal heterogeneous appearance.  Distal small\nand large bowel loops are decompressed.  There is new wall thickening of the\ncolon, which is nonspecific and may represent colitis, but may also be\nsecondary to venous congestion given obliteration of portions of the SMV and\nits tributary branches.\n\nSmall volume ascites is new.  No organized fluid collections are seen.\n\nPELVIS: Abnormal thickening and hyperenhancement of the left superolateral\nbladder wall (601:26) up to 1.0 cm is progressed, previously 0.6 cm.\n\nPelvic metastatic disease is overall increased with enlargement of several\nlarge metastatic implants in the left and posterior pelvis.  For example, a\nlarge conglomeration of soft tissue anterior to the sacrum now measures up to\n6.1 cm (2:72), previously 5.1 cm.  A large soft tissue mass along the left\nanterior pelvic sidewall measures up to 5.0 cm (2:70), previously 4.6 cm.\n\nLYMPH NODES: Prominent, extensive periportal, mesenteric, aortocaval and\npelvic sidewall lymphadenopathy is progressed.  For example, a large\nconglomeration of mesenteric lymph nodes in the right mid abdomen (02:55) span\nup to 9.2 cm, previously 7 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Severe compression of the IVC from lymphadenopathy is progressed. \nThere it are several areas of focal compression/obliteration of the SMV and\nits tributary branches secondary to mesenteric lymphadenopathy, for example\n(601:24)\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. Overall diffuse progression of metastatic disease in the abdomen and\npelvis, as detailed above.\n2. Upper gastrointestinal obstruction with transition point at the descending\nduodenum secondary to mass effect from large infiltrative pancreatic head mass\nand periportal adenopathy, with probable invasion of the duodenum.\n3. New, extensive peribronchovascular nodularity and ground-glass opacities in\nthe imaged lung bases is compatible with multifocal infection/aspiration.\n4. Internal-external PTBD in situ with interval improvement in intrahepatic\nbiliary dilatation, although there is focal severe dilatation of a left\nintrahepatic duct up to 9 mm in diameter.\n5. Progressed mesenteric and retroperitoneal lymphadenopathy results in severe\ncompression of the IVC and severe compression/obliteration of portions of the\nSMV and is tributary branches.\n6. New colonic wall thickening is favored to be secondary to venous congestion\ngiven above vascular findings, however colitis of an infectious/inflammatory\netiology is also a possibility.\n7. New small volume ascites.  No focal organized 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 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: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.  Within the resection bed is a hypodense collection\nmeasuring 2.7 x 3.3 x 2.6 cm (2:107, 602:42).  The urinary bladder and distal\nureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nRETROPERITONEUM/LYMPH NODES: There is extensive retroperitoneal\nlymphadenopathy predominantly in the left periaortic station with a nodal\nconglomerate measuring up to 9 cm in length (601:37) and 1.8 cm in diameter\n(2:75), in addition to haziness and stranding surrounding the proximal left\nureter just anterior to the left psoas (2:76).  There is a prominent\nnonenlarged gastrohepatic lymph node that measures 6 mm (02:49).  There is no\nretroperitoneal 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post hysterectomy and bilateral salpingo-oophorectomy with extensive\nretroperitoneal lymphadenopathy, and haziness about the proximal left ureter\nwith a hypodense collection in the resection bed highly concerning for\nrecurrent disease.\n2. Please see same day CT chest for characterization of intrathoracic\nfindings."
        },
        {
            "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.\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\nThe uterus and ovaries have 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 mild atherosclerotic calcifications of the abdominal\naorta.\n\nThe portal vein and hepatic veins are patent.\n\nA filling defect is seen in the right common femoral vein, likely due to\nmixing artifact.\n\nLymph nodes: There has been interval improvement of the retroperitoneal\nlymphadenopathy.  For instance, the largest para-aortic lymph node is seen on\nthe left, measuring 0.9 cm, series 4, image 66, previously measuring 2.0 cm.\n\nHowever, new lymph nodes are seen, which are not previously seen.  A 2.3 cm x\n1.7 cm soft tissue nodule is seen at the posteromedial aspect of the\niliopsoas, series 4, image 85.  A left external iliac lymph node is seen\nmeasuring 0.8 cm, not previously seen.  A left internal iliac 0.9 cm lymph\nnode is seen as well, not seen previously.  A new periceliac lymph is seen,\nmeasuring 1.0 cm in short axis, seen on series 4, image 54.\n\nBone and soft tissues: There is no suspicious bone lesion. There is mild\ndegenerative disc disease.",
            "output": "Mixed response to treatment, with interval improvement of the retroperitoneal\nlymphadenopathy, but new 2.3 cm x 1.7 cm soft tissue nodule seen at the\nposteromedial aspect of the iliopsoas, and new left external iliac, left\ninternal iliac and periceliac lymph nodes, 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 focal fatty deposition along the falciform ligament.  There is no\nevidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \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. Note is made of a small accessory spleen (05:15).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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. There is a\nmoderate fecal burden.\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 for\nthe patient's 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 atherosclerotic disease\nis noted.\n\nBONES: There 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 process in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Moderate fecal burden, correlate for constipation.\n3. 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: Wedge shaped hypoattenuating areas extending to the periphery,\npredominantly within the right hepatic lobe, are consistent with pathy areas\nof hepatic steatosis.  Focal fat is also noted adjacent to the falciform\nlesion.   The there is no evidence of concerning 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 are at least 3 nonobstruction calculi at the right renal\nsuperior pole calyx, the largest of which measures 1.2 cm (02:27).  Cortical\ndefect within the upper pole of the right kidney likely represent sequela of\nprior ischemic or infectious insult.  The left kidney is unremarkable.  No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  G-tube is noted in situ. 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 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, including calcified plaques at the origins of the celiac,\nSMA, bilateral renal and bilateral common iliac arteries without complete\nluminal occlusion.\n\nBONES: The bones are osteopenic.  There are chronic fractures of the right\ninferior and superior pubic rami with callus formation without bony bridging\nof the fracture sites.  There is also a right sacral ala chronic fracture. \nThese are chronic in appearance but new from ___ CT abdomen and\npelvis.\nLeft femoral intramedulary rod is re-demonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patchy hepatic steatosis without concerning focal liver lesions.\n2. Nonobstructing right renal calculi measuring up to 1.2 cm.\n3. No abdominopelvic metastatic disease.\n4.  Healing ( subacute to chronic) right pubic rami and sacral ala fractures\nwith callus formation are new from ___ CT abdomen and pelvis from\noutside facility."
        },
        {
            "input": "LOWER 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: There is a 1.4 cm nonobstructing stone at the midpole of the right\nkidney.  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.\n\nGASTROINTESTINAL: There is a PEG tube in place.  The stomach is otherwise\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 is nondistended.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There are calcified fibroids within the uterus. 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.\n\nBONES: There is an IM rod and screw fixating the left humerus.  There is an\nold fracture deformity of the right inferior and superior pubic ramus. 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. There is no evidence on CT of the abdomen/pelvis concerning for metastatic\ndisease.\n2. Evidence of prior pelvic trauma of uncertain age or etiology.  An addendum\ncould be dictated assessing interval change if prior studies become available.\n3. Please refer to dedicated CT of the chest for further characterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 is markedly atrophic.  There is no peripancreatic\nstranding or pancreatic duct 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 with normal nephrogram. \nThere is suggestion of urothelial enhancement of the left renal pelvis.  There\nare subcentimeter hypodense lesions in the left kidney that are too small to\ncharacterize.  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\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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Suggestion of urothelial enhancement of the left renal pelvis, which may\nrepresent urinary tract infection.  Recommend correlation with urinalysis.\n2. No bowel obstruction or bowel wall thickening.\n\nNOTIFICATION:  Updated findings were communicated with ___, MD by\n___., MD via telephone on ___ at 15:54."
        },
        {
            "input": "LOWER 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 3.7 cm cyst in segment 8. No lesions concerning for metastases are\ndemonstrated.  There is no biliary dilation.  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:\n\nAs demonstrated on the prior CT, there is a 7.3 x 6.7 x 7.3 cm heterogeneously\nenhancing right upper renal mass extending into the renal pelvis and abutting\nthe collecting system.  The anterior border of the mass abuts the posterior\nsurface of liver in the hepatorenal fossa but there is no evidence of gross\ninvasion.  There is also no evident involvement of the adrenal gland.\n\nContiguous with the mass, there is extensive tumor thrombus expanding the\nright renal vein and suprarenal IVC, with soft tissue mass extending into the\nright atrium.  The atrial component has been better evaluated with\nechocardiogram ___ and is not well evaluated on the CT due to near\nisoattenuation on portal venous and delayed phases, with only partial capture\non the arterial phase.  There is slight projection into the origin of the\nright hepatic vein (10:73) but otherwise no significant hepatic venous\ninvolvement.\n\nThere is no hydronephrosis.  The left kidney is unremarkable.\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 and bilateral adnexae are grossly 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 7.3 cm right renal mass (arterially hyperenhancing, likely clear cell RCC)\nwith extensive tumor thrombus throughout the right renal vein and IVC,\nextending into the right atrium.\n2. No evidence of nodal or remote metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report for CT chest."
        },
        {
            "input": "LOWER CHEST: Mild, dependent atelectasis.  No pleural or pericardial effusion.\nThe heart is mildly enlarged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic and extrahepatic\nbiliary dilatation is likely following 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 is enlarged, measuring 18.6 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. \nA cyst of the upper pole of the left kidney measures 2.8 cm.  Nonobstructing\nleft renal stones measure up to 1.2 cm.  No hydronephrosis of either the left\nor right kidney.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Anastomotic sutures are\ndemonstrated within the mid and left lower hemiabdomen.  The remaining small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Colonic diverticulosis, without evidence of acute diverticulitis.\n\nPELVIS: The 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPosterior fusion hardware spans L3-L5, with interbody fusion.  Right shoulder\narthroplasty incompletely imaged.\n\nSOFT TISSUES: Postsurgical changes are demonstrated following ventral hernia\nrepair.  A large ventral abdominal hernia contains multiple nonobstructed\nbowel loops.  Suspected tethering of small bowel loops to the anterior wall of\nthis hernia.",
            "output": "1. Postsurgical changes following ventral hernia repair.  Large ventral\nabdominal hernia, containing multiple nonobstructed bowel loops.  Suspected\ntethering of small bowel loops to the anterior wall of this hernia.\n2. Splenomegaly.\n3. Nonobstructing left renal stones, measuring up to 1.2 cm.  No left\nhydronephrosis."
        },
        {
            "input": "LOWER CHEST: Aside from bibasilar atelectasis, visualized lung fields are\nwithin normal limits.  There 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\nbiliary dilatation.  The CBD is mildly enlarged measuring at 8 mm, doubtful\nclinical significance. The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 with partial gastrectomy. \nDilute contrast is seen within the excluded stomach raising potential concern\nfor a gastrogastric fistula.  There is no evidence of bowel obstruction as\ncontrast material is seen within the cecum.  The remaining small bowel loops\ndemonstrate mild dilated caliber.  Otherwise, there is normal wall thickness,\nand enhancement throughout. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening and fat stranding. The appendix is\nmarkedly inflamed and thickened, measuring up to 10 mm.  There is extensive\nstranding with small amount of fluid surrounding the appendix.  In addition,\nthere is a tiny locule of intraperitoneal gas adjacent to the ascending colon\n(2:60), likely representing ex peritoneal air secondary to perforation. \nHowever, there is no discrete, organizing fluid collection.\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.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 concerning for acute appendicitis complicated by micro perforation\nwithout drainable collection.\n2. Mildly dilated small bowel loops, likely reactive.\n3. Dilute contrast within the distended excluded stomach, cannot exclude\ngastro gastric fistula."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 stable subcentimeter hypodensity in segment 7.  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 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. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume nonhemorrhagic 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.  No atherosclerotic disease\nis noted.\n\nBONES: A faint sclerotic focus in the left iliac bone is stable. There is no\nevidence of new osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.",
            "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. No significant disagreement from the outside facility 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.  6 mm hypodensity is noted in segment\nVII (series 5, image 109).  A 5 mm only arterial enhancing foci is noted at\nthe hepatic dome, likely representing a transient hepatic intensity difference\n(series 4, image 11).  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. \nNo hydronephrosis.  4 mm cortical hypodensity too small to be characterized at\nthe interpolar of the right 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.  Previously biopsied rectal lesion is not\nidentified.\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.  There is a right\ncorpus uterus 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: 9 mm indeterminate sclerotic lesion in the left posterior iliac bone is\nnoted (series 5, image 184).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No focal concerning lesion in the abdomen pelvis.\n2. Indeterminate 9 mm lesion in the left iliac bone.  Attention on future\nfollow-up."
        },
        {
            "input": "LOWER CHEST: There is a 5 mm spiculated pulmonary nodule in the right lower\nlobe, unchanged compared to CT of the chest from ___ (2:9), but\nnew compared to screening CT of the chest from ___.  There is no\npleural or pericardial effusion..\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 3 mm calcification in segment VI (2:46),, stable and likely\nsequelae of old granulomatous disease.  There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  A 3\nmm hyperdense focus along the posterior wall of the gallbladder (2:61) likely\ncorresponds to the tiny polyp seen on abdominal ultrasound from ___.  There is no gallbladder wall thickening or surrounding inflammatory\nchange.\n\nPANCREAS: There is mild diffuse atrophy of the pancreas.  There is no evidence\nof focal lesions 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 no focal renal lesions.  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 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. A\n4 mm sclerotic focus in the left ilium (2:113) likely represents a bone\nisland.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings or evidence of malignancy in the abdomen or pelvis.\n2. 5 mm spiculated pulmonary nodule in the right lower lobe, unchanged\ncompared to CT of the chest from ___, but new compared to\nscreening CT of the chest from ___.  Follow-up noncontrast CT of\nthe chest in 6 months is recommended to assess stability.\n\nRECOMMENDATION(S):  Noncontrast CT of the chest in 6 months\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 23:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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: A 14 mm cyst in the interpolar left kidney (601b:33) is noted, as\nwell as multiple subcentimeter left renal hypodensities, which are too small\nto characterize. Otherwise, the kidneys present symmetric nephrograms\nexcretion of contrast. 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.\n\nREPRODUCTIVE ORGANS: A small calcification is noted in the prostate gland\n(2:81).\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. No acute pathology in the abdomen or pelvis.\n2. Left renal cyst, and subcentimeter hypodensities, too small to\ncharacterize."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: The visualized uterus and bilateral 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple scattered soft tissue densities intermixed with air is\nseen in the anterior abdominal wall subcutaneous tissues, and are most\nconsistent with injection granulomas.",
            "output": "No evidence of acute intra-abdominal or intrapelvic etiology for patient's\nsymptoms."
        },
        {
            "input": "LOWER CHEST:  The visualized lung bases are clear. There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. An\narea of subcapsular calcification likely represents old hematoma. There is no\nevidence 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\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.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Diverticula are seen in the sigmoid colon without\ninflammatory changes.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries. The main portal\nvein, splenic vein and SMV are patent.\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 uterus is absent. A tiny focus of air is seen at the vaginal cuff.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. There is a tiny fat containing umbilical hernia.",
            "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2.  Mild sigmoid diverticulosis without diverticulitis."
        },
        {
            "input": "LOWER CHEST: There is a 4 mm right subpleural nodule.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 6 mm hypodensity at the periphery of segment 3 (series 2, image 18)\nlikely representing a 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: There is a 12 mm right adrenal nodule as well as a 13 x 7 mm soft\ntissue density next to the left adrenal which is indeterminate.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 13 mm hypodense lesion at the inferior pole of the right kidney\nwith indeterminate density.  Other tiny hypodensity too small to be\ncharacterize also noted bilaterally.  No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Uncomplicated\ndiverticulosis.  The appendix is normal.\n\nPELVIS: The urinary bladder is not well-distended.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  No adnexal masses.\n\nLYMPH NODES: No abdominal or pelvic adenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Pedicle screws are seen in vertebral body of L4 and L5.  Severe right\nhip degenerative changes.\n\nSOFT TISSUES: Uncomplicated fat containing umbilical hernia with a neck\nmeasuring 11 mm no other abdominal wall hernia.  No soft tissue mass effect..",
            "output": "1. Indeterminate 13 mm lesion in the right lower kidney pole.\n2. 4 mm right subpleural nodule.\n\nRECOMMENDATION(S):\n1. Abdominal MRI to further characterize right indeterminate kidney lesion.\n2. 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\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "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: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:\nNodular contour of the liver is consistent with cirrhosis.\nThere are 3 radiofrequency ablation zones as before.  The ablation zone in the\nanterior left hepatic lobe (3B: 110) measures 4.8 x 2.9 cm, unchanged.  Area\nof increased enhancement at the anterior border of the lesion is again noted\nalthough much less prominent.\nAblation zone in the segment 8 (3b:113) measures 3.3 x 3.2 cm, slightly\nsmaller (previously 3.8 x 3.4 cm).\nAblation zone in segment 6 (3B:143) measures 3.4 x 2.6 cm, slightly smaller\n(previously 4.3 x 3.1 cm).\nMore inferiorly in segment 6, there is a 1.0 cm focus of hyper enhancement\n(3b: 153), similar to before.\nAdjacent to this is a new area of arterial enhancement, measuring 3.2 x 1.3 cm\n(3b:153).  This area is also continuous with the ablation zone in segment 6. \nNo washout is demonstrated in these areas of arterial enhancement.\n2 small millimetric hypodense lesions in segment 8 seen on delayed phase\n(06:13) are unchanged compared to ___.\nEvidence of portosystemic collateralization including gastric varices is again\nnoted.\n\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: Spleen is borderline enlarged, measuring 13.2 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. \nSeveral nonobstructing renal stones measuring up to 5 mm are identified in\nbilateral kidneys, unchanged from before.  A small hypodense lesion in the mid\nleft kidney is unchanged and is too small to be characterized.  There is no\nevidence of 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 is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.  A replaced left hepatic artery arises from left gastric\nartery.\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 and seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nmixed lucent and sclerotic changes at the lateral right seventh rib is\nunchanged and likely fibrous dysplasia.\n\nSOFT TISSUES: Small ventral hernia containing mesenteric fat and vessels is\nsimilar to before.  Small fat containing right lumbar hernia is again noted.",
            "output": "1. 3 RFA zones are again identified which are stable in size or slightly\nsmaller.\n2. New 3.2 x 1.3 cm area of arterial enhancement in liver segment 6. \nPreviously noted focus of arterial enhancement in segment 6 is unchanged.  No\nwashout is demonstrated in these areas.  Continued attention on follow-up is\nrecommended.\n3. No new liver lesion is identified.\n4. Replaced left hepatic artery."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Trace\npericardial effusion.  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 patient is status post right iliac fossa renal transplant,\nwithout evidence of hydronephrosis, stones, perinephric collection, or\nconcerning mass lesions.  The native kidneys appear shrunken and quite\natrophic.\n\nGASTROINTESTINAL:  There is a small hiatal hernia.  The stomach is under\ndistended, but grossly normal.  Note is made of circumferential wall\nthickening of multiple loops of proximal jejunum, with more normal appearing\nloops of small bowel distally.  Few small jejunal diverticula are also seen\n(601b:38).  Multiple small mesenteric nodes in the region of small bowel wall\nthickening are likely reactive.\n\nThe colon is without evidence of wall thickening or obstructive mass lesions. \nThe appendix is located in the right upper quadrant, and is normal appearing. \nThere 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\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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Small amount of extraperitoneal fat along the left inguinal\ncanal.  Mild anasarca.",
            "output": "1.  Circumferential wall thickening of multiple loops of proximal jejunum is\nconsistent with enteritis, which may be infectious, inflammatory, or less\nlikely ischemic.  Small bowel (jejunal) diverticula.\n2.  Few prominent regional mesenteric lymph nodes are likely reactive.\n3.  Unremarkable unenhanced appearance of the right iliac fossa renal\ntransplant.  Atrophic native kidneys.\n\nNOTIFICATION:  Wet read was discussed with Dr. ___ by Dr. ___\ntelephone at 22:37 on ___, approximately 30 min after discovery."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\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: Again seen is a small wedge-shaped hypodensity at the inferior aspect\nof the spleen (series 4, image 35) which is similar appearing to the prior\nexamination.  The spleen is otherwise normal.\n\nPANCREAS: The pancreas is normal with no evidence of ductal dilatation.\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: A small metallic density within the stomach is again visualized and is\nunchanged from the prior study likely to related to prior intervention.  Loops\nof small bowel are unremarkable.  The large bowel is seen filled with stool\nand is normal-appearing.  There is minimal fat stranding throughout the\nmesentery as well as multiple, prominent mesenteric lymph nodes, which are\nunchanged in size or character from the prior exam.\n\nVESSELS: There is a filling defect in the right common femoral vein (series 4,\nimage 86) which likely represents a clot.  Though this study is not\nspecifically designed to evaluate the venous system, there is no evidence of\nportal venous system clot. The abdominal aorta is normal in caliber and its\nmajor branches are patent.\n\nLYMPH NODES: As stated above, there are few prominent lymph nodes throughout\nthe mesentery without any meeting pathological enlargement by CT size\ncriteria. There are no pathologically enlarged retroperitoneal nodes.  Again\nseen are several calcifications throughout the retroperitoneum and in the\npelvis consistent with prior lymph angiogram from ___.\n\nPELVIS: There is minimal free fluid within the pelvis as well as minimal\nperihepatic and perisplenic ascites.  The bladder remarkable. The rectum and\nsigmoid colon are normal. There is no pelvic sidewall lymphadenopathy by CT.\nThere is a small fat containing right size criteria inguinal hernia.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. Filling defect in the right common femoral vein which most likely\nrepresents a clot. Recommend further evaluation with right lower extremity\nultrasound.\n2. No evidence of clot in the portal venous system.\n3. No significant change from the prior examination with regard to stranding\nwithin the mesentery and prominent mesenteric lymph nodes.\n\nNOTIFICATION:\n\n The findings were discussed by Dr. ___ with Dr. ___ Dr. ___\nOn the telephone on ___ at 4:37 ___, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. A calcified nodule is noted in the\nright middle lobe (series 2, image 11), not significantly changed. There is no\npericardial or pleural effusion..\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The gallbladder\nis normal without radiopaque stones. The portal vein is patent. There is no\nintra or extrahepatic biliary ductal dilation.  Trace ascites has improved.\n\nThe spleen, and adrenal glands, and pancreas, are unremarkable.\n\nThe kidneys demonstrate symmetric nephrograms and excretion of contrast. The\nureters are normal in caliber along their course to the bladder. No focal\nregion renal lesions are seen. There is no hydronephrosis.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is\ndecompressed. The small bowel is normal in caliber without focal wall\nthickening.\n\nThere is mild diffuse bowel wall thickening of the colon, to a much lesser\ndegree and then prior study from ___. The thickening is most pronounced\nin the cecum and ascending colon. There is a associated fat stranding with\nmild stranding along the root of the mesentery. There is no evidence of\nintra-abdominal free air. There is no evidence of pneumatosis or portal venous\ngas. There are no drainable intra-abdominal fluid collections.  The appendix\nis well visualized and normal.\n\nThe abdominal aorta and its major branches are patent. Dense stippled contrast\nalong the retroperitoneal and iliac lymphatics is unchanged in to the prior\nlymphangiogram.  A calcification is again noted within the stomach. Scattered\nmesenteric lymph nodes are again seen, and likely reactive. A small fat\ncontaining left inguinal hernia is noted.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Mild diffuse bowel wall thickening, overall improved from ___, may\nrepresent residual mild colitis. Differential including infectious,\ninflammatory etiologies.\n\nNOTIFICATION:  Updated findings discussed with Dr. ___ by Dr. ___\non ___ at 09:30."
        },
        {
            "input": "There is a calcified granuloma at the right lung base. No pleural or\npericardial effusion is seen.\n\nLIVER: Geographic hypodensity along the left lobe may be related to retractor\ninjury.There is no focal hepatic mass or intrahepatic biliary duct dilation.\nThe portal vein is patent. The nondistended gallbladder is within normal\nlimits, without wall thickening or pericholecystic fluid.\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: 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:There is mild wall thickening of the distal esophagus consistent with a\nmild esophagitis, with contrast seen within the distal esophagus likely\nrelated to the patient's nausea/vomiting. The patient is status post\ngastrectomy and Roux-en-Y surgery, with the expected postsurgical changes.  A\nsmall amount of non-organized free fluid adjacent to the gastrectomy bed is\nlikely postsurgical. Percutaneous jejunostomy tube is noted, unremarkable in\nappearance. The small and large bowel demonstrate normal caliber, without wall\nthickening or evidence of obstruction. The large bowel is fluid-filled.\n\nRETROPERITONEUM: The aorta is normal in caliber, with no atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.  Hyperdense material within the\nretroperitoneal and iliac lymphatics is noted, likely related to prior\nlymphangiogram.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.  Midline\nskin staples are seen within the anterior abdomen.",
            "output": "1. Status post gastrectomy and Roux-en-Y surgery, with the expected\npostsurgical changes including a small amount of free fluid in the gastrectomy\nbed.  No evidence of bowel obstruction or drainable fluid collection.\n2. Thickening of the distal esophagus and contrast within the distal\nesophageal lumen likely related to esophagitis and reflux, given the patient's\nnausea and vomiting.\n3. Geographic hypodensity along the left lobe of the liver is likely related\nto retractor injury."
        },
        {
            "input": "CHEST:  A calcified granuloma is seen in the right lower lobe (2:7).  Linear\natelectasis is noted left lung base. Tiny surgical clips are seen along the\nleft anterolateral low chest wall.\n\nABDOMEN: Patient is status post gastrectomy. Suture material is noted at the\ndistal esophagus at the level of esophagojejunostomy. There is a small amount\nof adjacent free fluid which is not significantly changed from prior exam.\nThis patient is known to have retractor injury to segment 2 of the liver with\na linear hypodensity again seen consistent with laceration. Adjacent small\nvolume free fluid is noted. Liver appears otherwise unremarkable. Main portal\nvein is patent. Biliary tree appears normal. The gallbladder is normal. The\nspleen is top-normal in size measuring 13 cm in length. This pancreas and\nadrenal glands appear normal. The kidneys enhance symmetrically excrete\ncontrast promptly. Hyperdense appearance of the retroperitoneal and pelvic\nlymph node chain is consistent with prior lymphangiogram. The abdominal aorta\nis normal in course and caliber with widely patent major branches.\n\nThe small and large bowel are normal in caliber and without evidence of wall\nthickening. Since the prior exam, the jejunostomy tube has been retracted by\napproximately 11cm.  The jejunostomy tube enters the left mid abdominal wall\ntraversing the left rectus muscle, with the tip extending just 1-2 cm deep to\nthe anterior abdominal wall (2:43). The jejunostomy catheter tip appears to be\nintraluminal. No free air, fluid, or fat stranding is seen in the adjacent\nfat. Clips are seen adjacent to the jejunostomy tube.\n\nThere is mild haziness along the small bowel mesentery with several lymph\nnodes noted, unchanged compared to the prior study. No bowel obstruction is\nseen. SMV is patent.\n\nPELVIS: The appendix is normal. There is no pneumoperitoneum.\nThe bladder, sigmoid colon, and rectum are grossly unremarkable.  Mild fecal\nloading. There is no pelvic side-wall or inguinal lymphadenopathy by CT size\ncriteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Postsurgical changes in the upper abdomen from recent gastrectomy and\nesophagojejunostomy with known retractor injuries to segment 2 of the liver.\nSmall volume adjacent free fluid is again noted.\n2.  Interval retraction of jejunostomy tube with tip likely residing within a\nJ jejunal loop just deep to the insertion site. Findings were discussed in\nperson with Dr. ___.\n\nNOTIFICATION:  Findings were telephoned to Dr. ___ by Dr. ___\non ___ at 9:53AM."
        },
        {
            "input": "THORAX: As before, a calcified granuloma is seen in the right lower lobe,\nunchanged in size or character. The lung bases are otherwise clear. Surgical\nclips are seen along the left ventrolateral low chest wall as before. The\nheart and pericardium are within normal limits.\n\nABDOMEN: The liver enhances homogeneously and there is no focal liver lesion.\nThe hepatic and portal veins are patent.  Linear hypodensity seen within\nsegment 2 of the liver is consistent with a retractor injury from prior\nsurgery and a is stable in appearance from the prior study. The gallbladder,\npancreas, spleen, and adrenals are normal. The kidneys enhance symmetrically\nand excrete contrast without evidence of hydronephrosis or mass.  The patient\nis status post gastrectomy. Suture material is noted at the distal esophagus\nat the level of the esophagojejunostomy. The small bowel is normal in caliber\nand the colon is normal appearing. A J tube is seen terminating in the mid\nabdomen. Hyperdense appearance of the retroperitoneal and pelvic lymph node\nchain is consistent with prior lymphangiogram. The aorta is normal in caliber.\nThere is no portacaval, mesenteric and retroperitoneal lymphadenopathy. There\nis no free air or free fluid.\n\nCT PELVIS: The appendix is normal. The colon, rectum, and urinary bladder are\nnormal. There is no pelvic lymphadenopathy or free fluid.\n\nOSSEOUS STRUCTURES: There are no suspicious lytic or blastic lesions\nidentified.  Mild degenerative changes are seen throughout the thoracolumbar\nspine, as before.",
            "output": "Normal appendix. No evidence of colitis. No free air or fluid collection\nidentified in the abdomen or pelvis. The patient is status post gastrectomy\nand J-tube placement. No acute intra-abdominal or intrapelvic process\nidentified."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac axis, SMA, ___,\nrenal and iliac arteries and their major branches are patent with no signs of\nocclusive or aneurysmal disease. The portal system including SMV, splenic and\nportal veins is patent. The renal veins, iliac veins and IVC are patent and\ndemonstrate normal caliber.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  Calcified\ngranuloma is seen within the right lower lobe.  There is no 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,\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. \nSmall left renal cortical hypodensities may represent cysts, too small to\naccurately characterize (03:38, 58).  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.\n\nGASTROINTESTINAL: Patient is status post gastrectomy without evidence of\nanastomotic complication at the esophagojejunostomy.  Additional suture lines\nin the left upper quadrant indicate additional anastomoses appear\nunremarkable.  There no dilated loops to suggest obstruction.  There is a\nmoderate colonic fecal load.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nHyperdensity within the iliac chain and retroperitoneal lymph nodes is\nconsistent with prior lymphangiogram.\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 and seminal vesicles are normal.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia (3:82) and a\nsmall fat containing right inguinal hernia (3:137).",
            "output": "1. No acute intra-abdominal process.\n2. Status post multiple intra-abdominal surgeries without evidence of\nanastomotic complication or bowel obstruction.\n3. Patent abdominal vasculature without evidence for mesenteric ischemia."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits, except for an\nunchanged right lower lobe calcified granuloma measuring 5 mm (2:5). 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. \nMillimetric left renal hypodensities are too small to characterize by CT, but\nare statistically likely cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is post gastrectomy and esophagojejunostomy,\ndenoted by suture lines at the anastomosis (2:10) and at another anastomosis\nin the left upper quadrant (2:14).  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  Oral contrast is present\nin multiple nondilated small bowel loops.  The colon and rectum are normal in\ncaliber.  The appendix is normal (60___:27).\n\nHowever, since ___, there has been interval development of a large\namount of nonhemorrhagic mesenteric fluid.  No evidence of free\nintraperitoneal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nmoderate to large amount of nonhemorrhagic fluid in the pelvis (2:73).\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.  Hyperdensity within the iliac chain\nand retroperitoneal lymph nodes is consistent with prior lymphangiogram.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Except for postsurgical changes, the abdominal and pelvic wall\nis within normal limits.",
            "output": "1.  Since ___, interval development of extensive nonhemorrhagic\nmesenteric fluid, for which the differential diagnosis includes mesenteritis.\n\n2.  Small and the large bowel loops are normal in caliber.  Patient is post\ngastrectomy with an unremarkable anastomoses at the site of the\nesophagojejunostomy.  No evidence of free intraperitoneal air.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 00:30 on ___, 5 min after discovery.\n\nThe updated impression was communicated via telephone by Dr. ___ to Dr.\n___ at 08:38 on ___, 10 min after discovery."
        },
        {
            "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 stable intra and extrahepatic\nbiliary ductal prominence.  The gallbladder is prominent without surrounding\nfluid or 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 patient is status post gastrectomy without evidence of\ncomplication at the esophago jejunostomy.  The additional anastomosis denoted\nby suture line in the left upper quadrant is also unremarkable.  Loops of\nsmall bowel are normal in caliber, wall thickness, and enhancement.  The\nappendix is not visualized.  High-density foci adjacent the bilateral iliac\nvessels is unchanged since ___ and compatible with prior\nlymphography.\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 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": "No definite findings to explain patient's symptoms."
        },
        {
            "input": "Lungs and Heart: There are very large bilateral pleural effusions with\nadjacent compressive atelectasis in both lungs. A pericardial drain is seen. \nA calcified granuloma at the base of the right lung is not changed from the\nprior study.\n\nLiver, Gallbladder: The liver is normal in size and attenuation. There are no\nfocal lesions seen.  There is very minimal perihepatic fluid adjacent to the\ngallbladder and in the porta hepatis.  The gallbladder is unremarkable.\n\nSpleen: The spleen is normal in size and attenuation. There is trace\nperisplenic ascites.\n\nPancreas: The pancreas is normal in size and attenuation.  There is no\npancreatic ductal dilatation or focal lesion seen.\n\nKidneys, Adrenals: The bilateral adrenal glands are normal.  The kidneys are\nnormal and show no evidence of focal lesion or hydronephrosis.\n\nStomach, Bowel: The mesentery is hazy consistent with edema.  There is no\nlarge volume free fluid seen in the abdomen.  The small and large bowel are\ngrossly normal in appearance with no evidence of focal wall thickening.  The\nappendix is not clearly visualize however there are no secondary signs of\nappendicitis seen.\n\nVessels: The aorta is of normal caliber and its major branches are patent.\n\nLymph Nodes: There is no appreciable mesenteric or retroperitoneal\nlymphadenopathy. Again seen is hyperdense material along the preaortic,\ninguinal and pelvic sidewall lymph nodes which is most likely lipoidal from\nprior lymphangiogram.\n\nPelvis: There is no pelvic sidewall lymphadenopathy. The bladder is normal\nappearing a Foley catheter is seen in appropriate position. The rectum and\nsigmoid are unremarkable.\n\nOsseous Structures: No suspicious lytic or blastic lesions are identified in\nthe skeleton\n\nThere is significant soft tissue edema involving the abdomen bilateral lower\nextremities.",
            "output": "1. No cause for acute pain identified in the abdomen or pelvis. The appendix\nis not clearly visualized however there are no secondary signs of\nappendicitis.\n2. Bilateral, very large pleural effusions with adjacent compressive\natelectasis.\n3. Significant subcutaneous edema and edema involving the mesentery with no\nlarge intra-abdominal or intrapelvic fluid collection identified."
        },
        {
            "input": "CHEST:\n\nFor details regarding the chest including moderate bilateral nonhemorrhagic\npleural effusions and a drain within the pericardium with pneumopericardium,\nplease see dedicated chest CT report\n\nABDOMEN:\n\nEvaluation of the solid organs and tissues is limited without intravenous\ncontrast. The liver has a normal noncontrast appearance with no focal lesions\nor intrahepatic biliary dilatation. The gallbladder, pancreas, spleen and\nadrenal glands are unremarkable.  The kidneys have a normal noncontrast\nappearance without stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  High density is again seen in the multiple retroperitoneal,\npelvic and inguinal lymph nodes, unchanged from prior possibly related to\nprior lymphangiogram.  There is trace perihepatic ascites. No free air or\nabdominal hernia. No retroperitoneal hematoma is identified.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is a trace amount of fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.  There is\nextensive body wall edema",
            "output": "1. No evidence of hematoma in the abdomen or pelvis\n2. Persistent anasarca with a small amount of free fluid in the abdomen and\npelvis\n3. For details regarding the chest please see dedicated chest CT report"
        },
        {
            "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 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 accessory spleen seen medially.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The sigmoid colon\nis notable for multiple diverticula, wall thickening, hyperemia, and\nsurrounding mesenteric fat stranding (series 2, images 75-80).  Additionally,\nin the anti dependent portion of the abdomen, there are multiple locules of\nfree air, suggestive of acute perforated diverticulitis.  No related fluid\ncollections or fistula are 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: Mild retrolisthesis of L5 on S1.  At L5-S1, there is also joint space\nnarrowing, osteophyte formation, and subchondral sclerosis representing\nmoderate degenerative change.  Mild anterior wedging of the T8 vertebral body\nappears chronic.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Complicated sigmoid diverticulitis.  No loculated fluid collection.\n\nRECOMMENDATION(S):  Given the degree of sigmoid colon wall thickening,\nfollowing treatment, recommend colonoscopy or repeat imaging to exclude an\nunderlying malignancy."
        },
        {
            "input": "LOWER CHEST:\nPunctate calcification is noted in the anterior left lung base consistent with\na granuloma. Imaged bilateral lung bases are clear.  Imaged portion of heart\nand pericardium appear unremarkable.\n\nABDOMEN:\n\nGENERAL:  There are multiple large loculated gas containing fluid collections\nconsistent with abscesses throughout the abdominal cavity, some in\ncommunication with another.  These show thick enhancing rims.  There is no\nevidence of oral contrast extravasation into these collections.  The largest\npockets are measured as follows:\nA pocket in the right upper quadrant (5:35) measure 3.8 x 9.4 cm.\nA pocket in the right lower quadrant lateral to the ileostomy location,\nmeasures 7.5 x 9.0 cm.\nA pocket in the left mid abdomen measures 5.2 x 11.3 cm (5:37).\nA pocket in the left upper quadrant in subdiaphragmatic location measures 6.5\nx 12.6 cm.  This collection is contiguous with the infarcted portion of the\nspleen and may extend into the spleen.\nAn extension of fluid is seen deep to the surgical incision at the midline\nmeasuring 1.4 x 4.4 cm, and this may be in communication with the right upper\nand left mid abdominal collections anteriorly.  This may communicate with the\nsurgical incision in several locations (5:19, 05:55 as representative images).\nAt least one track contains gas (5:19).\n\nThe embolization coils in the left upper quadrant is compatible with recent\nsplenic artery embolization.  No evidence of extravasation of contrast on this\nsingle phase examination.\nGASTROINTESTINAL:  Patient is status post right-sided partial colectomy. \nSuture material is noted at the left upper quadrant at what appears to be a\nproximal descending colon ___ pouch.  Stool fills the colonic remnant. \nThere is a right sided end ileostomy.  Patient is also status post partial\ngastric resection and G tube placement.\nThere are dilated small bowel loops without a bowel obstruction; oral contrast\nhas passed to the ileostomy bag. Circumferential surgical suture material is\nnoted at the sigmoid.\n\nHEPATOBILIARY:  The liver is unremarkable.  There is no biliary duct dilation.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nADRENALS:  Unremarkable.\nSPLEEN:  As above.\nURINARY: The kidneys are unremarkable.\n\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.  No extravasation is\nidentified.  Splenic artery embolization coils.\n\nPELVIS:\nGas is noted in the bladder, likely related to possible prior instrumentation.\nProstate is unremarkable.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1.  Multiple intraabdominal gas and fluid containing collections consistent\nwith abscesses.  There is no evidence of oral contrast extravasation to\nsuggest enteric leak.  Collections may communicate with the surgical incision\nat several sites.\n2.  Splenic infarct with apparent communication with a left upper quadrant\nabscess.  Prior splenic artery embolization with no evidence of extravasation\nof contrast.\n3.  No evidence of bowel obstruction.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with ___, NP on the\ntelephone on ___ at 3:50 ___, 5 minutes after discovery of the findings."
        },
        {
            "input": "Lingular calcified granuloma is partially visualized.  Minimal left base\natelectasis.\n\nPercutaneous drains are present within the left upper quadrant, left lower\nquadrant and right lower quadrant. Again demonstrated is contrast\nextravasating from the gastric fundus into the collection anterosuperior to\nthe spleen with an air-fluid level, which surrounds the pigtail catheter. No\nsignificant fluid collection remains around the other pigtail loops.\n\nNo focal liver lesions. Layering hyperdense material within the gallbladder,\nlikely small stones versus vicarious excretion of contrast. No significant\nbiliary dilatation. Patent portal veins. Pancreatic parenchyma appears\nunremarkable.\n\nMultiple splenic peripheral wedge-shaped hypodensities, likely infarcts,\nappears similar to prior.  Contrast from the adjacent stomach is noted\nextravasating within the infarcts.\n\nSymmetric contrast excretion of bilateral kidneys without hydronephrosis. No\nsuspicious renal lesions.\n\nGastrojejunostomy tube is present, terminating and the proximal ileum. There\nis interval resolution of possible small bowel pneumatosis since the prior\nscan. Colorectal anastomosis appears intact. Patient is post right and\ntransverse colectomy, without adjacent fluid collection or appearing contrast\nextravasation. Overall prominence of small bowel loops is present, maximum\ndiameter 4.3 cm within the pelvis, polyp focal transition point.  Right lower\nquadrant ileostomy is demonstrated with contrast within the stoma bag.\n\nNormal caliber abdominal aorta.\n\nNone evident foci of gas within the bladder, most likely secondary to recent\ncatheterization. No free pelvic fluid. Mild pelvic stranding is noted.\n\nMultilevel Schmorl's nodes. No suspicious osseous lesions.",
            "output": "-Left upper quadrant percutaneous pigtail drain is again demonstrated within\nperisplenic air-contrast collection and extravasation of oral contrast from\nthe gastric fundus, similar to prior\n-Left lower quadrant and right lower quadrant pigtail drains in place without\nsignificant surrounding fluid collection.\n-Interval resolution of previously demonstrated possible small bowel\npneumatosis.\n-No evident bowel obstruction with contrast extending through right lower\nquadrant ileostomy.\n-Gastrojejunostomy tube terminates within proximal jejunum.\n- Other findings as detailed above."
        },
        {
            "input": "VASCULAR:\n\nLOWER CHEST: Atelectasis versus scarring is present at the left lung base. The\nright lung base is clear. No pleural or pericardial effusion.  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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The patient is status post splenic artery embolization.  Wedge shaped\nhypodensity in the peripheral spleen probably reflects a prior infarction. \nThe 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:\n\nThe patient is a status post partial gastrectomy, as well as extended right\nhemicolectomy with right lower quadrant ileostomy.\n\nA chronic cavity posterior to the gastric fundus measuring approximately 3.0 x\n2.8 cm appears to communicate with the stomach (303:20, 602:104).  This cavity\nappears smaller than ___.  A small amount of hyperdense material is\ndemonstrated layering dependently along the in the gastric fundus on\nprecontrast images, without change on post-contrast images, possibly\nreflecting residual blood products (2:20, 301:39).\n\nSmall bowel loops are normal in caliber, including the ileostomy.  There is no\nparastomal hernia.  The remaining descending colon and rectum are\nunremarkable, including a pelvic anastomosis.  No free intraperitoneal air.\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 mildly enlarged with coarse internal\ncalcifications.  Seminal vesicles are unremarkable.\n\nVASCULAR: No abdominal aortic aneurysm.  Hepatic vascular anatomy appears\nconventional.  There is an accessory right renal artery supplying the inferior\npole.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Right lower quadrant ostomy is noted.  No parastomal hernia.",
            "output": "1. No evidence of active contrast extravasation.  A 3.0 x 2.8 cm cavity\nposterior to the gastric fundus likely reflects that seen postoperatively in\n___, and appears to communicate with the stomach.  This could potentially\nreflect the ulceration seen on recent endoscopy.  Complete evaluation of the\ncavity is slightly limited due to the absence of oral contrast.  No free\nintraperitoneal air.\n2.   Extensive postsurgical changes following partial gastrectomy and extended\nright hemicolectomy with right lower quadrant ileostomy.  No evidence of bowel\nobstruction or anastomotic failure.\n3.   Status post splenic artery embolization with chronic splenic infarct."
        },
        {
            "input": "LOWER CHEST:  Trace non-hemorrhagic left pleural effusion.  No 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. \nNo convincing evidence for nephritis.  A 7 mm hypodensity in the interpolar\nregion of the left kidney, and a smaller 4 mm hypodensity in the left lower\npole, are too small to characterize.  No hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastric banding.  Stomach is\notherwise unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  The colon and rectum are within normal\nlimits.  Normal appendix.  No ascites or pneumoperitoneum.\n\nPELVIS:  Urinary bladder is only minimally distended though the bladder wall\ndoes appear mildly thickened.  Perivesical and periureteral fat stranding\nsuggests infection.\n\nREPRODUCTIVE ORGANS: Prostate gland contains coarse calcifications.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Findings concerning for cystitis with ascending ureteral infection."
        },
        {
            "input": "CHEST: The visualized lung bases are clear with mild left basilar atelectasis.\nNo pleural effusion or pericardial effusion. The heart is top-normal in size.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by the lack of\nintravenous contrast. The liver and gallbladder are normal. The pancreas and\nspleen are unremarkable. The adrenal glands are normal bilaterally. The\nkidneys are normal in size and morphology with no stones or hydronephrosis.\nThe stomach and small bowel are normal in caliber. The appendix and large\nbowel are unremarkable. There are scattered colonic diverticula, without\nevidence of diverticulitis.  Terminal ileal diverticla are also seen.  There\nis stable thickening of the peritoneal fascia at the left dome of the bladder,\nwith soft tissue extending from the proximal sigmoid colon to the left bladder\ndome, representing sequelae of prior diverticulitis, with no fistula at this\ntime.  There is no mesenteric lymphadenopathy, free air, or free fluid.\n\nPELVIS: The urinary bladder, prostate, and seminal vesicles are normal. There\nis no pelvic free fluid or lymphadenopathy.\n\nVESSELS: The aorta is normal in caliber.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute intra-abdominal process.\n\nPancolonic diverticulosis without diverticulitis.\n\nSequelae of prior diverticulitis between the proximal sigmoid colon and left\nbladder dome."
        },
        {
            "input": "THORAX:  Consolidations in the right middle lobe and lingula are concerning\nfor pneumonia. The visualized heart and pericardium are normal.\n\nLIVER:  In the absence of IV contrast, the liver is normal in size and\nattenuation.\n\nGALLBLADDER: The gallbladder is decompressed. There is no evidence of\ncholelithiasis.\n\nSPLEEN: The spleen is normal-appearing.\n\nPANCREAS: The pancreas is within normal limits and there is no peripancreatic\nfat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS:  Kidneys show no evidence of hydronephrosis or stones.\n\nBOWEL: The stomach is seen filled with oral contrast and is within normal\nlimits. The small bowel is normal in caliber and shows no evidence of\nobstruction.  The appendix and large bowel are unremarkable. Again seen are\nscattered colonic diverticula without evidence of diverticulitis.  Few\nterminal ileal diverticula are again seen.  Stable thickening of the\nperitoneal fascia at the dome of the bladder is unchanged from the prior\nexamination and is consistent with sequela from prior diverticulitis.\n\nVESSELS: The abdominal aorta is normal in caliber.\n\nLYMPH NODES: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPELVIS: There is minimal thickening at the bladder dome as described above.\nThe bladder is otherwise normal. The rectum is within normal limits. There is\nsigmoid diverticulosis without diverticulitis. There is no pelvic sidewall\nlymphadenopathy.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "No acute intra-abdominal process.  Pancolonic diverticulosis with no evidence\nof acute diverticulitis.  No significant change from the prior study done on ___.  Thickening of the peritoneal fascia at the dome of the bladder\nis unchanged from the prior examination, however is minimally increased from\nthe CT done in ___ and is consistent with sequela from prior\ndiverticulitis.\n\nConsolidations in the right middle lobe and left upper lobe are concerning for\npossible pneumonia.\n\nNOTIFICATION:  Findings were communicated to Dr. ___ telephone at\n9:48 on ___ by Dr. ___."
        },
        {
            "input": "CT ABDOMEN:  The imaged portions of the lungs are clear. No pleural effusion\nis identified. The visualized heart and pericardium unremarkable.\n\nThe unenhanced appearance of the liver, pancreas, spleen and adrenal glands is\nunremarkable. The gallbladder is decompressed. The kidneys are unremarkable\nwithout evidence of hydronephrosis. There is no portacaval, mesenteric or\nretroperitoneal lymphadenopathy. There is no free air or free fluid.  The\naorta is non aneurysmal and there is no significant atherosclerotic\ncalcification of the main abdominal vessels.\n\nThere is mild diffuse stranding of the root of the mesentery. The small bowel\nis grossly unremarkable. The appendix is visualized and is not inflamed.\n\nThere is extensive colonic diverticulosis, more pronounced in the sigmoid.\nThere is mild stranding surrounding the sigmoid (series 2, image 72),\ncompatible with uncomplicated diverticulitis.  Of note, anterior to the\nurinary bladder there is residual stranding at the site of a prior\nintraperitoneal gas and fluid collection which communicated with affected\nsigmoid and was present in the previous exam (series 2, image 76). A tiny\nlocule of gas is still seen in this area. The portion of the urinary bladder\nadjacent to this area shows severe focal wall thickening measuring up to 2.8\ncm.\n\nCT PELVIS:  For description of the urinary bladder please see above. Bilateral\npelvic wall lymph nodes are not enlarged by CT size criteria. The prostate is\nunremarkable. There is no inguinal lymphadenopathy.\n\nOSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for\nmalignancy.",
            "output": "1.  Mild stranding surrounding the sigmoid may represent mild diverticulitis.\n\n2.  Severe focal urinary bladder wall thickening along the anterior aspect of\nthe urinary bladder adjacent to a region of a prior intraperitoneal abscess\nwhich communicated with the affected sigmoid colon raises concern for severe\nreactive cystitis versus developing colovesical fistula. There is no free air\nin the urinary bladder to suggest patent fistula. Further assessment with\ncystoscopy is recommended.\n\n3.  Mild diffuse stranding of the root of the mesentery is compatible with\npanniculitis, likely reactive to the recurrent peritoneal inflammation."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: The nonenhanced appearance of the liver is within normal limits,\nwithout obvious mass.  The nondistended gallbladder is within normal limits,\nwithout wall thickening or pericholecystic fluid.\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: The adrenal glands are unremarkable.\n\nKIDNEYS: The kidneys are symmetric and normal in size, without obvious mass or\nstone.\n\nGI:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized.There is colonic diverticulosis without evidence of acute\ndiverticulitis.  Mild sigmoid wall thickening and minimal fat stranding\nadjacent to the urinary bladder is decreased compared to ___, suggestive\nof resolving prior diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, without atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: There is persistent wall thickening of the urinary bladder adjacent\nto an area of diverticulosis.  Tiny foci of extraluminal air are again seen in\nthis region.  No discrete intraluminal focus of air is identified.There is no\npelvic wall lymphadenopathy.  Inguinal lymph nodes are prominent but not\npathologically enlarged by CT size criteria.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES/SOFT TISSUES:No focal lesion suspicious for malignancy\npresent.  A small fat containing periumbilical hernia is noted.",
            "output": "1. Diverticulosis, without evidence of acute diverticulitis.\n2. Persistent wall thickening of the urinary bladder adjacent to the site of\nprior sigmoid diverticulitis with persistent tiny foci of extraluminal air,\nwhich again could be concerning for developing colovesicular fistula. \nHowever, no discrete intraluminal focus of air is present. Given persistent\ninflammation over the past 2 months without improvement, consider cystoscopy\nto confirm that there is no underlying bladder mass lesion.\n3. Small fat containing periumbilical hernia.\n\nNOTIFICATION:  Additional recommendations were emailed by Dr. ___\nto the ED QA nurses at 1716 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 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.  Again demonstrated, is chronic\ncircumferential thickening of the sigmoid colon with lack of fat plane between\nthe sigmoid colon bladder consistent with a chronic colovesicular fistula.  No\nevidence of gas within the bladder.  No definite evidence of acute\ndiverticulitis.  The rectum isn't thin normal limits.\n\nPELVIS: The urinary bladder again demonstrates thickening of its superior\nwall, representing chronic colovesicular fistula.  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.  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": "Unchanged circumferential thickening of the sigmoid colon and thickened\nanterior superior bladder wall, most likely represents chronic diverticulitis\nwith chronic colovesicular fistula, as seen on prior imaging.  No evidence of\nacute diverticulitis otherwise."
        },
        {
            "input": "LOWER CHEST: 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 consistent\nwith hepatic steatosis.  There is no focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nanterior superior aspect of the bladder demonstrates unchanged wall thickening\nwhich is in close proximity to a loop of sigmoid colon.  This is consistent\nwith known chronic colonic fascicular fistula.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness. Redemonstrated is a focal segment of\nsigmoid colon demonstrating wall thickening without significant fat stranding.\nThis loop is in close proximity to the bladder without evidence of flat pain\nconsistent with known chronic colovesicular fistula.  No evidence of gas\nwithin the bladder.  No evidence of acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS: There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Stable known colovesical fistula, involving the distal sigmoid colon and\nthe anterior left bladder wall, without significant fat stranding, surrounding\nfluid, or sign of acute inflammatory changes.\n2. No evidence of acute diverticulitis.\n3. 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 homogenous attenuation throughout. \nThere is 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 is atrophic with 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 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.  Simple cyst in\nthe right kidney measuring up to 1.3 cm (2:31).  Unremarkable anastomosis in\nthe colon.  The rectum is within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\nUnchanged right anterior approach drainage catheter (2:50).  Fluid is nearly\ncompletely solved.\nRight posterior drainage catheter has been removed.  Instead a left posterior\ndrainage catheter has been placed into the pelvic collection (2:54) which has\nresolved.  No new collection.\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, notably in the origin of the SMA.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 over L5.  Mild retrolisthesis of L5 over S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right anterolateral pelvic drain in unchanged position with near complete\nresolution of pelvic collection.\n2. Interval removal of right posterior pelvic drain and placement of left\nposterior pelvic drain with near complete resolution of pelvic collection.  No\nnew collection.\n3. Uncomplicated cholelithiasis."
        },
        {
            "input": "LOWER CHEST: There is right basilar atelectasis.  A small right pleural\neffusion is also present.  ICD leads and postsurgical changes in the\nmediastinum are partially imaged.\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 normal attenuation throughout, without evidence of\nfocal lesions.  The pancreatic duct is dilated at the uncinate process\nmeasuring 5 mm (07:26).  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 few intermediate density lesions are seen in bilateral kidneys, measuring\n1.5 cm in the right kidney (07:38), 1.8 cm in the left kidney (07:35) and 1.1\ncm in the left kidney (07:30).  A few subcentimeter hypodensities are seen in\nbilateral kidneys, too small to characterize, likely simple cysts.   There is\nno 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\nappendix is normal.  Colonic diverticulosis is noted and enteric contrast is\nseen to the level of the rectum. There is extraluminal oral contrast  in the\npelvis likely from two tracts from the sigmoid colon.\n\nPELVIS: The urinary bladder is unremarkable.  Surrounding the sigmoid colon in\nthe upper pelvis and extending to the cul-de-sac, there is extensive fat\nstranding, free air, and some free fluid/contrast compatible with bowel\nperforation (07:31).  Pneumoperitoneum is seen extending up to the level of\nthe left upper quadrant.  No discrete fluid collection is present.\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.  The left hepatic artery branches off of the left gastric\nartery.  The main portal vein is patent.  There is extensive atherosclerotic\ncalcification of the origin of the SMA.\n\nBONES: Chronic left-sided mildly displaced rib fractures are again noted. \nGrade 1 anterolisthesis of L4 on L5 is again noted.  Endplate sclerosis of\nL4-5 is increased compared to the prior study, compatible with degenerative\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": "1. Extensive phlegmonous changes and pneumoperitoneum surrounding the sigmoid\ncolon and rectum  with extraluminal oral contrast concerning for colonic\nperforation, possibly in two  locations.  Findings may be secondary to\ncomplicated diverticulitis.  Surgical consult is recommended.\n2. Intermediate density lesions in bilateral kidneys previously characterized\nas simple cysts on ultrasound from ___.\n\nRECOMMENDATION(S):  Surgical consult is recommended.\n\nNOTIFICATION:   The findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:14 am, 15\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There has been interval increase in bilateral, nonhemorrhagic\npleural effusions, moderate on the right and small on the left. There is mild\nassociated atelectasis.\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 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.\n\nADRENALS: The 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 relatively hyperattenuating lesion in the left mid kidney has a\ndensity of 66 ___, and likely represents a hemorrhagic cyst.  There is no\nevidence of hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post\nsigmoid colectomy and left lower quadrant end colostomy.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  The\nappendix is normal.  No extraluminal contrast is identified.  A right lower\nquadrant abdominal drain terminates within the midline pelvis, where there is\na small amount of simple appearing fluid.  No rim enhancing fluid collections\nare identified.  There are a few residual scattered locules of gas throughout\nthe abdomen and pelvis, which are likely postsurgical or related to the prior\nbowel perforation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus and 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRe-demonstrated are nondisplaced fractures in the posterior left ninth and\ntenth ribs (02: 4, 11).  There is grade 1 anterolisthesis of L4 on L5.  There\nare moderate degenerative changes in the lower lumbar spine.\n\nSOFT TISSUES: There is diffuse anasarca.",
            "output": "1. Status post sigmoid colectomy and left lower quadrant end colostomy.  No\nextraluminal contrast or rim enhancing fluid collection.  Small amount of free\nfluid within the pelvis surrounding the abdominal drain is likely\npostsurgical.  However, close clinical follow-up and correlation with WBC is\nrecommended.\n2. Interval increase in bilateral, nonhemorrhagic pleural effusions.\n3. Re-demonstration of nondisplaced fractures in the posterior left ___ and\n___ ribs.\n4. Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: There is atelectasis at the lung bases and small to moderate\nbilateral pleural effusions are noted stable in size..  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.2 cm hypodense lesion in segment 4 B of the liver on series 5,\n___ 28.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains small 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. \nDense lesion in the interpolar region of the right kidney most consistent with\na cysts.  There is a hypodense lesion interpolar region of the left kidney\nthat is measuring 1.5 cm and 53 ___.  It is incompletely characterize and not\nsignificantly changed in size from ___.  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: Air is seen in the bladder likely due to recent instrumentation.  The\npatient is status post sigmoid colectomy and left lower quadrant end\ncolostomy.  Within the deep pelvis there is a 8.3 x 5.3 cm fluid collection\nthat contains a surgical drain this is slightly decreased in size previously\nmeasuring 9.0 x 5.5 cm.  A second collection posterior to the drain measures\n6.2 x 2.2 cm and is not changed in size.\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. \nOld fractures of the left posterolateral ribs are again noted\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Only minimal decrease in size of lobulated pelvic fluid collection now\nmeasuring 8.3 cm containing a surgical drain\n2. 1.5 cm indeterminate left renal lesion further evaluation with MRI should\nbe considered\n3. 1.2 cm liver lesions stable compared to ___ may represent an\nhemangioma and can be confirmed at the time of renal MRI\n\nRECOMMENDATION(S):  MRI of the kidneys for indeterminate lesion in the left\nkidney is recommended as an outpatient once the patient has recovered"
        },
        {
            "input": "Small bilateral pleural effusions have decreased in size since the ___ examination (series 2, image 3).  There is mild adjacent compressive\natelectasis.  There is no pericardial effusion.  The heart size is top-normal.\n\nThe liver density is within normal limits.  A 1.2 cm segment IV lesion is\nunchanged (series 2, image 25), previously characterized as a hemangioma. \nThere is no intra or extrahepatic bile duct dilation.  The gallbladder is\ndecompressed, containing a subcentimeter gallstone (series 2, image 29).\n\nThe pancreas demonstrates normal density, with mild atrophy, without focal\nmass or duct dilation.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  A well-circumscribed 1.2 x 1.4 cm right interpolar renal\nlesion is unchanged over multiple prior examinations, demonstrating\nintermediate density (series 2, image 35).  Subcentimeter hypodensity along\nthe lower pole the left kidney are also unchanged, too small to completely\ncharacterize, but also likely representing cysts (series 2, image 35, 33).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  The patient is post sigmoid colectomy with a left\nlower quadrant ostomy.  There is moderate distention of a loop of proximal\njejunum (series 601, image 24), without transition point, and oral contrast\nprogresses into the ileum without high-grade obstruction.\n\nThe bladder is mildly distended, and appears normal.  The uterus is in mid\nposition, and normal in size.  No concerning adnexal lesions are detected.\n\nA previously-seen presacral collection no longer demonstrates any appreciable\nresidual fluid.  A right posterior approach pigtail catheter remains in situ\n(series 2, image 57).  No new abdominopelvic collection is detected.\n\nMild anterolisthesis of L4 over L5 cannot minimal retrolisthesis of L5 over S1\nare unchanged (series 602, image 43).  There are no osseous lesions concerning\nfor malignancy or infection.\n\nThere are extensive atherosclerotic calcifications throughout the abdominal\naorta and iliac branches, without flow limiting stenosis or dissection.  The\nceliac trunk, SMA, and renal arteries are patent.",
            "output": "1. Interval resolution of a presacral collection, with a pigtail catheter\nremaining in situ.  No significant residual fluid remaining.  No new\ncollection.\n2. Post sigmoid colectomy with a left lower quadrant ostomy.  Moderate\ndistension of the loop of proximal jejunum without focal transition point,\nlikely ileus.\n3. Unchanged 1.4 cm right interpolar renal lesion remains indeterminate, and\ncan be followed on palpation MRI as recommended on the ___\nexamination.\n4. Small bilateral pleural effusions have decreased in size since ___."
        },
        {
            "input": "Heart is moderately enlarged.  Patient is status post replacements of the\ntricuspid and mitral valves.  Three lead pacemaker/ICD device is present.\n\nThere is a trace right sided pleural effusion and a small pleural effusion on\nthe left.  These are accompanied by minor atelectasis, again greater on the\nleft than right.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified.  There is no biliary dilatation.  Small calcified stone in the\ngallbladder in addition to the more vague hyper dense material may represent\nadditional stones or sludge.  Pancreas is moderately atrophic.  The spleen is\nnormal in size.  Adrenals are unremarkable.  Right kidney demonstrates mild\nhydroureteronephrosis which is probably due to mild ureteral obstruction by a\ncollection in the pelvis, unchanged.  No hydronephrosis on the left.  No\nstones.  In the mid to lower left kidney, hyperattenuating lesion measuring 12\nmm in diameter with density of nearly 70 Hounsfield units is most consistent\nwith a hemorrhagic cyst, stable finding.\n\nThe stomach is nondistended.  There is a small bowel small bowel anastomosis\nin the left upper quadrant.  Patient is also status post sigmoid colectomy\nwith a sigmoid rectal anastomosis.\n\nEndoluminal contrast has filled essentially the whole remaining colon in\nretrograde fashion.  There is mild-to-moderate narrowing at the anastomosis\nwithout upstream dilatation or obstruction to contrast flow.  There is an\nirregular collects presacral collection with contrast and fluid.  The superior\npart of this measures about 8.6 x 3.5 cm in axial ___ compared to 8.4 x\n4.5 cm on the prior day with increased air content and mild overall\ndecompression.  Inferior component lying immediately to the right of rectum\nwith mild mass effect on the mid rectum measures up to 55 x 38 mm in axial\n___, which is unchanged.  These collections likely interconnect\nposteriorly.  The contents are about 30 Hounsfield units suggesting debris in\naddition to fluid content.\n\nA catheter has been there is packing material along a posterior gluteal drain\ntrack with decompression of vague collections along the course of the track.\n\nUterus is difficult to separate from these as well as the right adnexa, but no\nindication of abnormality.  No left adnexal mass.  Bladder is collapsed and\ncontains a Foley catheter.  A right iliac venous catheter terminates in the\nproximal right common iliac vein.  Vascular calcification is moderately\nwidespread.  There is no lymphadenopathy.\n\nNonunited left posterolateral tenth rib fracture.  There are no suspicious\nbone lesions.",
            "output": "Mild decrease in air and fluid containing collection in the presacral space,\nsince the prior day, without evidence for contrast leakage into the\ncollection.  New packing along previous drain track with decompression of more\nsuperficial collections."
        },
        {
            "input": "LOWER CHEST: At least moderate bilateral pleural effusions have increased in\nsize compared to the prior examination of ___.  There is mild\noverlying compressive atelectasis.  Ill-defined parenchymal opacification of\nthe right middle lobe may reflect developing pneumonia and/or aspiration (for\nexample series 2, image 7).  No pericardial effusion.  The heart is markedly\nenlarged with incompletely assessed pacer leads.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatomegaly.  The liver has diffusely low density consistent\nwith steatosis.  There is no suspicious focal lesion.  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 solid renal lesions.  Trace bilateral perinephric\nfluid stranding.  Small bilateral renal cortical hypodensities are too small\nto characterize.  There is no hydronephrosis or hydroureter.  Single focus of\nintravesicular air may reflect sequelae of prior instrumentation.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is not visualized.\n\nPELVIS: Status post pigtail catheter placement of a right presacral collection\nwhich appears near completely collapsed.  Additional anterior approach right\nlower quadrant pigtail catheter is seen in the noncommunicating superior\npresacral collection which measures approximately 8.2 x 1.6 x 3.5 cm (AP by SI\nby ___; series 602, image 36, series 2, image 62) previously measuring up to\n10.6 x 2.5 x 4.2 cm (AP by SI by ___), on the pre interventional CT performed\n___.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  Small\npelvic and inguinal lymph nodes are not pathologically enlarged by CT size\ncriteria.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Anterolisthesis of L4 on L5 is unchanged compared to the prior\nexamination and is likely degenerative.  No aggressive osseous lesions are\nidentified.\n\nSOFT TISSUES: High-density packing material along the posterior right gluteal\nwall is again demonstrated.  Mild body wall anasarca.",
            "output": "1. Status post pigtail catheter placement (x2) in two noncommunicating\npresacral collections which appears overall decreased in size compared to the\npre intervention CT of ___.\n2. Interval increase in at least moderate bilateral pleural effusions compared\nto the prior examination.\n3. Ill-defined opacification of the right middle lobe may reflect developing\npneumonia and/or aspiration.\n4. Moderate cardiomegaly, partially evaluated."
        },
        {
            "input": "LOWER CHEST: Bilateral small pleural effusions and linear atelectasis in the\nleft lower lobe have improve from ___ CT.\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 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n1.9 cm left lower pole and 1.3 cm right lower pole cyst with proteinaceous\ndebris.  There is no evidence of solid renal lesions or hydronephrosis. \nNonspecific bilateral perinephric edema suggests third-spacing from volume\noverload.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Small bowel small\nbowel anastomosis in the right lower abdomen is redemonstrated and\nunremarkable.  The colon and rectum are within normal limits.   The rightward\napproaching pigtail drainage catheter sits within the larger of the 2\npresacral collection.  This midline collection measures 6.7 x 3.2 x 3.0 cm has\nminimally decreased in size in the interim measuring 8.2 x 3.5 x 2.9 cm 4 days\nago (2:57, 602:38).  Of note the pigtail catherter tip sits within the\nanterior portion of this collection.  There has been interval resolution of\nthe smaller collection just to the right of midline within which the right\nposterior approaching pigtail catheter sits (2:67, 602:35).  Status post\nremoval of the right posterior gluteal high-density packing material, there is\na new small 2.3 x 1.2 cm collection within the right piriformis muscle, too\nsmall to drain (2:60).\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 of the infrarenal aorta extending to the common iliac arteries\nbilaterally.\n\nBONES: L4-L5 anterolisthesis with disc space loss and L5-S1 vacuum disc\nphenomenon remain unchanged from 4 days ago.  No aggressive osseous lesions. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous body wall soft tissue edema compatible with third\nspacing.",
            "output": "1. Status post removal of the right posterior gluteal packing material there\nis a new tiny 2.3 x 1.2 cm collection within the right piriformis muscle\n(where the packing material once resided), too small to drain.\n2. Minimal interval decrease in size of the midline presacral collection\ncontaining the rightward approaching pigtail catheter since 4 days ago. Of\nnote the pigtail catherter tip sits within the anterior portion of this\ncollection.\n3. Resolved right presacral collection containing the right posterior\napproaching pigtail catheter.\n4. Improved bilateral, now small, pleural effusions and left lower lobe\natelectasis."
        },
        {
            "input": "Lower Thorax: There is bibasilar dependent atelectasis. There is no\ncardiomegaly.\n\nPeritoneal Cavity: The mainly right-sided bilobed, retroperitoneal fluid\ncollection in the anterior pararenal space is slightly decreased in size with\nthe pocket anterior to the right kidney measuring 1.9 x 3.7 cm versus 2.5 x\n4.9 cm previously and a similar craniocaudal extent.  Right-sided\n___ drain remains in place with tip just anterior to the take-off of\nthe left renal vein.  Another JP drain has its tip anterior to the distal\nstomach adjacent to another unchanged fluid collection. There is evidence of\nrecent laparotomy with surgical staples in the anterior abdominal wall and\nstranding, as previously seen. There is no free air.\n\nLiver: There is an unchanged lobulated hepatic cyst in segment 2. The liver is\nunchanged.\n\nGallbladder and Biliary System: The gallbladder has been surgically\nremoved.There is interval decrease in intra and extrahepatic biliary\ndilatation, although there remains persistent mild dilatation.\n\nPancreas: The patient is status post ___'s surgery with unchanged and\nnormal residual pancreatic tissue.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The previously noted pneumatosis coli has resolved.  There is no\nevidence of bowel obstruction or abnormal bowel wall thickening.  The\nthickening and dilatation of the proximal jejunum adjacent the\npancreaticojejunostomy site has also improved.  There is an unchanged\ngastrostomy in place.\n\nPelvis:  The urinary bladder is unremarkable.  The uterus and ovaries are\nunremarkable with no adnexal mass.\n\nLymph Nodes: There is no significant mesenteric, pelvic or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1. Interval resolution of pneumatosis coli.\n2. Interval mild decrease in retroperitoneal fluid collection post Whipple\nsurgery with decreased inflammatory changes at the pancreaticojejunostomy site\nand persistent surgical drains in 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 are multiple liver hypodensities, which are too small to characterize,\nbut statistically likely represent biliary hamartomas versus 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nThere are multiple colonic diverticula without surrounding inflammation to\nsuggest diverticulitis.  Subtle inflammation in this area is limited due to\nlack of oral contrast and lack of intraperitoneal for natural contrast.  The\nappendix is air-filled and appears overall within normal limits.\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 uterus and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No convincing etiology identified for patient pain.  IV contrast mildly limits\nevaluation for small nephrolithiasis.  Within these limitations, no\nnephrolithiasis.  Diverticulosis without surrounding inflammation to suggest\ndiverticulitis.  Lack of intravenous contrast limits evaluation for subtle\ninflammation in the region of the pelvis.  Normal appendix."
        },
        {
            "input": "Visualized lung bases appear clear.  Heart is borderline in size, which is\nsomewhat striking for age.\n\nThere is no biliary dilatation.  No suspicious focal liver lesions are\nidentified.  A few scattered sub 5 mm hypoattenuating foci in the liver are\ntoo small to characterize but doubtful in clinical significance.  The gall\nbladder is only partly full and appears normal.  The pancreas is also\nunremarkable.  The spleen is normal in size and appearance.  The adrenals are\nsomewhat difficult to assess due to crowding of structures but show no\nabnormality.  No evidence for stones, solid masses or hydronephrosis involving\neither kidney.  Sub 5 mm hypodense focus in the left upper pole is too small\nto characterize but doubtful in clinical significance, probably a tiny cyst.\n\nBowel is somewhat difficult to assess due to crowding of structures but no\nabnormality of the small or large bowel is found.  Stomach appears normal. \nAppendix is not well visualized but there is no evidence of appendicitis.\n\nVague hypoattenuating areas in the anterior uterine fundus, centered in the\nmyometrium, span over a 2 cm area and suggest fibroids or focal adenomyosis. \nAdnexa appear normal.  The bladder appear normal.  There is no\nlymphadenopathy.  Trace free fluid is within physiological range.  Major\nvascular structures appear widely patent.\n\nVertebral body heights and interspaces appear preserved in height.  Mild\ndegenerative changes affect the pubic symphysis.  Posterior elements of S1 are\nincompletely closed which is consistent with a normal variant.  Vertebral body\nheights and interspaces are preserved in height.  Minimal narrowing and\nretrolisthesis of L5 on S1 is associated with a shallow broad-based posterior\ndisc bulge.",
            "output": "No evidence of acute abnormality involving the abdomen or pelvis. Suspected\nfibroid or adenomyosis in the uterine fundus."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases demonstrates bilateral lower lobe\natelectasis.  No pleural effusion. The visualized heart is normal in size\nwithout pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones.\n\nThe spleen is normal.  A 1.3 x 1.2 cm (4A: 52) accessory spleen is noted.  The\npancreas enhances homogenously and is without focal lesions, peripancreatic\nfat stranding, or focal fluid collection. The adrenal glands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. No focal\nrenal lesions. No hydronephrosis or hydroureter identified. No renal or\nproximal ureter calculi.\n\nA small hiatal hernia is present. The stomach is grossly unremarkable in\nappearance. The small bowel is normal in caliber without wall thickening. \nThere is diffuse  bowel wall thickening involving the descending colon and\nsigmoid colon starting at the splenic flexure with associated fat stranding\nand mucosal hyper enhancement. On arterial phase imaging there is significant\narterial enhancement within the mucosa of this bowel.  No evidence of brisk\nactive extravasation however acute mucosal hyper enhancement is consistent\nwith colitis. Multiple reactive lymph nodes within the abdomen pelvis.  The\nremaining large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. The appendix is normal without evidence of\nacute appendicitis.\n\nMultiple enlarged retroperitoneal and mesenteric lymph nodes have slightly\nincreased in size.  For example a left retro aortic lymph node measures 1.8 x\n1.2 cm (4A: 75) (previously 1.5 x 0.6 cm).  No pneumoperitoneum, abdominal\nwall hernia, or free abdominal fluid.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria. No free pelvic fluid\nseen.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.\n\nCTA: The portal vein, SMV, and splenic vein are patent. The abdominal aorta is\nnormal in caliber without aneurysmal dilatation. Small amount of\natherosclerotic calcification noted. The celiac axis, SMA, and ___ are patent.\nThe common iliac, external, and internal iliac arteries are normal in course\nand caliber. Bilateral single renal arteries are patent.",
            "output": "1. Colitis involving the descending and sigmoid colon with diffuse bowel wall\nthickening, fat stranding and mucosal hyper enhancement. Differential includes\nischemic, inflammatory, and ischemic etiologies.\n2.  No brisk active extravasation.\n3.  Multiple reactive lymph nodes within the abdomen/pelvis."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and ovaries are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: No suspicious osseous lesion.  Superior anterior endplate irregularity\nof L5 distant with compression fracture is new since ___, although no\ndefinite surrounding soft tissue hematoma or stranding to suggest acuity. \nDegenerative changes of the visualized lower lumbar spine are mild.  There is\nminimal anterolisthesis of L4 on L5.  Mild osteophyte formation is also noted\nin the bilateral hips.  The bilateral hip joint space is preserved.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No sacral fracture.\n2. L5 mild superior endplate compression deformity is new since ___,\nplease correlate for focal pain as this may represent an acute compression\nfracture.\n3. No acute abnormality within the visualized pelvis.\n\nNOTIFICATION:  The updated impression was emailed by Dr. ___ on\n___ at 20:22 to ED QA nurses."
        },
        {
            "input": "LOWER CHEST: Left lower lobe posterior basal segment atelectasis is unchanged.\nThe partially imaged lung bases are otherwise unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular in contour.  No focal lesions identified. \nThe portal veins are patent.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains gallstones without\nwall thickening or surrounding inflammation.  There is small volume abdominal\nascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: Splenomegaly has increased since ___ measuring up to 17 cm,\npreviously 16 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 with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient appears status-post sleeve gastrectomy.  There is a\nsmall locule of gas along the prior percutaneous gastrostomy tract suggesting\ntract patency (series 2, image 30; series 601, image 11).  High-density\nstructure/material appears to extend focally through the left anterior\nabdominal wall at the site of prior percutaneous jejunostomy tube.  (Series 2,\nimage 42).  Small bowel loops are mildly dilated with gradual tapering at the\nlevel of the mid to distal ileum.  Enteric contrast material progresses to the\nlevel of the distal ileum.  Small bowel loops adjacent to prior enteric\ncutaneous fistula are intimately associated with the abdominal wall.  Apparent\nwall thickening in the distal descending colon is likely related to\nunderdistention.  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: An intrauterine device is noted.\n\nLYMPH NODES: Porta hepatic and retroperitoneal lymph nodes are subcentimeter\nin size.  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. \nIncidental note is made of transitional anatomy at the lumbosacral junction.\n\nSOFT TISSUES: Soft tissue in the left anterior abdominal wall may reflect\ninflammation from persistent enterocutaneous fistula or chronic fibrosis from\nprior enterocutaneous fistula and surgery.  Fibrotic changes in the midline\nanterior abdominal wall reflect prior laparotomy.  There is a small, fat\ncontaining ventral/umbilical hernia.  There is diffuse anasarca.",
            "output": "1. Suspect persistent enterocutaneous fistulas at prior percutaneous\ngastrostomy tube and percutaneous jejunostomy tube sites.  No evidence of\nabscess.\n2. No evidence of bowel obstruction.\n3. Cirrhosis with evidence of portal hypertension including ascites, upper\nabdominal collaterals, and increased splenomegaly.\n4. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: Aside from linear atelectasis in the left lung base, 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. \nSimilar to prior, the liver demonstrates a nodular contour.  There is small\nvolume intra-abdominal ascites.  There is no evidence of focal lesions. 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 is enlarged measuring up to 15.7 cm.  The spleen shows\nnormal 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: Similar to prior, the patient is status post sleeve\ngastrectomy.  There is persistent soft tissue stranding extending along the\nprior percutaneous gastrostomy tract (02:28).  However, there are no locules\nof gas to suggest tract patency.  As before, there is high-density material\nextending focally through the left anterior abdominal wall at the site of the\nprior percutaneous jejunostomy tube (02:37).  There are small locules of air\nextending into the superficial subcutaneous tissues suggesting presence of an\nenteric cutaneous fistula.  However, no drainable fluid collections are\nidentified.  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.\n\nREPRODUCTIVE ORGANS: An IUD is visualized within the uterus.  No adnexal\nabnormalities are seen.\n\nLYMPH NODES: There are multiple prominent retroperitoneal and mesenteric\nnodes, however, these are not pathologically enlarged by CT size criteria. \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\nis noted.  Numerous upper abdominal collateral vessels are noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is extensive soft tissue edema.",
            "output": "1. Redemonstration of persistent enterocutaneous fistulous at prior\npercutaneous gastrostomy tube and percutaneous jejunostomy tube sites.  No\nevidence of a drainable fluid collection.\n2. Re-demonstration of a cirrhotic appearing liver with evidence of portal\nhypertension including ascites, upper abdominal collaterals and splenomegaly.\n3. Cholelithiasis without evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: There is left basilar atelectasis.  Visualized lung fields are\notherwise within normal limits.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates nodular contour, with 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. \nThere 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 is enlarged, measuring up to 16.6 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 patient is status post gastrojejunostomy with subsequent\nreversal.  The site of prior percutaneous gastrostomy tract is similar in\nappearance, with mild fat stranding (02:30), and no evidence of tract patency.\nSoft tissue is again seen at the site of prior left mid abdomen percutaneous\njejunostomy tract.  Within this tract, there is subtle hypoattenuation and rim\nenhancement (602:66).  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 a\nsmall amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.  An IUD is again 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.  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, with more focal edema overlying the\nbilateral flanks and gluteal regions.",
            "output": "1. Along the tract of the prior percutaneous jejunostomy, there is subtle\nlinear hypodensity with slight rim enhancement, suggestive of persistent\nenterocutaneous fistula versus small developing abscess.  No drainable fluid\ncollection.\n2. Similar appearance of mild fat stranding along the prior gastrostomy tract,\nwith no evidence of tract patency.\n3. Cirrhotic liver, with sequela of portal hypertension including trace\nascites and splenomegaly.\n4. Cholelithiasis without evidence for cholecystitis"
        },
        {
            "input": "Lower chest: Large bilateral pleural effusions are again seen associated with\natelectasis in the left and right lower lobes.\n\nHepatobiliary: The liver is unchanged in size and appearance with no solid\nfocal mass lesions.  No bile duct dilatation is seen.  The gallbladder is not\ndistended.  No gallstones are seen.\n\nPancreas: On this nonenhanced study, the pancreas appears unremarkable.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: The left no adrenal glands unchanged in size and appearance.\n\nUrinary: The kidneys of normal size and appearance with no mass lesions or\nstones.  No hydronephrosis is present.\n\nGastrointestinal: There is interval increase in the amount of intraperitoneal\nascitic fluid.  There is slight diminution in the amount of free\nintraperitoneal air seen based under the right hemidiaphragm.  The visualized\nloops of large and small bowel are unremarkable.  The stomach is filled with\ndebris.  The degree of bowel dilatation has decreased when compared to the\nprior study.  No intraperitoneal abscess is identified.\n\nPelvis: Numerous vascular calcifications are seen within the vessels of the\npelvis.  The bladder is mildly distended.  No free fluid is seen within the\npelvis.\n\nReproductive organs: The reproductive organs are unremarkable.  Incidental\nnote is made of several calcifications within the prostate.\n\nLymph nodes: No significant retroperitoneal or inguinal lymphadenopathy is\nseen.\n\nVascular: Aortic calcifications are seen extending down into the vessels of\nthe pelvis.  No aneurysms are identified.\n\nBones: No new concerning lytic or blastic lesions are seen within the bones. \nPostop changes are seen in the lumbar spine.\n\nSoft tissues: No soft tissue abnormalities are identified.",
            "output": "When compared with study from ___, there is a slight increase in\namount of intraperitoneal ascitic fluid and diminution of intraperitoneal free\nair.  No intraperitoneal abscess is identified.\n\nIncrease in size of bilateral pleural effusions."
        },
        {
            "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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is post wedge resection of the gastric schwannoma\npreviously seen on the greater curvature of the gastric body.  The remaining\nstomach appears normal without abnormal wall thickening.  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: Anteverted uterus is unremarkable.  There are no large\nadnexal 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.  No atherosclerotic disease\nis noted.  Celiac axis, SMA, bilateral renal arteries, and ___ are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a well-marginated sclerotic focus within the right ilium, likely a\nbone island.  Unchanged multilevel degenerative changes and endplate Schmorl's\nnodes are noted at L1-L2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post gastric wedge resection without evidence of local recurrence or\nmetastatic disease within the abdomen or pelvis.\n2. Prior colitis 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: 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 are a few foci of\ncalcification in the pancreas.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a small amount of free fluid surrounding\nthe spleen. 4\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is bilateral hydronephrosis likely due to a distended bladder.  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 is very distended and extends to the level of the\numbilicus.  The distal ureters are unremarkable.  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\nfracture.Multilevel degenerative changes are present in the lumbar 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. Bilateral hydronephrosis likely due to a distended bladder that extends to\nthe level of the umbilicus\n3. There are a few foci of calcification in the pancreas that may be\nindicative of chronic pancreatitis.\n4. Trace ascites surrounding the spleen\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: 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: 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 6 mm anterolisthesis of L5 on S1 with bilateral pars defects.\n\nSOFT TISSUES: There is thickening at the umbilicus site of the patient's known\ninfection there is no evidence of intra-abdominal extension. No focal fluid\ncollection or stranding.",
            "output": "Mild soft tissue thickening at the umbilicus at the site of the patient's\nknown infection without an associated subcutaneous or deeper intraperitoneal\ndrainable fluid collection.  No evidence of intra-abdominal extension."
        },
        {
            "input": "LOWER CHEST: There are consolidations in the bilateral lung bases, likely\nrepresenting atelectasis with superimposed pneumonia not excluded.  There are\nsmall 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 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 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.  The patient is\nstatus post ___ procedure with resection of the descending and sigmoid\ncolon.  There is a surgical drain entering the left anterior abdominal wall\nterminating in the pelvis adjacent to the rectal stump. There is no evidence\nof intra-abdominal abscess as clinically questioned.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a bicornuate 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 anterolisthesis of L4 on L5 with loss of disc height and endplate\nsclerosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post ___ procedure with expected postoperative findings.  No\nevidence of intra-abdominal abscess as clinically questioned.\n2. Bicornuate uterus."
        },
        {
            "input": "LOWER CHEST: Incidental note is made of a right upper lobe mass on the single\ncoronal images of the chest have been provided.  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 or\nextrahepatic biliary dilatation.  Non-obstructing gall bladder calculi are\nnoted with no wall thickening or surrounding 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: There are small nonenhancing lesions in both kidneys that are\nconsistent with cysts.  The largest is a 23 mm left lower pole renal cyst. \nBoth kidneys are otherwise normal in size and appearance.  There are no solid\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\nPELVIS: The bladder is distended and there is evidence of descent of the\nbladder at rest suggestive of a minor degree of bladder prolapse.\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.  Incidental note is made of a retr-aortic left renal 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. No evidence of primary malignancy or metastases in the abdomen or pelvis.\n2. Mild bladder prolapse.\n3. Please see report of CT chest performed on the same day for thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: There is no evidence of pleural or pericardial effusion.  There\nis minimal atelectasis at the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: Relative hypoattenuation of the left hepatic lobe suggests\ngeographic steatosis.  A 1 cm intermediate density lesion in segment VI\n(series 2:29) is incompletely characterized.  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 tiny hypodensity in the spleen is too small to\ncharacterize (601:29).\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is mild wall\nthickening of the mid transverse colon with surrounding fat stranding and a\nsmall amount of non-organized fluid, consistent with colitis.  No diverticula\nare seen in this segment.  The descending and sigmoid colon are unremarkable. \nThe appendix is not visualized.  No organized fluid collection or\npneumoperitoneum.\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 lymphadenopathy.  Few prominent\nmesenteric lymph nodes are likely reactive.  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: There is a small umbilical hernia with ventral protrusion of a\nsmall bowel loop.",
            "output": "1. Mild wall thickening of the mid transverse colon with surrounding fat\nstranding and a small amount of non-organized fluid, consistent with colitis. \nNo diverticula seen in this segment.  No extraluminal gas or organized fluid\ncollection.\n2. 1 cm intermediate density lesion in hepatic segment VI is likely benign but\nincompletely characterized.  Recommend follow-up non-emergent liver ultrasound\nfor further evaluation.\n3. Relative hypoattenuation of the left hepatic lobe suggests geographic\nsteatosis."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar dependent atelectasis, the lung\nbases are clear.  There is severe coronary artery calcifications.  No\npericardial or pleural effusion.  There is a 5 mm left lower lobe perifissural\nnodule (2:4).\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 1.1 cm left interpolar cortical cyst.  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. 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 gland 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 small fat containing umbilical hernia.",
            "output": "1. No acute findings in the abdomen or pelvis to explain the patient's\nsymptoms.\n2. 5 mm left lower lobe pulmonary nodule.  In a low risk patient, no follow-up\nis required.  In a high-risk patient, an optional 12 month follow-up chest CT\nis recommended.\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: There is mild bilateral dependent atelectasis.  The heart is\ntop-normal in size.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 1.1 cm simple cyst in the interpolar region of the left kidney is unchanged\nsince ___.  Few other subcentimeter hypodensities throughout the\nbilateral kidneys elsewhere are too small to characterize but statistically\nlikely represent simple cysts well.  Trace bilateral perinephric stranding is\nnon-specific, but has a common age-related finding.  There is no\nhydronephrosis or hydroureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is top normal diameter\nof small bowel loops within the left lower quadrant which are fluid-filled and\nmeasure up to 2.5 cm in diameter (2:108).  There is abrupt tapering of these\nsmall bowel loops in the left lower quadrant (2:17) with relative collapse of\nsmall-bowel loops distally.  The appearance is nonspecific but not suggestive\nof obstruction.  The terminal ileum is prominent and fluid-filled suggestive\nof ileocecal valve incompetence.  Small bowel wall thickness and enhancement\nappears normal throughout.  There is mild sigmoid diverticulosis.  There is a\nmoderate amount of stool within the cecum and ascending colon.  The colon is\notherwise normal in caliber, wall thickness, and enhancement throughout.  The\nappendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged and demonstrates TURP\nchanges.  The seminal vesicles are unremarkable.\n\nLYMPH NODES: Within the left external iliac region, there is an irregular 3.9\nx 2.3 x 4.0 cm lesion which demonstrates similar attenuation to surrounding\nmuscle (2:142, 601:54) which likely represents Prolene plugged improved from\nrecent inguinal hernia repair.  Known mesh is not seen discretely from the\npresumed left inguinal plug.  Elsewhere, there is no retroperitoneal or\nmesenteric lymphadenopathy.   There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is a discrete 2.5 cm lucency within the superolateral left\nfemoral head with surrounding sclerosis (601:74, 2:49) which is continuous\nwith a least 2 focal cortical defects in the articular surface of the head of\nthe femur (601: 72, 78), suggestive of avascular necrosis with impending\ncortical collapse.\n\nSOFT TISSUES: Postoperative changes of left inguinal hernia repair.  There is\na small fat containing umbilical hernia.",
            "output": "1. No acute process within the abdomen or pelvis.  Specifically, no current\nfindings to suggest bowel obstruction.\n2. Status post left inguinal"
        },
        {
            "input": "LOWER 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: There is a G-tube 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 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. \nNote is again made of bilateral L5 pars defects with grade 1 anterolisthesis\nat L5-S1 and associated degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of abdominal or pelvic metastatic disease.\n2. Please refer to the separate report for the CT chest."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  The left hemidiaphragm is\nelevated, unchanged.\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: A percutaneous G-tube is present in 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 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 no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: There are bilateral pars defects at L5 with associated degenerative\nchanges at L5-S1 including mild anterolisthesis.  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 evidence of metastatic disease in the abdomen or pelvis.  Unchanged\nelevation of the left hemidiaphragm.\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.  Chronic elevation of the left\nhemidiaphragm is re-demonstrated.\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.\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 unremarkable.\n\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 bilateral spondylosis and mild grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of metastatic thyroid carcinoma in the abdomen or pelvis.\n2. Please refer to the separately dictated CT chest report from the same date\nfor a description 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: 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 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 or 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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is bilateral L5 spondylosis with associated grade 1 anterolisthesis of\nL5 on S1.  There are stable sclerotic lesions within the right ilium,\nunchanged since CT from ___, likely representing bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute intra-abdominal or pelvic pathology.\nNo evidence of metastatic disease in the abdomen or pelvis.\n For chest findings reference is made to CT chest report of the same day"
        },
        {
            "input": "Study is SNR-limited by decreased beam penetration.\n\nBibasilar atelectasis.  Please refer to chest CT report for thoracic details.\n\nAn ill-defined hypodense area in the hepatic dome (3K, 89) measuring\napproximately 3.5 x 4 cm is noted. Additional ill-defined hypodensity within\nsegment VIII is noted, approximately 2.9 x 1.9 cm (3, 30), which is better\nvisualized on recent outside CT, now appearing somewhat linear and possibly\nrelated to the anterior branch right portal vein. Interval placement of\nplastic CBD stent with expected pneumobilia and moderate intrahepatic biliary\ndilatation, slightly improved from prior. Mildly distended gallbladder is\nnoted with mild wall thickening, nonspecific finding.\n\nAn ill-defined hypoenhancing region within the pancreatic head, neck and body\nis noted, approximately 4.2 x 2.9 cm (3K, 130), with upstream pancreatic\nductal dilatation and glandular atrophy.  Intrahepatic portal veins are\ngrossly patent. There is marked narrowing and probable occlusion of the\nproximal main portal vein, portal-splenic and portal-SMV confluence, and SMV\nand splenic vein.  There is probable encasement of the celiac arterial\nbifurcation, encasement of the common hepatic artery, GDA and proper hepatic\nartery.  There is abutment against the upstream splenic artery. The SMA\nappears uninvolved.\n\nSplenomegaly, 17 cm, without focal lesion. 2.3 x 1.9 cm left adrenal nodule,\nincompletely characterized. Normal right adrenal.\n\nNo nephrolithiasis or hydronephrosis. No suspicious renal lesions.\n\nUnderdistended stomach containing probable medication. Low-density colonic\nstool, possibly indicating malabsorption. No small bowel dilation.\n\nNormal caliber abdominal aorta. Conventional hepatic arterial anatomy. 2 left\nand 2 right renal arteries are noted. There is prominent adenopathy within the\nupper abdomen. A cluster of celiac axis nodes is noted, largest individual\nnode 2.8 x 1.4 cm (3K, 121). Enlarged and suspicious portal caval nodes are\npresent, largest 1.7 cm. Retroperitoneal adenopathy is present. Prominent\nnodes and generalized hazy stranding extends into the central mesenteric,\nlargest node 1.6 cm. Thrombus is visualized within the SMV branches. Mild\nascites is present, increased from prior study.\n\nNo focal bladder wall thickening. Internal os pelvic stranding and small\namount of free pelvic fluid within the rectovesical pouch.\n\nMultiple small sclerotic foci within the bony pelvis, most likely bone\nislands. No suspicious osseous lesions. Mild degenerative changes of the\nspine.\n\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): approximately 3.5 x 4 cm\nLocation (head right of SMV, body left of SMV): Head, neck and body\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: Plastic CBD\nstent in place\n\nArterial evaluation\n\nSMA involvement: Adjacent hazy attenuation\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: present\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: Present, within the\ncommon hepatic artery, hepatic artery proper and GDA\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: complete occlusion\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):\nOcclusion of portosplenic confluence\n\n___ involvement: complete occlusion\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:  present\nThrombus within vein: SMV; type of thrombus:  Incompletely characterized\nVenous collaterals: absent\n\nExtrapancreatic evaluation\nLiver lesions: indeterminate, suspicious for metastases.\nPeritoneal or omental nodules: Hazy mesenteric stranding\nAscites: present\nSuspicious lymph nodes: Present within the mesentery, retroperitoneum,\ngastrohepatic ligament and portacaval regions\nOther extrapancreatic disease (invasion of adjacent structures): absent",
            "output": "1. Ill-defined hypoenhancing pancreatic head/ neck mass with upstream ductal\ndilatation and gland atrophy, concerning for adenocarcinoma.  The mass\noccludes the portosplenic confluence and results in encasement of celiac axis\nbranches as noted above. Plastic CBD stent in place.\n2. Incompletely characterized hypodense liver lesions as detailed above,\nconcerning but not diagnostic for metastases.  One  of the liver lesions is\nsomewhat linear and may represent a right anterior portal venous thrombus.\n3. Porta hepatis, mesenteric, and retroperitoneal lymphadenopathy concerning\nfor tumor involvement.\n4. Small amount of abdominopelvic ascites has increased from recent CT scan.\n5. Splenomegaly.\n6. Please refer to chest CT for thoracic details."
        },
        {
            "input": "ABDOMEN:There is minimal basilar atelectasis. Calcifications of the aortic\nvalve are noted. There is no pericardial effusion. The non contrast appearance\nof the liver is unremarkable.  Patient is status post cholecystectomy. The\ncommon bile duct is dilated measuring 13 mm, unchanged since ___. The\npancreas spleen and adrenal glands are unremarkable.  There is no\nhydronephrosis in the right kidney however multiple nonobstructing stones are\nidentified the largest is within the lower pole measuring 7 x 7 mm. Two other\nsmaller nonobstructing stones are located near the upper pole.  There is mild\nleft hydronephrosis with perinephric stranding and a 8 mm stone within the mid\nureter. Two nonobstructing stones are present in the interpolar region, the\nlarger measuring 5 mm.  The previously seen upper pole in ___ is not\nvisualized and is likely the stone that has migrated into the ureter.  A 5.7 x\n5.2 cm left renal cyst is present. The stomach, small intra-abdominal large\nbowel are unremarkable. There is no free fluid, free air lymphadenopathy\nwithin the abdomen. The aorta is of normal caliber and there is no aneurysm\nhowever there is atherosclerotic disease at the origins of all of the major\narteries.\n\nPELVIS: The bladder rectum and sigmoid colon are unremarkable. The uterus is\nunremarkable.  There is no free fluid, free air lymphadenopathy within the\npelvis.\n\nOSSEOUS STRUCTURES: There is no acute fracture. A sclerotic lesion in the T9\nvertebral body may represent a bone island.",
            "output": "1. 7 mm obstructing stone in the mid the ureter with perinephric stranding and\nmild to moderate left hydronephrosis.\n2. Bilateral nonobstructing renal stones.\n3. Left renal cyst."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden of\nthe abdominal aorta.  There are mild calcifications of the origin of the\nceliac axis and moderate calcifications at the origin of the SMA both which\nremain patent.  The ___ is patent.  There are moderate calcifications at the\norigins of bilateral renal arteries which also remain patent.  Bilateral\ncommon, external, and internal iliac arteries are patent.\n\nLOWER CHEST: Mild atelectasis bilaterally.  No pleural effusion.  Coronary\nartery calcifications a mitral annular, and aortic valvular calcifications are\nnoted.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  Mild extrahepatic biliary dilation is likely\nrelated to cholecystectomy.\n\nPANCREAS: Pancreas is diffusely atrophic.  No focal lesions or pancreatic\nductal dilation.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size 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 cortical renal thinning is again noted.  There is no\nevidence of focal renal lesions or hydronephrosis.  Nonobstructive right-sided\nnephrolithiasis is noted with stone measuring up to 9 mm in lower pole of the\nright kidney.  Simple cyst measures up to 1.1 cm in lower pole of the left\nkidney and up to 1.5 cm in the upper pole the right kidney.  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. Colon and rectum are within normal limits. \nAppendix is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters a7re unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  No adnexal abnormalities are\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. No acute intra-abdominal process.  No evidence of mesenteric ischemia.\n2. Nonobstructive right-sided nephrolithiasis."
        },
        {
            "input": "LOWER 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 extrahepatic bile duct is dilated\nmeasuring up to 1.4 cm, which is similar to the prior study.  Central\nintrahepatic bile ducts are also mildly dilated.  There is a large gallstone\nmeasuring up to 2.6 cm, and an additional punctate stone near the fundus.\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.  A 1 cm nodule along the inferior margin of\nthe spleen has slightly decreased in size compared to the prior exam, and\nlikely represents a capsular implant (08:35).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSince the prior CT performed on ___, there has been interval\ndisplacement of the previously seen left lower pole renal stone into the\nproximal left ureter, which now results in mild hydronephrosis.  It measures\nup to 0.8 cm in craniocaudal dimension (08:30).  There is no hydronephrosis on\nthe right.  There is a 1.6 cm simple cyst in the lower pole of the right\nkidney.  In the upper pole the right kidney, there is an additional 1.1 cm\nlesion demonstrating intermediate attenuation, and equivocal enhancement\n(05:50).\n\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\nPERITONEUM: There has been significant interval improvement in extent of\nperitoneal carcinomatosis compared to the prior CT performed in ___,\nwith minimal residual omental stranding (5:69).  Discrete nodules that were\nseen on the prior exam are no longer apparent.  However, there is persistent\nparietal peritoneal thickening along the superior hepatic margin/undersurface\nof the diaphragm.  It now measures up to 0.5 cm in maximum thickness,\npreviously measuring up to 0.9 cm (05:53, 08:26).\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus is heterogeneous in attenuation.  The ovaries are\ntop-normal in size.  The previously seen solid soft tissue masses within the\novaries are no longer apparent on today's exam.  Additionally, the cystic mass\nin the posterior cul-de-sac present on the prior study have also resolved in\nthe interim.\n\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.  A\nsclerotic lesion in the L2 vertebral body likely represents a bone island.  A\nsimilar probable bone island is seen in the right posterior iliac bone (5:98).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval response to treatment with significant improvement in peritoneal\ncarcinomatosis compared to ___, with resolution of previously seen\ndiscrete omental nodules and ascites.  There is mild residual soft tissue\nthickening of the perihepatic parietal peritoneum, decreased size of a\nperisplenic capsular deposit, and minimal residual omental stranding.\n2. Bilateral ovaries are top-normal in size, although the previously seen\nsolid soft tissue masses about the ovaries has resolved in the interim. \nCystic/necrotic posterior cul-de-sac lesion has also resolved.\n3. New obstructing 0.8 cm left proximal ureteral stone, resulting in mild\nhydronephrosis.\n4. Unchanged mild intrahepatic and extrahepatic biliary dilation, potentially\nreflecting ampullary stenosis or sphincter of Oddi dysfunction.\n5. Indeterminate 1.1 cm right upper pole renal lesion, may represent a complex\ncyst and could be followed on routine surveillance CT's.\n\nRECOMMENDATION(S):   The findings were discussed with ___, (RN working\nwith Dr. ___ by ___, M.D. on the telephone on ___ at\n4:13 pm, 5 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Minimal dependent atelectasis.  Small hiatal hernia.\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.  Redemonstration of extrahepatic biliary ductal dilatation\nmeasuring up to 1.4 cm, unchanged from prior study.  The gallbladder appears\ndecompressed around a large calcified gallstone, without evidence of\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 and attenuation throughout, without\nevidence of focal lesions.  The previously seen nodule along the inferior\nmargin the spleen is not well-visualized on the current 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 concerning focal renal lesions or hydronephrosis. \nStable 1.5 cm simple cyst at the right lower pole.  A subcentimeter\nhypodensity at the right upper pole is too small to characterize, likely\ncompatible with simple renal cyst.  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. There is diffuse colonic wall thickening involving the entirety of\nthe colon and rectum, which is fluid-filled and demonstrates wall\nhyperenhancement, worst in the region of the ascending colon, concerning for\npancolitis.  The appendix is surgically absent.\n\nPELVIS: Mild thickening of the bladder wall at the fundus is likely secondary\nto adjacent inflammatory change.  The urinary bladder and distal ureters are\notherwise unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES AND PERITONEUM: There is no retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.  The\npreviously seen nodularity related to peritoneal carcinomatosis is again not\nvisualized on the current study.  Minimal residual omental fat stranding is\nsimilar to prior study (02:25).  Subtle hypodense thickening between the liver\nand the right hemidiaphragm unchanged (601:30).  Hypodense perihepatic left\nsubdiaphragmatic lesion scalloping the left hepatic lobe on series 601, image\n22 was not conspicuous on the prior exam and bears attention on follow-up\nimaging.  Hypodense left subdiaphragmatic lesion best seen on series 601,\nimage 34 measuring 14 mm in transverse dimension was not seen on prior and\nalso bears attention on follow-up imaging as malignant implants not excluded.\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: Few tiny soft tissue nodules in the right lower abdominal wall\nare likely consistent with injection granulomas.  Mild stranding along the\numbilicus is likely consistent with postsurgical change after laparoscopy.",
            "output": "1. Acute pancolitis, most pronounced along the ascending colon.\n2. 2 left subdiaphragmatic nodular lesions not clearly seen on prior imaging\nbear attention on follow-up imaging as nodular tumor implants not excluded.\n3. Postoperative changes noted in the setting of recent TAHBSO, omentectomy,\nappendectomy.\n4. Unchanged mild extrahepatic biliary ductal dilatation, potentially\nreflecting ampullary stenosis or sphincter of Oddi dysfunction.\n5. Cholelithiasis without evidence of acute cholecystitis.\n\nNOTIFICATION:  The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 8:39 pm, shortly 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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic biliary\ndilatation is unchanged.  Redemonstration of extrahepatic biliary ductal\ndilatation measuring up to 1.4 cm, unchanged from prior studies.  The\ngallbladder appears decompressed around a large calcified gallstone, without\nevidence of gallbladder 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 and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 a 1.2\ncm simple cyst at the right upper pole and a 1.6 cm cyst at the right lower\npole.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Minimal sigmoid diverticulosis without evidence of\ndiverticulitis.  The colon and rectum are within normal limits.  The\npreviously seen inflammatory changes involving the cecum and colon are no\nlonger visualized on the current study.  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 patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is redemonstration of an oblong soft tissue nodule in the\nleft upper quadrant adjacent to the stomach, measuring up to 6 mm (8:11,\n4:56), unchanged in appearance from multiple prior studies and most likely\nrepresenting a lymph node.  There is no retroperitoneal lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.  The previously seen soft\ntissue thickening between the liver and left hemidiaphragm is no longer\nvisualized on the current study.\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. \nSmall sclerotic foci within the right iliac bone and L2 vertebral body,\nunchanged and likely compatible with benign bone islands.\n\nSOFT TISSUES: Mild stranding along the umbilicus is likely consistent with\npostsurgical change after laparoscopy.  The abdominal and pelvic wall is\notherwise within normal limits.",
            "output": "1. No definite evidence of metastatic disease identified within the abdomen or\npelvis.\n2. Previously suspected nodular soft tissue implants along the hepatic dome\nnear the left hemidiaphragm are no longer visualized on the current study.\nStable appearance of an oblong soft tissue nodule in the left upper quadrant\nadjacent to the stomach, measuring up to 6 mm and unchanged in appearance from\nmultiple prior studies, most likely representing a lymph node.\n3. Interval resolution of previously seen inflammatory changes involving the\ncecum and the colon.\n4. Postoperative changes consistent with prior TAHBSO, omentectomy, and\nappendectomy.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. 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\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is minimal left central\nintrahepatic biliary dilatation.  The CBD measures to 13 mm (8:20), and taper\nsmoothly into the ampullary region, without evidence of a focal lesion, as\nbefore.  The gallbladder contains a large gallstone 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 are intermediate density cysts in the upper and lower pole of the right\nkidney measuring 11 mm (8:35) and 16 mm (8:31).  There is no evidence of solid\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\nunchanged position of a loop of small bowel, which adhered to the anterior\nabdominal wall midline surgical scar (5:87).  Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nunchanged soft tissue stranding abutting the right posterior bladder wall\n(5:108) and the adjacent sigmoid colon wall likely representing posttreatment\nchanges..  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There has been interval increased size of upper abdominal and\nretroperitoneal lymph nodes, as follows:\nLeft upper para-aortic (5:65) now measuring 1.3 cm, previously 0.4 cm.\nRetrocaval (5:65) now measuring 0.7 cm, previously 0.4 cm.\nAortocaval (5:69) now measuring 0.8 cm, previously 0.5 cm.\nLeft external iliac now measuring 0.9 cm (5:105), previously 0.6 cm.\n\nCluster of subcentimeter soft tissue nodules in the posterior left\nsubdiaphragmatic region, is more conspicuous than on prior study (5:54, 8:33).\n\nVASCULAR: There is no 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 increased size several upper abdominal and retroperitoneal lymph\nnodes.  The most conspicuous node in the left upper para-aortic now measuring\n1.3 cm, is suspicious for metastasis.\n2. Increased conspicuity of a cluster of subcentimeter soft tissue nodules in\nthe left subdiaphragmatic region, are suspicious for metastasis.\n3. Stable postsurgical changes in the pelvis, without evidence of"
        },
        {
            "input": "Pelvis: There is trace amount of free fluid in the pelvis.\n\nGastrointestinal: No evidence of bowel dilatation or obstruction.\n\nVascular: There has been marked improvement of the nonocclusive small focal\nleft internal iliac vein thrombus.\n\nLymph nodes: No enlarged pelvic lymph nodes.\n\nBone and soft tissues: \\Small fat-containing left inguinal hernia.\n\nSurgical clips are seen overlying the left inguinal region, with subcutaneous\nfluid and gas, slightly increased compared to previously.  For example a\nloculated pocket of fluid now measures 3.7 cm, previously 1 cm.\n\nThere has been interval insertion of a pigtail catheter with the distal tip in\nan abscess between the left gluteus minimus and medius muscles.  The abscess\nhas significantly decreased in sized, measuring 0.7 cm x 3.8 cm, previously\n2.7 cm x 8.2 cm.\n\nMultiple loculated abscesses are seen within the surrounding muscles as well,\nand have overall decreased in size.  For example, the left iliacus abscess\nmeasures 1.2 cm x 4.5 cm, previously 2.0 cm x 6.0 cm.  A rectus femoris muscle\nnon-organized fluid collection seen on series 2, image 24, measures 3.7 cm x\n2.6 cm, previously 5.0 cm x 2.6 cm.  An abscess is seen within the lateral\naspect of the gluteus medius muscle, measuring 3.0 cm x 1.1 cm, previously 1.9\ncm x 3.8 cm.  The left ileopsoas and sartorius muscles also contain abscesses,\nwhich have slightly decreased in sized.",
            "output": "1. Interval decrease in sizes of multiple abscesses in muscles surrounding the\nleft hip after pigtail catheter insertion.\n\n2. Interval resolution of the nonocclusive small focal left internal iliac\nvein thrombus.\n\n3.  Mild increase of a fluid collection containing gas subjacent to the skin\nstaples in the left proximal thigh."
        },
        {
            "input": "LOWER CHEST: In compared to the abdominal pelvis CT from ___, the\nright and left pleural effusion decreased in size and are small on the left\nside and trace of fluid on the right side.  Secondary passive atelectasis. \nAgain is seen an indeterminate 8 mm nodule in the inferior aspect of the\nlingula.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder surgically removed\n\nPANCREAS: The pancreas has normal attenuation throughout, without pancreatic\nductal dilatation.  Again seen is a 5 mm hypointense lesion at the tail of the\npancreas.  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 distended.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Important the\nstool burden.  The appendix 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.  No new venous thrombosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSmall fat containing left inguinal hernia.\n\nSOFT TISSUES: We again see a subcutaneous fluid collection non encapsulated\ncontaining air overlying the left inguinal region that decreased in size\nmeasuring 28 x 12 mm (previously 37 x 22 mm).\n\nThe 2 previously pigtail are unchanged in position; the first 1 is situated in\nthe left iliac muscle in a nearly collapsed collection measuring today 46 x\n6.5 mm (previously 45 x 11 mm ) and the second 1 between the left gluteus\nmuscles in a nearly collapsed fluid collection measuring 5.6 mm in thickness\n(previously 7.5 mm).\n\nIn the interim, a new drain was positioned in the left anterior thigh medially\nto the rectus femoris muscle with the distal tip in the superior previously\ndescribed collection that has completely resolved.\n\nThere is an unchanged fluid collection with peripheral enhancement lateral to\nthe gluteus medius muscle measuring 10 x 28 mm.  The previously described left\nileo-psoas abscesses are collapsed and hardly viewed.  No new collection.  No\nsignificant the intra-articular joint effusion in the left hip.",
            "output": "1. Interval decrease in size of multiple abscesses in the muscles surrounding\nthe left hip in which 3 pigtail catheters are seen.\n2. 8 mm lingula nodule to be followed in 3 months.\n\nRECOMMENDATION(S):  Chest CT in 3 months."
        },
        {
            "input": "URINARY: Limited evaluation as only a small portion of the kidneys included in\nfield of view.  No acute abnormality.\n\nGASTROINTESTINAL: Visualized loops of small and large bowel are normal..  The\nappendix 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: No aneurysm identified.  Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been interval removal of surgical catheter involving\nthe left anterior thigh.  There has been interval increase in what is now a\nrim enhancing fluid collection along its previous tract compatible with\nreaccumulated abscess with two separate but likely communicating pockets.  The\nmore superficial and superior pocket measures 4.1 cm AP x 1.8 cm transverse by\n7.6 cm craniocaudal (series 302, image 39 and series 601, image 16).  The\ndeeper and more inferior pocket measures 2.7 cm AP x 1.3 cm transverse by 5.7\ncm craniocaudal (series 302, image 41 and series 601, image 24).  There is a\npigtail drainage catheter which again terminates within the region of the left\niliac muscle.  There is no residual fluid seen around this catheter.  There is\na second pigtail drainage catheter which terminates between the left gluteus\nminimus and medius muscles.  There has been improvement of surrounding fluid\ncollections with largest residual collection along the posterior margin of the\niliac bone measuring 6.1 x 1.1 cm as seen on series 302, image 22.\n\nIncidental note made of a small fat containing left inguinal hernia.",
            "output": "1. Reaccumulation of abscess left anterior thigh at site of prior surgical\ndrain as detailed above which may be accounting for patient's recurrence of\nfevers.\n2. Continued decrease in size of multiple abscesses surrounding the pigtail\ndrainage catheter within the left gluteal musculature.\n3. No significant residual abscess noted surrounding the pigtail drainage\ncatheter located within the region of the left iliac muscle.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:29 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 intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 2.1 cm cyst or biliary hamartoma in the hepatic\ndome.  A few additional subcentimeter hypodensities in the left hepatic lobe\nare too small to characterize.  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 no evidence of solid renal lesions.  A few tiny cortical\nhypodensities in both kidneys are too small to characterize.  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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The appendix is normal.\n\nPELVIS: The urinary bladder is only mildly fluid filled and grossly\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a cystic lesion in the left adnexa measuring 2.9\nx 2.1 cm with an adjacent coarse calcification, corresponding with a simple\ncyst seen on ultrasound from ___.  The coarse calcification could\nalso represent a dermoid. There is another cystic lesion in the right adnexa\nmeasuring 1.7 cm in diameter.  Surgical clips within the pelvis are secondary\nto prior 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 mild dextroscoliosis of the thoracolumbar ___ at\nL1.  There are moderate degenerative changes of the lumbar spine.  A 2.8 x 1.5\ncm a mixed lucent and sclerotic lesion in the sacrum is nonspecific but does\nnot appear aggressive.  Two subcentimeter sclerotic lesions in the left\nsuperior acetabulum likely represent bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No findings on CT of the abdomen/pelvis suggest malignancy.  If clinical\nsuspicion for a paraneoplastic process persists, a PET/CT scan could be\nconsidered."
        },
        {
            "input": "LOWER CHEST: Multiple pacemaker leads are identified in the partially imaged\nenlarged heart.  A left lower lobe bulla measures 3.1 cm.  No pleural\neffusion.  Mild 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 no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  In the left lower quadrant,\nthere is a segment of sigmoid colon with marked wall thickening, mucosal\nhyperemia, and severe adjacent fat stranding (2:  49- 60, 601b:36).  Multiple\ndiverticula are identified throughout the colon.  Findings are compatible with\nacute sigmoid diverticulitis and colitis.  No drainable fluid collection or\nextraluminal air detected.  A mildly dilated loop of adjacent small bowel in\nthe left mid abdomen (60___:36) is likely due to focal ileus from adjacent\ninflammation.  The appendix is not directly visualize, but there are no\nsecondary findings of acute appendicitis.\n\nPELVIS: There is a small right-sided diverticulum in the otherwise normal\nurinary bladder.  The distal ureters are unremarkable.  There is no free fluid\nin 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.  Multilevel mild to\nmoderate degenerative changes of the lumbar spine are present.  Subtle\nsuperior endplate deformity of the T12 vertebral body is likely chronic in\nnature and related to degenerative change.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1.  Acute sigmoid diverticulitis and/oe colitis without definite extraluminal\nair or drainable fluid collection.\n\n2.  Mildly dilated loop of small bowel in the left mid abdomen is likely due\nto focal ileus from adjacent inflammation."
        },
        {
            "input": "Lower Thorax: Please see CT chest from same day for further details.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\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 no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: There is minimal colonic diverticulosis with no evidence of\ndiverticulitis.  The appendix is unremarkable.  There is no evidence of bowel\nobstruction nor abnormal bowel wall thickening.\n\nPelvis:  The urinary bladder is unremarkable.The prostate gland is within\nnormal limits.\n\nLymph Nodes: In the left inguinal region, there is a partially visualized soft\ntissue lesion extending into the left inguinal canal that may represent an\nundescended testis, but is indeterminate.  There are no suspicious lymph nodes\nby morphology nor size criteria.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1.  No radiological explanation for patient's fever identified.\n2.  Partially visualized soft tissue lesion in the left inguinal canal may\nrepresent an undescended testis - for physical exam correlation/ palpation."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nEvaluation is slightly limited due to body habitus and resultant increased\nfield of view.\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 measures 9 mm which is within normal\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 is mildly enlarged measuring 13.8 cm in craniocaudal\ndimension.  There is otherwise normal parenchymal 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 with normal nephrogram. \nThere is no evidence of focal renal lesions 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 total hysterectomy and left\nsalpingectomy.  No adnexal abnormality is seen.  There is trace stranding and\nminimal fluid about the surgical bed adjacent to the vaginal cuff without\norganized fluid collection or abscess.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: An infrarenal IVC filter is in situ.  There is no abdominal aortic\naneurysm.  No 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 of which the\nneck measures 2.8 cm (02:58).",
            "output": "1. Status post total hysterectomy and left salpingectomy.  Trace pelvic free\nfluid and stranding about the surgical bed is likely postsurgical.  No\norganized fluid collection or abscess.\n2. Infrarenal IVC filter in situ.\n3. 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:  There is a 1.3 cm simple cyst in hepatic segment VII (5:117). \nSeveral additional sub cm hypodensities (5:114, 124, 126, 135, 143) are too\nsmall to characterize, but unchanged from the prior study on ___\nand most likely represent cysts.  Liver parenchyma otherwise demonstrates\nhomogeneous 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 known pancreatic body/tail mass measures 5.2 x 6.2 x 3.9 cm TV\nby AP by CC (5:139, 601b:32).  This appears slightly smaller compared to\ntoday's measurement of the prior study on ___, where it was 5.3 x\n6.5 x 4.1 cm (6: 108).  The tumor appears more diffusely hypodense, compatible\nwith expected necrotic response to CyberKnife treatment.  Remaining pancreatic\nparenchyma is atrophic.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild background\natherosclerotic disease is noted. The main celiac axis is patent, but there is\ntumor immediately abutting the left lateral aspect of the vessel (4:40).  The\npancreatic mass severely attenuates a portion of the splenic artery (4:37),\nbut the vessel appears normal in caliber distally towards the splenic hilum. \nSuperior mesenteric artery is widely patent, without evidence of perivascular\nsoft tissue stranding.  There are two renal arteries bilaterally, all of which\nare patent. Inferior mesenteric artery and bilateral iliac branches are\npatent.\n\nThe main portal vein and superior mesenteric vein are patent and without\nevidence of tumor involvement.  The splenic vein is again noted to be\nobliterated by the mass, unchanged from the prior study (5:140).  The spleen\ndrains via numerous collaterals draining into the superior mesenteric vein.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Incidental note is made of a 0.9 cm splenule.\n\nADRENALS: Right adrenal gland is normal in size and shape.  There is\nsuggestion of a 1.8 x 1.1 cm nodularity along the posterior aspect of the\npancreatic mass that is inseparable from the left adrenal gland (5:142).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is an 8 mm hypodensity in the lower pole of the left kidney that is too\nsmall to characterize, but most likely represents a cyst.  There are no\nenhancing parenchymal masses or hydronephrosis.  No nephrolithiasis.  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.  Normal appendix.  No free fluid or free air\nwithin the peritoneal cavity.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is unremarkable.\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.  A\n5 mm sclerotic focus in the left posterior iliac bone 5:214) is unchanged from\n___ comment most likely represents a bone island.  There is mild loss\nof height at L1, which is unchanged from the prior study.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild interval decrease in size of the pancreatic body/tail mass, currently\nmeasuring 5.2 x 6.2 x 3.9 cm.  Increasing tumor necrosis is compatible with\nexpected response to CyberKnife treatment.\n2. There is unchanged appearance of vascular involvement including tumor\nimmediately abutting the left lateral aspect of the main celiac axis, severe\nattenuation of the splenic artery and obliteration of the splenic vein. \nStable fat stranding in the left anterior perirenal fascia.\n3. A 1.8 x 1.1 cm left adrenal nodule closely abuts, and is inseparable from\nthe the medial aspect of the pancreatic mass.\n4. CT chest dictated separately."
        },
        {
            "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: There has been marked interval progression of disease compared\nto the prior exam of ___.  There are innumerable new lesions and\nenlargement of previously seen lesions in the liver, consistent with\nmetastatic disease.  Index lesion within segment 6 now measures 8.6 x 5.5 cm,\npreviously measuring 4.2 x 3.1 cm (3:112).  Largest new lesion within segment\n8 measures 5.0 x 5.1 cm (3:99).  Largest new left lobe lesion in segment 2\nmeasures 1.9 x 1.7 cm (3:96).  Other stable well-defined hypodense lesions\nwithin the liver are consistent with hepatic cysts or biliary hamartomas.  No\nintrahepatic or extrahepatic biliary duct dilatation.  The gallbladder is\nwithin normal limits, without stones or gallbladder wall thickening.\n\nHepatic and portal veins are patent.  Left hepatic artery arises from the left\ngastric artery.  Interval enlargement of a portacaval lymph node measuring 2.5\nx 2.2 cm, previously measuring 2.3 x 1.2 cm (3:106).  This demonstrates\ncentral hypo enhancement, consistent with necrosis.\n\nPANCREAS: The hypodense heterogeneous mass within the tail of the pancreas has\nincreased in size measuring 7.7 x 5.5 cm, previously measuring 4.8 x 5.2 5.2 x\n4.8 (measured at the level of the fiducial markers).  The left adrenal gland\nis not visualized separate from the mass.  The splenic vein is occluded,\nunchanged.  The splenic artery courses through the mass and appears occluded. \nThe distal branches enhance normally.  The mass abuts the left lateral aspect\nof the celiac trunk and comes in close proximity to the left lateral aspect of\nthe SMA but they remain patent.\"  The main portal vein and SMV are patent. \nThe remainder of the head and uncinate process of the pancreas is unchanged.\n\nSPLEEN: The spleen demonstrates new peripheral geographic areas of\nhypodensity, consistent with splenic infarcts.\n\nADRENALS: The left adrenal gland is invaded by the pancreatic tail mass.  The\nright adrenal gland is normal size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal ren interval al lesions, or\nhydronephrosis.  Tiny hypodense lesion within the lower pole of the left\nkidney is too small to definitively characterize but is unchanged.  There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A G-tube is noted in situ.  Small bowel loops are\nunremarkable.  The colon and rectum 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.  Small volume ascites is noted\nin the pelvis, minimally increased compared to the prior exam.\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. The primary pancreatic tumor in the tail of the pancreas is larger in size.\nThere is complete occlusion of the splenic artery and new peripheral\ngeographic hypodense lesions of the spleen, consistent with splenic infarcts.\n2. Interval progression of disease with development of innumerable hepatic\nmetastases and enlargement of previously seen metastases.\n3. Interval increase in small volume ascites."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.  The\nappendix is normal.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is severe bilateral hip joint space narrowing, osteophytosis,\nsubchondral sclerosis, and subchondral cystic change.  The possible subtle\nfemoral neck fracture seen on same-day hip radiographs reflect a large\numbrella osteophyte.  No evidence of fracture.  There is a large left hip\njoint effusion without evidence of osseous erosion\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of fracture or dislocation.\n2. Severe bilateral hip osteoarthritis with a large left hip joint effusion.\nNo osseous erosion to suggest infection. If clinical concern for infection,\nleft hip aspiration should be considered.\n\nRECOMMENDATION(S):  Severe bilateral hip osteoarthritis with a large left hip\njoint effusion. No osseous erosion to suggest infection. If clinical concern\nfor infection, left hip aspiration should 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 homogenous attenuation throughout. \nSubcentimeter hypodensity in segment 3 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 seen, however there are\nno secondary signs of inflammation.\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 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, narrow necked fat containing midline ventral\nabdominal wall hernia just superior to the umbilicus.  There is mild fat\nstranding within the hernia.",
            "output": "1. small midline fat containing ventral abdominal wall hernia with a narrow\nneck just superior to the level of the umbilicus.  Mild fat stranding within\nthe hernia sac is nonspecific."
        },
        {
            "input": "CHEST:\nThe visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\n\nABDOMEN:\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\npancreas, and bilateral adrenal glands are normal.  Patient is status post\ncholecystectomy. Calcified granulomas are noted within the spleen. Multiple\nrenal cysts are seen and bilateral kidneys, the largest one measuring 3.2 x\n3.4 cm in the upper pole of the right kidney. No evidence of nephrolithiasis\nor hydronephrosis.\n\nThe stomach, small bowel, and large bowel are unremarkable in appearance\nwithout dilation or wall thickening.  There is extensive diverticulosis\nwithout evidence of diverticulitis. The appendix is normal.  There is a small\nright lower ventral wall hernia containing fat (2:66). There is no ascites. No\npneumoperitoneum. Extensive atherosclerotic calcifications are noted\nthroughout the abdominal aorta. No focal aneurysmal dilation of the abdominal\naorta. An IVC filter is noted in unchanged position.\n\nPELVIS:\nSeveral dropped gallstones are noted within the posterior to the rectum. The\nbladder, sigmoid colon, and rectum are grossly unremarkable.  The uterus is\nnot visualized.  No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:\nExtensive degenerative changes throughout the thoracolumbar spine, overall\nunchanged since ___.  A calcified disc extrusion is noted at L5-S1\nresulting in severe central canal narrowing. There is a small left hip\neffusion, best appreciated on series 2, image 70 with extensive degenerative\nchanges of both hips.",
            "output": "1. No acute intra-abdominal process.\n2. Bilateral renal cysts.\n3. Calcified disc extrusion at L5-S1 results in severe central canal\nnarrowing, unchanged."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel demonstrate\ndiverticulosis.  The urinary bladder and distal ureters are unremarkable.\nThere is no free fluid in the pelvis.  Partially imaged IVC filter is noted. \nOval calcific densities in the pelvis appear benign and may reflect dropped\ngallstones.\n\nREPRODUCTIVE ORGANS: There is a left adnexal cyst measuring 1.5 x 1.5 cm, best\nseen on series 3, image 45, unchanged multiple prior exams and has been\npreviously characterized by a pelvic MR from ___.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: Severe degenerative changes of the lower lumbar spine noted with\nassociated levoscoliosis and prominent left-sided endplate spurs.  Severe\nosteoarthritis at the left hip noted with joint space narrowing, subchondral\nsclerosis, prominent osteophytosis and flattening of the left femoral head\nalong the superior margin.  Right hip osteoarthritis is also severe though to\na lesser degree than the left, with joint space narrowing and marginal\nosteophytosis noted.  There is no acute fracture.\n\nSOFT TISSUES: A small fat containing umbilical hernia noted.  A second fat\ncontaining hernia is seen along the right anterior pelvic wall with prevesical\nfat extending superiorly into the body wall lateral to the right rectus\nmuscle.",
            "output": "1. No acute fracture or dislocation.\n2. Severe degenerative disease at bilateral hips, left greater than right.\n3. Additional chronic findings as described above."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  The visualized lung bases are\notherwise clear.  Mitral annulus and aortic root calcifications are noted. \nCoronary artery calcifications are noted in the LAD territory.  No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post liver transplant.  The transplant liver\nis normal in appearance within limitation of a unenhanced study.  No\nintrahepatic biliary ductal dilatation.  The gallbladder is surgically absent.\nNo perihepatic free 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 is slightly enlarged measuring 13.8 cm in axial diameter. \nNo focal splenic lesions within the limitation on unenhanced 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There are punctate nonobstructing stones or vascular\ncalcifications within the right kidney (2:43).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is no small bowel obstruction.  Scattered colonic\ndiverticula are noted without evidence of diverticulitis.  The colon and\nrectum are otherwise unremarkable.  The appendix is normal.  No free fluid in\nthe abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Small amount of air in the upper vagina, nonspecific. \nThe uterus is unremarkable in appearance.  No adnexal masses.\n\nLYMPH NODES: There are few scattered conspicuous retroperitoneal lymph nodes. \nNo lymphadenopathy by CT size criteria within the abdomen or pelvis.\n\nVASCULAR: No abdominal aortic aneurysm.  There is extensive atherosclerotic\ndisease.  There are splenorenal shunts, gastric varices and dilated veins\nadjacent to the rectum.\n\nBONES: No acute fracture worrisome osseous lesion.  Severe degenerative\nchanges in the distal lumbar spine again noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute process in the abdomen or pelvis.\n2. Status post liver transplantation. The liver transplant is normal in\nappearance within the limitation on un-enhanced study.\n3. Splenomegaly and abdominopelvic varices as described above.\n4. Coronary calcifications are noted in the LAD territory.\n5. Degenerative changes in the lumbar spine."
        },
        {
            "input": "LOWER CHEST: There are dependent changes at the lung bases bilaterally, but no\ngross consolidation.\n\nABDOMEN:\n\nHEPATOBILIARY: Postsurgical changes are seen after liver transplant.  Liver\nhas a borderline low attenuation, consistent with mild steatosis.  Allowing\nfor the noncontrast technique of image acquisition, there is no suspicious\nfocal lesion.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The patient is status post cholecystectomy.  There is no\nperitoneal free fluid present.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation or peripancreatic stranding.  There is a\nperiampullary duodenal diverticulum arising from the second portion of the\nduodenum.\n\nSPLEEN: The spleen is borderline enlarged, measuring 14 cm in AP dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a 3 mm calcification seen arising from the interpolar aspect\nof the right kidney which might represent a stable stone versus a vascular\ncalcification.  This had a similar appearance on the prior study.  The\nallowing for noncontrast imaging technique, there is no suspicious focal renal\nmass.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Aside from the duodenal\ndiverticulum as described above, there is no focal abnormality evident\ninvolving the small bowel loops.  The colon and rectum are within normal\nlimits. The appendix is normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  Small\nretroperitoneal lymph nodes are seen, but not meeting size criteria for\npathologic enlargement.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild to moderate atherosclerotic disease is present, particularly\ninvolving the infrarenal aorta.  There is no abdominal aortic aneurysm. \nProminent perirectal blood vessels are consistent with chronic varices into\nthe IMV.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a mild right convex scoliosis of the lumbar spine and associated disc\ndegenerative changes particularly at L2-S1..\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Somewhat limited examination without intravenous contrast, but no CT\nimaging findings to explain the patient's left lower back pain.\n2. Mildly steatotic liver.  Steatohepatitis and more advanced liver disease\ncannot be excluded based on imaging.\n3. Equivocal 3 mm punctate nonobstructing right kidney stone.\n4. Periampullary duodenal diverticulum arising from the second portion the\nduodenum."
        },
        {
            "input": "Lower Thorax: Please see CT thorax from same day for further details\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\n\nLiver: The liver is nodular in keeping with cirrhosis.  There is a new\nmillimetric hypodense lesion in segment II that is too small to characterize (\n02:46 ).\n\nGallbladder and Biliary System: The gallbladder has been surgically\nremoved.There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: There is gross splenomegaly, measuring up to 22.0 cm.There is no focal\nsplenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits with\nno evidence of bowel obstruction.\n\nPelvis: The urinary bladder is unremarkable.The prostate gland is within\nnormal limits.\n\nLymph Nodes: There are enlarged but stable retroperitoneal and mesenteric\nlymph nodes, measuring up to 12 mm in the region of the gastrohepatic ligament\n( 02:50) and 11 mm in the aortocaval region ( 2: 78). There is no new\nsuspicious lymphadenopathy in the abdomen or pelvis.\n\nVessels: There are multiple significantly enlarged splenic varices and to a\nlesser extent gastric and esophageal varices related to portal hypertension. \nThe portal veins appear patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1. Cirrhotic liver with multiple varices and splenomegaly related to portal\nhypertension.\n2. Retroperitoneal and to a lesser extent mesenteric lymphadenopathy that\nappears stable compared to ___ is likely therefore related to\npatient's underlying sarcoidosis rather than a lymphoproliferative disorder."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nAlthough no significant stenosis of the celiac axis is appreciated, there is\nmild fusiform dilatation of the distal celiac axis measuring up to 1.0 cm. \nThere is a replaced left hepatic artery arising from the left gastric artery. \nNormal appearance of the SMA.  There is a replaced right hepatic artery\narising from the SMA.  Single right and single left renal arteries are noted. \nThe ___ is patent.  However, there is focal short segment stenosis at the ___\n___.  Heavy calcific and noncalcific plaque at the aortic bifurcation.  On\nthe right side, the external and internal iliac arteries are patent.  The CFA,\nSFA, and profunda femoris are also patent.  On the left side, there is\nmoderate mural plaque in the left common iliac artery resulting in\napproximately 50% stenosis.  There is a focal penetrating ulcer (03:108)\nwithin the plaque.  The external and internal iliac arteries are patent,\nwithout significant stenosis.  The CFA, SFA, and profunda femoris are grossly\npatent.\n\nLOWER CHEST: Minimal atelectasis as well as small subpleural opacities are\nappreciated in bilateral bases.  No pleural or pericardial effusion.  Heart\nsize within normal 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 within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: Normal attenuation of the pancreas.  The main pancreatic duct is not\ndilated.  There is a small hypo attenuating focus in the pancreatic head which\nmay represent a fat lobule versus small side branch IPMN measuring 0.5 cm. \nThis is also seen remote CT chest dated ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  There are bilateral\nmildly enlarged external iliac lymph nodes, largest on the right measuring up\nto 1.1 cm in short axis.  These exhibit normal appearing morphology with fatty\nhila.  Multiple inguinal lymph nodes are also seen, which are within the upper\nlimits of normal.  There is a fat containing right-sided inguinal hernia.\n\nBONES: There 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 atherosclerosis, most significant at the left common iliac artery,\nwith there is mural plaque and penetrating atheroma, resulting in\napproximately 50% stenosis.\n2. Bilateral borderline enlarged pelvic lymph nodes, which exhibits normal\nmorphology.  These are likely reactive.\n3. Right-sided fat containing inguinal hernia."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar atelectasis.  A 8 mm nodule at the\nright lung base is stable.  There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are scattered punctate calcified granulomas in the liver.  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 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 are scattered punctate calcified 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.  A 3.5 cm cyst in the\ninterpolar region of the right kidney is not significantly changed. \nAdditional subcentimeter hypodense lesions are not significantly changed.  Two\nintermediate density lesions in the right lower pole measuring up to 15 mm are\nnot significantly changed, possibly representing proteinaceous or hemorrhagic\ncysts.  There is no hydronephrosis.  There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a small bowel\nanastomosis in the right lower quadrant and a colonic anastomosis deep in the\npelvis.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  Extensive diverticulosis of the colon is noted, without evidence\nof wall thickening and fat stranding.  The rectum is underdistended however\nappears slightly wall thickened (2:73; 601:43).  The appendix is normal\n(02:55).\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.  Previously noted left adnexal cyst has essentially resolved.\n\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 compression deformity of the L1 vertebral body is not significantly\nchanged.  Multilevel degenerative changes the lumbar spine are not\nsignificantly changed.  There are hemangiomas in the L4 vertebral bodies and\nin the sacrum.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Mild rectal wall thickening consistent with proctitis."
        },
        {
            "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\nare bilateral nonobstructive renal stones measuring up to 5 mm in the right\nlower renal pole and 4 mm in the left lower renal pole (2: 83, 87). \nAdditionally, there are a couple stones seen in the left proximal ureter\nmeasuring up to 6 mm with associated mild hydroureteronephrosis (601:61). \nThere is no perinephric abnormality.\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 colon is\nunremarkable.  The appendix is normal.\n\nPELVIS: The urinary bladder is mildly distended.  There is no distal\nhydroureter.  There is no free 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.  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. Two renal stones are seen within the left proximal ureter, with the distal\nstone obstructive and measuring 6 mm, with associated mild\nhydroureteronephrosis.\n2. Nonobstructive renal stones noted in bilateral lower renal calices,\nmeasuring up to 5 mm."
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nLiver is normal in attenuation with no intrahepatic biliary dilatation. The\nportal and hepatic veins are patent. The gallbladder is nondistended with a\nperipherally calcified stone near the body of the gallbladder, but no evidence\nof cholecystitis. The pancreas is mostly atrophic, with no duct dilatation or\nsurrounding stranding. The spleen is normal in size with a focal hypodensity\nat the lower pole (03:52), likely a cyst. Small accessory spleen is noted. The\nadrenal glands are morphologically normal bilaterally. The kidneys enhance and\nexcrete contrast symmetrically. The bilateral peripelvic cysts are noted.\nThere is a small to moderate hiatal hernia. The stomach is decompressed. Small\nbowel is normal in caliber with no obstruction. The appendix is not visualized\nhowever there are no secondary signs of appendicitis. The large bowel contains\noral contrast to the level of the rectum, there is pancolonic diverticulosis\nwithout diverticulitis. There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes. No intra-abdominal free air or free fluid.\n\nPELVIS:  The distal ureters and urinary bladder are unremarkable. The uterus\nand adnexae are unremarkable. No pelvic sidewall or inguinal lymphadenopathy.\nNo free fluid in the pelvis.\n\nVESSELS: The aorta demonstrates mild vascular calcification without aneurysmal\ndilatation and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  No evidence of malignancy in the abdomen or pelvis.\n2.  Cholelithiasis without cholecystitis.\n3.  Sub cm hypodensity at the lower pole of the spleen is likely a cyst.\n4.  Pancolonic diverticulosis without diverticulitis.\n5.  Please see a separate report discussing findings within the chest."
        },
        {
            "input": "LOWER CHEST: Partially visualized 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: The kidneys are atrophic bilaterally. There is no evidence of focal\nrenal lesions or hydronephrosis.  There is no nephrolithiasis. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL:  Extensive intraperitoneal fluid with locules of\nanti-dependent air is likely related to peritoneal dialysis.  The peritoneal\ndialysis catheter enters in the left lower quadrant and terminates left upper\nquadrant without discontinuity.  Small bowel loops demonstrate normal caliber\nand wall thickness throughout. Colon and rectum are within normal limits. The\nappendix is not definitively visualized. There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerosis noted\nwithin the bilateral iliac arteries and scattered throughout the major\nabdominal vasculature.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. There is no\nevidence of pelvic or inguinal lymphadenopathy.\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 small air filled umbilical hernia.",
            "output": "1. No evidence of acute intra-abdominal process.\n2. Moderate ascites with intraperitoneal air likely related to peritoneal\ndialysis.  Evaluation for peritonitis is limited in the absence of IV\ncontrast."
        },
        {
            "input": "LOWER 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.  The\ngallbladder is within normal limits.\n\nPANCREAS: 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: There are punctate hyperdensity involving the right renal midpole\nlikely representing nonobstructive calculus.  There is no hydronephrosis. \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 with surgical sutures in the\nright lower quadrant which may be secondary to appendicectomy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Normal CT 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": "No hydronephrosis bilaterally.  Several punctate nonobstructive calculi in the\nright renal midpole."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases are clear.  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.  An 8 mm 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 solid renal lesions or hydronephrosis.  There is a 2\nmm nonobstructing stone in the lower pole of the right kidney (series 601:33).\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 is no pericecal inflammation of 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: A large cystic lesion in the right adnexa measures 7.2 x\n6.8 cm, evaluated with same day ultrasound characterized as an endometrioma. \nAdditionally, there is a tubular cystic structure in the right adnexa, also\nevaluated on ultrasound in suggestive of a hematosalpinx.  There are two\ncystic structures in the left ovary measuring up to 2.3 cm, also characterized\nas endometriomas.  There is no evidence of surrounding inflammation.  The\nuterus is within normal limits.\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. No acute findings in the abdomen or pelvis.\n2. Appendix is not definitively visualized.  No pericecal inflammation of the\nright lower quadrant.\n3. Bilateral cystic ovarian lesions are better evaluated on pelvic ultrasound\nfrom the same day, and have been characterized as endometriomas.  Please note\npelvic MRI is recommended for further assessment on an outpatient basis.\n4. 2 mm nonobstructing right renal stone.  No hydronephrosis."
        },
        {
            "input": "There is mild bibasilar atelectasis.  The heart and pericardium are normal.\n\nOn this noncontrast exam, the liver is unremarkable.  There is cholelithiasis\nwith no evidence of cholecystitis.  The spleen, and bilateral adrenal glands\nare normal. The pancreas is unremarkable.  There are multiple renal stones\nseen throughout the right kidney as well as a large stone seen in the proximal\nright ureter.  Specifically, there is a 0.6 x 1.1 cm stone, which is\nnonobstructing in the lower pole of the right kidney as well as a 5 mm\nnonobstructing stone seen more inferiorly.  There is a 1.3 x 0.9 x 1.8 cm\nobstructing stone in the proximal right ureter (series 2, image 41 and series\n601b, image 26) which causes moderate to severe upstream dilation of the\ncollecting system.  There is moderate stranding seen around the ureter and the\nright kidney.  A simple cyst is seen in the upper pole of the left kidney\nmeasuring 2 cm. The left kidney and left ureter are otherwise unremarkable.\n\nIn the absence of oral contrast the small bowel is unremarkable. There are few\ncolonic diverticula with no evidence of diverticulitis. There are no\npathologically enlarged retroperitoneal or mesenteric lymph nodes by CT size\ncriteria. The abdominal aorta is not aneurysmal.\n\nThe bladder is unremarkable. The rectum and sigmoid colon are normal. Note is\nmade of prostatic, and vas deferens calcifications. There is no pelvic\nsidewall lymphadenopathy.\n\n There are no suspicious lytic or blastic lesions seen in the visualized\nosseous structures.",
            "output": "1.3 x 0.9 x 1.8 cm obstructing stone in the proximal right ureter (series 2,\nimage 41 and series 601b, image 26) which causes moderate to severe upstream\ndilatation of the collecting system on the right."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nAbdomen: The liver enhances normally containing no concerning focal liver\nlesions.  The gallbladder is normal.  No biliary ductal dilation.  Main portal\nvein is patent.  The pancreas appears normal.  The spleen is normal in size. \nAdrenals are normal bilaterally.  The kidneys enhance symmetrically.  No\nworrisome renal lesion or hydronephrosis.  The abdominal aorta is normal in\ncourse and caliber without appreciable atherosclerotic calcification.  No\nretroperitoneal adenopathy.  The stomach and duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nAppendix is normal.  The colon contains a mild fecal load and is thin walled\nwithout signs of inflammation.  The uterus appears normal.  The adnexal\nregions are unremarkable.  No free fluid.  No free air.  Urinary bladder\nappears mildly thickened, correlate for cystitis.  No pelvic sidewall or\ninguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Normal appendix.\n2. Mild thickening of the urinary bladder, correlate for cystitis."
        },
        {
            "input": "Lower Chest: Please see CT chest report from today.\n\n\nAbdomen and Pelvis:\n\nHepatobiliary: Hepatic cirrhosis, similar to prior.  Suggestion of stone at\nthe gallbladder neck, similar.  Gallbladder is contracted, which accentuates\nits wall thickness, similar to prior.  There is no pericholecystic stranding. \nNormal bile ducts.\n\nSpleen: Enlarged spleen measuring 18 cm, stable.\n\nAdrenals: Normal\n\nKidneys, Bladder, Ureters: No renal abnormalities.  No hydronephrosis.\n\nPancreas: No focal pancreatic abnormalities.  There is mild peripancreatic\nstranding, may be reactive, consider acute pancreatitis if clinically\nappropriate.  No fluid collection.\n\nGastrointestinal: Enteric tube terminates in the distal esophagus, it should\nbe advanced.  Normal stomach, small bowel loops.  Rectal tube in place.  No\ncolonic wall thickening.  Normal appendix.\n\nLymph Nodes: No adenopathy\n\nPelvis: No free fluid.  Foley catheter in place in the bladder.\n\nReproductive Organs: No abnormalities.\n\nVascular: Mild atherosclerotic calcifications.\n\nSoft Tissues: No abnormalities.  Few injection size anterior abdominal wall.\n\nBones: Degenerative changes spine, hips, sacroiliac joints.",
            "output": "Enteric tube tip is in the distal esophagus, should be advanced.\nHepatic cirrhosis.  Splenomegaly.\nMild peripancreatic stranding, consider pancreatitis if clinically\nappropriate.\n\nNOTIFICATION:  The findings were discussed with ICU RN by ___,\nM.D. on the telephone on ___ at 6:26 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "Re-demonstrated is a large left retroperitoneal hematoma, increased in size\nsince yesterday's scan measuring approximately 13.8 x 7.8 cm ___ X AP).  Its\ncraniocaudal dimension spans from the level of the inferior left kidney\nthrough the upper thigh.  There is no evidence of active extravasation within\nthe hematoma however.  Since yesterday there has been embolization of several\nleft lumbar arteries.\n\nThere is a new right groin hematoma with evidence of active extravasation seen\non the arterial phase and then more pronounced on the portal venous phase\n(3:185, 3:422).  This hematoma measures approximately 9.8 x 2.9 x 9.2 cm.  A\nsignificant amount of fat stranding is seen within the adjacent right groin,\npresumably postprocedural.  A small amount of stranding/hematoma tracks along\nthe right lateral conal fascia and adjacent to the right psoas however there\ndoes not appear to be a right psoas hematoma per se.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  See above for the\ndescription of the active extravasation in the right groin.  No active\nbleeding is seen within the left psoas hematoma.\n\nLOWER CHEST: There is a new moderate left pleural effusion which demonstrates\nincreased density and is nonspecific but concerning for a hemothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous 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.  There is minimal perihepatic\nfluid, 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: The spleen is surgically absent.\n\nADRENALS: The right adrenal gland is normal in size and shape.  Unchanged 1 cm\nfat density lesion along the lateral limb of the left adrenal gland,\ncompatible with an adrenal myelolipoma.\n\nURINARY: The kidneys are atrophied.  Bilateral renal cysts are again seen. \n1.3 cm cyst in the right interpolar region demonstrates a calcified rim and is\nunchanged.  A hemorrhagic cyst in the left interpolar region is again noted. \nThere is no hydronephrosis or perinephric abnormality.  Scattered\nnonobstructing renal calculi are visualized and are unchanged.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon demonstrates extensive diverticulosis\nwithout evidence of diverticulitis..  The appendix is normal.\nThere is no evidence of mesenteric lymphadenopathy however there is mesenteric\nstranding.\nRETROPERITONEUM: See above\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  A small amount of free fluid\nis noted within the pelvis\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbar spine are again present, most pronounced at\nL3-L4.\n\nSOFT TISSUES: See above for description of the findings within the right\ngroin.  Unchanged defect in the left anterior abdominal wall consistent with a\nprior site of a peritoneal dialysis catheter.",
            "output": "1. Increased size of a left retroperitoneal hematoma as described above with\nno evidence of active bleeding.\n2. New hematoma within the right groin with areas of active hemorrhage as\ndescribed above.\n3. New moderate-sized high-density left pleural effusion suggestive of a\nhemothorax, of unclear etiology."
        },
        {
            "input": "LOWER CHEST: There is moderate-severe cardiomegaly with severe atherosclerotic\ncalcification of coronary arteries and the aortic and mitral valves.  Evidence\nof prior median sternotomy, CABG and aortic valve repair.  There is no\npericardial effusion.  There is a trace right pleural effusion.  Mild\ndependent atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nWithin the right hepatic lobe there is a subcentimeter hypoattenuating\nstructure which is too small to characterize but statistically most likely a\nsimple cyst or biliary hamartoma.there is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains prominent\ngallstones near the gallbladder neck without pericholecystic fluid or evidence\nof 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: Right adrenal gland is within normal limits.  The left adrenal gland\ncontains a 2.4 cm adrenal adenoma (series 3, image 32).\n\nURINARY: The kidneys are of normal and symmetric size.  There is a 1.6 cm\nintermediate density structure within the interpolar left kidney (series 3,\nimage 41).  Superior left renal parapelvic cyst.  There is no hydronephrosis. \nThere is no nephrolithiasis. There is no perinephric abnormality.\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 or fat\nstranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains radiotherapy seeds and is otherwise\ngrossly unremarkable.\n\nRETROPERITONEUM/LYMPH NODES: The retroperitoneum is symmetric without evidence\nfluid collection, hematoma or expansion.  There is no retroperitoneal or\nmesenteric lymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Infrarenal abdominal aortic\nectasia measures up to 2.6 cm (series 3, image 50).  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMedian sternotomy wires are partially visualized.  Diffuse degenerative\nchanges are mild-moderate, including a Schmorl's node at the T12 vertebral\nbody.\n\nSOFT TISSUES: There is slight asymmetry to the right gluteal muscles compared\nto the left suggesting intramuscular hematoma.  There is ill-defined stranding\nalong the posterior right thigh extending to the knee, without focal fluid\ncollection.  There is a small right-sided hydrocele.",
            "output": "1. Mild edema and enlargement of the right gluteus maximus compared to the\nleft suggestive of an intramuscular hematoma. There is mild associated\nsubcutaneous edema along the posterior right thigh without focal collection. \nIf deemed clinically relevant, this could be better evaluated with MR.\n2. No retroperitoneal hematoma. No free fluid within the abdomen or pelvis.\n3. Cholelithiasis without gallbladder wall thickening or pericholecystic\nfluid.\n4. Heavy atherosclerotic calcification of the heart which is moderate-severely\nenlarged. Evidence of prior median sternotomy with related surgical change.\n5. Infrarenal abdominal aortic ectasia measuring 2.6 cm.  No aneurysm.\n6. Ill-defined, intermediate density lesion within the interpolar left kidney\nmeasuring 1.6 cm. Recommend nonurgent follow-up with ultrasound.\n7. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S):  Ill-defined, intermediate density lesion within the\ninterpolar left kidney measuring 1.6 cm. Recommend nonurgent follow-up with\nultrasound."
        },
        {
            "input": "Lower thorax: There is interval decrease in size of right pleural effusion\nwith re-expansion of the right lung. There is no pleural effusion on the left.\n\nCT abdomen: Liver enhances homogeneously without suspicious lesions or biliary\ndilatation. Portal vein is patent. Gallbladder, spleen, and pancreas are\nwithin normal limits. Previous 1 cm left adrenal lesion now measures 2.0 x 2.8\ncm (5:66) with additional new 1.5 cm left and 2.4 cm right adrenal lesions\n(5:59, 5:60), consistent with metastatic disease.  The kidneys enhance and\nexcrete symmetrically without suspicious lesions or hydronephrosis.\n\nStomach is largely decompressed and difficult to evaluate. Contrast opacified\nloops of small bowel are normal in course and caliber. Colon is within normal\nlimits. Multiple new mesenteric and serosal soft tissue nodules\n(5:69,67,73)measure up to 2.5 cm in diameter. There is marked interval\nincrease in retroperitoneal lymphadenopathy with the largest conglomerate\nmeasuring 3.2 x 4.4 x 8.2 cm (trv x ap x cc) extending along the distal\nabdominal aorta and left common iliac artery. The abdominal aorta demonstrates\natherosclerotic calcifications without aneurysmal dilatation. Major branch\nvessels are patent.\n\nCT pelvis: The bladder, seminal vesicles and prostate gland are within normal\nlimits. There is no pelvic free fluid or lymphadenopathy. A soft tissue mass\ncentered on the right iliacus/paraspinal muscles has increased in size\nmeasuring 7.3 x 4.2 cm, previously 4.3 x 2.8 cm (5:91) with bony erosions of\nthe adjacent superior sacrum and ileum.\n\nBone window: Compression deformity and lucency in the T12 vertebral body is\nunchanged.",
            "output": "1. Marked progression of metastatic disease in the abdomen and pelvis as\ndescribed above.\n\n2. Please refer to separately dictated CT chest report from the same day for\nfull description 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 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.  No obstructing renal ureteral calculus.\n\nGASTROINTESTINAL: The stomach is 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 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.  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 within the abdomen or pelvis.  No obstructing renal or\nureteral calculus.  Normal appendix."
        },
        {
            "input": "LUNG BASES:  The partially imaged lung bases are clear. There is no pleural\neffusion. A trace amount of pericardial fluid is likely within normal\nphysiologic range.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without focal lesion. There is no\nintrahepatic biliary ductal dilation. The portal vein is patent.  The\ngallbladder does not show evidence of stones or wall thickening.  There is\nhomogeneous pancreatic enhancement. There is no peripancreatic stranding or\nductal dilation.  The adrenal glands are normal.  There is no splenomegaly or\nfocal splenic lesion.\n\nNon-contrast images do not demonstrate evidence of renal, ureteral, or bladder\ncalculi.  Images obtained following administration of intravenous contrast\ndemonstrate normal symmetric renal enhancement.  There is no hydronephrosis.\n\nNon-dilated small bowel loops are normal in course and caliber without\nevidence of obstruction. The colon is unremarkable. The appendix is normal.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation. Proximal tributaries are patent.\n\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nAn IUD is seen appropriately positioned within the endometrial cavity.\nOtherwise, the imaged pelvic organs including the bladder and terminal ureters\nare unremarkable. There is no pelvic sidewall or inguinal lymphadenopathy.\nThere is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nA 10 mm sclerotic density in the right iliac bone is compatible with a bone\nisland. Otherwise, there are no concerning focal lytic or sclerotic osseous\nlesions.",
            "output": "No evidence of urinary tract abnormality. No evidence of renal, ureteral, or\nbladder calculi.  No hydronephrosis."
        },
        {
            "input": "CHEST:  Mild atelectasis at the lung bases. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. The gallbladder is surgically absent. Mild\nintrahepatic biliary duct dilation is likely postsurgical.\n\nThe spleen and adrenal glands are unremarkable. An accessory spleen is noted. \nThe pancreas enhances homogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia.  The stomach is\ndecompressed. The small and large bowel are normal in caliber and without\nevidence of wall thickening. The appendix is normal.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria.  The uterus is unremarkable. No\nfree pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy. There is mild anterolisthesis of L5- S1 with disc space narrowing.\nNo pars defect is seen.",
            "output": "1. No evidence of colitis.\n2. Fluid-filled ascending colon - given this finding, a mild gastroenteritis\nwould be difficult to excluded in the correct clinical setting.\n3. Status post cholecystectomy, mild intrahepatic biliary duct dilation is\npostsurgical."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: The 7 mm hypodense lesion is seen within the right liver lobe  that is\ntoo small to characterize. Otherwise, the liver enhances homogeneously without\nfocal lesion or intrahepatic biliary duct dilation. The portal vein is patent.\nThe nondistended gallbladder is within normal limits, without wall thickening\nor pericholecystic fluid.\n\nThe spleen, pancreas, adrenal glands are unremarkable.\n\nKIDNEYS: There is a small hypodensity in the left kidney, that is too small to\ncharacterize but is likely a simple cyst. The kidneys demonstrate symmetric\nnephrograms and excrete contrast promptly. There is no hydronephrosis.\n\nGI: The stomach has no obvious intraluminal mass or wall thickening.  A\nnormal, air-filled appendix is visualized.There is colonic diverticulosis\nwithout evidence of diverticulitis. Large fecal load is noted extending\nthroughout the colon. There is no evidence of bowel obstruction. No free air\nor free fluid is seen within the intra-peritoneum\n\nRETROPERITONEUM: The aorta is normal in caliber, with scattered\natherosclerotic calcifications. There is no retroperitoneal or mesenteric\nlymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nOSSEOUS STRUCTURES: Degenerative changes of the lumbar spine is seen,\nincluding mild retrolisthesis of L2 on L3. Trace superior endplate compression\ndeformity of the L4 vertebral body which are likely chronic. Otherwise, no\nacute fractures noted.",
            "output": "1. No acute abdominopelvic findings to account for pain.\n2. Moderate colonic fecal loading without evidence of obstruction."
        },
        {
            "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 examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the\ngallbladder, pancreas, spleen, and bilateral adrenal glands are normal.  The\nliver contains multiple hypodense lesions, stable from the prior examination\nand likely representing cysts or biliary hamartomas. The bilateral kidneys are\ngrossly unremarkable in appearance and there is no evidence of nephrolithiasis\nor hydronephrosis.\n\nThe patient is status post gastrectomy with Roux-en-Y. Visualized loops of\nsmall and large bowel are unremarkable in appearance without dilation or wall\nthickening.  There is no overt retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum. The aorta and\nits major branches contain calcifications.\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.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nthroughout the visualized thoracolumbar spine.  Mild anterolisthesis of L4 on\nL5 is unchanged. No focal lytic or sclerotic lesion concerning for malignancy.",
            "output": "No evidence of remnant renal or ureteral calculus."
        },
        {
            "input": "LOWER CHEST: Bibasilar subsegmental atelectasis.  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 or\nextrahepatic biliary dilatation.  The gallbladder is not visualized.\n\nPANCREAS: The pancreas is atrophic 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, without\nevidence of focal lesions.\n\nADRENALS: The 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 cm simple appearing cyst the upper pole of the left kidney.  Other\nsubcentimeter cortical hypodensities in bilateral kidneys are too small to\ncharacterize.  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. 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.  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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small right inguinal fat containing hernia and diastasis of the\nlower anterior abdominal wall, likely in large part related to postsurgical\nchanges.",
            "output": "No evidence of acute intra-abdominal or pelvic findings."
        },
        {
            "input": "There is an intramuscular hematoma within the adductor compartment of the\nright medial upper thigh, measuring approximately 9.7 x 6.8 x 11.8 cm as seen\non earlier ultrasound. No pelvic extension.\n\nPELVIS: There is mild diffuse bladder wall thickening, which may relate to\nchronic bladder outlet obstruction. Multiple brachytherapy seeds are seen\nwithin the prostate gland. There is no pelvic free fluid. There are no\npathologically enlarged pelvic sidewall or inguinal lymph nodes by CT size\ncriteria. The imaged large and small bowel demonstrate appear normal.\nAtherosclerosis involving the abdominal iliac vessels noted. No\nretroperitoneal hematoma.  There is a small fat containing right inguinal\nhernia.\n\nBONES AND SOFT TISSUES: No worrisome bony lesions. Degenerative changes are\nnoted in the lumbar spine, with disc height loss, vacuum disc phenomenon, and\nosteophytosis.  Post-laminectomy changes in the lumbar spine noted.",
            "output": "Intramuscular hematoma within the adductor compartment of the medial right\nupper thigh measuring approximately 9.7 x 6.8 x 11.8 cm. No intrapelvic\nextension."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Portal venous system is patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient had underwent left lateral hepatic segmentectomy.  A\n3.7 x 2.2 cm seroma at the site of resection is smaller compared to before\n(previously 4.3 x 2.7 cm).  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 is within\nnormal 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: Left adrenal gland is unremarkable.  Right adrenal gland is\nsurgically absent.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA stable 1.6 cm round lesion at the right kidney lower pole has intermediate\ndensity, likely hemorrhagic or proteinaceous cyst.  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 is normal.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS:  Prostate is mildly 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. No extravasation of IV contrast is identified to suggest active hemorrhage.\nNo acute abdominal pathology is identified.\n2. Stable intermediate density lesion in the right kidney seen to represent\nproteinaceous or hemorrhagic cyst on prior MRI from ___"
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  In addition to the left atrial\nappendage filling defect noted on prior CT chest, there is a 10 mm hypodense\nfilling defect in the left ventricle which appears new compared with ___, concerning for ventricular thrombus (02:48).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is stable coarse calcification in the left hepatic lobe.  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.  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. \nFew subcentimeter cortical hypodensities are too small to characterize,\nhowever not significantly changed from prior and likely represent cysts. \nThere is no 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. Focus\nof soft tissue density at the cecum is felt to be due to underdistention with\nnonfilling of contrast (2:89; 601:20).  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: 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes in the lumbar spine are not\nsignificantly changed.  There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: There is diffuse anasarca.",
            "output": "1. No definite evidence of metastatic disease in the abdomen or pelvis.\n2. Focus of soft tissue density in the cecum is felt to be due to\nunderdistention and nonfilling of contrast, however attention on follow-up and\ncorrelation with any prior available colonoscopies is recommended.\n3. Diffuse anasarca and trace free fluid in the pelvis.\n4. New 10 mm hypodense filling defect in the left ventricle, in addition to\nthe likely thrombus in the left atrial appendage noted on CT chest, concerning\nfor ventricular thrombus.\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 by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 10:38 am, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac axis, SMA, bilateral\nrenal arteries, ___, bilateral common iliac arteries and their major branches\nare patent.  Incidental note is made of a replaced left hepatic artery\noriginating from the splenic artery.\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.  Coarse\ncalcifications in the left hepatic lobe are again demonstrated.  No focal mass\nlesions are identified.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor 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. \nBilateral subcentimeter hypoattenuating lesions are too small to characterize.\nNo focal mass lesions are identified.  There is no evidence of stones.  There\nis mild right-sided hydroureteronephrosis.  The distal right ureter is\ndecompressed.  No obstructing transition point is seen.  There is no left\nhydroureteronephrosis.  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 is not visualized.\n\nLYMPH NODES: There is no evidence of abdominal or pelvic lymphadenopathy.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An enlarged fibroid uterus is unchanged from ___.  No adnexal abnormality is seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is diffuse subcutaneous edema.",
            "output": "1. No evidence of aortitis or renal abscess.\n2. Mild proximal right hydroureteronephrosis is new from ___. \nHowever, the distal right ureter is decompressed, without an obstructing\ntransition point seen.  Findings are nonspecific.\n3. Diffuse subcutaneous edema.\n4. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "LOWER CHEST:\nThere is linear atelectasis in both lower lobes.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously with no focal\nlesions.  The portal vein and its branches are patent.  No intrahepatic\nbiliary ductal dilation noted.\nThe gallbladder is partially distended with hyperdense material layering\nwithin it, likely sludge versus calculi without pericholecystic inflammation.\nPANCREAS: There is homogeneous enhancement of the pancreatic parenchyma\nwithout main duct dilation or focal pancreatic lesions.\nSPLEEN:  No splenomegaly or focal splenic lesions.  Accessory spleen is noted\nat the hilum (05:13)..\nADRENALS: There are no adrenal nodules\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is no bowel obstruction.  A large stool burden is\nnoted throughout the colon.  Normal appendix.\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The prostate and\nseminal vesicles appear normal.  No free fluid in the pelvis or pelvic\nlymphadenopathy.  No inguinal lymphadenopathy noted.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "There is no 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 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 redemonstration of a splenule in the\nsplenic hilum measuring 1.2 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.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear normal.  Patient\nis status post left orchiectomy.  The right testicle is incompletely\nvisualized on the provided images\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. 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. 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 normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions 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 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 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 and pelvis.\n2. Please refer to separate report of CT chest performed same day for\ndescription of thoracic findings."
        },
        {
            "input": "LOWER CHEST: A 1 mm right lower lobe pulmonary nodule is stable dating back to\nat least CT of the chest from ___.  Visualized lung bases are\nclear.  There 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 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\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.\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. Sub-centimeter periaortic nodes are\nunchanged from prior.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis 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": "1. No acute process in the abdomen or pelvis to explain the symptoms of pelvic\npain.\n2. No evidence of metastatic disease within the abdomen or pelvis.\n3. Cholelithiasis."
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nThe liver demonstrates heterogeneous areas of attenuation in the right lobe\nsuperiorly (05:44), and in the right lobe inferiorly (5:65). These are likely\nperfusion abnormalities.  There is a stable hypodensity in hepatic segment II\n(05:52), too small to characterize.  There is no intrahepatic biliary\ndilatation. The portal vein is patent. The gallbladder is non-distended, with\nno stones. The pancreas is normal in attenuation and does not demonstrate\nstranding. The spleen is surgically absent.  Lobulation of the diaphragm in\nthe left upper quadrant does not represent a retroperitoneal soft tissue mass\n(05:50).  The adrenal glands are normal morphologically bilaterally. The\nkidneys enhance normally. There is no hydronephrosis.\nThe distal esophagus and stomach are normal appearing. The small bowel is\nnormal in caliber. There is evidence of prior colonic resection with a patent\nrectosigmoid anastomosis. The large bowel does not demonstrate wall thickening\nto indicate colitis.\nProminent lymph nodes in the lower central mesentery (12:21) are unchanged\nsince ___, with the largest lymph node measuring up to 1 cm. 1 cm\naortocaval lymph node is stable (12:3).\n\nPELVIS: The urinary bladder is relatively well distended and normal appearing.\nLeft inguinal sidewall lymph node measures 9mm, previously 7mm (12:49).\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: Bilateral total hip arthroplasties appear in standard\nposition.  There has been prior L3 through L5 posterior spinal fusion with\nL4-L5 laminectomy. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5.\nThere is partial fusion between the L3 through L5 vertebral bodies. No\nconcerning osseous lesions are seen.  Small ventral hernia is noted.",
            "output": "1. Slight interval increase in size of left pelvic sidewall lymph node,\nmeasuring 9 mm, previously 7 mm. Otherwise, stable central mesenteric and\naortocaval lymph nodes since ___.\n2.  Heterogeneous attenuation of the right lobe of the liver, at the dome and\ninferiorly, is likely perfusional, however attention on followup is\nrecommended.\n3.  Stable appearance of bilateral hip arthroplasties and lumbar fusion\nhardware. No evidence osseous metastases in the abdomen or pelvis.\n4. Please see a separately dictated report discussing intrathoracic findings."
        },
        {
            "input": "LUNG BASES:  Please see dictation for separately reported CT Chest\nexamination.\n\nCT ABDOMEN:\nIrregular areas of hyperenhancing hepatic parenchyma near the liver dome, as\nwell as similar areas near the tip of the liver are again identified (series\n2, image 49 and series 2, image 69) which again do not persist on delayed\nphase images, likely representing perfusional anomalies.  An ill-defined 6 mm\nhypodensity in segment III (series 5, image 14) is stable since at least\n___, too small to characterize but likely a simple hepatic cyst. \nOtherwise, the liver enhances homogeneously without evidence of focal lesion. \nThere is no intrahepatic biliary ductal dilation.  The portal vein is patent. \nThe pancreas enhances homogeneously.  There is no peripancreatic stranding or\nductal dilation.  The adrenal glands are normal bilaterally.  The patient is\nstatus post splenectomy.\n\nA hypodensity measuring approximately 5 mm in the medial left renal cortex\n(see series 5, image 19) is too small to characterize.  Otherwise, there is\nnormal symmetric renal enhancement bilaterally.  There is no hydronephrosis.\n\nThe stomach and duodenum are unremarkable.  Non-dilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening or\nobstruction, although it should be noted that several small bowel loops in the\ndependent portions of the peritoneal cavity extend into the pelvis and are\nsomewhat obscured by artifact from nearby bilateral hip prostheses.  The colon\nis filled with stool, but otherwise unremarkable.  The appendix is not\ndirectly visualized, however there are no secondary signs of appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation.  Major proximal tributaries appear patent.\n\nAgain seen is diffuse retroperitoneal/periaortic lymphadenopathy spanning from\napproximately the level of the renal arteries to the aortoiliac bifurcation. \nThis appears more prominent in comparison to prior exams; in particular,\nenlarged periaortic lymph nodes are matted, in areas now appearing more as\nconglomerate nodal masses.  For example, see series 2, image 65, were a\nconglomerate nodal mass currently measures 1.4 x 1.3 cm in axial ___. \nAdditionally, more inferiorly there is increased irregular soft tissue density\nabutting the lateral aspect of the aorta, more prominent than on priors\n(series 2, image 73), likely matted lymphadenopathy.  Lymphadenopathy\ninvolving the mesenteric root is stable since exam from ___ (series\n2, image 70).\n\nCT PELVIS:\nHardware artifact from bilateral total hip prosthetic hardware significantly\nlimits evaluation of the pelvic structures.  Within this limitation, there is\nno evidence of obvious pelvic abnormality.\n\nMUSCULOSKELETAL:\nRectus abdominus diastasis spanning approximately 4.5 cm at largest extent\nminimally contains normal appearing protruding small bowel loops which are\nwithout evidence of obstruction or ischemia (series 2, image 64).  This is\nunchanged from exam from ___.  The patient is status post bilateral\ntotal hip arthroplasty, with no evidence of hardware-related complication. \nAdditionally, L3-5 bilateral posterior spinal fusion rods and transpedicular\nscrews are again seen in grossly appropriate and stable position without\nevidence of loosening or other complication.  Grade 1 L3-L4 and L4-5\nanterolistheses are unchanged.  The L3 and L4 vertebral bodies are fused,\nunchanged from prior exams.  There is no evidence of concerning focal lytic or\nsclerotic osseous lesion.",
            "output": "1. Interval progression of retroperitoneal lymphadenopathy, now with multiple\nareas of matted, conglomerate nodal masses abutting the abdominal aorta. \nStable mesenteric root matted lymphadenopathy.\n2. No additional sites of metastasis within the abdomen or pelvis.\n3. Please see separate report for intrathoracic findings from same-day CT\nchest."
        },
        {
            "input": "Additional scattered sclerotic foci throughout the pelvic bones were also\npresent on the prior scan.  LOWER CHEST:\nPartially included on this scan is a rim enhancing right-sided pleural\ncollection with a chest tube within it.\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There are unchanged scattered hepatic cysts.  A 0.7 cm\nhomogeneously enhancing lesion in the left lobe (series 5, image 61) is also\nunchanged dating back to ___ and is likely a hemangioma.  There are no\nnew focal hepatic lesions.\nThe gallbladder is surgically absent.  Mild central prominence of intrahepatic\nbile ducts is likely related to prior cholecystectomy.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation.  9 mm hypodense lesion in the uncinate process of the pancreas\nis unchanged, likely a branch duct IPMN.\nSPLEEN:  No splenomegaly.  Again visualized is a focal hypodensity within the\nspleen (series 5, image 55) that now measures 0.3 cm compared to a prior of\n0.8 cm, nonspecific but smaller in size compared to prior.  No new splenic\nlesions identified.\nADRENALS:  No adrenal nodules..\nURINARY: There is bilateral symmetric mild renal cortical atrophy.  No\nhydronephrosis seen on either side.  No solid enhancing renal masses\nidentified.  There is an unchanged simple cortical cyst in the lower pole of\nthe right kidney.\nGASTROINTESTINAL: There is no bowel obstruction.\n\nLYMPH NODES: There are unchanged subcentimeter short axis left para-aortic\nlymph nodes that do not meet criteria for pathologic enlargement..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nAgain visualized is a 6.4 by 5.4 cm (series 5, image 104) fluid containing\nleft adnexal lesion with thin internal septations and no solid components,\noverall unchanged in size and appearance compared to the prior exam.\n\nBONES AND SOFT TISSUES:\nThere is a new 1.2 cm sclerotic lesion within the left femoral neck (series 5,\nimage 116).",
            "output": "1. New 1.2 cm sclerotic lesion within the left femoral neck is concerning for\nan osseous metastasis-correlation with bone scan is recommended.\n2. No other metastatic deposit in the abdomen or pelvis.\n3.6.4 cm cystic left adnexal lesion remains unchanged compared to multiple\nprior exams.  Although the lesion is stable compared to multiple prior exams,\nfurther characterization by dedicated pelvic ultrasound and GYN consult, if\nnot already performed should be considered.\n4. Unchanged scattered hepatic cysts and a left hepatic lobe hemangioma, and a\n9 mm, likely branch duct IPMN within the pancreatic uncinate process.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 14:15 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider."
        },
        {
            "input": "Partially imaged lung bases are clear. There is no pleural effusion.\n\nCT abdomen: Liver enhances homogeneously without concerning lesions or biliary\ndilatation. Portal vein is patent. Gallbladder, spleen, pancreas, and adrenal\nglands are within normal limits. Kidneys enhance and excrete symmetrically\nwithout concerning lesions or hydronephrosis. A duplicated collecting system\nis noted on the right where two separate ureters extend all the way down to\nthe bladder. A small ureterocele is present.\n\nStomach is partially decompressed. Nondilated loops of small bowel are normal.\nThere is no obstruction. The colon is notable for diverticulosis without\ndiverticulitis. There is no intra-abdominal free air or fluid. There is no\nmesenteric or retroperitoneal lymphadenopathy. Abdominal aorta is of normal\ncaliber throughout with mild atherosclerotic calcifications.\n\nCT pelvis: Bladder, terminal ureters, and uterus are unremarkable.  Adnexa\nappear normal. There is no mesenteric or retroperitoneal lymphadenopathy.\n\nBone window: No concerning lytic or sclerotic osseous lesion identified.\nSymmetric widening of the L4-L5 facet joints, is possibly due to presence of\nfluid in the joint and likely degenerative in nature.",
            "output": "No evidence of acute intra-abdominal process."
        },
        {
            "input": "CHEST:  There is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:  The liver enhances homogeneously, without concerning focal lesion.\nThe patient is status post cholecystectomy.  The biliary tree is normal. The\npancreas is normal, without focal lesion or duct dilation. The spleen is\nnormal in size, without focal lesion. The adrenal glands are normal. The\nkidneys enhance normally and excrete contrast briskly. There are no solid\nrenal lesions or hydronephrosis. The stomach and duodenum are normal. The\nsmall bowel and large bowel are normal in caliber, without wall thickening or\nmass.  The appendix is air-filled and normal.  There is no significant\ndiverticulosis or diverticulitis.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS: The urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no pelvic or inguinal\nlymphadenopathy. The uterus is normal. There is a 3.5 cm simple right ovarian\ncyst and trace physiologic pelvic free fluid.\n\nBONES AND SOFT TISSUES: There is no acute fracture. There are no destructive\nosseous lesions concerning for malignancy or infection. There are no soft\ntissue masses.",
            "output": "1. No diverticulitis or other acute process in the abdomen or pelvis to\naccount for the patient's pain.\n2. Right adnexal cyst measuring 3.5 cm likely normal in a premenopausal\nindividual."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is a\nsliver of right-sided pleural effusion.  No left pleural effusion 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 is moderately fatty replaced.  There is some spared\ntissue near the junction of the body and tail which appear slightly prominent.\nHowever, at its appearance is unchanged since ___, and likely represents non\nfatty infiltrated residual pancreatic tissue.  The pancreas is otherwise\nwithin normal limits.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:   Slightly nodular appearance of both adrenal glands, with no\ndominant nodules identified.  The appearance is unchanged when compared to\nprevious from ___.\n\nURINARY: A 0.7 x 0.9 x 0.9 cm (AP by trans by CC) obstructing stone is seen\nwithin the proximal third of the right ureter.  It is causing moderate\nupstream hydronephrosis ureter.  There is minimal flat stranding surrounding\nthe ureter at the level of the stone, likely reactive.  There is no\nsignificant fat stranding or inflammatory change surrounding the right kidney.\n2 other millimetric nonobstructing stones are seen within the right collecting\nsystem.\n\n2 high density partially exophytic nodules are seen arising from the lower\npole of the right kidney, measuring 7 and 9 mm respectively.  They are too\nsmall to confidently characterize, however 1 of them was seen on the prior\nstudy.  The second 9 mm nodule is not definitely seen on the prior exam,\nhowever measures 55 Hounsfield units, and is most likely compatible with a\nhemorrhagic cyst.\n\nThere are no suspicious renal lesions identified.\n\nGASTROINTESTINAL: A small hiatus hernia seen, otherwise the visualized small\nand large bowel loops 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:  A 6.3 x 6.2 cm partially calcified fibroid is seen\narising from the right aspect 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.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There are degenerative bony changes noted within the lumbar\nspine.  Mild scoliosis is noted.  The abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. 0.7 x 0.9 x 0.9 cm (AP by trans by CC) obstructing stone is seen within the\nproximal third of the right ureter causing moderate upstream hydronephrosis\nand hydroureter.  Additional nonobstructing calculi in the right kidney with\nthe largest measuring 7 mm in the lower pole.\n2. At least 2 hyperdense, likely hemorrhagic cysts in the right lower pole and\nan enlarged fibroid uterus are additional incidental findings\n\nNOTIFICATION:  Findings discussed with Dr. ___ by ___ on ___ at 18:15, 5 minutes after findings were made"
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  There is no large adnexal mass.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: Minimally displaced fracture is noted of the right inferior pubic\nramus.  Additionally, there is a nondisplaced fracture of the parasymphyseal\nleft superior pubic ramus.  There is irregularity and fracture line through\nthe right, anterior sacrum (series 2; image 37), which likely represents a\nsmall sacral insufficiency fracture.  Further, there is a nondisplaced\nfracture of the superior right acetabulum (series 2; image 60).  Lastly, there\nis a nondisplaced fracture the L5 transverse process.\n\nSOFT TISSUES: Minimal soft tissue surrounds the fracture lines without\nevidence of large resultant hematoma.",
            "output": "Acute, minimally displaced fracture of the right inferior pubic ramus. \nNondisplaced fracture of the parasymphyseal left superior pubic ramus.\nIrregularity and fracture line through the right anterior sacrum likely\nrepresents associated, small sacral fracture.  Nondisplaced fracture of the\nright superior acetabulum.  Nondisplaced fracture of the L5 transverse\nprocess.  No resultant hematoma."
        },
        {
            "input": "There is no acute fracture.  Specifically, the proximal left femur is\nunremarkable.  Severe degenerative changes noted at the left hip with joint\nspace loss, subchondral sclerosis and osteophyte formation.  Degenerative\nchanges are noted in the spine.  Retrolisthesis of L5 on S1 is unchanged. \nPubic symphysis and SI joints are preserved.  Bone island in the proximal left\nfemur is again noted.\n\nAtherosclerotic calcifications noted in the lower abdominal aorta which\nmeasures up to 2.4 cm in diameter.  Right common iliac artery measures 1.5 cm\nand the left common iliac artery measures 1.7 cm.\n\nPatient is status post sigmoid colectomy.  Other included portions of the\ncolon and small bowel are unremarkable.  Appendix is normal.  Bladder,\nprostate and seminal vesicles are unremarkable.  Penile prosthesis is\nincidentally noted.",
            "output": "No 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: Respiratory motion mildly limits evaluation of the upper abdomen.\n\nHEPATOBILIARY: Linear hypodensity in the left hepatic lobe is most likely\nrelated to motion artifact (5:62).  The liver parenchyma is otherwise normal. \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 measures 13.6 cm, mildly enlarged.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The multiple\nsubcentimeter hypodensities are too small to characterize, most likely cysts. \nThe urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Changes from prior\nsigmoidectomy are noted, with a suture line in the mid-pelvis.  The colon is\notherwise unremarkable.  The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland is unremarkable.  There is a penile\nprosthesis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Ectatic abdominal aorta with moderate calcified atherosclerotic\ndisease.  No aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.Severe multilevel lumbar spondylosis is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Assessment of the upper abdomen is mildly limited due to respiratory\nmotion.\n2. Within this limitation, there are no acute findings in the abdomen or\npelvis.  No abdominal mass.\n3. Mild splenomegaly.\n4. Please refer to the separately dictated CT chest report from the same date\nfor description of thoracic findings."
        },
        {
            "input": "LOWER CHEST: Redemonstrated subpleural reticulation seen in the bilateral lung\nbases, predominantly peripherally, is not significantly changed compared to\nprior.  Partially visualized cardiac leads terminate in the right atrium and\nright ventricle.  There are mitral and aortic valve calcifications as well as\ncoronary artery calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodensity seen in the left lobe of the liver is likely a cyst or biliary\nhamartoma and measures 6 mm (series 2, image 43).  Additional scattered\nhypodensities are too small to characterize, however likely represent cysts. \nThere is mild periportal edema.  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 bilateral renal cysts measuring up to 2.7 cm on the right and 1.3 cm\non the left.  Additional bilateral hypodensities are too small to\ncharacterize, however likely represent additional cysts.  There are peripelvic\ncysts bilaterally.  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 prior sigmoidectomy with sutures seen in the pelvis.  There is fat\nstranding and fluid surrounding the ascending colon with wall edema and\nthickening of the lateral conal fascia.  The appendix is normal (601:42,\n2:119).\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. \nThere is a penile prosthesis with reservoir in the right pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an ectatic infrarenal abdominal aorta, measuring up to 2.4\nx 2.1 cm.  Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes seen throughout the spine.  Chronic right rib fractures\nare noted.  Severe degenerative changes also noted at the left hip.\n\nSOFT TISSUES: There is mild diffuse anasarca.",
            "output": "Inflammation surrounding the proximal ascending colon with wall edema suggests\ncolitis, likely of infectious or inflammatory etiology."
        },
        {
            "input": "LOWER CHEST: Previously noted bilateral pleural effusions have resolved.  No\nsignificant abnormalities are seen at the visualized lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\npreviously seen bowel hyperdense lesion in segment 7 is not well seen on the\ncurrent study.  Scratched 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 measures 12.4 cm in greatest dimension, which is normal and\ndecreased since prior examination.  A 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 rectum is\nunremarkable.  The patient is status post appendectomy.\n\nThe previously identified, small rim enhancing collection adjacent to the\nlateral aspect of the cecum is not well seen on this examination.  Again seen\nis a rim enhancing collection adjacent to the surgical staples at the\nappendectomy site, significantly decreased in size since prior examination,\nnow measuring 4.3 x 4 cm (6b:40 ; previously 4.5 x 9.5 cm).  A drain\nterminates within the collection. The collection previously identified in the\nleft lower quadrant now measures 2.3 by 1.9 cm (previously 1.9 x 7.1 cm).  A\ndrain terminates within.  Other smaller collections, for example along the\nleft pelvic sidewall, have resolved.\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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  There is anterior abdominal wall soft tissue abnormality from\nrecent laparotomy.",
            "output": "1. Multiple, rim enhancing abdominal collections, overall decreased in size\nsince prior 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: 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: There is moderate atrophy of the pancreatic neck and body.  There is\nno focal lesion, and the main duct is nondilated.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 subserosal calcified 2.5 cm fibroid arising\nfrom the posterior uterine body.  Both ovaries are visualized, and there is no\nevidence 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 to moderate\natherosclerotic disease is noted.  There is tortuosity and mild dilatation of\nthe proximal celiac artery, without evidence of ostial stenosis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative disc disease involving the lumbar spine, as well as a\n5 mm retrolisthesis of L2 over L3, and minimal retrolisthesis of L3 over L4. \nLower lumbar facetal degenerative changes.  Minimal wedge-shaped deformity\ninvolving T12, with 10% loss of height.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Mild loss of vertebral body height at T10."
        },
        {
            "input": "LOWER CHEST: There is asymmetric thickening of the skin overlying the left\nbreast in the left pectoralis muscle (series 2, image 1), which given history\nof left breast cancer, is concerning for malignancy.  Punctate calcifications\nand surgical clips are also seen within the left breast parenchyma.\n\nAdditionally, there is slightly increased conspicuity of reticular opacities\nat the bilateral lung bases, likely a chronic process.  There is no evidence\nof pleural or pericardial effusion.\n\nThere is a partially visualized enlarged subcarinal lymph node (series 2,\nimage 1) and several prominent cardiophrenic recess lymph nodes (series 2,\nimage 7 and 13).\n\nMitral annular calcifications as well as aortic valve calcifications are\npresent.\n\nABDOMEN:\n\nHEPATOBILIARY: Within the right anterior lobe, there is a 1.1 cm\nirregularly-shaped hypoenhancing lesion (series 2, image 32).  Otherwise, the\nliver enhances homogeneously and there is no evidence of additional focal\nlesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder contains a 1.8 cm gallstone without evidence of\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: Within the spleen, there are several rounded regions of\nhypoenhancement, measuring up to 1.4 cm.  2 these lesions (series 2, image 30\nand 43) were previously also seen on prior MR, but several are new and warrant\nattention on follow-up exam.  Interval increase in splenomegaly, measuring up\nto 17.4 cm on current exam.  2 splenules measuring up to 2.2 cm are located at\nthe 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. \nWithin the bilateral kidneys, there are multiple tiny hypodense rounded\nlesions, better characterized on prior MR and representing simple renal cysts.\nRedemonstration of focal cortical atrophy and scarring of the left renal\ncortex.  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 descending and sigmoid colon is noted, without evidence of wall thickening\nand fat stranding.  A soft tissue tract extending form a sigmoid diverticulum\nto the vaginal cuff which appears to contain enteric contrast is concerning\nfor a colovaginal fistula (series 2, image 82.  No inflammation is seen in the\nsurrounding fat.  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 patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.  There is evidence of enteric contrast and air within\nthe vaginal vault.  A soft tissue tract extending form a sigmoid diverticulum\nto the vaginal cuff which appears to contain enteric contrast is concerning\nfor a colovaginal fistula.  (Series 2, image 82\n\nLYMPH NODES: In comparison to ___ MR abdomen and at ___ CT, there is\nmarkedly interval increase in diffuse bulky retroperitoneal, perihepatic,\nmesenteric, pelvic, and inguinal lymphadenopathy.  The largest lymph nodes are\nlocated along the pelvic sidewalls, measuring up to 3.4 cm in the short axis,\ncompared to prior measurement of 1.6 cm on ___ CT.  Bilateral enlarged\ninguinal lymph nodes are also seen, and these may be most amenable for biopsy.\nThese findings are suspicious for recurrence or progression of patient's known\nchronic lymphocytic leukemia.\n\nVASCULAR: 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 laminectomy of levels T10 through L2.  Degenerative\nchanges are seen in the lumbar spine, with stable retrolisthesis of L1 on L2.\n\nSOFT TISSUES: A left inguinal hernia containing fat is noted.",
            "output": "1.  Findings concerning for patent colovaginal fistula extending from a\nsigmoid diverticulum to the vaginal cuff.\n2.  Marked interval increase in diffuse abdominopelvic lymphadenopathy and\nsplenomegaly since ___ MR and ___ CT, concerning for recurrence or\nprogression of known chronic lymphocytic leukemia.  Bilateral inguinal lymph\nnodes may be amenable for biopsy.\n3.  Asymmetric left breast skin and left pectoralis muscle thickening, new\nsince ___ CT and concerning for malignancy given history of left breast\ninvasive ductal carcinoma.\n4.  Slightly increased conspicuity of bilateral lung base reticular opacities,\nlikely a chronic process.\n5.  Several small new hypodense splenic lesions, measuring up to 1.4 cm, which\nare nonspecific and warrant attention on follow-up exams.\n6.  Cholelithiasis without acute cholecystitis.\n\nRECOMMENDATION(S):   Recommend clinical correlation for left breast skin\nthickening.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:33 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider. The\nfindings were also discussed with ___, M.D. by ___, M.D.\non the telephone on ___ at 9:45 am."
        },
        {
            "input": "CHEST:\n\nA contrast enhanced CT of the chest was also performed on this patient.\nInterpretation of this component of the study is issued as a separate report\nin the ___ medical record.\n\nABDOMEN:\n\nThe liver enhances homogeneously, without concerning focal lesion. The\ngallbladder and biliary tree are normal. The pancreas is normal, without focal\nlesion or duct dilation. The spleen is normal in size, without focal lesion.\nThe adrenal glands are normal. The kidneys enhance normally and excrete\ncontrast briskly. There are no solid renal lesions or hydronephrosis.  There\nare bilateral subcentimeter hypodensities which are too small to characterize.\nThe stomach and duodenum are normal.\n\nThe small and large bowel are normal in caliber.  There is wall thickening and\nmural lipomatosis of the proximal ascending colon and the cecum (6:50,\n601b:37).  There is an adjacent, 9 mm mesenteric lymph node, which is not\npathologically enlarged by size criteria, but which may be reactive\nnonetheless (6:51).\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches. Portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is nearly empty, making assessment difficult.  The uterus\nis not seen. The rectum is unremarkable. There is no pelvic mass. There is no\nfree fluid. There is no pelvic or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.  The\nspinal mass seen on the MRI is is almost impossible to discern by CT.  There\nare no adjacent osseous changes.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. No vertebral osseous changes adjacent to the spinal mass.\n3. Incidental findings suggestive of mild chronic colitis involving the\nproximal ascending colon and cecum.  If the patient is asymptomatic, these\nfindings may not be clinically significant.  Correlation with prior\ncolonoscopies is suggested."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 the left hepatic lobe (02:10) is too small to\ncharacterize.  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. \nIndeterminate, 1.0 cm renal hypodensity within the lower 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: An IUD is in place, but appears inverted.  Otherwise, the\nuterus 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Within the superficial soft tissues of the right upper anterior\nabdominal wall is an approximately 3.5 x 1.1 x 3.3 cm (2:21, 602:25) hypodense\ncollection, with mild adjacent fat stranding, concerning for abscess.  Small,\nfat containing umbilical hernia.  Otherwise, the abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. Superficial hypodense collection measuring 3.5 x 1.1 x 3.3 cm within the\nright upper anterior abdominal wall, with mild adjacent fat stranding,\nconcerning for abscess.\n2. An IUD is in place, but appears inverted.\n3. Otherwise, no acute intra-abdominal abnormality.\n4. 1 cm indeterminate right renal hypodensity.  A nonemergent ultrasound may\nbe obtained for further evaluation.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 09:53 into the Department of Radiology ED QA\nnurses 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 underlying liver is fatty with heterogeneous, ill-defined\nlesions scattered throughout, consistent with known metastatic disease better\ncharacterized previously.  There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis unremarkable.\n\nPANCREAS: The pancreas demonstrates fatty replacement, without focal lesion 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. There is no evidence of\nfocal renal lesions or hydronephrosis.  There is no nephrolithiasis.\n\nGASTROINTESTINAL: Ill-defined wall thickening and contour defect of the lesser\ncurvature of the stomach is consistent with known gastric cancer (2:19). \nMultiple surgical clips again seen in the left upper quadrant.  Small bowel\nloops demonstrate normal caliber and wall thickness throughout. Colon and\nrectum are within normal limits.  The appendix is air-filled and normal,\nwithout adjacent fat stranding. There is no evidence of mesenteric\nlymphadenopathy.  There is no ascites or free intra-abdominal air.\n\nRETROPERITONEUM: Previously described borderline enlarged periaortic lymph\nnode measures 1.0 cm, unchanged (601b:41).\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: Multilevel degenerative changes of the lumbar spine\nare unchanged since the prior study. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Within the limitations of a non IV contrast study, no acute intra-abdominal\nprocess.  No evidence of free intraperitoneal air.\n2. Re-demonstrated ill-defined stomach wall thickening, consistent with known\ngastric cancer, and hepatic 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: There is hepatic steatosis, with multiple ill-defined lesions\nscattered throughout, consistent with known metastatic disease.  No intra or\nextrahepatic biliary ductal dilatation.  The gallbladder is within normal\nlimits.\n\nPANCREAS: Pancreas is fatty replaced and atrophic.  No peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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: Known gastric cancer involving the lesser curvature of the\nstomach is better is seen on CT abdomen and pelvis dated ___ when the\npatient drank oral contrast.  Multiple surgical clips are again seen in left\nupper quadrant.  Small bowel loops demonstrate normal caliber on wall\nthickness.  Colon and rectum are within normal limits.  Appendix is normal\nappearing.  Note is made of a small amount of nonspecific fluid in the right\nlower quadrant and pelvis, which is new.  No intra-abdominal free air.\n\nPELVIS: The bladder is under distended, but grossly normal.  There is trace\npelvic free fluid\n\nLYMPH NODES: The previously described borderline enlarged left para-aortic\nlymph node appears unchanged (601b:52).  No pathologically enlarged pelvic\nsidewall lymph nodes.\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.  There are bilateral fat containing inguinal hernias.",
            "output": "1. No evidence of small bowel obstruction.\n2. No intra-abdominal free air to suggest the presence of a perforated viscus.\n3. Trace nonspecific fluid in the right lower quadrant and pelvis.\n4. Normal appendix.\n5. Known gastric mass is better appreciated on CT dated ___.\n6. Re- demonstration of hepatic metastatic disease."
        },
        {
            "input": "Please see the dedicated CT chest report from the current date for the\nthoracic findings.\n\nLIVER: The liver is fatty with new regions of ill-defined hypodensities\nparticularly in segments V and VI (4:75-78, and 8:32-33). . These could be due\nto focal fatty infiltration or new infiltrative disease/neoplasm. No\nintrahepatic biliary duct dilation. The portal vein is patent.The\nnon-distended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: Splenomegaly up to 14.4 cm is largely unchanged (8:52).\n\nPANCREAS: Fatty attenuation throughout the pancreas without evidence of focal\nlesions are pancreatic ductal dilatation.\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach is distended without obvious intraluminal mass or wall\nthickening.The small and large bowel are within normal limits, without wall\nthickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild to moderate atherosclerotic calcifications. There is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.  The\npreviously described 1.7 cm gastrohepatic ligament lymph node is not seen on\nthe current study.  Multiple surgical clips seen in the left upper quadrant,\nunchanged.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.Bilateral fat containing inguinal hernias\nare unchanged.  Calcifications in the prostate are also unchanged.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.",
            "output": "1. New regions of ill-defined hypoensity, particularly in hepatic segments V\nand VI, may be due to focal fatty infiltration. However, infiltrative\ndisease/neoplasm is on the differential diagnosis. MRI of the abdomen is\nrecommended now, or alternatively, obtain a non-contrast CT of the abdomen and\npelvis followed by a portovenous phase during the next scheduled follow-up.\n\n2. Previously described gastrohepatic ligament lymph node is not seen on the\ncurrent study.\n\n3. Please see the dedicated CT chest report from the current date for the\nthoracic findings.\n\nNOTIFICATION:  The above findings were entered into the radiology imaging\nfindings dashboard for communication to the ordering clinician at 17:10 on ___."
        },
        {
            "input": "Lung Bases:  Imaged lung bases are clear.  The imaged portion of the heart\nnotable for mitral annular calcification.  There is mild left atrial\nenlargement.  No pleural or pericardial effusion is seen.\n\nAbdomen: A nodular contour of the liver is again noted consistent with\ncirrhosis.  Perihepatic and perisplenic ascites is moderate.  Main portal vein\nis patent.  Gallbladder is surgically absent.  Common bile duct is stably\ndilated.  No discrete worrisome liver lesion is identified.  The spleen is\nenlarged as on prior measuring 15.4 cm in length.  Adrenals, pancreas and\nkidneys appear normal.  Several small renal cortical hypodensities may\nrepresent simple cysts.  The abdominal aorta is densely calcified and non\naneurysmal.  No adenopathy is seen.  Portosystemic varices are noted.  Stomach\nand duodenum appear normal.\n\nPelvis: Small large bowel demonstrate no signs of ileus or obstruction.  A\nsupraumbilical small hernia containing fluid is new from prior and may\nrepresent site of palpable abnormality.  No colonic obstruction or\ninflammatory changes.  Appendix is normal.  Diverticulosis without\ndiverticulitis noted.  The uterus and adnexal structures appear normal. \nVarices extend into the deep pelvis.  Urinary bladder is only partially\ndistended appearing normal.  No pelvic sidewall or inguinal adenopathy.  There\nis evidence of mild pelvic floor descent.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Cirrhosis, splenomegaly, moderate volume ascites.\n2. Fluid-filled supraumbilical hernia, new from prior likely corresponding to\npalpable abnormality.\n3. Extensive atherosclerosis."
        },
        {
            "input": "The lack of intravenous contrast administration limits the evaluation of the\nintra-abdominal solid organs and the bowel.\n\n Lungs: There has been significant interval progression of the patchy\nconsolidations within the visualized lower lobes, consistent with multifocal\npneumonia. Changes of paraseptal emphysema are again seen in the visualized\nlung bases.\n\nLiver: Cirrhotic morphology of the liver is again seen.\n\nBiliary: There is no intrahepatic or extrahepatic bile duct dilatation. The\ngallbladder has been surgically removed.\n\nSpleen: The spleen is enlarged measuring 13.7 cm.\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 a small amount of ascites.\n\nThe uterus and ovaries are visualized.\n\nGastrointestinal:  There is fecal loading of the entire colon.  There is no\nevidence of bowel dilatation or obstruction.\n\nVascular: There is moderate to severe 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 is\nredemonstration of the umbilical hernia, no containing small bowel.  No\ncomplications are seen. Subacute fractures of left ribs ___ are seen.\n\nThere is a small amount of fluid of simple density tracking along the right\nabdominal wall, likely related to the recent ultrasound-guided paracentesis.\nNo evidence of hematoma. There is anasarca.",
            "output": "1. Significant interval progression of the patchy consolidations within the\nvisualized lower lobes, consistent with multifocal pneumonia.\n\n2. Fluid tracking in the subcutaneous tissues along the right abdominal wall,\nlikely related to the recent ultrasound-guided paracentesis. Anasarca.\n\n3. Cirrhotic morphology of the liver with splenomegaly. Small amount of\nascites."
        },
        {
            "input": "LOWER 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 vicarious excretion\nof 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: Punctate 1 mm nonobstructive calculi are seen in both kidneys.  There\nis a 1.8 cm cyst within upper pole of the left kidney.  Otherwise the kidneys\nare of normal and symmetric size with normal nephrogram.  There is no evidence\nof solid 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 is collapsed surrounding a Foley catheter,\ncontaining postprocedural air.  There is a small volume of free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are subcentimeter retroperitoneal lymph nodes nonspecific\ncommon may be 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. No evidence of metastatic disease in the abdomen and pelvis.\n2. Subcentimeter retroperitoneal lymph nodes are nonspecific may be reactive.\n3. Nonobstructive 1 mm bilateral renal calculi.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: There is a small pleural effusion on the right with mild\nassociated basilar atelectasis.  For full details, please refer to the\nseparate chest CT report.\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 adrenal gland are normal in size and shape.  The left\nadrenal gland exhibits mild nodular enlargement without discrete nodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are multiple bilateral subcentimeter hypodensities, the largest of which\nmeasures approximately 7 mm in the superior pole on the right, which most\nlikely represent simple renal cysts.  There is no evidence of solid renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is not sufficiently distended for proper\nevaluation. However, there appears to be a lesion in the antrum on series 4\n___ 76 small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. The colon and rectum are within normal limits aside\nfrom diverticulosis of the sigmoid and descending colon without complication,\nsuch as diverticulitis.  There is a severe colonic stool burden.\n\nPELVIS: Th there is a Foley catheter in place in the urinary bladder, which is\ndecompressed.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is severe enlargement 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are mild-to-moderate degenerative changes of the lumbar spine,\nspecifically and the L4-L5 level with vacuum degenerative change and\nosteophytosis.  There is mild osteopenia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Findings concerning for lesion in the stomach.  Endoscopy recommended\n2. Prostatomegaly, as above.\n3. Large colonic stool burden.\n4. Mild nodular enlargement of the left adrenal gland without discrete nodule.\n5. Please refer to separate CT chest report for thoracic findings.\n\nRECOMMENDATION(S):  Upper endoscopy\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 10:28 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "PELVIS:  A large amount of stool fills the rectum and sigmoid colon otherwise\nthe partially visualized small and large bowel are unremarkable. The urinary\nbladder and distal ureters are unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: Degenerative changes are seen in the lower lumbar spine.\n\nSOFT TISSUES: There is small soft tissue umbilical calcification otherwise the\nabdominal and pelvic wall is within normal limits.  There is partial\nvisualization of hyperdense expansion in the quadriceps muscle in the anterior\nleft thigh consistent with an intramuscular hematoma.",
            "output": "1. No fracture.\n2. Partially imaged intramuscular hematoma in the left anterior thigh."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 dilatation,\nwith prominence of the common bile duct, likely following cholecystectomy.\n\nPANCREAS: The pancreas is mildly hypoattenuating, which may reflect prior\npancreatitis.  No evidence of active inflammation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 renal stones are seen within the left kidney, the largest stone or\nconglomerate of stones measuring up to 8 mm.  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 majority of\nthe colon is fluid-filled, which can be seen in the setting of diarrhea.  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: Fibroid uterus.  The bilateral adnexa appear\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.  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 acute intra-abdominal process noted.\n2. Mildly hypoattenuating pancreas, which may reflect prior pancreatitis.  No\nevidence of active inflammation, on today's exam.\n3. The majority of the colon is fluid-filled, which can be seen in the setting\nof diarrhea.\n4. Mild intrahepatic biliary dilatation and prominence of the common bile\nduct, likely following cholecystectomy.\n5. Numerous, nonobstructing left renal stones, the largest stone or\nconglomerate of stones measuring up to 8 mm.  No hydronephrosis on either\nside.  No calculi 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 parenchyma enhances homogeneously.  No focal liver\nlesions.  No intrahepatic biliary ductal dilation.  The gallbladder is\ndistended with no radiopaque calculi within it.\n\nPANCREAS: Patient is status post distal pancreatectomy.  There is a small\nfluid collection in the surgical bed at the pancreatic tail measuring 2.8 x\n4.1 cm abutting the suture line (series 2, image 27).\n\nSPLEEN: Patient is status post splenectomy.  In the splenectomy bed, there is\nextensive stranding of fat, scattered pockets of fluid along with multiple\ntiny locules of air.  These locules of air are either related to presence of\nthe surgical drain or reflect super added infection, in the appropriate\nclinical scenario.\n\nADRENALS: The right and left adrenal glands 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.  Punctate nonobstructing left\nrenal midpole calculus noted.  There is no perinephric abnormality.  There is\nno hydronephrosis or hydroureter.  1.7 cm simple cyst in the lower right lower\npole The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: No bowel obstruction.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.8 cm by 5.7 cm\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the lumbar spine with intervertebral disc\nheight loss, joint-space narrowing and osteophyte formation most prominent the\nlevels of L2-3 through L5-S1. degenerative disc disease is noted at L5-S1\nlevel.\n\nSOFT TISSUES: Postsurgical changes are seen along the midline abdomen.",
            "output": "Status post distal pancreatectomy and splenectomy.\n\n1. There is a rim enhancing fluid collection measuring up to 4.1 cm in maximum\ndimension abutting the surgical clips at the distal pancreas in the surgical\nbed.  In the splenectomy bed there are multiple tiny locules of air, diffuse\nstranding of fat and scattered pockets of fluid surrounding the surgical\ndrain.  These changes suggest either postsurgical changes or evolving\ninfection with phlegmonous changes without yet developing a well-defined\nabscess at this site on today's exam.\n2. There is no fluid collection at the tip of the surgical drain, which lies\nin the left subphrenic space.\n3. Prostatomegaly.\n\nNOTIFICATION:  The findings were discussed by Dr. ___, MD with Dr. ___\n___, MD on the telephone on ___ at 3:38 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 homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Patient is post distal pancreatectomy for combined duct IPMN with\nhigh-grade dysplasia.  There has been interval evolution of the previously\nseen fluid collection at the pancreas section margin.  There is decreased\nfluid component and this area now appears to represent mostly fat necrosis\n(6:26).  There is no main pancreatic duct dilatation or new suspicious focal\nlesions in the remaining pancreas head and body.\n\nSPLEEN: The spleen is surgically absent.  There has been evolution of\npostsurgical changes in the splenectomy bed with 2 contiguous areas of fat\nnecrosis noted that measure approximately 9.3 cm in aggregate (6:24).\n\nTwo tubular fluid collections near left lateral abdominal wall along the tract\nof the previously seen surgical drain are bigger.  The more posterolateral\ncollection measures 6.5 x 1.9 cm (6:26).  The more anterior collection\nmeasures 4.2 x 2.2 cm (8:17).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions.  A 1.7 cm intermediate density\ncystic lesion in the right lower pole is unchanged (8:33) and likely\nrepresents a hemorrhagic/proteinaceous cyst.  There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  Two small\nnonobstructing stones again seen and measure up to 5 mm in the left interpolar\nregion (8:35).  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding. The\nappendix is normal.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic 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 evolution of postsurgical changes from distal pancreatectomy and\nsplenectomy for combined duct IPMN, notable for:\n2. Decreased fluid component at the site of previously seen fluid collection\nat the pancreas resection margin.  This area now appears to be mostly fat\nnecrosis.\n3. Two left upper quadrant tubular fluid collections along the tract of the\npreviously seen surgical drain measuring up to 6.5 x 1.9 cm  and 4.2 x 2.2  cm\nare bigger.\n4. Evolution of fat necrosis in the splenectomy bed.\n5. Persistent nonobstructing nephrolithiasis."
        },
        {
            "input": "There is mild atelectasis at each lung base wake.  On the right, this includes\ntrace pleural fluid that is new since the prior CT.\n\nThere is no biliary dilatation within the limitations of a non-contrast\nexamination.  No focal liver lesions are identified.  The gall bladder appears\nnormal.  Pancreas appears normal.  Spleen is normal in size and appearance. \nAdrenals appear normal.  No evidence for stones or hydronephrosis involving\neither kidney.\n\nStomach, small and large bowel are unremarkable.\n\nProstate is mildly enlarged with central hypertrophy.  Distal ureters, seminal\nvesicles and bladder are unremarkable.  There is new trace free fluid in the\npelvic cul de sac.  No enlarged lymph nodes are found.\n\nA pigtail catheter terminates anterior to the psoas muscle and in entirely\ncollapsed collection.  The only residual fluid collection is located along the\ninner anterior abdominal wall of the left locomponent wer quadrant, slightly\nmedial to the course of the drain measuring 32 x 12 mm in axial ___\n(2:62).  There is also a very small left lateral residual component measuring\n32 x 13 mm (02:52).\n\nInferior vena cava filter is noted.  Vascular calcification is minimal.  The\naorta is not dilated.\n\nThere is a very small unchanged very small fat-containing umbilical hernia.\n\nPostoperative changes along the anterior abdominal wall have decreased\nincluding decreased air.\n\nPatient is status post anterior L4-L5 and L5-S1 fusions, unchanged, including\nstable left anterior postoperative paraspinal findings.",
            "output": "Minimal residual collections.  Appropriately positioned percutaneous pigtail\ncatheter.  New trace ascites.  New trace right pleural fluid."
        },
        {
            "input": "LOWER 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.\nThere is very mild intrahepatic biliary ductal dilatation and prominence of\nthe extrahepatic duct, likely secondary 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. A small 9 mm\nhypodensity within the medial posterior spleen is consistent with a cyst as\nseen on the recently performed MR spine.\n\nADRENALS: The right adrenal gland is unremarkable. A bilobed 1.9 cm lesion in\nthe adrenal gland is unchanged dating back to at least ___.\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.\n\nGASTROINTESTINAL: There is a small hiatal hernia. No small bowel obstruction.\nThe colon and rectum are within normal limits. No free fluid in the abdomen.\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: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild to moderate\natherosclerotic disease is noted.\n\nBONES: A 2.8 x 2.0 x 1.3 cm lytic lesion involving the L1 vertebral body is\nagain noted with evidence of height loss of the superior endplate, better\ncharacterized on the MR lumbar spine dated ___.\n\nThere are extensive new lytic and soft tissue lesions involving the sacrum,\nleft iliac bone and acetabulum. For example, within left iliac bone there is a\n3.0 cm lesion with anterior and posterior cortical destruction (6:93).  A\nsmall enhancing soft tissue component extends from this lesion into the\ngluteus musculature (6:94).  In addition, lytic and soft tissue lesions are\nseen to involve the left acetabulum also with cortical destruction, for\nexample a 2.4 cm enhancing lesion involving the posterior column (6:07).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive new osseous metastatic lesions as described above. Lesions\ninvolving left iliac bone and posterior column of the acetabulum are\nassociated with cortical destruction placing the patient at high risk for\npathologic fracture.\n2. Known L1 vertebral body metastatic lesion is again noted, better assessed\non the MR lumbar spine ___.\n3. Stable 1.9 cm left adrenal lesion, unchanged dating back to ___\nand most consistent with an adenoma\n4. No evidence of metastatic disease within the abdominopelvic solid organs.\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 Dr. ___. by\n___, M.D. on the telephone on ___ at 4:41 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nThe super renal abdominal aorta is of normal in caliber without evidence of\naneurysm or dissection. A fusiform, infrarenal abdominal aortic aneurysm is\nstable, measuring up to 6.1 x 5.0 cm in maximum dimension (3:66), previously\n6.2 x 5.1 cm on ___. There is no evidence of endoleak. The celiac\naxis, SMA, bilateral renal arteries, and ___ are grossly patent.\nAtherosclerotic mural calcifications are seen throughout the aorta and its\nmajor branches.\n\nABDOMEN:\n\nThe visualized lung bases demonstrate bibasilar atelectasis. There is no\nevidence of pericardial effusion.\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 and bilateral adrenal glands are normal.\nRedemonstrated is a 1.4 cm splenic hypodensity (3:38), likely representing a\ncyst. The pancreas demonstrates diffuse calcifications and several focal\nregions of ductal dilation, unchanged from the prior exam and likely\ncorrelating with the sequelae of chronic pancreatitis. The kidneys enhance\nsymmetrically and are without suspicious 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. Colonic\ndiverticulosis is present without evidence of diverticulitis. There is no\nretroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal 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.\n\nOSSEOUS STRUCTURES: The patient is status post right total hip arthroplasty.\nMultilevel, multifactorial degenerative changes are seen within the visualized\nthoracolumbar spine. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Status post EVAR of a infrarenal fusiform AAA measuring up to 6.1 cm in\nmaximum diameter, stable from the prior examination. No evidence of endoleak.\n\n2. Extensive colonic diverticulosis.\n\n3. Diffuse pancreatic calcifications, likely representing the sequelae of\nchronic pancreatitis."
        },
        {
            "input": "VASCULAR:\n\nAs before, an aorto bi-iliac stent is demonstrated.  The proximal portion of\nthe stent overlies the origin of the bilateral renal arteries, however both\nrenal arteries demonstrate normal opacification with contrast.  The fusiform\ninfrarenal aneurysm is unchanged in size from the prior examination and\nmeasures 5.7 x 4.6 cm (previously 5.7 x 4.6 cm).  AAA.  Small endoleak is\nidentified on series 5, image 58, most likely related to retrograde filling of\nthe aneurysm sac from the inferior mesenteric artery, minimally increased in\nsize from the prior examination in ___.\n\nThe celiac axis, and superior mesenteric artery are widely patent.  There is\ncalcified atheromatous within the bilateral common, internal and external\niliac artery is as before.  There is no hemodynamically significant stenosis\nidentified.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  There is marked calcified atherosclerosis of\nthe coronary arteries.\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: As before, the pancreas is atrophic and contains innumerable coarse\ncalcifications consistent with a history of chronic pancreatitis.\n\nSPLEEN: The spleen is normal in size.  The 16 x 18 mm hypoattenuating, non\nenhancing lesion is noted in the anterior spleen which is oval from prior\nexams and may represent a cyst.\n\nADRENALS: Mild thickening of the left adrenal gland is stable from the prior\nexamination.  The right adrenal gland is normal.\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.  Nonspecific perinephric\nstranding is re- demonstrated.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is sigmoid colon diverticulosis without\nevidence of diverticulitis as before.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder wall is minimally thickened, but similar in appearance to\nthe prior examination possibly due to obstructive uropathy due to the\npatient's markedly enlarged prostate.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged up to 6 cm\n\nBONES: The patient is status post total right hip arthroplasty.  Degenerative\nchanges of the thoracolumbar spine are similar to the prior exam.\n\nSOFT TISSUES: There is a small fat containing inguinal hernia.",
            "output": "1. Stable appearance of an abdominal aortic aneurysm status post endovascular\nrepair with an aorto bi-iliac stent.  The maximum diameter of the aneurysm sac\nis approximately 5.9 cm, stable from the prior study.\n2. A type 2 endoleak is minimally increased in size and most likely related to\nretrograde flow through the inferior mesenteric artery as described above.\n3. Colonic diverticulosis without evidence of diverticulitis.  Findings\nconsistent with chronic pancreatitis are stable.\n4. Minimal bladder wall thickening and a markedly enlarged prostate."
        },
        {
            "input": "VASCULAR:\n\nPatient is status post endograft repair of a large infrarenal abdominal aortic\naneurysm.  There is re- demonstration of a type 2 endoleak likely from\nretrograde filling from the ___ (03:58, 62) The excluded aneurysmal sac\nmeasures 6.0 x 4.8 cm (3:68), previously 5.9 x 4.6 cm, unchanged in size.  The\nvolume of the aneurysm is also unchanged compared to the prior study measuring\n110 cm3, previously also 110 cm3.\n\nThe celiac axis and SMA are widely patent. The proximal end of the stent\noverlies the origin of the bilateral renal arteries but both are patent. \nThere is persistent aneurysmal dilatation of the bilateral common iliac\narteries cover by the stent graft which measures 1.6 cm on the left and 1.9 cm\non the right.  Heavy atherosclerotic calcifications are present in the\ninternal and external iliac arteries but these are widely patent, as are the\ncommon femoral and superficial and deep femoral 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. 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 are extensive coarse calcifications throughout the entire\npancreas compatible with history of chronic pancreatitis.  There is unchanged\npancreatic ductal dilatation measuring up to 9 mm. There is no peripancreatic\nstranding or fluid collection.\n\nSPLEEN: The spleen is normal in size. A 12 mm hypodense lesion is unchanged\nfrom prior exam and possibly represents a cyst.\n\nADRENALS: Diffuse thickening of the left adrenal gland is unchanged. The right\nadrenal gland is normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nNonspecific perinephric stranding is also unchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber without wall thickening or surrounding stranding. There is\nsigmoid diverticulosis without acute diverticulitis.  The appendix is not\nclearly identified but there are no secondary signs of appendicitis. There is\nno evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There is bladder wall thickening which may be related to chronic\nbladder outlet obstruction.  . There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes throughout the entire lumbar spine as well as\nthe bilateral sacroiliac joints. Patient is status post right total hip\narthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post endograft repair of a large infrarenal abdominal aortic\naneurysm with persistent type 2 endoleak likely from the ___.  The size of the\naneurysm sac is unchanged with maximum diameter of 6.0 cm.\n2. Sequelae of chronic pancreatitis with diffuse pancreatic calcifications and\nductal dilatation.\n3. Sigmoid 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.  There are no obstructing renal stones.\n\nGASTROINTESTINAL: The patient is status post gastric lap band placement which\nappears in appropriate position.  No small bowel obstruction.  There are\nscattered sigmoid diverticula.  Within a portion of the mid sigmoid colon\nthere is wall thickening and surrounding fat stranding indicative of acute\ndiverticulitis (2:78).  No evidence of focal abscess, fluid collection or free\nair.  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 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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSlight kyphosis at the thoracolumbar junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute, uncomplicated sigmoid diverticulitis.\n2. Status post gastric lap band placement without evidence of complication.\n3. No obstructing renal stones."
        },
        {
            "input": "LOWER CHEST: There is streaky atelectasis at the lung bases bilaterally.  No\npleural effusion.  Heart size is normal, without a 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.  Scattered colonic diverticula\nare present without diverticulitis.  The colon and rectum are otherwise within\nnormal limits.  Normal appendix.  No ascites.  No pneumoperitoneum.\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.  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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES:  Minimal subcutaneous fat stranding along the upper anterior\nabdominal wall (02:20), and at the level of the umbilicus (02:39), likely\nrelated to recent laparoscopic port placement.",
            "output": "1. No acute intra-abdominal process identified.  No evidence of hernia.\n2. Mild subcutaneous fat stranding along the upper anterior abdominal wall and\nat the umbilicus, likely related to recent laparoscopic cholecystectomy."
        },
        {
            "input": "LOWER 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 unremarkable, without\npericholecystic fluid or 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. \nAn unchanged subcentimeter hypodensity in the interpolar left kidney is too\nsmall to characterize, but likely a cyst (08:34).  No new focal renal lesion\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL:  As described previously, patient is post gastrectomy and\nlymph node resection.  Previously noted necrotic lymph node in the\ngastrohepatic ligament is no longer identified.  Surgical clips in the porta\nhepaticus are again seen.  There has been interval removal of the jejunal\nfeeding tube.  The previously described omental fatty lesion in the right\nlower quadrant, consistent with omental infarction, is smaller in size and\nmeasures 3.6 x 3.0 cm currently (8:11, 5:86).  Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits.  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 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.  Multiple pelvic phleboliths again identified.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: Mild multilevel degenerative changes of the\nthoracolumbar spine, with osteophytosis formation at L1-L2, are unchanged. No\numbilical or inguinal hernia identified.",
            "output": "1.  Patient is post gastrectomy and lymph node resection, without evidence of\nrecurrent metastatic disease or malignancy in the abdomen and pelvis.\n\n2.  Previously described omental infarct has decreased in size."
        },
        {
            "input": "ABDOMEN:\n\nLung Bases: The chest portion of this report will be dictated separately.\n\nHepatobiliary: The liver demonstrates homoenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is collapsed and not well\nevaluated.\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 adrenal gland is normal. There is stable minimal\nnodularity to the left adrenal.\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 bowel loops and mesentery are normal in appearance. The site of\nknown gastric carcinoma in the cardia is not identifiable on CT. There is no\nevidence of obstruction of abnormal wall thickening.\n\nRetroperitoneum: The necrotic lymph node along the lesser curvature of the\nstomach appears stable in size currently measuring 4 x 3.4 cm when measuring\nin similar planes compared to the prior exam.  No new abnormal appearing or\nenlarged lymph nodes are identified.\n\nVascular: The abdominal vasculature appears patent.\n\nPELVIS:\n\nThe visualized pelvic organs are normal. There is no significant pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "Stable necrotic lymph node along the lesser curvature of the stomach. No new\nsites of disease identified in the abdomen or pelvis."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion. Please see a separate report discussing findings within\nthe thorax.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal lesions. The gallbladder is\nnormal with no radio-opaque gallstones.  The pancreas is normal with no\nperipancreatic fat stranding or fluid collections.  The spleen is normal in\nsize and homogeneous in attenuation.  The adrenal glands are normal in size\nand morphology. The kidneys enhance symmetrically and display prompt contrast\nexcretion with no focal lesions, hydronephrosis, or radio-opaque stones.\n\nThe known focus of gastric carcinoma in the gastric cardia is not appreciable\nby CT.  Necrotic lymph node at the lesser curvature of the stomach measures 4\nx 3.3 cm, unchanged since ___.  The small bowel is normal in caliber\nwith no evidence of metastatic deposits. The large bowel contains stool but is\notherwise normal. The appendix is not visualized.  Scattered mesenteric and\nretroperitoneal lymph nodes are not enlarged by CT size criteria. No new\nenlarged lymph nodes are appreciated.  There is no intra-abdominal free air or\nfree fluid.\n\nPELVIS: The distal ureters and urinary bladder are normal.  The prostate is\nmildly enlarged and seminal vesicles are unremarkable.  There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nVESSELS: The aorta demonstrates mild atherosclerotic disease without\naneurysmal dilatation and its major branches are patent.  There is mild\nnarrowing of the right common iliac artery due to asymmetric atherosclerotic\ncalcification.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Stable necrotic lymph node at the lesser curvature of the stomach, since the\nprior examination from ___. Known focus of gastric cancer in the cardia is\nnot appreciable by CT. No evidence of new tumor deposits."
        },
        {
            "input": "LOWER CHEST:\nSince the prior study performed on ___, there has been interval\nenlargement of bilateral right greater than left pleural effusions. \nLoculation of fluid in the left upper lobe and lung base are similar/slightly\nmore pronounced (02:18).  Consolidation at the lung bases likely represents\ncompressive atelectasis.\n\nVASCULAR:\nPatient is status post repair of a descending thoracic aortic aneurysm, with\nthe excluded sac measuring up to 5.5 cm (02:12), overall similar to the prior\nstudy on ___.\n\nAgain seen is a stent graft in the proximal abdominal aorta with an SMA stent,\nas well as a tandem infrarenal aorto-biiliac stent graft.  Right iliac stent\nextends from the distal abdominal aorta to the external iliac artery.  Left\niliac stent extends to the distal common iliac artery.  Excluded infrarenal\nabdominal aortic aneurysm sac measures 5.9 x 4.4 cm TV x AP (2:68), which is\nunchanged.  Previously noted locules of air in this excluded aneurysm sac are\nno longer seen.  Stent graft noted in the celiac artery and right renal\nartery.\n\nStreak artifact from prior embolization of right hypogastric artery.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is a 4.5 x 4.0 cm cyst in the of the liver (02:30).  Other subcentimeter\nlesions are too small to characterize, but may represent additional cysts or\nbiliary hamartomas.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Hyperdense material within the gallbladder likely\nrepresents vicarious excretion of contrast.\n\nPANCREAS: Pancreas is atrophic.  Interval placement of a pigtail pancreatic\nstent, which extends from the downstream pancreatic duct to the duodenum\n(2:63).\n\nSPLEEN: Post splenectomy.\n\nADRENALS: Right adrenal gland is normal in size and shape.  The left adrenal\ngland is not well visualized.\n\nURINARY: Right kidney is normal in size, without evidence of nephrolithiasis\nor hydronephrosis.  There is a 1.6 cm simple cyst arising from the interpolar\nregion of the right kidney (02:59).  Left kidney is absent.\n\nGASTROINTESTINAL: Proximal gastric wall appears diffusely thickened and\nedematous, likely due to third spacing.  Small bowel loops are normal in\ncaliber.  There is a left paramidline colostomy.  The rectal stump is\nunremarkable.  Mild generalized mesenteric edema.\n\nThere is a jejunostomy tube entering the right abdomen, in unchanged position.\nPosterolaterally in the right abdomen, there is a pigtail catheter within a\n4.7 x 2.7 cm collection which has slightly decreased in size from the prior\nstudy (2:68).  Another communicating component of this collection more\nmedially also appears to have decreased, although evaluation is limited on\nthis noncontrast study.\n\nIn the left abdomen, the peripancreatic collection containing the most\nsuperiorly located catheter has decreased measuring approximately 5.0 x 3.1 cm\n(2:62), previously 5.6 x 3.2 cm.  Pigtail portion of the catheter now abuts\nthe anterior aortic wall (2:63).  Two additional pigtail catheters are noted\nin the left lower quadrant, with unchanged position of the anterior catheter\nand minimal decrease in size of the collection containing the posterior\ncatheter (2:78).\n\nNo new fluid collections are identified.\n\nPELVIS: Urinary bladder is largely collapsed around a Foley catheter, with\npost instrumentation air.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland does not appear enlarged, and\ndemonstrates central gland calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nBONES: No acute fractures are identified.  Multilevel degenerative changes are\nnoted throughout the thoracolumbar spine.  There is grade 1 anterolisthesis of\nL5 on S1 due to bilateral pars defects.\n\nSOFT TISSUES: Evaluation of the soft tissues is notable for diffuse anasarca,\nwhich has increased from the prior study on ___.",
            "output": "1. Slight interval decrease in size of multiple fluid collections since ___ with multiple pigtail catheters in place as described above.  No\nnew collections are identified.\n2. Suggestion of proximal gastric wall thickening and edema, which is likely\ndue to third spacing.\n3. Increased right greater than left pleural effusions since ___,\nwith increased loculation of the left effusion.\n4. Stable size descending thoracic aortic aneurysm sac, measuring up to 5.5\ncm.\n5. Stable size of excluded infrarenal abdominal aortic aneurysm sac, measuring\nup to 5.9 cm.  Previously identified locules of air within the aneurysm sac\nhave resolved in the interim."
        },
        {
            "input": "Heterogeneity and hyperemia superior and posterior to the right testicle could\nrepresent an inflamed epididymis or possibly torsion of the spermatic cord\n(2:117).  There is equivocal slight prominence of the right spermatic cord\ncompared with the left (for example series 3, image 82).  A small posterior\nhypodensity may represent a small fluid collection (02:28).  There is no fat\nstranding or gas within the subcutaneous tissues of the perineum to suggest\n___ gangrene.  Prominent inguinal lymph nodes are likely reactive in\netiology.  The urinary bladder and distal ureters are unremarkable. There is\nno evidence of pelvic lymphadenopathy. There is no free fluid in the pelvis. \nThe partially visualized large and small bowels are normal in appearance.  The\nappendix is normal.\n\n\nBONES:\n\nThere is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Heterogeneity and hyperemia within the right testicle with a small\nhypodensity that may represent a small fluid collection.  Equivocal slight\nprominence of the right spermatic cord compared with the left (for example\nseries 3, image 82) could suggest vasitis ; associated epididymitis and small\nfluid collection/ abscess not excluded. These findings would be better\nevaluated by testicular ultrasound.\n2. No soft tissue gas to suggest ___ gangrene.\n\nRECOMMENDATION(S):  Testicular ultrasound to better evaluate findings within\nthe right testicle."
        },
        {
            "input": "The bases of lungs demonstrate small new bilateral pleural effusions, left\ngreater than right with adjacent compressive atelectasis.\n\nOverall, extensive peritoneal metastatic disease is re- demonstrated, overall\nincreased compared to the prior exam, particularly along the anterior abdomen.\nLoculated ascites is seen anterior to the liver, with mass effect on the left\nlobe of the liver.  The liver itself demonstrates no focal lesions concerning\nfor malignancy.  There is no intrahepatic biliary ductal dilatation.  The\npancreas is normal without evidence of focal lesions, or pancreatic ductal\ndilatation.  The spleen is homogeneous, and normal in size.  The adrenal\nglands bilaterally are normal.  The kidneys bilaterally are normal.  The\nportal vein, splenic vein, and SMV are patent.\n\nThe patient is status post small bowel resection with end ileostomy (2;45). \nAlthough contrast is seen passing through the small bowel to the ileostomy\nbag, there is a focal area area of transition in the caliber of the small\nbowel (601b;30), with mild proximal dilatation.\n\nA second ostomy is seen inferior to the end ileostomy (2;58), and is likely a\ndistal loop ileostomy, as no contrast passes through this ostomy.  There is a\nsmall amount fecal loading within the colon.  Per her nodes available on the\n___ medical record this may have been created as part of a small bowel\nobstruction surgery performed in ___, and the full operative note is not\navailable.  Mild diverticulosis, without evidence of diverticulitis is\nidentified.\n\nCT pelvis:  The urinary bladder is unremarkable.  There is no pelvic wall, or\ninguinal lymphadenopathy.\n\nIncidental note is made of asymmetric enhancement involving the common iliac\nveins, with the right common iliac vein demonstrating higher attenuation\ncompared to the left.\n\nOsseous structures:  No lytic or blastic lesions concerning for malignancy are\nidentified.",
            "output": "1.  Extensive peritoneal metastatic disease is re- demonstrated, overall\ndemonstrating interval progression compared to the prior CT from ___.\nNew loculated ascites is seen anterior to the liver, with mass effect on the\nleft lobe of the liver, and inferior extension anterior to the pancreas.\n\n2.  Patient is status post small bowel resection with an end ileostomy. \nAlthough contrast appears to pass into the ileostomy bag, there is a focal\narea of transition of caliber of the small bowel (2;45), with mild proximal\ndilatation, raising concern for a partial small bowel obstruction due to\nmetastatic involvement of the bowel.\n\n3.  Second, likely distal loop ileostomy, is seen inferior to the end\nileostomy (2;58).  A small amount of fecal loading is seen within the colon.\n\n4.  New small bilateral pleural effusions with adjacent compressive\natelectasis.\n\n5.  Asymmetric enhancement of the common iliac veins bilaterally.  This could\nbe seen in the setting of early filling of the right lower extremity veins\n(such as can be due to an AV-fistula or metastatic disease), or delayed\nfilling on the left (such as can be due to thrombus or upstream compression). \nNo upstream compressive lesions are identified more proximally in the left\npelvic veins.  If further evaluation if clinically indicated, a lower\nextremity ultrasound may be helpful for further evaluation.\n\nNOTIFICATION:  Updated findings were d/w Dr. ___ by Dr. ___ at 1A on\n___ by phone."
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion with associated\natelectasis, similar to prior exam.  Partially imaged right gynecomastia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic in morphology.  Heterogeneity of the\nliver, particularly at the hepatic dome (02:12) is new since prior.  There is\na new 0.6 cm low-density lesion in the right hepatic lobe (series 2, image 23)\nincompletely characterized on this exam.  There is no evidence of intrahepatic\nbiliary dilatation.  The gallbladder is surgically absent.  The common bile\nduct is dilated measuring up to 1.3 cm, similar to prior exam and can be seen\nin post cholecystectomy status.  There is no obstructive lesion or stone\nnoted.  There is trace volume of 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: There is splenomegaly measuring 15.6 cm in largest dimension,\nunchanged.  Wedge-shaped areas of hypoattenuation along the lateral aspect of\nthe spleen are new.\n\nADRENALS: The right adrenal gland is normal in size and shape.  There is left\nadrenal thickening, 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: A nasogastric tube in place with distal tip in the duodenum.\nDuodenal diverticula is seen and unchanged.  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 rectal tube in place.\n\nPELVIS: The urinary bladder is collapsed surrounding a Foley catheter, and\nfocus of post procedural air noted in the bladder.  Small volume of ascites is\nseen in the pelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  there\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Perisplenic and gastrohepatic varices are seen. There is no\nabdominal aortic aneurysm.  Mild atherosclerotic disease is noted.  The portal\nvein and SMV are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are new small fat and fluid containing umbilical and\nparaumbilical hernias.  There is fluid containing right inguinal hernia.",
            "output": "1. Small right pleural effusion with associated atelectasis, unchanged.\n2. Cirrhosis with portal hypertension, splenomegaly and trace volume of\nascites in the abdomen and pelvis.\n3. New heterogeneous enhancement of the liver, particularly at the hepatic\ndome as well as a subcentimeter low-density lesion in the right hepatic lobe\nmeasuring 0.6 cm, incompletely evaluated on this exam.\n4. Wedge shaped peripherally located hypoenhancing splenic lesions are most\nlikely reflective of splenic infarcts, new since prior.\n\nRECOMMENDATION(S):  Contrast enhanced MRI of the liver."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  A celiac artery stent is\nvisualized at the takeoff of the aorta which appears partially occluded though\nthere is filling of the left gastric and common hepatic artery distally\npossibly secondary to collateral filling.  Additionally there is a SMA artery\nstent at the takeoff from the aorta which appears partially occluded with a\ndiminutive SMA that fills distally via the ___.  There is a SMA to left common\niliac bypass stent which is patent throughout its course.\n\nThe bilateral common iliac arteries, external iliac arteries, and superficial\nfemoral arteries are patent throughout their course.\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. \nThere are multiple scattered subcentimeter hepatic hypodensities are too small\nto characterize though likely represent hepatic cysts versus biliary\nhamartomas.  There is no evidence of intrahepatic biliary dilatation.  Common\nbile duct is slightly prominent measuring up to 8 mm in diameter to the level\nof the ampulla.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\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 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.  Patient is status post partial colectomy with\nanastomotic sites visualized in the right lower quadrant and in the rectum\nwith mildly prominent loops of large bowel though no focal abnormalities are\nvisualized and likely represent a postsurgical appearance.  Appendix is not\nvisualized.  There is no evidence of mesenteric.  There is a large cystic\nlesion at the root of the mesentery on the left that measures to 6.7 x 4.9 x\n4.2 cm with no adjacent fatty 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 no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus. No adnexal\nabnormality 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": "1. No evidence of mesenteric ischemia.  No acute intra-abdominal process.\n2. Large cystic lesion centered in the mesentery on the left.  This could be\npotentially postoperative given prior surgery though lymphangioma would be\npossible.  Follow-up MR should be obtained on a nonemergent basis if not\nalready performed.\n3. Occluded celiac stent of unknown chronicity with filling of the major\nbranch vessels distally likely from collaterals.\n4. Partially occluded SMA stent with diminutive SMA that fills distally from\nthe ___ and patent SMA to left common iliac stent.\n\nRECOMMENDATION(S):  Recommend follow-up nonemergent MR for further\ncharacterization of cystic lesion if not already performed an outside\ninstitution."
        },
        {
            "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: The visualized lower lobes appear clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 3.5 cm x 3.0 cm round lesion demonstrating average\nHounsfield unit measurement of 50 on noncontrast imaging within segment II of\nthe liver.  This demonstrates peripheral puddling on contrast-enhanced\nexamination.  It was seen on prior MRI of ___ where it measured 2.3\nx 2.1 cm.  This demonstrates discontinuous enhancement on postcontrast\nimaging.  While this may reflect a hemangioma, given the increased attenuation\non precontrast imaging and increase in size from 2.7 cm on prior MRI,\nhemorrhagic hepatic adenoma is not excluded.\n\nSubcentimeter hypoattenuating foci within segments 5 and 6 are too small to\ndefinitively characterize.\n\nFocal fatty infiltration along the ligamentum teres is also also seen.   \nThere is no intrahepatic biliary ductal dilatation.  The gallbladder is within\nnormal 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.  There is slightly heterogeneous\nenhancement.  There is a 0.4 cm hypodense lesion in the spleen on series 3,\n___ 28.  This is too small to characterize although statistically most likely\nrepresents a hemangioma.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys appear atrophic.  A 1.5 cm hyperdense cyst is seen in the\ninterpolar region on the mid right kidney on series 3, ___ 68.  This measures\n43 ___ on the noncontrast enhanced images and 45 ___ on the contrast-enhanced\nimages.  .  In addition, there is a 5 mm exophytic enhancing lesion along the\nlower pole of the right kidney (3:79).\n\nGASTROINTESTINAL: Post sleeve gastrectomy changes are seen. There is soft\ntissue fullness about the gastroesophageal junction, with adjacent lymph nodes\nmeasuring up to 11 mm in short axis.  Intraluminal fluid is also identified\nwithin the visualized distal esophagus.  Underlying GE junction mass cannot be\nexcluded.  Mild circumferential mural thickening of the distal gastric body\nmay be due to underdistention.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout. Colon and rectum are within normal\nlimits.  Appendix is not visualized.    There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There several retroperitoneal lymph nodes.  The largest\nmeasures 1.0 cm in short axis and is at the upper limits of normal as seen on\nseries 3, ___ 86.  The lymph nodes are increased in size compared to ___.\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: Degenerative changes are seen in the lumbar spine, greatest at L4-5. \nThere is 4 mm anterolisthesis of L5 on S1 related to bilateral pars defects.\n\nSOFT TISSUES: There is a large skin defect overlying the right lower quadrant,\nmeasuring approximately 5.6 cm transverse.  There is underlying subcutaneous\nfat stranding within this region.  There is a prominent artery extending in\nthe region of the wound, appearing to arise as a branch of the right inferior\nepigastric artery (3:111-129).  Prominent draining veins are also noted, some\nof which traverse close to the ulcer base.\n\nAn 11 mm ventral skin defect is seen at the left lower quadrant.",
            "output": "1. No evidence for active extravasation or pancreatic mass.\n2. 3.5 cm hemangioma in segment 2 of the liver is slightly increased in size\nfrom ___.  The rate of interval growth is consistent with hemangioma\n3. Approximately 5.6 cm right lower quadrant ulcer with large subcutaneous\nveins coursing close to the ulcer base.  A branch of the right inferior\nepigastric artery is seen extending to the region of the ulceration.  A small,\n11 mm skin defect is also seen at the left lower quadrant.\n4. 5 mm enhancing exophytic lesion along the inferior pole of the right kidney\nis concerning for a renal cell carcinoma.  Followup imaging is recommended.\n5. Retroperitoneal lymph nodes are at the upper size limits of normal. \nHowever there are in decreased in size from ___.  Attention should be paid to\nthis region on follow-up imaging in 6 months\n6. Apparent soft tissue fullness at the gastroesophageal junction with\nadjacent 11 mm lymph node.  In conjunction with moderate fluid within the\nvisualized distal esophagus, partially obstructing GE junction mass cannot be\nexcluded.  Differential diagnosis includes esophagitis.\n\n This preliminary report was reviewed with Dr. ___\nradiologist.\n\nRECOMMENDATION(S):  1.   Right renal lesion concerning for renal cell\ncarcinoma 6 month follow-up MRI is recommended to evaluate for growth of the\nlesion.\n2. Consideration of endoscopy for evaluation of GE junction lesion.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:26 ___, 5 minutes\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields show small bilateral pleural effusions and\nsubjacent atelectasis.  There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nfocal lesions.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.  Mild perihepatic simple\nascites is noted.\n\nPANCREAS: The pancreas is edematous when compared to its appearance in\n___ with a new focal non enhancing portion of the neck. \nAdditionally, there is peripancreatic fluid and fat stranding surrounding the\npancreas and upper abdomen including around the mesenteric and anti mesenteric\nthe size of the stomach remnant and proximal duodenum.  The fluid collections\ndo not demonstrate rim enhancement.  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 kidneys are atrophic with multiple punctate cystic lesions,\nunchanged same prior study.  There is no evidence of solid renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is post sleeve gastrectomy..  Duodenal hyperemia\nand wall edema are most likely reactive to the adjacent pancreatic\ninflammatory process and there is no evidence of perforated ulcer.  No free\nair is visualized.  The colon and rectum are within normal limits but contain\na moderate amount of stool.\n\nPELVIS: The urinary bladder is underdistended, distal ureters are\nunremarkable.  Free-fluid from the upper abdominal process tracks into the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus 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: Unchanged lumbar spine degenerative changes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute necrotizing pancreatitis as described above with non enhancement of\nthe pancreatic neck, significant upper abdominal inflammatory stranding and\nnon organized fluid.\n2. While there is hyperemia and wall edema of the proximal duodenum, these\nfindings are likely reactive to the adjacent pancreatic process.  No free air\nor extraluminal enteric contrast to suggest a perforated gastric or duodenal\nulcer.  If there is continued clinical concern, further evaluation with an EGD\nand direct visualization is recommended.."
        },
        {
            "input": "This examination is motion degraded.\n\nLOWER CHEST: There is increasing moderate bilateral pleural effusions, right\ngreater left, with adjacent compressive atelectasis.\n\nABDOMEN:\n\nSmall intra-abdominal ascites is appears not significantly changed.  There is\nno intra-abdominal free air.\n\nHEPATOBILIARY: The dome of the liver is not completely included within the\nfield-of-view this study.  Peripherally enhancing hypoattenuating lesion\nmeasuring 1.8 cm within the medial left hepatic lobe is stable and likely a\nhemangioma.  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 mildly\ndistended with hyperdense material which may represent vicarious excretion of\ncontrast or sludge/small stones.  Mild perihepatic ascites has improved.\n\nPANCREAS: Focal nonenhancing small linear segment of the pancreatic neck is\nunchanged, compatible with necrotizing pancreatitis.  Degree of peripancreatic\ninflammatory changes including fat stranding and surrounding non organized\nperipancreatic fluid appears to have slightly improved from ___. \nNo interval development of any new organized peripancreatic fluid 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: Kidneys are atrophic bilaterally with numerous too small to\ncharacterize hypoattenuating foci, similar to previous study.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Postsurgical changes from sleeve gastrectomy are noted. \nWall thickening and fat stranding surrounding the stomach and duodenum is\nlikely reactive.  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: Urinary bladder is sub maximally distended.  There is small amount\nintrapelvic fluid which is not significantly changed\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There are scattered on enlarged mesenteric and retroperitoneal\nlymph nodes without pathologically enlarged lymphadenopathy.  There is no\npelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No splenic vein thrombosis\nor SMV thrombosis within the limits of this examination.  There is a left\nfemoral venous line.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Subcutaneous body wall edema, most pronounced in the flankshas\nincreased.",
            "output": "1. Acute necrotizing pancreatitis which overall appears similar to previous\nimaging on ___. The degree of peripancreatic inflammatory changes\nincluding fat stranding and surrounding non organized peripancreatic fluid\nappears to have slightly improved.\n2. Increasing moderate bilateral pleural effusions, right greater than left,\nwith compressive atelectasis.\n3. Stable small amount of intra-abdominal and intrapelvic ascites.\n4. Mild gall bladder distention with vicarious excretion of contrast or small\nstones/biliary sludge."
        },
        {
            "input": "LOWER CHEST: Moderate bilateral pleural effusions, right greater than left,\nwith associated atelectasis.  Moderate atherosclerotic calcifications.  Aortic\nannulus calcifications.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhypodense lesion within the left hepatic lobe (05:19) measures 1.8 cm,\nunchanged, likely a hemangioma.  No evidence of other lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis distended, with layering hyperdensity, which may reflect vicarious\nexcretion of previously administered contrast, or hyperdense sludge/tiny\nstones.\n\nPANCREAS: Again seen is hypoenhancement within the pancreatic neck, compatible\nwith known necrotizing pancreatitis.  Adjacent to the pancreatic neck is a\nnew, approximately 7.7 x 4.8 x 5.2 cm fluid collection, demonstrating layering\ndensity, along with a focal hyperdensity (05:30) concerning for active\ncontrast extravasation.  A linear hyperdensity is also seen in the region of\nthe pancreatic neck (07:30, 05:28).  A smaller fluid collection just inferior\nto the gastric sleeve (05:29) measures 1.8 cm.  Mild associated peripancreatic\nfat stranding, which appears similar to 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 bilateral kidneys are atrophic.  Subcentimeter right renal\nhypodensities are too small to characterize.  There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post sleeve gastrectomy.  Again seen\nis circumferential wall thickening of the distal gastric sleeve and proximal\nduodenum.  Otherwise, small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.\n\nPELVIS: The bladder is decompressed, limiting evaluation.  Trace pelvic free\nfluid.\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable.  No adnexal masses.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The origin of the splenic vein appears mildly narrowed, but appears\npatent.  The portal vein and SMV are patent.  The study is not optimized for\nevaluation of the arteries.  A left femoral catheter is again seen.  There is\nno abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: A sclerotic focus within the left superior pubic ramus (5:81) is likely\na bone island.  A slight anterior compression of the L2 vertebral body appears\nnew since ___, but unchanged over the most recent prior studies. \nNo worrisome osseous lesions.  Multilevel degenerative changes of the lumbar\nspine.\n\nSOFT TISSUES: Diffuse anasarca.",
            "output": "1. Interval development of peripancreatic fluid collections, the largest\nlikely a hematoma measuring up to 7.7 cm, which demonstrates layering density\nand a more focal hyperdensity concerning for active extravasation.  Given the\nabsence of precontrast or delayed imaging, evaluation of active extravasation\nis mildly limited.  It is noted that given the small size of the hematoma,\nthis is unlikely to be a singular cause of the patient's hypotension/shock.  \n___ consultation is recommended for further evaluation/management options.\n2. Linear hyperdensity adjacent to the necrotic pancreatic neck is also\nconcerning an additional site of active extravasation.\n3. Otherwise, findings compatible with acute necrotizing pancreatitis have not\nsubstantially changed.\n4. Moderate bilateral pleural effusions, with associated atelectasis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:55 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions, slightly larger on the right and\nincreased in size when compared to the previous study.  Adjacent bilateral\nlower lobe atelectasis.  Coronary artery calcification noted.\n\nABDOMEN:\n\nHEPATOBILIARY: 17 mm centrally low-density lesion in left lobe of the liver\n(5.20) with some globular peripheral enhancement consistent with a hemangioma.\nNo other focal liver lesions.  Layering high density material within the gall\nbladder is likely sludge.  No intra or extrahepatic biliary ductal dilatation.\nSlight increase in the volume of ascites.\n\nPANCREAS: Pancreas appears swollen and there is surrounding fat stranding. \nThe adjacent heterogeneous fluid collection, which is consistent with\nhematoma, now measures approximately 6.8 x 4.6 cm, previously 7.7 x 4.8 cm,\nand extends slightly more inferiorly into the small bowel mesentery.  Interval\nembolization of an adjacent vascular structure with no evidence of bleeding on\nthe current study.\n\nSPLEEN: The spleen shows normal size.  Interval development of some peripheral\nhypoenhancing foci in the superior spleen which may represent small infarcts.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Atrophic kidneys bilaterally.  There is no evidence of solid renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Prior gastric surgery noted.  Esophagogastric tube in situ\nwith the tip in the stomach.  Increased fluid and stranding of the fat\nadjacent to small bowel loops in the left anterior abdomen.  Sigmoid\ndiverticulosis without evidence of diverticulitis.  Myochosis coli noted. \nRectal tube in situ.  He\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.  Central venous and arterial catheters entering the left common\nfemoral vessels.\n\nBONES: 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 arterial embolization with no evidence of bleeding on the current\nstudy.\n-The main component of the hematoma adjacent to the pancreas appears slightly\nsmaller than prior however there are pockets extending into the small bowel\nmesentery that have slightly increased in size.\n-Mild increase in the volume of ascites and mesenteric inflammatory change."
        },
        {
            "input": "LOWER CHEST: Moderate right and small left pleural effusions and adjacent\nconsolidations at the lung bases are stable to slightly improved from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a stable 1.5 cm likely hepatic hemangioma in the left hepatic lobe. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is hyperdense sludge or small stones in the elbow.  No gallbladder wall\nthickening or pericholecystic fluid.  Trace perihepatic ascites is improved\nfrom prior.\n\nPANCREAS: Again seen is edematous pancreas with peripancreatic stranding. \nThere are embolization coils adjacent to the pancreatic body related to\nembolization of a pancreatic arcade branch.  A peripancreatic fluid collection\nwith a component of internal hyperdense material is increased in size from\nprior.  At the level of the pancreatic body, this collection measures 6.8 x\n5.6 cm in the axial plane, previously measuring 6.8 x 4.6 cm.  However, more\ninferiorly in the small bowel mesentery, this collection measures\napproximately 7.6 x 5.2 cm where a previously measured 4.5 x 3.4 cm.  In\nconglomerate, in the coronal plane, this collection spans approximately 12 x\n11 cm, previously spanning approximately 11 x 6 cm (08:18).  Majority of this\ncollection is fluid density, with a small amount of hyperdensity along the\nsuperior aspect compatible with hematoma, similar to prior (04:32).\n\nMore inferiorly, just deep to the anterior abdominal wall in the midline,\nthere is a 5.0 x 1.5 cm fluid collection just anterior to small-bowel loops\n(06:56).  There is a similar smaller pocket on the left spanning approximately\n2 cm (06:44).  An additional fluid collection in the left upper quadrant, just\ndeep to the anterior abdominal wall, is increased in size, currently spanning\napproximately 5.0 x 1.2 cm, previously spanning 3.7 x 0.3 cm (09:54; 06:26).\n\nSPLEEN: The spleen is normal in size.  Some peripheral foci of hypoenhancement\nin the spleen are similar to prior, however there are additional new foci of\nperipheral hypoenhancement along the superior spleen, likely small infarcts\n(08:34).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic.  There is no evidence of solid\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are postsurgical changes in the stomach.  A post\npyloric feeding tube terminates in the proximal jejunum.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is diverticulosis of the sigmoid colon which\nappears slightly wall thickened, however unchanged from prior.  No evidence of\nacute diverticulitis.  Rectal tube remains in place.  The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of free fluid in the pelvis slightly improved from prior.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.  There has been interval removal of a left femoral central venous\ncatheter.  A left femoral arterial catheter remains in place. There are\nembolization coils adjacent to the pancreatic body related to embolization of\na pancreatic arcade branch.\n\nBONES: Degenerative changes lumbar spine including mild loss of height at L1,\nare not significantly changed.  There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: There is diffuse anasarca.",
            "output": "1. Interval increase in size a peripancreatic fluid collection, the majority\nof which is fluid density, however there is a small amount of hyperdensity\nalong the superior aspect compatible with hematoma, similar to prior.\n2. Multiple additional smaller fluid collections in the anterior abdomen are\nincreased in size or new from prior, however all of which are likely too small\nfor drainage.\n3. Interval slight decrease in perihepatic ascites and free fluid in the\npelvis.\n4. Likely small splenic infarcts, some of which are unchanged from prior,\nhowever few which are new from prior.\n5. Moderate right and small left pleural effusions and adjacent consolidations\nat the lung bases are stable to slightly improved from prior."
        },
        {
            "input": "Chest is reported separately.\n\nSmall irregular collection along the anterior margin of the left lateral\nsegments measures about 16 mm, similar to the prior study.  Along the medial\naspect of the left lateral segments there is a new small fluid collection\n(05:43) which measures up to 48 x 29 mm 43 x 29 mm. The gall bladder\ndemonstrates a Phrygian cap.  Layering hyperdense material may be due to\nvicarious excretion of contrast the some degree but stones may be present.\nThere is no biliary dilatation.  Small splenic infarct appears unchanged. \nOverall spleen is not enlarged.  Adrenals are unremarkable.  Kidneys are\nmarkedly atrophic.\n\nPreviously there was a large fluid collection arising from the inferior margin\nof the pancreas that had measured up to as much as 121 x 57 mm in axial\n___.  This has now been drained percutaneously.  The pigtail catheter\nresides in the fully collapsed anterior small residual loculations are present\nonly.  Component along the pancreatic tail has appeared since the prior CT and\nnow measures 42 x 16 mm.  A component posterior to the pancreas is also newly\napparent and measures up to 65 x 18 mm in axial ___.  These newly\napparent collections probably inter communicate with each other as well as\nwith the collapsed anterior component of the recently drained collection. \nInflammatory change persists about the pancreas.\n\nThere is a small hiatal hernia.  A feeding tube terminates in the proximal\njejunum.  Stomach is mostly collapsed.  Patient is apparently status post\nsleeve gastrectomy.  Small bowel is unremarkable.  Few sigmoid diverticular\npresent.  Rectal tube is in place.\n\nUterus and adnexa are unremarkable.  There is no lymphadenopathy in the\nabdomen or pelvis.  Small but mildly increased ascites mostly resides in the\npelvic cul de sac and to a lesser extent about the liver.  Moderate\natherosclerotic change.  Aorta is normal in caliber.  Major vascular\nstructures appear widely patent.  Coils project along the inferior margin of\nthe pancreas as before.\n\nBony findings associated with renal osteodystrophy are unchanged.  There are\nno suspicious bone lesions.  Mild superior endplate compression fracture of L1\nappears stable.",
            "output": "Large collection about the pancreas has mostly resolved, although with two\nprobably anterior communicating peripancreatic loculations that are newly\napparent.  Catheter terminates in the fully collapsed anterior part.  New\nsmall perihepatic collection."
        },
        {
            "input": "LOWER CHEST: Moderate bilateral pleural effusions, with associated compressive\natelectasis.  The left pleural effusion has increased in size from the prior\nstudy.  Mitral annulus calcifications.  Coronary artery calcifications.  No\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nhemangioma within the left hepatic lobe measures 1.7 cm.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\nlayering hyperdensity, likely vicarious excretion of previously administered\ncontrast.  Adjacent to the left hepatic lobe is a fluid collection which\nmeasures approximately 5.8 x 3.5 cm, previously 4.6 x 3.1 cm (05:20).\n\nPANCREAS: The pancreas remains edematous, but improved from the prior study. \nPeripancreatic fat stranding has also improved.  Embolization coils at the\ninferior margin of the pancreatic body are redemonstrated.\n\nMultiple peripancreatic fluid collections appear more organized.  A fluid\ncollection along the pancreatic tail measures approximately 5.1 x 3.4 cm,\npreviously 5.2 x 4.2 cm.  A fluid collection posterior to the portosplenic\nconfluence spans approximately 6.2 x 2.0 cm, previously 5.8 x 1.8 cm.  A fluid\ncollection adjacent to small bowel loops within the left hemiabdomen (05:41)\nmeasures up to approximately 7.3 x 4.8 cm, increased in size and more\norganized than the prior study.  A pigtail catheter tip located anteroinferior\nto the pancreas is unchanged in position, with the previously visualized fluid\ncollection completely drained.\n\nSPLEEN: The spleen is normal in size.  Prior hypodensities likely reflecting\nsplenic infarcts are less conspicuous.  Multiple hyperdense foci of the spleen\nmay reflect small calcifications.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic.  Subcentimeter right renal\nhypodensities are too small to characterize.  There is no hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The patient is status post sleeve\ngastrectomy.  An enteric tube tip terminates in the proximal duodenum.  Mild\nwall edema of the distal duodenal and proximal jejunal loops is likely\nsecondary to adjacent pancreatic inflammation.  The remaining small bowel\nloops appear unremarkable.  No bowel obstruction.  Scattered colonic\ndiverticulosis, without evidence of acute diverticulitis.  No free\nintraperitoneal air.\n\nPELVIS: The bladder is decompressed, limiting evaluation.  Small volume free\nfluid within 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: Although not optimally assessed on this study, the celiac axis,\nsplenic artery, and SMA are grossly patent.  The splenic vein is patent. \nThere is no abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions.  Bilateral pars\ndefects of L5.  An anterior compression deformity of L1 appears unchanged.\n\nSOFT TISSUES: Diffuse anasarca.",
            "output": "1. Interval increase in size and organization of multiple peripancreatic fluid\ncollections, particularly adjacent to the left hepatic lobe, posterior to the\nportosplenic confluence, and adjacent to small bowel loops within the left\nhemiabdomen.\n2. Improved pancreatic edema and peripancreatic fat stranding, which persists.\n3. Unchanged position of the anterior pigtail catheter, with the previously\nvisualized fluid collection completely drained.\n4. Moderate bilateral pleural effusions, with interval increase in size of the\nleft pleural effusion."
        },
        {
            "input": "LOWER CHEST: Persistent moderate to large volume bilateral pleural effusions\nwith bibasilar compressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nPreviously characterized hemangioma along the anterior segment II measuring up\nto 2 cm.  Slight interval decrease in the fluid collection along the lateral\naspect of the left hepatic lobe measuring 5.0 x 2.6 previously measuring 5.8 x\n3.5 cm.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder containing layering ___ reflect\nvicarious excretion of contrast.\n\nPANCREAS: Redemonstrated edematous appearance of the pancreas with\nperipancreatic stranding, similar to prior.  New since the prior CT is an\nanterior peripancreatic collection measuring 5.4 x 4.9 cm (image 40, series\n5).  This has increased in size since the MRI dated ___\npersistent pancreatic tail collection measuring up to 5.6 x 3.7 cm, similar to\nprior.  No significant interval change in the collection posterior to the\nportal vein measuring 5.5 x 2.2 cm.  Anterior pigtail catheter in place, with\nnear complete resolution of the previously noted collection.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: Atrophic appearance of bilateral kidneys.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is decompressed with enteric tube in place. \nPatient is status post sleeve gastrectomy.  No abnormally dilated loops of\nbowel.  Diverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.\n\nPELVIS: Trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: No large adnexal lesions.\n\nLYMPH NODES: There is no retroperitoneal or 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 destructive osseous lesions.\n\nSOFT TISSUES: Diffuse anasarca",
            "output": "1. Redemonstrated changes of acute pancreatitis, with interval development of\nan enlarging collection along the anterior inferior portion of the pancreas\nmeasuring up to 5.4 cm, in addition to multifocal peripancreatic collections,\nsimilar to prior.\n2. Moderate to large bilateral pleural effusions with compressive atelectasis\nof bilateral lower lobes."
        },
        {
            "input": "LOWER CHEST: Partially imaged moderate to large volume bilateral pleural\neffusions and bibasilar compressive atelectasis persist.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\npreviously characterized 2 cm hemangioma in segment 2 of the liver.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains layering hyperdensity, as seen on the prior study, likely\nrepresenting vicarious excretion of contrast.  Again seen is a 4.8 x 3.5 x 4.6\ncm  fluid collection along the medial aspect of the left hepatic lobe (8:20),\npreviously measuring 4.6 x 3.0 x 4.2 cm.\n\nPANCREAS: The pancreas is edematous with peripancreatic stranding, similar to\nthe prior study.  Again seen is an anterior peripancreatic collection\nmeasuring 3.9 x 5.4 x 4.4 cm (8:35), previously measuring 5.4 x 4.4 x 4.6 cm. \nA 2.9 x 3.8 x 5.8 cm pancreatic tail collection (8:24) is again noted,\npreviously measuring 3.0 x 3.9 x 6.2 cm.  The 2.9 x 3.4 x 2.0 cm collection\nposterior to the portal vein (8:20), previously measured 2.9 x 3.4 x 1.9 cm. \nAgain noted is an anteriorly placed pigtail catheter adjacent to a 3.0 x 2.6 x\n3.1 cm collection (8:41), new since the prior study.  A 4.8 x 2.9 x 3.5 cm\ncollection along the left mesentery (8:41) previously measured 3.5 x 2.8 x 4.8\ncm.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral kidneys are atrophic and contain multiple subcentimeter\nhypodensities, too small to characterize.\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.\n\nGASTROINTESTINAL: Patient is status post sleeve gastrectomy with an enteric\ntube terminating in the proximal duodenum.  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.\n\nPELVIS: The urinary bladder is under distended.  No large adnexal masses are\nnoted.  There is no free fluid in the pelvis.\n\nLYMPH NODES: Multiple subcentimeter retroperitoneal lymph nodes are noted. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Mild L1 compression deformity is unchanged.  No new suspicious bony\nlesions.\n\nSOFT TISSUES: Mild diffuse soft tissue edema is again noted.",
            "output": "Edematous pancreatitis with persistent multifocal peripancreatic, perihepatic,\nand mesenteric collections.  There is a new collection in the anterior abdomen\nadjacent to the anterior percutaneous pigtail catheter.\n\nNOTIFICATION:   The findings and recommendations were communicated to ___\n___ via phone at 6:17 pm on ___."
        },
        {
            "input": "LOWER CHEST: Redemonstration of partially imaged moderate to large volume\nbilateral low-density pleural effusions and adjacent bibasilar atelectasis. \nThere is no pericardial effusion.  Coronary atherosclerotic calcifications are\nseen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstration of a 2.1 cm hemangioma in segment 2 of the liver (2:17). \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThere is vicarious excretion of contrast in the gallbladder.  Again, there is\na low-density rounded fluid collection abutting the medial aspect of the left\nhepatic lobe, measuring 4.6 x 3.4 x 4.2 cm on current study (2:18, 601:28),\npreviously 4.8 x 3.5 x 4.6 cm.\n\nPANCREAS: The pancreas is edematous with peripancreatic stranding, similar to\nprior study.  Embolization coils noted at the pancreatic body.  A 3.2 x 3.7 x\n5.9 cm pancreatic tail collection is again noted (2:20), similar in size to\nprior.  In a anterior peripancreatic collection currently measures 2.4 x 4.0 x\n3.4 cm (2:33, 601:30), previously 3.9 x 5.4 x 4.4 cm.  The collection between\nthe portal vein and IVC measures 1.5 x 2.7 cm (2:26), previously 2.0 x 2.9 cm.\nAgain seen is an anteriorly placed pigtail catheter, and the previously-seen\n3.1 cm adjacent collection is no longer visualized.  The anterior pigtail\ncatheter does not appear to communicate with any sizable fluid collections.  A\ncollection along the left mesentery measures 2.8 x 3.6 cm (2:38), previously\nmeasuring 2.8 x 3.5 cm.  Portal vein and SMV are patent.  Splenic vein is\nattenuated in the region of the pancreatic tail though is patent, an\nappearance similar compared to 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 bilateral kidneys are atrophic and contain multiple subcentimeter\nhypodensities, too small to characterize though likely cysts.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.  The urinary bladder is decompressed.\n\nGASTROINTESTINAL: Patient is status post sleeve gastrectomy.  There is mild\nwall thickening and surrounding soft tissue stranding involving the distal\nstomach, pylorus, and proximal duodenum, likely reactive.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. there is small\namount of soft tissue stranding around the distal portion of the transverse\ncolon, likely reactive.  Diverticulosis of the descending and sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding. The appendix is\nnormal (601:34).\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: Multiple prominent upper mesenteric lymph nodes are seen (2:34,\n37), likely reactive, however, there are not pathologically enlarged by CT\nsize criteria.  There is no retroperitoneal, pelvic, or inguinal\nlymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nL5 spondylolysis is noted without spondylolisthesis.  L1 superior endplate\nSchmorl's node with associated mild height loss of the vertebral body is\nchronic.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Similar appearance of previously seen pancreatitis with persistent\nmultifocal peripancreatic, perihepatic, and mesenteric collections.  Overall,\nthere has been mild interval decrease in size of the collections, without\nevidence of new collections.  The anterior abdominal wall pigtail catheter\ndoes not appear to communicate with a sizable fluid collection.\n2. Redemonstration of multiple prominent upper mesenteric lymph nodes, likely\nreactive.\n3. Reactive changes are also seen within the adjacent bowel loops, including\nthe distal transverse colon, the distal stomach, and proximal duodenum.\n4. Redemonstration of partially imaged moderate to large volume bilateral\neffusions."
        },
        {
            "input": "LOWER CHEST: Moderate to large nonhemorrhagic pleural effusions bilaterally\nare slightly worsened compared to the study from ___ there is\nassociated relaxation atelectasis at the lung bases.  Otherwise the partially\nimaged lung bases are clear.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n2.3 cm hemangioma in segment 2 is unchanged (series 6: 19).  No intrahepatic\nor extrahepatic biliary dilatation.  There is vicarious excretion of contrast\nin the gallbladder, which appears normal and without wall thickening or\npericholecystic fluid.\n\nAgain seen is a 4.2 x 3.0 cm well-rounded fluid collection abutting the medial\naspect of the liver (series 6:19), previously measuring 4.6 x 3.4 cm.\n\nPANCREAS: The pancreas is again noted to be somewhat edematous, similar to the\nprior study.  A pigtail catheter is unchanged in position anterior to the\npancreas.  The catheter is again retracted in relation to a 2.6 x 1.9  Cm\ncollection along the transverse colon (series 6:27).  This collection measured\n2.2 x 1.5  Cm on the study from ___.\n\nA collection in the tail the pancreas is decreased in size measuring 3.9 x 1.7\nx 1.3 cm, previously 3.2 x 3.7 x 5.9 cm.  The collection between the portal\nvein in the IVC measures 2.8 x 1.3 cm, previously 2.7 x 1.5 cm (series 6:25). \nA collection along the left mesentery measures 3.2 x 2.6 cm, previously 3.6 x\n2.8 cm (series 6:37).  No new collection within the abdomen or pelvis.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions. Punctate calcifications are likely related to prior\ngranulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic and contain subcentimeter hypodensities, too\nsmall to characterize by CT.  The urinary bladder is under distended which\nlimits evaluation.\n\nGASTROINTESTINAL: Status post sleeve gastrectomy.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding.\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 by size\ncriteria.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Similar appearance of an edematous pancreas.  The collection along the\ntransverse colon is slightly increased in size measuring 2.6 x 1.9 cm,\npreviously 2.2 x 1.5 cm.  The pigtail catheter is retracted from this\ncollection and is not located in any sizable collection.  If there is minimal\noutput, this drain could likely be removed.\n2. Interval decrease in remaining perihepatic, peripancreatic, and mesenteric\nfluid collections, as above.\n3. Slight increase in moderate to large nonhemorrhagic pleural effusions."
        },
        {
            "input": "LOWER CHEST: There is bilateral compressive atelectasis of both lower lobes\nwith near complete collapse left greater than right.  There are large\nbilateral pleural effusions, similar to prior.  There is no pericardial\neffusion.  Mitral annulus calcifications and mild coronary artery\ncalcifications are seen.  Partially visualized central lines terminate in the\nright atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is redemonstration of a segment II 2.4 x 2.5 cm hemangioma (4; 22). \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nThere is again vicarious excretion of the contrast in the gallbladder without\nwall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas is again edematous, with slight interval improvement\ncompared to the prior study.  The main pancreatic duct is difficult to\nvisualize separately.\n\nThere is a fluid collection in the pancreatic tail measuring 1.6 cm, similar\nto prior, appears less fluid-like and may represent phlegmonous change versus\nincreased necrotizing component given clinical history, (6; 22).  There is a\nlobule of pancreatic parenchyma with cystic change projecting from the\npancreatic body which likely represents an area of involuting focal necrosis\n(4; 28).\n\nA pigtail catheter from the right anterior abdominal wall terminates anterior\nand inferior to the pancreas without adjacent fluid but does communicate with\nstranding that lies below area of prior coil embolization which tethers areas\nof cystic change in the pancreas as well as the adjacent small bowel loop (6;\n16).\n\nThere is redemonstration of a fluid collection adjacent to the transverse\ncolon measuring 1.6 x 2.3 cm,(4; 31) with increased internal density and less\nfluid component, likely more phlegmonous change or potentially or necrotizing\ngiven clinical history.\n\nA fluid collection between the portal confluence and the IVC measures 1.9 x\n3.0 cm, similar to prior (4; 32).\n\nThere is slight interval decrease in a left hepatic lobe subcapsular fluid\ncollection measuring 2.9 x 2.3 cm, previously 3.0 x 4.2 cm.\n\nThere is stable left deep mesenteric 2.5 x 3.3 cm fluid collection (4; 45).\n\nThere is trace perihepatic ascites, increased compared to prior.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, with stable\npunctate calcific densities, likely sequela of remote granulomatous infection.\nThere is trace perisplenic ascites, new since prior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral kidneys are atrophic and contain subcentimeter\nhypodensities, too small to be characterized on CT, likely representing cysts.\nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post prior sleeve gastrectomy.  The\nstomach wall appears more edematous compared to prior with pockets of fluid\nwithin anterior wall and communicates with each other and measures\napproximately 1.3 x 4.3 cm (4; 30), new since prior, concerning for early\nabscess.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  There is tethering of the cecum to the right ovary.  There is\ntethering of soft tissue between the ascending colon in the pancreas, in an\narea of prior fluid collection measuring approximately 3.3 cm in short axis\nwith ___ of 80 (4; 40).  The ascending colon is decompressed.  The appendix is\nnormal.\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 grossly within\nnormal limits.\n\nLYMPH NODES: There are prominent retroperitoneal lymph nodes in number without\nmeeting CT size criteria for pathologic enlargement, for example a retrocaval\nlymph node measuring 0.6 cm in short axis (4; 28), likely reactive and similar\nto prior.  Multiple prominent mesenteric lymph nodes are also demonstrated\nmeasuring up to 0.8 cm in short axis (4; 41).  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Embolization coils are again seen adjacent to the pancreas. \nSplenic artery and vein are patent.\n\nBONES: There are multiple punctate densely sclerotic foci throughout the\nvisualized pelvic bones that are unchanged on multiple prior exams, likely\nbone islands.  There is diffuse osteopenia, similar to prior.  Mild multilevel\ndegenerative changes are noted most notable at L4-L5 with bilateral pars\ndefects at L5-S1.  Minimal chronic anterior wedge compression deformity of the\nL1 vertebral body is similar to prior.\n\nSOFT TISSUES: Mild anasarca improved compared to prior.  Soft tissue density\nwith calcification in the right gluteus subcutaneous tissues is noted, likely\nan injection granuloma, similar to prior (4; 90).",
            "output": "1. New fluid collection in the anterior gastric wall concerning for early\nabscess.\n2. No residual fluid collection adjacent to the pigtail catheter which\nterminates inferior to the pancreas in the embolization coils.  Stranding is\nnoted adjacent to the pigtail catheter tethering cystic changes of the\npancreas as well as adjacent loop of small bowel.  Agree with prior\nrecommendation for pulling catheter.\n3. Stable 1.6 cm pancreatic tail fluid collection and 2.3 cm collection\nadjacent to the transverse colon with interval increased density which may\nrepresent phlegmonous change or increased necrotizing component given clinical\nhistory.\n4. Slight interval decrease in size of subcapsular fluid collection adjacent\nto the left hepatic lobe.\n5. Slight interval decrease in edema of the pancreas with persistent and\nfluctuating cystic changes of the parenchyma.\n6. Increased trace perihepatic and perisplenic ascites.\n7. Stable bilateral large pleural effusions with compressive atelectasis."
        },
        {
            "input": "LOWER CHEST: There are large bilateral pleural effusions with associated\ncompressive atelectasis resulting in near collapse of bilateral lower lobes,\nsimilar to prior.  There is moderate coronary artery calcification.  There is\nno pericardial effusion.\n\nABDOMEN: Trace perihepatic and perisplenic ascites is similar to the prior\nstudy.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a hepatic segment II hemangioma measuring approximately 2.1 x 1.8 cm\n(3:20).  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  There is gallbladder sludge without gallbladder wall thickening\nor pericholecystic fluid.\n\nPANCREAS:\n\nThe pancreas is edematous with adjacent stranding, overall similar to the\nprior study and suggestive of ongoing acute pancreatitis.  The main pancreatic\nduct is difficult to visualize.  Embolization coils are again seen adjacent to\nthe pancreas.  A right upper anterior abdominal wall pigtail catheter\nterminates anteroinferior to the pancreas without adjacent fluid collection,\nsimilar to prior (3:32).\n\nCollections include:\n\n1. Pancreatic tail, 2.9 x 2.4 cm (previously 3.0 x 2.4 cm), ill defined likely\nphlegmonous change (3:19)\n2. Pancreatic head, 2.1 x 2.1 cm, phlegmon\n3. Adjacent to the transverse colon, 1.5 x 0.8 cm (previously 2.3 x 1.6 cm),\nwithout significant fluid component and may represent phlegmonous change\nversus necrotizing component given clinical history (3:27)\n4. Between the portal confluence and IVC, 3.1 x 1.4 cm (previously 3.0 x 1.5\ncm), developing collection (3:28)\n5. Left deep mesenteric, 3.1 x 2.4 cm (previously 3.3 x 2.5 cm), fluid\ncollection (3:40)\n\nSPLEEN: The spleen contains numerous punctate calcifications, likely sequela\nof prior granulomatous infection.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The bilateral kidneys are atrophic.  There is no evidence of solid\nrenal lesions or hydronephrosis.  Hypoattenuating renal lesions are too small\nto completely characterize, but statistically likely reflect simple cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Status post sleeve gastrectomy.  The stomach wall appears\nedematous, however, the previously seen anterior gastric wall rim enhancing\nfluid collection is less pronounced on the current study (3:24).  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.\n\nPELVIS: The urinary bladder is decompressed.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: Retroperitoneal lymph nodes are prominent in number without\nmeeting CT size criteria for pathologic enlargement.  There is no mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Portal and splenic veins are patent.\n\nBONES: Bilateral L5-S1 pars defects are again noted.  Mild anterior L1\ncompression deformity, chronic.  Diffuse osteopenia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute on chronic pancreatitis with overall stable appearance of\nperipancreatic collections as detailed above. Anterior abdominal wall drainage\ncatheter terminates anteroinferior to the pancreas without adjacent fluid\ncollection, similar to prior exam.\n2. Interval resolution of anterior gastric wall fluid collection.  However,\nthere is persistent gastric wall thickening, suggestive of gastritis.\n3. Trace perihepatic and perisplenic ascites.\n4. Large bilateral pleural effusions with associated compressive atelectasis,\nsimilar to the prior study."
        },
        {
            "input": "LOWER CHEST: Bilateral moderate-large pleural effusions adjacent compressive\natelectasis, right greater than left.  No mass or significant pulmonary\nnodules within the visualized aerated portions of the lung.  No pericardial\neffusion.  Moderate calcification of the visualized coronary arteries.\n\nABDOMEN:\n\nHEPATOBILIARY: Compared to ___, increased perihepatic ascites. \nUnchanged, 2.0 x 2.3 cm segment 2 hemangioma.  Otherwise, the liver\ndemonstrates homogenous attenuation throughout. No evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains sludge, however\nnon-thickened or distended.\n\nPANCREAS: Pancreas is similarly edematous with areas of non enhancement in\nkeeping with history of necrotizing pancreatitis.  Similar degree of\nperipancreatic fat stranding.  The prior anterior percutaneous peripancreatic\ndrain has been removed.\n\nCollections:\n1.  Left deep mesenteric- smaller measuring 27 x 22 mm (6:41), previously 31 x\n24 mm\n2.  Pancreatic head- decreased to 12 mm (6:37) previously 21 mm\n3.  Portal caval-smaller measuring 28 x 13 mm (6:30), previously 31 x 14 mm.\n4.  Perihepatic-smaller measuring 19 x 19 cm (6:21), previously 20 x 22 mm.\n\n\nSPLEEN: Punctate splenic calcifications likely represent prior granulomatous\ndisease.  Otherwise, the spleen shows normal size and attenuation throughout,\nwithout evidence of focal lesions.  Similar amount of perisplenic free fluid.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic in keeping with history of ESRD.  Multiple\nsubcentimeter hypodensities are too small to characterize, but likely\nrepresent renal cysts.  No evidence of solid renal lesions or hydronephrosis. \nNo perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube is seen to pass within the esophagus,\nthrough stomach, and terminates distally within jejunum.  Evidence of prior\nsleeve gastrectomy.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits.\n\nPELVIS: The urinary bladder is decompressed.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus appears unremarkable.  No gross masses of\nbilateral adnexa.\n\nLYMPH NODES: Subcentimeter paraceliac lymph nodes noted, likely reactive in\nsetting of necrotizing pancreatitis.  No retroperitoneal or mesenteric\nlymphadenopathy.  No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Mild atherosclerotic disease is\nnoted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRe demonstrated L5-S1 pars interarticularis defects.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Evidence of ongoing necrotizing pancreatitis with overall mildly decreased\nsize of multiple fluid collections as detailed above.\n2. Interval removal of the anterior percutaneous perihepatic pancreatic drain.\n3. Subcentimeter paraceliac lymph nodes, reactive.\n4. Mildly increased perihepatic and unchanged perisplenic ascites.\n5. Moderate to large bilateral pleural effusions with adjacent compressive\natelectasis."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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.  The entire colon\ndemonstrate diffuse wall thickening, submucosal fat deposit luminal narrowing,\nmild hyperemia and adjacent Vasa recta engorgement concerning for acute on\nchronic inflammatory bowel disease.\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 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 entire colon demonstrate submucosal fat deposits with luminal narrowing\nand adjacent vasa recta engorgement concerning for acute on chronic\ninflammatory bowel disease.\nNo evidence of bowel obstruction."
        },
        {
            "input": "ABDOMEN:\n\nThe lung bases are clear.  The liver demonstrates homogeneous enhancement,\nwith no suspicious focal lesions identified.  No intrahepatic or extrahepatic\nbiliary ductal dilatation.  Portal veins are patent.  The adrenal glands,\npancreas, spleen and gallbladder are unremarkable. Both kidneys demonstrate\nsymmetric enhancement and excretion of contrast. No focal renal lesions are\nidentified. No hydronephrosis. No ascites. A few subcentimeter periaortic\nlymph nodes are identified, however none enlarged meeting size criteria for\nlymphadenopathy.\n\nPersistent circumferential, contiguous wall thickening of the rectum, sigmoid\ncolon, descending colon and distal transverse colon is again identified. The\nrectal and sigmoid colonic walls are ill-defined. There is evidence of fat\nstranding, vascular hyperemia and engorgement (5:76),  \"Comb sign\" , in the\npelvis. The wall thickening and hyper enhancement of terminal ileum was better\ndelineated on MR enterography, however mild wall thickening at the terminal\nileum is suspected (07:14). No evidence of loculated collections to suggest\nabscess formation.\n\nPELVIS:\n\nPartially distended urinary bladder is unremarkable. An anteflexed uterus is\nwithin normal limits. Small amount of pelvic free fluid is identified (5:82)\n08:23). No inguinal lymphadenopathy. Multiple perirectal prominent lymph nodes\nare identified (5:82, 76) largest measuring 7 mm. The anal complex is not well\nassessed on this CT study.\n\nOSSEOUS STRUCTURES:\n\nNo focal osteolytic or osteoblastic lesions are identified.",
            "output": "1. Persistent circumferential, contiguous wall thickening of the rectum,\nsigmoid colon, descending colon and distal transverse colon, as seen on MR\nenterography from ___. Active signs of inflammatory bowel disease\nincluding fat stranding, vascular hyperemia and engorgement (comb sign), and\nmultiple prominent perirectal lymph nodes are again noted. No loculated fluid\ncollections to suggest abscess formation.\n2. Wall thickening and hyper enhancement of terminal ileum was better\ndelineated on prior MRI enterography, however mild wall thickening at the\nterminal ileum is suspected."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  There is a 4 mm\nnonobstructing renal calculus in the left kidney interpolar region (series 2,\nimage 29).  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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.  4 mm non-obstructing left renal calculus.\n2.  Fibroid uterus.\n3.  No evidence of malignancy 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  A 1.6 cm right ovarian\ncorpus luteum cyst demonstrates crenulated walls, likely involuting, with a\nsmall amount of mildly complex pelvic free fluid noted.  Left adnexa is\nnormal.\n\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 calcifications are present.\n\nBONES: There 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. 1.6 cm ruptured right corpus luteal cyst with small amount of pelvic free\nfluid."
        },
        {
            "input": "UROGRAM:\n\nThe patient is status post left upper pole partial nephrectomy. There is a 1.1\ncm low-attenuation lesion within the interpolar region of the left kidney that\nhas increased slightly in size since ___ (previously 0.8 cm) and appears to\nenhance post-contrast (___ units = 2.5 pre- contrast and 51.5\npost-contrast; 7:44 and 10:42). There is a further 1.1 cm hypodensity within\nthe lower pole of the left kidney that has also increased in size since ___\n(previously 0.7 cm) but does not enhance post contrast (6:32) and is\nconsistent with a cyst. There is mild fullness of the collecting system in the\nright kidney. The right kidney is otherwise unremarkable.\n\nNo radiopaque urinary tract calculi. Contrast is excreted symmetrically via\nthe ureters into the bladder. The bladder appears unremarkable.\n\nABDOMEN:\n\nThe liver is within normal limits. No concerning liver lesions. The portal and\nhepatic veins are patent. No intra or extrahepatic duct dilatation. The\npatient is status post cholecystectomy.\n\nThe pancreas is unremarkable. The spleen is within normal limits. The adrenal\nglands are unremarkable.\n\nThe small and large bowel are within normal limits. No free air or fluid\nwithin the abdomen or pelvis. No mesenteric or retroperitoneal adenopathy. The\nabdominal aorta is of normal caliber.\n\nThere is minor scarring within both lower lobes. The lung bases are otherwise\nclear. A central venous catheter is noted with its tip at the cavoatrial\njunction. The visualized portion of the heart and pericardium is otherwise\nunremarkable.\n\nPELVIS:\n\nThe uterus is unremarkable. No pelvic adenopathy.\n\nOSSEOUS STRUCTURES:\n\nNo concerning sclerotic or lytic lesions are identified within the osseous\nstructures of the abdomen or pelvis.",
            "output": "1. 1.1 cm low-attenuation lesion within the interpolar region of the left\nkidney that has increased slightly in size since ___ and appears to enhance\npost-contrast, concerning for a slow-growing cystic neoplasm.  MR is\nrecommended at future follow-up to further assess this lesion.\n\n2. No evidence of metastatic disease within the abdomen or pelvis."
        },
        {
            "input": "CHEST: Visualized lung bases are notable for minimal bibasilar atelectasis. No\npleural effusion or large pneumothorax. The heart is normal in size and there\nis no evidence of pericardial effusion.  Central venous catheter is seen in\nthe right atrium.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. The gallbladder is surgically absent.\n\nThe spleen and adrenal glands are unremarkable. The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. Patient\nis status post partial nephrectomy of the left kidney upper pole. Again seen\nis a 1.1 x 0.7 cm (05:20) (previously 1.1 x 1.0) cm) hypodense round lesion\nwithin the lower pole of the left kidney, most consistent with a simple cyst.\nAn additional 1.0 x 0.8 cm (5: 32) (previously 1.1 x 0.7 cm) hypodense lesion\nis seen within the interpolar region of the left kidney and may demonstrate\nmild internal enhancement (05:32).  A subcentimeter hypodense lesion within\nthe lower pole of the right kidney is stable since ___. No additional focal\nrenal lesions. There is no hydronephrosis. The ureters are normal in caliber\nand course to the bladder. No renal or ureteral calculi identified.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening or fat stranding. The appendix is\nnormal without evidence of acute appendicitis.No diverticulitis seen. No free\nair, abdominal wall hernia, or free fluid.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches contain minimal calcifications and are normal in course and caliber.\nThere is no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria.\n\nPELVIS:\n\nThe bladder is well distended and normal. A 0.5 cm dense opacity seen along\nthe left posterior lateral aspect of the bladder likely represents a bladder\ncalculi. Differential includes excreted contrast however given lateral\nposition and absence of layering contrast this is most likely to represent a\nstone. No pelvic sidewall or inguinal lymph nodes enlarged by CT imaging\ncriteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1. Nonobstructing 0.5 cm bladder calculus with in the left posterior lateral\naspect of the bladder. No hydroureter or hydronephrosis.\n2. Stable 1 cm lesion within the interpolar region of the left kidney with\nmild internal enhancement. This may represent a slow growing neoplasm or\nhyperdense cyst.  Consider dedicated ultrasound, however, due to body habitus\nan MR may be a more definitive study for further evaluation.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 3:20 ___, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "VASCULAR:\n\nStable postsurgical changes following infrarenal EVAR placement.  The stent\nterminates above the bifurcation of the iliac arteries.  No evidence of\nendoleak.  There is no abdominal aortic aneurysm.  There is severe calcium\nburden in the abdominal aorta and great abdominal arteries.  There is\nextensive calcified atherosclerosis involving the celiac, SMA and renal\narteries.\n\nLOWER CHEST: In the left hemidiaphragm is a small fat containing Bochdalek's\nhernia, (series 7, image 19).  Minimal atelectasis is noted in the lung bases.\nThere 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 is resected.  The common\nbile duct measures up to 14 mm which is dilated following 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 are millimetric well-circumscribed hypodensities of bilateral kidneys\ntoo small to characterize on CT but statistically renal cysts.  There is no\nevidence of stones, or hydronephrosis. There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stable postsurgical changes following Roux-en-Y gastric\nbypass.  Small hiatal hernia.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout. Colon and rectum are within normal\nlimits. There is no evidence of mesenteric lymphadenopathy.  The appendix is\nnormal.\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 surgically absent.  No adnexal abnormality\nis seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable postsurgical changes following ventral hernia repair.",
            "output": "1. Stable postsurgical changes following infrarenal aortic EVAR placement.  No\nendoleak.\n2. Post Roux-en-Y gastric bypass.\n3. Diverticulosis without evidence of diverticulitis.\n4. Post cholecystectomy with moderate dilation of the CBD."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: Moderate pancreatic parenchymal atrophy.  No pancreatic ductal\ndilation.  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 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.  There is\ntethering of the anterior ileal bowel loops to the phlegmonous soft tissue\nthickening around the midline ventral hernia repair site (2:93).  There is no\nbowel obstruction.  There is no evidence of extraluminal oral contrast\nextravasation.  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: 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: L4-L5 and L5-S1 degenerative disc disease with vacuum disc phenomenon. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Patient is status post mesh repair of an incisional midline\nventral hernia.  When compared to the most recent ___ reference CT\nabdomen and pelvis, there is increased phlegmonous soft tissue thickening\nsurrounding the midline mesh material, both superficial (within the\nsubcutaneous fat) and deep to the midline mesh material.  There is increased\ntethering of the anterior ileal bowel loops to the phlegmonous soft tissue\nthickening associated with the mesh (2:96).  Midline anterior abdominal wall\nphlegmonous soft tissue changes extends from L2 vertebral body level down to\nS5 level.  The previously seen short segment of focal incisional site\ndehiscence is now associated with a small 1.4 x 1.4 x 1.3 cm area of phlegmon\n(2:110, 602:82) situated superficial to the mesh.  Anterior midline\nsubcutaneous fat stranding and overlying skin thickening is redemonstrated.",
            "output": "1. Status post midline incisional ventral hernia repair, degree of phlegmonous\nsoft tissue thickening both superficial to and deep to the midline mesh\nmaterial has increased since ___ reference CT abdomen and pelvis. \nThere is also increased tethering of the anterior ileal bowel loops to the\nphlegmonous soft tissue.  No bowel obstruction.  No extravasation of oral\ncontrast.\n2. Previously seen short-segment of incisional site focal dehiscence is now\nassociated with a new 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 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 unremarkable without calcified stones.\n\nPANCREAS: The pancreas demonstrates normal bulk..  There is no main pancreatic\nductal 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 normal in size and morphology with a 3 mm\nnonobstructing stone in the interpolar region.  No right\nhydroureteronephrosis. There is a 4 mm obstructing left distal ureteral stone\nwith mild upstream hydroureteronephrosis, as well as perinephric and\nperiureteral fat stranding.  There is no additional nonobstructing stone in\nthe left kidney.  Evaluation for focal parenchymal renal lesions is limited in\nthe absence of intravenous contrast; none are identified.  A cortical defect\nis again seen in the lower pole of the left kidney..\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening or fat stranding. The appendix is unremarkable.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\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: There is a persistent fat containing left inguinal hernia. \nThere is a small fat containing periumbilical hernia.",
            "output": "1. 4 mm obstructing left distal ureteral stone with mild upstream\nhydroureteronephrosis and periureteral/perinephric stranding.\n2. Chronic cortical defect in the lower pole of the left kidney.\n3. 3 mm nonobstructing stone in the right kidney.\n4. Diverticulosis without acute diverticulitis.\n\nNOTIFICATION:  Electronic preliminary report was provided by Dr. ___\non FRI ___ 1:33 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 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: There is a 5 mm obstructing ureteral stone in the left mid ureter at\napproximately level of L4-5 with moderate upstream hydroureteronephrosis. \nThere is an additional 3 mm nonobstructing stone in the left lower pole. \nBilateral subcentimeter hypodensities are too small to characterize, but\nstatistically likely represent simple cysts.\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.\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. 5 mm obstructing left mid ureteral stone with moderate upstream left\nhydroureteronephrosis.\n2. Additional 3 mm nonobstructing stone in the left lower pole."
        },
        {
            "input": "VASCULAR:  The abdominal aorta is normal in caliber without aneurysmal\ndilatation.  There is moderate atherosclerotic disease extending into the\norigin of the celiac axis, SMA, as well as bilateral renal arteries.  The ___\nis patent.  Hepatic arterial anatomy is conventional.\n\nLOWER CHEST:  Limited views of the lung bases demonstrate dependent\natelectasis.  There is no pericardial or pleural effusion.  Atherosclerotic\ncalcifications of the native coronary arteries are severe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation.  12 mm\nhypodense structure in the left lobe is present, likely reflecting a cyst or\nbiliary hamartoma.  There is no intra or extrahepatic biliary ductal\ndilatation.  No suspicious focal liver lesion is seen.  The gallbladder is\nminimally distended and contains gallstones.  There is no gallbladder wall\nedema or pericholecystic fluid.\n\nPANCREAS: The pancreas demonstrates homogeneous attenuation.  A 12 mm\nhypodensity is seen at the pancreatic body (604:66), statistically represent a\nside branch IPMN.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  A 1.7 cm left adrenal adenoma is noted.  The right adrenal gland is\nunremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of renal stones or hydronephrosis.  Scattered cortically\nbased hypodensities are present, most of which are too small to fully\ncharacterize but likely represent simple cysts.  Mild perinephric stranding is\nnonspecific.\n\nGASTROINTESTINAL:  There is a very large hiatal hernia with the majority of\nthe stomach herniated into the thoracic cavity.  The small bowel is normal in\ncaliber without wall thickening, dilatation or stranding.  There is extensive\ncolonic diverticulosis.  At the sigmoid colon, there is a large 4.8 cm\ndiverticulum with thick wall and mild surrounding stranding (601b:55). \nSlightly distal to this large diverticulum, there is a segment of sigmoid\ncolon which appears to contain dense material on the portal venous phase only.\nThis may represent slow venous oozing.  No arterial bleed is identified.\n\nRETROPERITONEUM: There is no retroperitoneal or mesenteric 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: Brachytherapy seeds are visualized within the prostate\ngland, which is mildly enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are present throughout the thoracic and lumbar\nspine.  A left hip arthroplasty is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of arterial bleeding.  Contrast seen on portal venous phase in\na segment of the sigmoid colon likely represents venous bleeding, possibly\nsecondary to diverticulosis.\n2. Extensive colonic diverticulosis with a large 4.8 cm sigmoid diverticulum\nwith mild acute on chronic diverticulitis.\n3. Large hiatal hernia with herniation of nearly the entire stomach into the\nthorax.\n4. 12 mm hypodense lesion in the pancreatic body.  The standard follow up\nrecommendation is MRCP in 6 months.\n5. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: Mild inferior lingular subsegmental atelectasis.  The lungs are\notherwise clear.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nlinear hypodensity in segment V (5:31) is likely related to the recent\nsurgery.  There is left lobe predominant pneumobilia.  The gallbladder is\nsurgically absent.  There is trace edema in the gallbladder fossa compatible\nwith postsurgical changes.\n\nPANCREAS: The patient is status post Whipple procedure, the pancreatic remnant\nappears normal.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The patient is status post distal antrectomy and subsequent\ngastrojejunostomy.  Enteric contrast is seen filling the stomach, extending\nthrough the gastrojejunostomy into the efferent jejunal limb and\npancreaticobiliary limb.\n\nThere is a 3.1 x 4.7 x 1.7 cm (CC x TRV x AP) rim enhancing fluid collection\nlateral to the pancreaticobiliary limb, adjacent to the pancreatico jejunal\nanastomosis.  This is continuous with a fluid collection adjacent to a focal\ndiscontinuity of the lateral wall of the pancreaticobiliary limb (series 5,\nimage 24), suggestive of a contained leak near the biliary-enteric\nanastomosis.\n\nThere is an additional rim enhancing fluid collection adjacent to the stump of\nthe pancreaticobiliary limb measuring approximately 7.5 x 3.6 x 8.4 cm (series\n5, image 22) containing multiple pockets of gas, also concerning for a\ncontained leak.\n\nThere is layering fluid posterior to the proximal pancreaticobiliary limb\n(series 5, image 26) without evidence of a definite isolated collection.\n\nThe colon and rectum are within normal limits. The appendix is normal (series\n7, image 26).\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 ovaries are present and\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. \nMultiple prominent mesenteric retroperitoneal nodes that are likely\nreactionary.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The portal vasculature is patent.  The superior mesenteric artery is\npatent.  There is no abdominal aortic aneurysm.  There is mild calcified\natherosclerotic plaque within the bilateral common iliac arteries and their\nbranches.  Incidental note is made of a retroaortic left renal vein.\n\nBONES: Degenerative disc disease is noted at L5-S1 level.\n\nSOFT TISSUES: There is a rim enhancing fluid collection along the midline\nsurgical incision at the level of the umbilicus measuring 5 x 2 x 2.1 cm (CC x\nTRV x AP).  More superiorly there is a focus of phlegmonous change measuring\n3.7 x 3.2 x 3.1 cm  (CC x TRV x AP) that is likely continues with the\nabdominal cavity but does not appear to be continuous with the intra-abdominal\nfluid collections (series 8, image 40).\n\nThere are multiple rim enhancing fluid tracks seen along the right anterior\nabdominal wall, some of which contain small pockets of gas, likely\nrepresenting postsurgical changes.",
            "output": "1. Status post Whipple procedure with evidence of anastomotic leak and an air\nand fluid containing collection adjacent to the pancreatico jejunal\nanastomosis, measuring up to 5.7 cm in maximum dimension, communicating with a\nmore linear rim enhancing fluid collection extending across the midline to the\nleft measuring up to 8.4 cm in maximum transverse dimension.  Consult ___ for\npercutaneous drainage.  Smaller rim enhancing fluid collections in the right\nlower quadrant as well as within the subcutaneous tissues at the surgical\nsites in the midline and right lower abdominal wall respectively-as described\nin detail above.\n2. Pneumobilia, post cholecystectomy status, locules of subcutaneous\nair-related to the recent procedure, are additional incidental findings.\n\nRECOMMENDATION(S):  ___ consult for percutaneous drainage of the collection\ndescribed above.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:18 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.  A linear hypodensity within segment V\n(2:33) appears less conspicuous.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure.  The remnant pancreas\ndemonstrates normal attenuation throughout, without focal lesions or\npancreatic ductal dilatation.  Diffuse peripancreatic stranding is likely\nsequela of prior 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post gastrojejunostomy.  Multiple\nintra-abdominal fluid collections have decreased in size.  There is been\ninterval placement a pigtail catheter within a peripherally enhancing fluid\ncollection adjacent to the stump of the pancreaticobiliary limb, which\nmeasures approximately 3.1 x 2.1 cm, previously 4.1 x 3.7 cm.  Lateral to the\npancreaticobiliary limb is approximately 2.3 x 0.8 cm peripherally enhancing\nfluid collection, which is decreased in size from 4.7 x 1.7 cm previously\n(2:39).  No new intra-abdominal fluid collections are identified.  The\nremaining 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 bladder appears unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  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.  Mild atherosclerotic disease\nis noted.  Retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: Postsurgical changes are again seen within the anterior\nabdominal wall. A thin fluid collection within the right lateral abdominal\nwall measures approximately 3.0 x 0.6 cm (2:46), previously approximately 3.4\nx 0.8 cm.  A fluid collection within the mid anterior abdominal wall, at the\nlevel of the umbilicus, measures approximately 0.6 x 1.4 x 4.4 cm (2:48,\n602:45), previously 2.1 x 2.0 x 5.0 cm.  A deep, anterior abdominal wall\ndefect is seen within the upper abdomen, with small locules of air within the\nabdominal wall (2:23, 27).",
            "output": "1. Postsurgical changes following Whipple procedure, with interval decrease in\nsize of intra-abdominal fluid collections, the largest with a pigtail catheter\nin situ, measuring up to 3.1 cm, previously 4.1 cm.  No new fluid collections\nidentified.\n2. Interval decrease in size of multiple fluid collections within the anterior\nabdominal wall, likely post surgical."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Mild dependent\natelectasis bilaterally.  There is no evidence of pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure.  The remnant pancreas\ndemonstrates normal attenuation throughout, without focal lesion or pancreatic\nductal dilatation.  There has been interval decrease in the amount of\nperipancreatic stranding compared to the prior study.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The patient is status post gastrojejunostomy.  There has\nbeen interval resolution of the fluid collection adjacent to the stump of the\npancreaticobiliary limb.  There remains soft tissue stranding surrounding the\nformer site of the collection.\n\nLaterally to the pancreaticobiliary limb is approximately 1.8 x 0.9 cm\nperipherally enhancing fluid collection, which is decreased in size from 2.3 x\n0.8 cm (series 5, image 36; series 7, image 25).\n\nThere are no new intra-abdominal fluid collections identified.\n\nThe remainder of the small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement. The colon and rectum are decompressed throughout\nbut appear normal.  The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\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.  Retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative change of the thoracolumbar spine.\n\nSOFT TISSUES: Postsurgical changes are seen along the anterior abdominal wall.\nThere has been interval resolution of the rim enhancing fluid collection in\nthe right lateral abdominal wall and the mid anterior abdominal wall.  There\nis significant soft tissue edema and a small fluid collection in the upper mid\nabdomen that measures 1.6 x 0.9 x 1.2 cm, which may represent a sinus tract. \nThere is no evidence of fistulous connection to the peritoneum or bowel.",
            "output": "1. Postsurgical changes following Whipple procedure, with significant interval\ndecrease in the size of multiple intra-abdominal fluid collections.\n2. The fluid collection adjacent to the pancreaticobiliary limb stump with\npercutaneous drain in place, has completely resolved.\n3. No new or drainable fluid collections are identified.\n4. Persistent soft tissue inflammation along the anterior abdominal wall, with\na small 1.6 cm fluid collection in the superior aspect that may represent a\nsinus tract."
        },
        {
            "input": "LOWER CHEST: There is no pericardial effusion.  The lung bases are clear. \nThere is no pleural effusion or pneumothorax.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous though slightly decreased\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.  There is a focus of air within the liver centrally\n(2:17), presumably pneumobilia (series 2, image 17).  Previously seen drain\nwithin the right upper quadrant is not visualized on today's exam.\n\nPANCREAS: There are postsurgical change of Whipple procedure.  The remnant\npancreas is atrophic with no focal lesion visualized.  There is no fat\nstranding adjacent to the pancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is postsurgical change\nof gastrojejunostomy.  No residual fluid collection identified..  The colon\nand rectum 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 grossly 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.  Retroaortic left renal vein is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild multilevel degenerative changes of the spine noted most\nsignificantly at the lumbosacral junction.\n\nSOFT TISSUES: There is anterior abdominal wall large surgical scarring.  No\nfluid collection identified.",
            "output": "1. Soft tissue density suggestive of scarring seen along the anterior\nabdominal wall without focal collection.\n2. Postsurgical change of Whipple procedure and gastrojejunostomy.\n3. A focus of air visualized adjacent to the left portal vein is most likely\npneumobilia."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 6.6 x 3.3 cm (3:128) cm\nLocation (head right of SMV, body left of SMV): Neck and body\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: None\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: present\nSolid soft-tissue contact:  >180\u00b0\nIncreased hazy attenuation/stranding contact:  >180\u00b0\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: present\n\nVariant anatomy:  Small accessory left hepatic arteries arising from the left\ngastric artery.\nSolid soft-tissue contact:  None\nIncreased 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):\npresent\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: suspicious\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Strands of accessory left\nhepatic artery are seen at the ligamentum venosum arising from the left\ngastric artery.\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: In the dome of the liver, there is a subcentimeter hypodensity\n(03:10 3), too small to characterize by CT.  In segment II and segment III,\nthere are 9 mm, 1.1 cm, 0.7 cm ill-defined hypodensities (3:123, 131, 137). \nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: New since ___, there is a 6.6 x 3.3 cm hypoenhancing\nmass in the neck and body of the pancreas, largely replacing the parenchyma. \nThere is upstream dilation of the main pancreatic duct and atrophy of the\npancreatic tail.  There is minimal enhancing pancreatic parenchyma at the tail\n(601b:55).  The hypoenhancing mass encases the common hepatic artery, the\nsplenic artery, the celiac axis, the gastric artery without significant\nnarrowing.  There are soft tissue stranding extending to the SMA, though there\nis no solid tissue contact.   The main portal vein is also encased by the\nhypoenhancing mass (3:132) as it approaches the portal confluence and is\nsignificantly attenuated with a string like contrast column remaining near the\nportal confluence on the AP dimension.  In addition, there is narrowing of the\nproximal SMV as it approaches the portal vein, and is encased by the soft\ntissue density arising from the pancreatic hypodensity (___:44).  The splenic\nvein is severely attenuated with a small amount of contrast column remaining\nat the level of the portal confluence (3:132).  However, there is no evidence\nof thrombus within the venous structures.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 right kidney, unchanged from prior exam on ___.  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: 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 pathologic retroperitoneal\nlymphadenopathy by CT criteria.  However, there are scattered small\nparatracheal nodes along the course of the splenic artery and near the celiac\naxis.  There are punctate calcifications in the soft tissue density adjacent\nto the right mid ureter (3:175), which may represent calcifications within the\nlymph nodes versus previously thrombosed right gonadal vein.\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: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Pancreatic neck and body mass measuring up to 6.6 cm, with liver\nhypodensities, concerning for metastatic disease.  The mass is encasing\nadjacent hepatic vasculature, severely narrowing the main portal vein and\nproximal SMV at the hilum.\n2. Hepatic hypodensities, concerning for metastatic disease."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 5.1 cm (4:110)\nLocation (head right of SMV, body left of SMV): Neck/body\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: absent\n\nArterial evaluation\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 ___ 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 (4:108)\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:  absent\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:  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\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 (4:13)\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: suspicious\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Again seen are strands of\naccessory left hepatic artery arising from the left gastric artery.\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: Previously noted hepatic lesions are smaller.  For example, at\nthe dome of the liver, a subcentimeter hypodensity now measures 4 mm,\npreviously measuring 11 mm (4:85).  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS: The hypoenhancing mass in the neck and body of the pancreas is\ndecreased in size, now measuring 5.1 x 2.5 cm (4:110), previously measuring\n6.6 x 3.3 cm.  Re-demonstration of upstream dilatation of the main pancreatic\nduct and atrophy of the pancreatic tail.\n\nThe pancreatic mass still encases the celiac axis, splenic artery, common\nhepatic artery, and left gastric artery.  There is moderate narrowing at the\nproximal splenic artery (4:108).  Again seen is soft tissue stranding\nextending to the superior mesenteric artery, without direct solid tissue\ncontact.\n\nThe mass also encases the main portal vein and the splenic and superior\nmesenteric veins near their confluence.  Again seen is moderate narrowing of\nthe main portal vein (4:113), and splenic vein (4:112).  There is no evidence\nof thrombosis within these venous structures.\n\nSPLEEN: A subcentimeter hypodensity is seen near the superior pole (4:90), too\nsmall to characterize, 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 stones, focal renal lesions, or hydronephrosis.  Again\nseen is fullness to the right renal pelvis, not significantly changed.  There\nis no 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 normal.\n\nLYMPH NODES: There is increased conspicuity of periaortic nodal tissue, below\nthe left renal vein, now more ill-defined.\n\nPELVIS: There is thickening of the bladder wall, likely secondary to\nunderdistention.    There is no free fluid in the pelvis.  Uterus is not\nvisualized.  No adnexal abnormality is seen.\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. Interval decrease in size of pancreatic neck/body mass, which still encases\nadjacent vascular structures, as described above.\n2. Decreased size and conspicuity of hepatic metastatic lesions.\n3. Increased conspicuity of periaortic nodal tissue, below the left renal\nvein, now more ill-defined. This may be related to treatment effect and is\ntherefore concerning for tumor involvement."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 5.0 cm\nLocation (head right of SMV, body left of SMV): Neck/body\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\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:  absent\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:  absent\n\n\nVenous evaluation\n\nMPV involvement: complete occlusion\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 (03:39)\n\nSMV involvement: complete occlusion\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.  The previously described 4 mm hypodense lesion at the\nliver dome is not appreciated in today's study.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\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 liver is diffusely heterogenous throughout, likely due to\nperfusion variations. The previously described 4 mm hypodense lesion at the\nliver dome is not appreciated in today's study. There is no evidence of\nsuspicious focal lesions. 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 has been no significant change in the size of the\nhypoattenuating pancreatic neck/body mass since ___, measuring 5.0 x\n3.0 cm today, previously measuring 5.1 x 2.5 cm (03:36).  Upstream 6 mm\ndilation of the main pancreatic duct and pancreatic tail atrophy is\nre-demonstrated and unchanged.\n\nThere is stable encasement of the celiac axis, splenic artery, common hepatic\nartery, left gastric artery and SMA by the tumor mass.  There is stable\nmoderate narrowing of the proximal splenic artery (3:34) and proximal SMA ,\nunchanged from prior.  There is persistent soft tissue stranding of the\nproximal superior mesenteric artery, unchanged from prior, without direct\ncontact with the tumor mass.\n\nThere is stable persistent encasement of the main portal vein, splenic and\nsuperior mesenteric vein near the confluence with moderate narrowing of the\nmain portal vein (3: 39), also unchanged from most recent prior study.  There\nis no evidence of venous thrombus.\n\nSPLEEN: The subcentimeter hypodensity, too small to characterize, at the dome\nof the spleen remains unchanged (03:12).  The spleen otherwise shows normal\nsize and attenuation throughout, without evidence of 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.\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 is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder decompressed 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 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. Stable size of the pancreatic neck/body mass and stable degree of vascular\nencasement, grossly unchanged since the ___ CT abdomen and pelvis.\n2. No new solid organ masses or suspicious osseous lesions to suggest\nmetastasis.  No significant lymphadenopathy."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, ___, renal and\niliac arteries are patent.  The SMV and portal veins are patent.  The renal\nveins, iliac veins and IVC demonstrate normal caliber. There is minimal\ncalcium burden in the abdominal 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\nThe previously described hepatic lesions suspicious for metastases are less\nconspicuous and no difficult to see.  There is a 3 mm hypodense lesions at the\ndome (5:93) which is similar to ___ and too small to characterize. \nThe liver is otherwise unremarkable.\n\nAn approximately 3.6 x 1.6 cm pancreatic mass measured up to 5 cm on prior. \nThere is similar vascular involvement including complete encasement of the\nceliac axis.  There is severe attenuation of the splenic vein with\ngastroepiploic collaterals, as on prior.  The distal pancreas is atrophic as\non prior with stable duct dilation.\n\nThe spleen, adrenals, and kidneys are unremarkable.\n\nGASTROINTESTINAL: No small bowel obstruction or ascites.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno free fluid in the pelvis.  Post surgical changes status post TAH-BSO are\nagain seen with nonocclusive thrombus in the right gonadal vein.\n\nBONES: There is no evidence of worrisome osseous lesions.",
            "output": "Interval improvement of disease include decrease in size of the pancreatic\nmass with similar vascular involvement."
        },
        {
            "input": "LOWER CHEST: Please refer to the separate CT chest report for description of\nthoracic findings.\n\nABDOMEN:\nSmall ascites is present.\n\nHEPATOBILIARY: Numerous hypodense lesions in the liver are larger compared to\n___.  For example, the largest lesion is located in segment 3 measures\n3.1 x 2.6 cm (6: 105), larger than before (previously 2.4 x 2.4 cm).  There is\nand area of hyperenhancement in liver segment 8.  Gallbladder is similarly\ndistended compared to ___, however the gallbladder wall has become\nthicker and there is new hyperenhancement of the adjacent liver parenchyma. \nThere is focal disruption of the gallbladder wall at the fundus with linear\nextension of fluid tract superiorly along the liver surface (6:125).  CBD\nstent is in place.  Pneumobilia is present..\n\nPANCREAS: Hypodense mass in the pancreatic head measures approximately 4.6 cm\n(6:106), increased from before (previously 3.7 cm).  There is upstream\npancreatic duct dilation and parenchymal atrophy, similar to before.\nThe mass encases the celiac trunk, common hepatic artery the and proximal\nsplenic artery, which are stenotic.  The mass also encases the SMA which is\nstenotic.  Main portal vein is severely stenotic.  Collateral vessels are\nnoted along the anterior 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: The kidneys are of normal and symmetric size with normal nephrogram. \nMild hydronephrosis is new.  Right ureter is not well visualized.  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. Colon and rectum are within normal limits. \nAppendix is not visualized.  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: Uterus is absent.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal 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. Distended gallbladder with wall thickening and focal wall disruption at the\nfundus is concerning for acute cholecystitis with contained gallbladder wall\nperforation.\n2. Interval progression of metastatic pancreatic cancer, as evidenced by\nenlarging pancreatic head mass and numerous liver lesions.\n3. New mild right hydronephrosis.\n4. Unchanged pancreatic mass encasement of the celiac trunk, SMA, and SMV,\ncausing vascular stenosis.\n\nRECOMMENDATION(S):  The impression 1. and 2 were discussed with ___,\nM.D. by ___, M.D. on the telephone on ___ at 12:02 pm, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Mild-to-moderate atelectasis is noted in bilateral lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: Percutaneous cholecystostomy tube courses through the right\nlobe of the liver and terminates in the gallbladder neck.  Irregular\nhypodensities are identified in the gallbladder fossa, adjacent to the\ncollapsed gallbladder, suspicious for hepatic and perihepatic abscess. \nLargest measures 2.2 by 1.0 cm (06:23).  The gallbladder is collapsed and the\nhyperenhancing wall is irregular.  The wall is discontinuous at the fundus\nwith small amount of fluid tracking from the gallbladder fundus into the right\npara colic gutter.  Findings are suspicious for gallbladder perforation. \nIntra and extrahepatic bile ducts are normal caliber.  There is\nhyperenhancement extrahepatic bile ducts, likely from inflammation in setting\nof cholecystitis.\n\n5.5 x 2.0 cm wedge shaped area of hypoenhancement in liver segment 4 B is\nlocated adjacent to the area of suspected hepatic abscess and cholecystostomy\ntube (04:27) may reflect area of ischemia, edema or a developing hepatic\nabscess.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \n6.0 cm cyst is identified in the upper pole of left kidney with single\ncalcified septation.  Other cysts in the left kidney are smaller.  There is no\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Transesophageal tube terminates in stomach.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThere is focal wall thickening of colonic hepatic flexure adjacent to the\ngallbladder.  Appendix is not visualized.\n\nPELVIS: Foley catheter is in the bladder.  Trace free fluid is noted in the\npelvis.\n\nREPRODUCTIVE ORGANS: Multiple metallic seeds are 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.  Heavy atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nPatient is status post total right hip arthroplasty.\nSOFT TISSUES: Metallic objects are identified in the anterior right abdominal\nwall, likely related to prior surgery.",
            "output": "1. Gallbladder wall appears discontinuous at the fundus with small amount of\nfluid extending beyond the expected confines of the gallbladder fundus. \nFindings are suspicious for perforated cholecystitis.  Percutaneous\ncholecystostomy tube is in gallbladder neck.\n2. New hypodensities measuring up to 2.2 cm in the gallbladder fossa and\nwithin the hepatic parenchyma in the region of the percutaneous\ncholecystectomy tube are suspicious for perihepatic and hepatic abscesses.\n3. 5.5 x 2.0 cm area of hypoenhancement in the liver segment 4B  may reflect\nedema, ischemia or a developing hepatic abscess.\n4. Focal wall thickening at hepatic flexure of the colon is likely\ninflammatory secondary to adjacent 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 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 suspicious\nrenal 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.\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. Normal noncontrast CT of the abdomen pelvis."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nSub cm hypodensities in segment 2 and 8 of the liver is too small to\ncharacterize (series 2, image 17 ; series 2, image 6). The liver otherwise\nenhances homogeneously and is without focal lesions. The portal vein is\npatent. The gallbladder is normal without radiopaque gallstones. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. A sub cm\nhypodensity in the lower pole the left kidney is too small to characterize..\nThere is no hydronephrosis. The ureters are normal in caliber and course to\nthe bladder.\n\nThe distal esophagus is normal without a hiatal hernia.  The stomach is\ndecompressed. The small and large bowel are normal in caliber and without\nevidence of wall thickening.  Appendix is normal.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.  Fat containing umbilical hernia is noted.\n\nPELVIS:\n\nThe bladder is well distended and normal. Prostate and seminal vesicles are\nunremarkable. There is no pelvic side-wall or inguinal lymphadenopathy by CT\nsize criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No acute intra-abdominal process.  Normal appendix."
        },
        {
            "input": "LOWER CHEST: The visualized lung fields are unremarkable aside from bibasilar\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 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: Numerous calcified fibroids are seen within the uterus. \nA right adnexal cyst is noted.  It measures 3.7 x 4 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Mild\nstranding is seen adjacent to the right femur.",
            "output": "1. No evidence of intra-abdominal hematoma.\n\n2. Right adnexal cyst can be further evaluated on a nonemergent basis with\npelvic ultrasound."
        },
        {
            "input": "Patient is status post endovascular repair of an abdominal aortic aneurysm,\nwhich is widely patent.  No evidence of endoleak.  There is a slight interval\ndecrease in size of the excluded aneurysm sac which currently measures up to\n6.7 x 6.2 cm in maximum ___ (3:37), previously 7.0 x 6.4 cm in maximum\n___ (2:137).  A tiny hyperdense focus on series 3, image 44 is also\npresent on the non-contrast images and likely represents calcification.  The\nceliac axis, superior mesenteric artery and bilateral renal arteries are\npatent.  Bilateral iliac branches are patent.\n\nAAA MEASUREMENTS FROM IMAGING LAB:\n\n1. AAA diameter (largest centerline axis): 70 x 65 mm.\n2. AAA diameter (largest axial view): 71 mm.\n3. AAA volume: 204 cc\n4. Lowest renal artery to aortic bifurcation volume: 221 cc.\n5. Lowest renal artery to the iliac bifurcation volume: 269 cc.\n6. Neck length (infrarenal to aneurysm junction): 17 mm.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 mm stone in the upper pole of the right kidney (2:26).  No\nnephrolithiasis on the left.  No hydronephrosis.  A 6mm hypodensity is seen in\nthe lower pole of the right kidney (3:35), corresponding to a simple cyst that\nis unchanged from the recent MRI dated ___.  There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits.  Appendix is not visualized, but there are no\nsecondary signs of acute appendicitis.  No free fluid or free air within the\nperitoneal cavity.\n\nLYMPH NODES:  There is no retroperitoneal, mesenteric, pelvic sidewall or\ninguinal lymphadenopathy.\n\nPELVIS: The bladder is only minimally distended.  Two bladder diverticuli are\nnoted, measuring 5 mm anteriorly and 8 mm posteriorly (3:68).  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is top-normal in size.  Seminal vesicles\nare unremarkable in appearance.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes including anterior/posterior osteophytes, loss\nof intervertebral disc space height and endplate changes are noted throughout\nthe thoracolumbar spine.  There is grade 1 anterolisthesis of L5 on S1,\nunchanged from the prior study.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post endovascular repair of an infrarenal abdominal aortic aneurysm,\nwith slight interval decrease in size of excluded aneurysm sac as detailed\nabove.  No endoleak.\n2. 2 mm non-obstructing right upper pole renal stone."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.\nNormal appearing bladder with a small focus of gas, likely from\ncatheterization. There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lower lumbar spine.\n\nSOFT TISSUES: Ventral hernia containing fat and a small amount of fluid, with\na 1.9 cm aperture.  There is water density body wall edema, particularly on\nthe left at the level of the iliac crests.  No gluteal hematoma identified. \nCalcifications are noted in the midline paraspinal subcutaneous fat.",
            "output": "1. No gluteal hematoma identified.\n2. There is water density body wall edema, particularly on the left at the\nlevel of the iliac crests.\n3. Ventral hernia containing fat and a small amount of fluid, with a 1.9 cm\naperture.\nOf note, secondary to patient body habitus, the lateral most aspects of the\npatient body wall are not visualized bilaterally."
        },
        {
            "input": "LOWER CHEST: There is mild, left greater than right, bibasilar atelectasis. \nThe heart is moderately enlarged 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 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 hydronephrosis.  Numerous bilateral punctate nonobstructive renal\ncalculi measuring up to 4 mm are seen.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There are multiple\nfluid-filled distended loops of small bowel with extensive air-fluid levels\nseen throughout the abdomen with transition point identified within a small\nbowel containing left inguinal hernia (02:72).  The hernia neck measures\napproximately 1.6 cm with the internal hernia bowel contents fluid-filled and\nedematous with wall thickened up to 7 mm.  There is fat stranding within the\nhernial sac and in surrounding soft tissues.  There is a bowel wall\nenhancement of the incarcerated bowel though it may be slightly reduced\ncompared to intraperitoneal bowel.  There is no free air or pneumatosis to\nsuggest the devascularization or perforation.  There is no large drainable\nfluid collection.  No additional transition point is identified.  The large\nbowel is collapsed.  The appendix 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 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a right-sided total hip arthroplasty and partially imaged cannulated\nscrews within the left distal femur.  There are multilevel degenerative\nchanges of the lumbar spine with vacuum phenomenon, loss of intervertebral\ndisc space height, and osteophytosis with minimal endplate sclerosis, most\npronounced at L4-L5.\n\nSOFT TISSUES: There is mesenteric fat stranding and a small amount of\nsubcutaneous edema surrounding a left inguinal hernia sac.",
            "output": "1. Small-bowel obstruction with transition point identified within a left\ninguinal hernia.\n2. No specific imaging evidence of devascularization or perforation of\nincarcerated bowel given presents of extensive bowel wall edema and adjacent\nfat stranding early strangulation is difficult to exclude.\n3. Bilateral nonobstructive renal calculi."
        },
        {
            "input": "LOWER CHEST:\nA couple of millimetric pulmonary nodules in the lung bases are nonsuspicious.\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 surgically absent.\n\nPANCREAS: Atrophic appearance of the pancreas in keeping with history of\nchronic pancreatitis.  No pancreatic calcifications. No peripancreatic\nstranding or pseudocyst.  Chronic post pancreatitis changes in the form of\nscarring and tethering of the posterior gastric wall in the area of the\nprevious pseudocyst (series 5, image 41) appear similar compared to prior MR.\n___ noted small cystic lesions in the pancreatic tail in keeping with\neither side branch IPMN lesions or dilatation of side branch ducts secondary\nto post pancreatitis stricture is suboptimally assessed on the current study\nand reference is made to prior MRCP done ___.\n\nSPLEEN: Obliteration of the splenic vein with multiple portosystemic\ncollaterals are again noted.  Stable splenomegaly.  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.\n\nGASTROINTESTINAL: The stomach is 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. \nPossible uterine myometrial fibroid in the posterior wall (series 5, image\n119)\n\nLYMPH NODES: Multiple subcentimeter mesenteric lymph nodes are most likely\nreactive.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Chronic obliteration of the splenic vein with multiple portosystemic\ncollaterals.  Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight sacral sclerotic lesion is unchanged.  Bilateral L5 spondylolysis with\nmild anterior spondylolisthesis.\n\nSOFT TISSUES: Small anterior abdominal wall hernia in the inferior aspect of\nthe abdominal wall with no bowel herniating into the hernial sac which appear\nsimilar compared to prior CT done ___",
            "output": "1. No acute intra-abdominal or pelvic pathology.  No findings explaining the\npatient's new left upper quadrant pain.\n2. Chronic post pancreatitis changes are stable.  No new peripancreatic\nstranding or pseudocyst.\n3. Chronic obliteration of the splenic vein with multiple portosystemic\ncollaterals and splenomegaly are stable"
        },
        {
            "input": "LOWER CHEST: Bibasilar dependent 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 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. \nPunctate hypodensities, too small to characterize, are likely representative\nof simple renal cysts.  There is no evidence of suspicious focal renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Incidental noting of a\ntransient small bowel intussusception.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.  Complex fluid is noted along\nthe right paracolic gutter, which may represent hemorrhagic products.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ncomplex fluid in the pelvis compatible with hemorrhage.\n\nREPRODUCTIVE ORGANS: Redemonstration of an enlarged fibroid uterus with a\nlarge exophytic fibroid, measuring 8.3 x 7.6 x 7.7 cm, previously 7.2 x 7.0 x\n6.9 cm (601:25).  Interval enlargement of the central hypoattenuation\ncomponent and decreased enhancement.\n\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 fat containing umbilical hernia.",
            "output": "1. Complex fluid within the pelvis and right paracolic gutter and around the\nliver.  This can be seen in the setting of a ruptured hemorrhagic ovarian cyst\nthough none is definitively identified.  No other visualized source of\nhemoperitoneum identified.\n2. Interval progression in the degree of degeneration of an exophytic 8.3 cm\nprobable fibroid."
        },
        {
            "input": "LOWER CHEST: Mild subsegmental right and left lower lobe atelectasis noted. \nNo pleural effusion.  The imaged portion of the heart is unremarkable.\n\nABDOMEN: Mild to moderate volume hemoperitoneum is seen in the upper abdomen.\n\nHEPATOBILIARY: Liver enhances normally.  No concerning liver lesion.  Main\nportal vein is patent.  No biliary ductal dilation.  The gallbladder is\nnormal.  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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nPunctate hypodensities, too small to characterize, are likely representative\nof simple renal cysts.  There is no evidence of solid 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.  A small to\nmoderate amount of complex fluid is noted in the bilateral pericolic gutters\nand pelvis, increased from prior exams.  The colon and rectum are within\nnormal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nhyperdense free fluid, mild to moderate in volume consistent with\nhemoperitoneum.  The source of hemoperitoneum is most likely a ruptured\novarian cyst.\n\nREPRODUCTIVE ORGANS: A large complex cystic lesion is seen in the mid pelvis\nwith peripheral nodularity.  This lesion has been previously described as a\ndegenerating exophytic fibroid and has increased in size when compared with\nmultiple priors performed earlier this year.  This lesion which currently\nmeasures 10.8 cm x 10.8 cm x 10.0 cm, previously 9.6 x 8.2 x 8.5 cm on MR from\n___ and measured 8.3 x 7.6 x 7.7 cm on CT from ___.  Given\nincreased hypodense fluid noted centrally and decreased solid peripheral\ncomponent, findings most likely reflect an actively degenerating fibroid.  The\novaries appear unremarkable without discrete 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A small umbilical hernia contains fat and a tiny amount of\nfluid.",
            "output": "1. Mild-to-moderate volume hemoperitoneum, likely the sequelae of ruptured\novarian cyst.  Correlation with trending hematocrit levels is advised.\n2. Increased size of an exophytic fibroid as detailed above.  Given active\ndegeneration resulting in increased size, recommend OB Gyn consultation for\nmanagement decisions."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The visualized liver demonstrates homogenous attenuation\nthroughout.  Hypodensity within segment IV B along the falciform ligament\nlikely represents focal fat, a normal variant.  Otherwise, 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 dome of the spleen is excluded from view.  The visualized spleen\nshows normal size and attenuation throughout.   No suspicious 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. \nFew subcentimeter hypodensities throughout the left kidney are too small to\ncharacterize but likely represent cysts.  There is fullness of the right\nureter which may related to peristalsis.  There is no 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: There is an enlarged, fibroid uterus.  There is a large\nexophytic mass arising off the fundus which measures 7.2 x 7.0 x 6.9 cm and\nexhibits few areas of central hypoattenuation, consistent with a very large\nsubserosal degenerating fibroid.  No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Obstruction or\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": "Findings consistent with large subserosal uterine fibroid with cystic/necrotic\nchanges.  Evaluation with follow-up ultrasound or MR is recommended when\nclinically appropriate."
        },
        {
            "input": "LOWER CHEST: Findings suggestive of chronic aspiration including bronchial\nwall thickening, traction bronchiectasis, ground-glass opacities most\nprominent in the dependent portions of the lower lobes.\n\nABDOMEN: The liver, spleen, and adrenal glands are unremarkable.  Status-post\ncholecystectomy.  A few cystic pancreatic body lesions measure 6 and 10 mm\n(series 5, images 51 and 52).  No main pancreatic ductal dilatation.\n\n5.0 cm exophytic left upper pole simple renal cyst.  Additional\nhypoattenuating lesions are too small to completely characterize.  No\nhydronephrosis.\n\nGASTROINTESTINAL: There is intraluminal contrast extravasation in the proximal\ntransverse colon, best appreciated in the portal venous phase (series 5, image\n75; series 604, image 16).  There is no intestinal obstruction or ascites. \nThere is a small periampullary duodenal diverticulum.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nPELVIS: There is no pelvic free fluid.  Hysterectomy changes are present.  The\nurinary bladder is decompressed incident Foley catheter.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No aggressive osseous lesions are seen. \nExtensive degenerative changes include spondylolisthesis, posterior\nosteophytes, and posterior disc bulges result in at least multilevel spinal\ncanal narrowing.  Rectus diastasis and small fat containing left inguinal\nhernia are noted.",
            "output": "1. Active hemorrhage in the proximal transverse colon.\n2. Aspiration pneumonia at the lung bases.\n3. Pancreatic cystic lesions measuring up to 1 cm.  If a change in management\nwould occur at this age, MRCP could be obtained non emergently for further\nevaluation.\n\nRECOMMENDATION(S):  Probably cystic pancreatic body lesions measuring up to 10\nmm. Recommend nonemergent MRCP for further evaluation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:58 am, approximately\n15 minutes after discovery of the findings."
        },
        {
            "input": "There is a complete subcapital right femoral neck impacted and comminuted\nfracture with mild varus angulation.  The right femoral head is well seated\nwithin the acetabulum.  No additional fractures are visualized.  Dominant\ndistal fracture fragment is mildly displaced ventrally.  Mild adjacent fat\nstranding, but no large hematoma.  No suspicious osseous lesions. No\ndislocation.  Mild degenerative changes are noted involving both\nfemoroacetabular joints.\n\nExtensive atherosclerotic calcifications of the partially visualized abdominal\naorta without evidence of aneurysm formation.  Extensive diverticulosis\nwithout evidence of diverticulitis.  Otherwise, the partially visualized large\nand small bowel are within normal limits.  The prostate is enlarged measuring\n6.0 x 4.4 cm.  Multiple bladder diverticula are visualized.  There is no\nevidence of bladder wall thickening.  There is no free fluid within the\npelvis.  No lymphadenopathy.  There is a left inguinal hernia containing a\nnonobstructed loop of colon.",
            "output": "1. Complete subcapital right femoral neck comminuted and impacted fracture\nwith mild varus angulation.  No additional fractures.  No large hematoma.\n2. Other incidental findings include a left inguinal hernia containing a\nnonobstructed loop of colon, prostatomegaly, multiple bladder diverticula, and\ncolonic 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 homogeneous attenuation throughout. \nThere are multiple subcentimeter hypodensities seen throughout the liver which\nare too small to characterize but are likely hepatic cysts or biliary\nhamartomas.  A 1.2 cm hypodensity in the right hepatic lobe likely represents\na hepatic cyst (2; 20).  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 is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nmoderate left hydronephrosis and dilation of the proximal and mid left ureter\nleading up to a 1.1 cm ureteral stone (601; 28).  A 6 mm stone is seen in the\nleft lower pole.  A 3 mm nonobstructing stone is seen in the right kidney. \nThere is mild left perinephric stranding.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  There is severe wall thickening\nof the mid and distal sigmoid colon with extension into the upper rectum with\nsurrounding fat stranding (2; 58).  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: Calcifications are seen within the prostate.  Surgical\nclips are seen adjacent to the prostate.\n\nLYMPH NODES: There are multiple prominent retroperitoneal lobes was measure up\nto 1 cm.  Prominent mesenteric lymph nodes measure up to 6 mm.  There is no\npelvic 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 grade 1 anterolisthesis of L4 on L5.  There are multilevel\ndegenerative changes most severe at L4-5 with loss of vertebral disc height,\nendplate sclerosis, and osteophytosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Severe colonic wall thickening of the sigmoid colon with mild surrounding\nfat stranding and prominent mesenteric and retroperitoneal lymph nodes which\ncould be infectious (eg TB), inflammatory (eg IBD), or neoplastic (eg\nlymphoma) in etiology.\n2. Moderate left hydroureteronephrosis leading up to a 1.1 cm stone in the\nleft mid ureter.  Additional bilateral nonobstructive renal calculi."
        },
        {
            "input": "LOWER CHEST: There is linear atelectasis in the right middle lobe, improved\nfrom prior exam.  There is no pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple cysts or biliary hamartomas are unchanged from prior\nexam.  Otherwise the liver demonstrates homogenous attenuation throughout. \nThere is no new focal lesion. 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 new left nephroureteral stent in place resulting in\nresolution of previously seen left-sided hydronephrosis..  The previously seen\nsmall bilateral renal calculi not seen on this exam.  A 8 mm (cc) calculus is\nseen within the mid left ureter adjacent to the ureteric stent (6:37, 8:21). \n2.4 cm left inferior renal pole cyst is unchanged.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Administered\nrectal contrast is seen throughout the small bowel.\n\nEnteric contrast material has been injected through a rectal tube.  At the\nlevel of the upper rectum is a 1.9 cm defect (series 9, image 31) along the\nanterior wall, approximately 10.2 cm from the anal verge.  This defects\nconnects to a thick walled chronic appearing and contained perforation\nmeasuring approximately 3.7 x 10.2 cm on sagittal dimension.\n\nAt least 2 fistulous tracts are visualized extending from this collection to\nthe small-bowel.  Anteriorly (06:54) there is fistulization to a distal\njejunal/proximal ileal bowel loop.  A second thick walled fistulous track\nextends superiorly (series 9, image 28, 06:48) connecting to the distal ileum.\nThis latter fistulous tract opacifies the terminal ileum and cecum with rectal\ncontrast.  There is no opacification of the ascending colon and transverse\ncolon.  The mid to distal transverse colon is decompressed.  Multiple small\nfoci of gas are seen within the peritoneal cavity, presumably with in\ndecompressed bowel loops.  No evidence of free air around the liver or in the\nporta hepatis.\n\nThere is no other extraluminal extravasation, extraluminal air or\npneumoperitoneum.\n\nPELVIS: The distal tip of left nephroureteral stent is seen in the normal\nappearing bladder.\n\nREPRODUCTIVE ORGANS: Small focus of calcification is seen in central zone of\nprostate gland.\n\nLYMPH NODES: Multiple prominent retroperitoneal lymph nodes are seen measuring\nup to 1 cm (series 6, image 24) unchanged from prior exam.  There is no pelvic\nor 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 thoracic and lumbar spine with\nlevoscoliosis of thoracolumbar junction, unchanged.  There is grade 1\nanterolisthesis of L4 on L5, unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Contained thick walled, likely chronic perforation measuring 3.7 x 10.2 cm\non sagittal dimension located anterior to the upper rectum with fistulous\ntracts connecting to distal ileum and distal jejunum/proximal ileum.  No\nevidence of extravasated or extraluminal contrast.\n2. Stable retroperitoneal lymphadenopathy measuring up to 1 cm.\n3. Status post new left nephroureteral stent with interval resolution of\nleft-sided hydronephrosis.  A 8 mm calculus is still seen within the mid left\ndistal ureter adjacent to the stent.\n4. Stable grade 1 anterolisthesis of L4 on L5.\n\nNOTIFICATION:  The findings were discussed with ___ MD from colorectal\nsurgery, by ___, M.D. in person on ___ at 6:30 pm, 5 minutes\nafter 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.  13\nmm hypodensity in segment VII is again noted (series 11, image 15).  2\nsubcentimeter hypodensities in segment ___ are unchanged.  No new hepatic\nlesion.  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 normal in sizes.  A left nephroureteral stent is well\npositioned.  There is a 6 mm nonobstructive stone in the mid left ureter.  A 6\nmm nonobstructive stone in the inferior pole of left kidney is also noted. \nThere is a 1.9 cm cyst in the left inferior pole.\n\nOn the right, there is no hydronephrosis.  A 4 mm right upper pole\nnonobstructive stone is noted.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nAt the level of rectosigmoid junction, there is an anterior 1.5 cm defect\n(series 7, image 22) with a large patent fistula with a distal ileal loop in\nthe pelvis (series 7, image 21).  This ileal loop shows circumferential wall\nthickening which also appears unchanged.\n\nFrom this fistula, there is a small sinus tract (series 7, image 22).\n\nNo bowel obstruction.  No focal abscess.  No ascites.\n\nPELVIS: The urinary bladder is collapsed on a Foley catheter.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  There is significant narrowing of the origin of the celiac\nartery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nDegenerative changes are seen in the lumbar spine.  Grade 1 anterolisthesis of\nL4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large fistulous tract between the rectosigmoid junction and a distal ileal\nloop is again noted. A small sinus tract is also unchanged.\n2. No focal abscess.\n3. Left nephroureteral stent in place with no hydronephrosis.  Nonobstructive\n7 mm stone within the mid left ureter is again noted.\n4. Bilateral nonobstructive kidney stones."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Hepatic cyst within the right lobe.  Additional subcentimeter\nhypodensities are too small to characterize, but also likely represent cysts. \nOtherwise, the liver demonstrates homogenous attenuation throughout.  There is\nno evidence of enhancing lesions.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Intermediate density material layers\ndependently within the gallbladder (series 5, image 35).  This could represent\nvicarious excretion of contrast from the recent CT scan versus sludge.  No\nevidence 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: Left nephroureteral stent appears appropriate, terminating within the\nbladder.  There is no hydronephrosis.  11 mm stone within the mid left ureter\nis also unchanged (series 8, image 20).  Additional small nonobstructing stone\nwithin the upper pole the right kidney (series 5, image 21).  Large cyst\nwithin the lower pole of the left kidney.  Additional subcentimeter\nhypodensities are nonspecific, but also likely represents cysts.  Otherwise,\nthe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of enhancing renal lesions.  No perinephric stranding.\n\nGASTROINTESTINAL: Large caliber fistula from the rectosigmoid junction to\nileal small bowel loops is unchanged compared to prior (series 9, image 30). \nCircumferential wall thickening involving the sigmoid is also unchanged.  The\nsuperiorly projecting sinus tract containing air arising from the fistula is\nunchanged (series 9, image 29).  There is no evidence of new extraluminal\ncontrast.  There is no evidence of pneumoperitoneum.  No focal fluid\ncollections are visualized.  The stomach is unremarkable.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. The\nproximal 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.  Extensive atherosclerotic\ndisease is noted.  Unchanged narrowing at the origin of the celiac axis with\npoststenotic dilatation.\n\nBONES: S shaped scoliosis of the thoracolumbar spine with superimposed\ndegenerative changes.  Grade 1 anterolisthesis of L4 on L5 there is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse subcutaneous edema.  Otherwise, the abdominal and pelvic\nwall is within normal limits.",
            "output": "1. Unchanged large caliber fistula from the rectosigmoid junction to ileal\nsmall bowel loops with a superiorly projecting sinus tract.  No evidence of\nextraluminal contrast.  No focal fluid collections.\n2. Left nephroureteral stent appears appropriate without evidence of\nhydronephrosis.  11 mm mid left ureteral stone is unchanged."
        },
        {
            "input": "LOWER CHEST: With the exception of minimal bibasilar atelectasis, lung bases\nare clear.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nNumerous subcentimeter hypodensities scattered throughout the liver are too\nsmall to characterize, most likely reflecting simple cysts and are unchanged. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: Mild dilation of the pancreatic duct gradually tapering toward the\ntail is unchanged, measuring up to 5 mm in the head/neck (02:18).  No focal\npancreatic lesion 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 demonstrate normal, symmetric enhancement.  Mild\nright-sided hydronephrosis is new, with obstruction likely near the UPJ.  No\nfocal obstructing lesion is seen.  A left nephroureterostomy tube is\nre-demonstrated, in the left renal collecting system is decompressed. \nSubcentimeter cortical hypodensities are too small to characterize, most\nlikely cysts.  A left upper pole cyst is unchanged.  No suspicious solid focal\nrenal lesions.  Punctate nonobstructing stone is re-demonstrated in the right\nupper pole collecting system.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Contrast is demonstrated in\nthe distal small bowel.  There now a segment of distal ileum that has marked\nwall thickening including a layered appearance with intramural edema or\ninflammation.  This segment leads to the fistulous tract with the distal\nsigmoid colon (for example 02:58).  The fistulous tract is similar in size\n(02:55, 602:35).  In addition, there is also circumferential thickening of the\ndistal sigmoid and rectal wall open (02:57).  The remainder of the small bowel\nand colon are unremarkable.  No free intraperitoneal air.  Small volume\nascites.\n\nPELVIS: The distal and of the left nephroureterostomy tube is in the bladder. \nThe distal right ureter appears unremarkable.  There is small volume free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  No adnexal masses identified.\n\nLYMPH NODES: Enlarged retroperitoneal lymph nodes are similar, including left\nperiaortic node measuring 11 mm at the level of the left renal vein (02:22),\nand distal left periaortic conglomerate measuring 10 mm (02:33).  See no\nnew/increasing lymphadenopathy is seen.\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 of the lumbar spine are present, including\ngrade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New circumferential wall thickening involving a segment of distal ileum,\nwhich which is fistulized to the distal sigmoid colon.  The fistula is\nessentially unchanged in appearance.  No new fistulas are seen.  Differential\nfor this circumferential thickening includes bowel involvement of lymphoma, or\nenterocolitis.  The layered appearance is more consistent with a nonneoplastic\nprocess, however.  Less likely bowel ischemia.\n2. Similar retroperitoneal lymphadenopathy.\n3. New mild right-sided hydronephrosis, with obstruction likely near the UPJ. \nSimilar appearance of the left renal collecting system which is decompressed\nwith a nephroureterostomy stent in place.\n4. Unchanged prominence of the pancreatic duct without focal lesion."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Heart size is normal and tip of\na central venous catheter terminates in the proximal right atrium.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple subcentimeter hypodensities are seen throughout the liver, unchanged\nfrom prior study, presumed cysts.  There is no evidence of new focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nModerate volume ascites the gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Mild pancreatic ductal dilatation measuring up to 4 mm is\nre-demonstrated.  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. \nResolution of previously noted right-sided hydronephrosis\nAgain seen is a 6 mm nonobstructing calculus in the left lower pole and 3 mm\nnonobstructing calculus in the right upper pole.  Left nephroureteral stent is\nre-demonstrated in unchanged position without left-sided hydronephrosis. \nUnchanged left lower pole simple cyst.  There is no evidence of concerning\nfocal renal lesions there is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Again seen is a fistulous\ntract between the distal ileum and the sigmoid colon which appears to be\nsimilar in size and configuration compared to prior (series 601, 35).  An\napproximately 25 cm long segment of ileum proximal to the fistulous tract in\nthe left lower quadrant exhibits a targetoid appearance with circumferential\nwall thickening and edema compatible with an ileitis.  No evidence of definite\nnew fistulous tracts or discrete abscess formation.  The remainder of the\nsmall and large bowel is unremarkable.  The pending cyst not visualized.\n\nPELVIS: Distal pigtail of a left nephroureteral stent terminates within the\nbladder.  Otherwise the urinary bladder and distal right ureter is\nunremarkable.  There is moderate amount of free fluid in the pelvis.  No free\nair.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Prominent retroperitoneal lymph nodes are re-demonstrated\nincluding a 10 mm left periaortic node (02:23) and an 8 mm left periaortic\nnode at the level of the left renal vein (02:19).  There is no mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate diffuse calcified\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  9\nmm of anterolisthesis L4 over L5 is likely degenerative with intervertebral\ndisc height loss and osteophyte formation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\ndiffuse anasarca.",
            "output": "1. Similar size and morphology of fistulous tract between the distal ileum and\nsigmoid colon.  An approximately 25 cm long segment of the ileum proximal to\nthe site of the fistula continues to exhibit circumferential bowel wall\nthickening and edema concerning for an ileitis which may be infectious,\ninflammatory, with ischemia not excluded.  No evidence of new fistulous tracts\nor abscess formation.\n2. Interval resolution of right-sided hydronephrosis.  Bilateral\nnonobstructing renal calculi are noted.  Left-sided nephroureteral stent is in\nappropriate orientation without evidence for hydronephrosis.\n3. Moderate volume ascites.  Diffuse anasarca.\n4. Retroperitoneal lymphadenopathy, similar to the prior exam."
        },
        {
            "input": "LOWER CHEST: There is trace left pleural effusion with associated atelectasis.\nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are few scattered hypoattenuating cystic lesions in the liver which most\nlikely represent cysts or hemangiomas.  There is mild intrahepatic biliary\nductal dilatation within the left lobe of the liver.  The gallbladder is\nnondistended, within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 left double-J ureteral stent with the pigtail at the left renal\npelvis. There is no evidence of solid renal lesions or hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There remains the fistulous\nconnection between the distal ileum and the sigmoid which appears slightly\nsmaller compared to ___.  Oral contrast was not at the distal ileum\nat time of scanning, therefore patency cannot be excluded.  Again seen is\nthickening and edema of the walls of the distal ileum proximal to this\nfistulous connection which could represent ileitis.  No new fistulous tracts\nare appreciated.  There is no discrete abscess.  The remainder of the large\nsmall bowel is unremarkable.\n\nPELVIS: There is a stent within the left ureter.  There is a 7 mm stone within\nthe mid ureter.  The urinary bladder is unremarkable.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again seen are few prominent lymph nodes.  There is no\nlymphadenopathy by 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 anterolisthesis of L4 on L5.  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. Again seen is the fistulous connection between the distal ileum and the\nrectosigmoid colon.  It appears smaller in size compared to ___. \nEvaluation for patency of the tract cannot be excluded as oral contrast is not\nseen at the distal ileum.  No new fistulas are appreciated.\n2. Persistent edema and thickening of the distal ileum proximal to this\nfistulous connection is suggestive of ileitis.\n3. Again seen is the left ureteral stent with a stone at the mid ureter."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nA fusiform infrarenal abdominal aortic aneurysm is noted, and the patient is\nstatus post placement of an aortic stent which extends from the level of the\nrenal arteries to the bilateral common iliac arteries. There is no evidence of\nstent failure, contrast extravasation, or endoleak. The aneurysm sac now\nmeasures approximately 4.7 x 4.0 cm at maximum diameter (3:77), stable as\ncompared to prior examination.\n\nThe celiac axis, SMA, and bilateral renal arteries, are grossly patent. The\ninferior mesenteric artery appears to be occluded, unchanged from the prior\nexamination. Diffuse atherosclerotic mural calcifications are seen throughout\nthe aorta and its major branches, and are particular significant within the\niliofemoral arteries. The proper hepatic artery is noted to originate from the\nSMA. Interval placement of metallic material is noted with within the vicinity\nof the GDA, and likely represents intravascular coiling.  Assessment of the\nvenous vasculature is limited by the timing of contrast.\n\nABDOMEN:\n\nThe visualized lung bases demonstrate mild bibasilar atelectasis. There is no\nevidence of pericardial effusion.\n\nThe liver is normal in appearance and without focal suspicious lesion.\nRedemonstrated is a stable, 1.4 cm segment II hepatic hypodensity, most likely\nrepresenting a hepatic cyst or biliary hamartoma. The portal venous system is\npatent. The patient remains status post CBD stent placement, with\npostoperative pneumobilia and air-fluid levels seen within the gallbladder,\nunchanged from prior examination.\n\nInterval development of a 1.6 x 1.0 cm hypodense region within the pancreatic\nbody (3:59), may represent postoperative changes or the sequelae of\npancreatitis. Persistent mild dilation of the pancreatic duct measuring up to\n6 mm (3:49), stable as compared to the prior exam. The spleen and right\nadrenal gland are normal. A 1.2 x 1.1 cm left adrenal nodule measures 8\nHounsfield units in density, and is compatible with a stable adrenal adenoma.\nThe kidneys enhance symmetrically and are without suspicious solid mass.\nBilateral simple renal cysts are noted, the largest of which measures 6.5 cm\nin the upper pole left kidney (3:35).\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\nnormal in appearance. 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. A small\nright hydrocele is unchanged. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. Moderate scoliosis is noted with\nrightward convexity of the thoracolumbar spine. No focal lytic or sclerotic\nlesion concerning for malignancy.",
            "output": "1. Stable abdominal aortic aneurysm status post endovascular stent placement.\nNo evidence of endoleak.\n\n2. Interval development of a 1.6 x 1.0 pancreatic hypodensity. Given the acute\nonset of this lesion within only 6 weeks, findings may be postoperative in\nnature or related to the sequela of pancreatitis. Attention to be paid on\nfollowup.\n\n3. Stable, mild dilation of the pancreatic duct up to 6 mm.\n\n4. Status post CBD stent placement with residual pneumobilia."
        },
        {
            "input": "PELVIS: Limited evaluation again demonstrates large volume ascites and\nsignificant fecal retention.\n\nLYMPH NODES: No definite adenopathy however limited due to large volume\nascites and lack of contrast.  Left intra pelvic in extrapelvic fat show\nincreased attenuation consistent with anasarca.\n\nVASCULAR: Extensive atherosclerotic disease is again noted.\n\nBONES: Osteopenia.  Stable degenerative and postsurgical changes without acute\nfracture, suspicious osseous lesion, or hardware complication.  Patient is\nstatus post thoraco lumbosacral fusion, as seen previously.  There is no\nhardware loosening.  High density material again noted within the bilateral\nlungs presumably related to intraosseous cement placement.  Sacroiliac joints\nand lower lumbar into vertebral bodies are fused.  Pubic symphysis is narrowed\nin partly fused with chondrocalcinosis.  Hip joint spaces show moderate\nosteoarthritis.\n\nSOFT TISSUES: No acute or significant findings.",
            "output": "1. Stable degenerative change and postoperative change without acute fracture,\nsuspicious osseous lesion, or hardware complication.\n2. Partial visualization of large volume ascites.  Widespread anasarca.\n3. Findings consistent with ankylosing spondylitis.\n4. Overall no significant change 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 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. The appendix is normal (07:36).\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 with IUD in place.  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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a 1.4 x 1.1 x 1.4 cm (SI by AP by TRV; 7:29, 5:69) soft\ntissue density lesion in the deep subcutaneous tissues abutting the anterior\nabdominal wall musculature of the right lower quadrant with minimal adjacent\nstranding.  A small umbilical hernia containing fat is noted.",
            "output": "1. Normal appendix.\n2. 1.4 cm soft tissue density lesion in subcutaneous tissues of the right\nlower quadrant is incompletely assessed.  Dedicated contrast-enhanced pelvic\nMRI is recommended.\n3. Otherwise, no acute findings in the abdomen or pelvis to account for\npatient's symptoms.\n\nRECOMMENDATION(S):  1.4 cm soft tissue density lesion in subcutaneous tissues\nof the right lower quadrant is incompletely assessed. Dedicated\ncontrast-enhanced pelvic MRI is recommended\n\nNOTIFICATION:  The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:01 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  No active extravasation is\nseen on this exam, although region of linear contrast density on prior exam\nlikely represented acute contrast extravasation.\n\nLOWER CHEST: Please see concurrent CT chest for further description of\nintrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  Scattered, punctate hypodensities throughout\nthe liver are too small to characterize and likely represent cysts versus\nbiliary hamartomas.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor 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 left kidney is atrophic with multiple cysts, largest measuring up\nto 1.8 cm in the upper pole.  Right kidney is normal in size and shape with\nsome areas of cortical thinning.  There is no hydronephrosis on either side. \nNo concerning parenchymal renal lesions.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nIncidentally noted are two duodenal diverticula.  There is colonic\ndiverticulosis without surrounding inflammation to suggest diverticulitis. \nAppendix is unremarkable.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: Again seen in the left space of Retzius, is a 5.8 x 4.8 x 2.5\ncm hematoma, with rightward deviation of the adjacent bladder.  This hematoma\nis relatively unchanged to minimally increased compared to most recent CT.\n\nPELVIS: Urinary bladder is displaced rightward from the adjacent left pelvic\nsidewall hematoma which measures approximately 4.7 x 7.8 cm.  There is mild\nasymmetric bladder wall thickening of the left, anterior portion, likely\nreactive, but overall nonspecific.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no definite free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  There is no large\nadnexal mass.\n\nBONES: There is an acute fracture, which is comminuted and minimally\ndisplaced, of the left superior pubic ramus, with adjacent hematoma, as above.\nAcute nondisplaced left inferior pubic ramus fracture is also noted.  Multiple\nchronic fractures are again seen, including right inferior pubic ramus, right\nsuperior pubic ramus, left femoral neck status post gamma nail fixation. \nThere is dextroscoliosis of the visualized thoracolumbar spine.  Transitional\nanatomy noted at the lumbosacral junction.  Assuming 12 rib-bearing thoracic\ntype vertebral bodies, there is partial sacralization of L5.  Vertebroplasty\nchanges noted at T11 and T12.  Patient shows height loss at L4, which is of\nunknown chronicity though without CT evidence of acuity. No additional areas\nof height loss.  Defect in the left iliac bone is presumably postsurgical.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nAsymmetric atrophy of the left ileo psoas is noted.",
            "output": "1. Acute comminuted fracture of the left superior pubic ramus. Previously seen\narea of active extravasation is not visualized on this exam. No active\nextravasation in the region of pubic fracture. Left-sided space of Retzius and\nleft pelvic sidewall hematoma, with rightward mass effect on the bladder, is\nunchanged to minimally increased in size compared to prior.\n2. Multiple chronic fractures, as above. Height loss at the L4 vertebral body\nis of unknown chronicity. Patient is status post vertebroplasty at T11 and\nT12.\n3. Additional incidentals, as above, including diverticulosis without\ndiverticulitis, left renal atrophy, nephrolithiasis, and cysts, and hiatal\nhernia."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Limited assessment of the lung bases demonstrates bibasilar\natelectasis. No pleural effusion or large pneumothorax. The visualized heart\nis normal in size without pericardial effusion.\n\nABDOMEN:\nThe liver is homogeneous and grossly unremarkable. The gallbladder is normal\nwithout calcified gallstones.  Moderate amount of perihepatic nonhemorrhagic\nfree fluid identified.\n\nThe spleen is normal.  1 cm (2a: 9) rounded opacity inferior to the spleen may\nrepresent an accessory splenule or peritoneal deposit. The pancreas is\nhomogeneous without peripancreatic fat stranding or focal fluid collection.\nThe adrenal glands are unremarkable.\n\nThe kidneys are symmetric in size.  A 0.9 x 0.9 cm (2a: 13) hyperdensity is\nseen off the interpolar region of the left kidney. No hydronephrosis or\nhydroureter identified. No renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance.  The duodenum is pushed rightwards due to large\nabdominal mass and associated mass effect. No evidence of volvulus. The small\nbowel is diffusely prominent, measuring 3 cm.  Mild small bowel thickening\nadjacent to the mass likely related to bowel irritation.  No bowel wall edema.\nNo air-fluid levels. Moderate amount of intraperitoneal ascites is noted.\nContrast is seen throughout the colon. The large bowel is normal in caliber\nwithout wall thickening, fat stranding, or focal mass lesion. Colonic\ndiverticulosis is present without evidence of acute diverticulitis. The\nappendix is not visualized however no evidence of acute appendicitis.\nHeterogeneous opacity and fat stranding within the left upper quadrant (2a: 26\nwith mild prominence of the peritoneum is noted and may be related to ascites\nhowever cannot exclude omental/ peritoneal disease.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\niliac arteries are normal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo abdominal wall hernia. No pneumoperitoneum.\n\nPELVIS:\nThe bladder is well distended and normal. No pelvic side-wall or inguinal\nlymph node enlargement by CT size criteria. Moderate amount of free pelvic\nfluid seen. A large heterogeneous mass is seen extending off of the superior\nleft aspect of the uterus and in the left adnexa measuring approximately 12.1\nx 10.2 x 12.1 cm.Bilateral gonadal vessels are enlarged. A 5.9 x 4.7 cm (2a:\n47) circumferentially calcified lesion is seen within the uterus but other\nstructures in the uterus are poorly defined; there are likely multiple uterine\nfibroids, possibly some with cystic degeneration. The ovaries are not\ndefinitively identified.\n\nOSSEOUS STRUCTURES:\nBilateral degenerative changes at the sacroiliac joints. Multilevel,\nmultifactorial degenerative changes are seen within the visualized\nthoracolumbar spine. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Large 12.1 cm heterogeneous mass possibly extending off the left ovary or\nbroad ligament, or less likely exophytic from the uterus, with associated\nascites and omental stranding. Differential includes broad ligament fibroid,\nleiomyosarcoma and ovarian carcinoma given limited evaluation from absence of\nIV contrast. Recommend dedicated MR for further evaluation once creatinine\nimproves.\n2.  Moderate volume ascites.\n3.  Small bowel loops with abnormal wall thickening are likely reactive.  No\nobstruction."
        },
        {
            "input": "VASCULAR:\n\nModerate atherosclerotic calcifications of the abdominal aorta.\nRedemonstration of the thrombosis of the superior mesenteric artery, causing\nnear complete occlusion, for a length of 1.8 cm, unchanged (series 8, image\n32, series 6, image 64).  There is distal opacification with contrast.  Two\nright renal arteries are seen.\n\nLungs: A few calcified granulomas are seen scattered through the visualized\nlungs.  New small bilateral pleural effusions, greater on the right, with\nassociated subsegmental atelectasis.\n\nLiver: The liver is homogeneous with a smooth contour.  No suspicious liver\nlesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\ncontains layering sludge.  No gallbladder distension.  Stable minimal haziness\nof the fat in between the gallbladder and second portion of the duodenum.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: The right adrenal gland is unremarkable.  There is a small\nfat-containing lesion in the body of the left adrenal gland, measuring 1.1 cm,\ncompatible with myelolipoma.\n\nUrinary: Small bilateral cortical hypodensities are seen within both kidneys,\ntoo small to characterize, but likely cysts.  No hydronephrosis.  There is\nperinephric fluid.  Nonobstructive caliceal 5 mm stone is seen in the midpole\nthe right kidney, stable.\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:  Extensive colonic diverticulosis, no evidence of\ndiverticulitis.  No evidence of bowel dilatation or obstruction.\n\nLymph nodes: No size significant lymph nodes.\n\nBone and soft tissues: No suspicious bone lesion. Moderate multilevel\ndegenerative changes throughout the spine. There is evidence of previous\nanterior abdominal wall hernia repair.",
            "output": "1. Stable appearance of thrombus in the proximal superior mesenteric artery\nwith severe stenosis.\n2. Stable minimal haziness of the fat in the gallbladder fossa, nonspecific. \nSludge is again seen within the gallbladder.\n3. New small bilateral pleural effusions, greater on the right, with\nassociated subsegmental atelectasis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is stable appearance of a\npreviously identified SMA thrombus with a length of 1.9 cm, previously 1.8 cm\n(series 301, image 64).  There is contrast opacification distal to the\nthrombus.  Incidental note is made of 2 right renal arteries and a left\ngastric artery originating from the left hepatic artery.  There is moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Scattered calcified granulomas are seen in the bilateral lung\nbases.  Bibasilar patchy atelectasis is noted in the lung bases.  Interval\nresolution of bilateral pleural effusions.  No 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 contains layering sludge\nwithout surrounding fat stranding.\n\nPANCREAS: Pancreas is unremarkable without pancreatic ductal dilatation.\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 an unchanged 1.0\ncm fat containing lesion in the left adrenal gland, compatible with\nmyelolipoma.\n\nURINARY: Small subcentimeter bilateral hypodensities are too small to\ncharacterize, however likely represent renal cysts.  No hydronephrosis.  There\nis a nonobstructive 4 mm stone in the right renal pelvis, which was seen\npreviously.  There are no urothelial lesions in the kidneys or ureters. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  A small air-filled sac abutting the pancreatic\nhead likely represents a duodenal diverticulum.  Extensive colonic\ndiverticulosis without evidence of diverticulitis.  There is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere are enlarged bilateral inguinal lymph nodes measuring up to 2.0 cm, and\nleft external iliac chain lymph nodes measuring up to 1.1 cm new since the\nprior exam.  These demonstrate benign morphology and are likely reactive given\nacute presentation.\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: Course prostatic calcifications are again noted without\nprostatomegaly.  The seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel moderate degenerative disease of spine\n\nSOFT TISSUES: Surgical clips are noted in the anterior abdominal wall, likely\nfrom prior hernia repair.",
            "output": "1. Stable proximal superior mesenteric artery thrombus with severe stenosis\nand distal reconstitution.\n2. Cholelithiasis without cholecystitis."
        },
        {
            "input": "There is leakage of oral contrast material from the first segment of the\nduodenum just beyond the gastric pylorus, with contrast seen pooling along the\nanteroinferior margin of the liver (601b, 37).  Large volume of\npneumoperitoneum is demonstrated. Additional increased density perihepatic and\nperisplenic fluid is noted.\n\nAssessment the solid organs is limited without intravenous contrast.  Allowing\nfor this there is no hepatic lesion demonstrated. There is vicarious excretion\nof contrast into the gallbladder.  The spleen is normal size. There is no\npancreatic mass or ductal dilatation.\n\n9 mm right adrenal lesion measures 19 Hounsfield units. The left adrenal gland\nis unremarkable. There are bilateral cortical renal cysts largest of which is\nin the upper pole of the right kidney measures 6.5 cm. Additional smaller\ncysts are seen bilaterally. There is contrast material in the renal collecting\nsystems from recent coronary catheterization.\n\nThere is increased density fluid and locules of air tracking into the inguinal\ncanals bilaterally with stranding seen in the left inguinal region consistent\nwith postsurgical change.  Fat containing right inguinal hernia is noted.\n\nThere is bibasilar atelectasis and a small left pleural effusion.  The bones\nare unremarkable.",
            "output": "1. Perforated duodenal ulcer, with leakage of oral contrast, from the first\nsegment of the duodenum.\n2. Incidental right adrenal lesion measuring 9 mm is not well characterized\nbut likely represents an adrenal adenoma.\n3. Postsurgical changes in the left inguinal region related to the recent\nhernia repair. There is a small fat containing right inguinal hernia noted."
        },
        {
            "input": "LOWER CHEST: There is eventration of the left hemidiaphragm, also seen on the\nprior exam.  There are severe multi-vessel coronary calcifications.  Also\nnoted are aortic valve calcifications.  Fatty metaplasia within the myocardium\nof the left ventricle likely represent sequela of prior infarct.  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.  There is cholelithiasis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 1.1 cm left adrenal nodule, unchanged since ___,\nmost likely representing an adrenal adenoma.  The right adrenal gland is\nnormal in size and shape.\n\nSOFT TISSUES: There are two large, wide necked inguinal hernias that have\nincreased in size when compared to the outside CT from ___.  The left\nhernia contains the majority of the sigmoid colon.  The right hernia contains\ndistal small bowel loops and the right superior aspect of the urinary bladder.\nBoth hernias appear to be originating lateral to the inferior epigastric\narteries, consistent with indirect inguinal hernias.  There are no\ninflammatory changes, bowel wall thickening, or bowel obstruction.\n\nURINARY: There are multiple renal cysts, largest measuring 8 cm in the upper\npole of the right kidney, which is unchanged from prior exams.  There is a 1.2\ncm hyperdense left renal cyst (3:40).\n\nThere is mild-to-moderate hydroureteronephrosis on the left, noting dilation\nof the left ureter to the level of the pelvic sidewall where it crosses the\niliac vessels.  The most distal aspect of the left ureter is not distended\n(series 4, image 30).  No definite cause is identified, but may be secondary\nto altered anatomy due to the large inguinal hernias.\n\nThere is no suspicious renal lesions within the limitations of an unenhanced\nscan. There is no perinephric abnormality.\n\nPELVIS: As noted above, there is herniation of the right superior aspect of\nthe urinary bladder into the right inguinal hernia.  There is no free fluid in\nthe pelvis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is diverticulosis.  The\nappendix tip is dilated with hyperdense content, similar compared to prior. \nNo surrounding stranding to suggest acute infection/inflammation.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 6.2 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.  Moderate to severe\natherosclerotic disease is noted.\n\nBONES: There are moderate to severe degenerative changes of the thoracolumbar\nspine, noting multilevel osteophyte formation.  Minimal anterior compression\ndeformity at T11 is unchanged.  A 1.1 cm subcutaneous fatty lesion is\nredemonstrated in the right upper anterior abdominal wall (3:34).",
            "output": "1. Large right indirect inguinal hernia containing distal small bowel loops\nand the superior aspect of the urinary bladder.  Large left indirect inguinal\nhernia containing sigmoid colon.  No evidence of obstruction or strangulation.\n2. Mild-to-moderate left hydroureteronephrosis, new from prior exam. No\ndefinite cause is identified, but may be secondary to the altered anatomy due\nto the inguinal hernias.  Urologic consultation is recommended.\n3. Cholelithiasis without evidence of cholecystitis.\n4. Colonic diverticulosis without diverticulitis.\n5. Prostatomegaly.\n6. Moderate to severe coronary, aortic valve, and aortic calcifications. \nEvidence of prior myocardial infarct.\n\nNOTIFICATION:  Findings were communicated with the referring physician via\n___ on ___ at 12:54 p.m."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with associated\natelectasis.  Small area of ground-glass opacity seen right lower lobe (series\n303, image 1) likely infectious.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is cirrhotic morphology..  There is no evidence of\nfocal lesions. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.  There is moderate volume of ascites in the\nabdomen pelvis.  There is no evidence of intra-abdominal bleeding.\n\nVASCULAR: Patient is status post TIPS extending from right hepatic vein to the\nright portal vein.  The TIPS is patent.  There is no evidence of vascular\nextravasation suggest bleeding.  Incidental note is made of replaced left\nhepatic artery from the left gastric artery.  There is no abdominal aortic\naneurysm.  There is minimal calcium burden in the abdominal aorta and great\nabdominal arteries.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\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.\n\nREPRODUCTIVE ORGANS: The uterus is absent\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nRight anterolateral rib fractures are seen.\n\nSOFT TISSUES: There is a small ventral abdominal wall hernia containing fat\nand ascites.",
            "output": "1. No evidence intra-abdominal bleeding or hematoma.\n2. Cirrhosis with suspicious focal liver lesion and moderate volume of simple\nascites.\n3. Patent TIPS and main portal vein without evidence of thrombosis or active\nextravasation.\n4.  Small bilateral pleural effusions with associated atelectasis.\n5. Small area of ground-glass opacity seen right lower lobe likely infectious."
        },
        {
            "input": "The visualized lung bases are clear.  There is no pericardial or pleural\neffusion.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\ngallbladder, pancreas, spleen, and bilateral adrenal glands are normal. A\nright lower quadrant renal transplant is noted. The native kidneys are\natrophic.\n\nThe stomach, small bowel, and large bowel are unremarkable in appearance\nwithout dilation or wall thickening. The appendix is not visualized but there\nare no secondary signs of appendicitis of the right lower quadrant. There is\nno retroperitoneal or mesenteric lymphadenopathy by CT size criteria. There is\nno free abdominal fluid or pneumoperitoneum. The aorta and its major branches\ncontain minimal calcifications. A small fat containing umbilical hernia seen.\n\nPELVIS:\n\nViews of the pelvis are obscured by streak artifact from pelvic prostheses.\nThe bladder is under distended. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Mild multilevel, multifactorial degenerative changes are\nseen throughout the visualized thoracolumbar spine. No focal lytic or\nsclerotic lesion concerning for malignancy.",
            "output": "No acute intra-abdominal process."
        },
        {
            "input": "LOWER CHEST: At the left lower lobe is a 5 mm pulmonary nodule, (series 2,\nimage 11).  There 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 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 measures 12.2 cm and is homogeneous the attenuating\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. There is\npandiverticulosis, with extensive diverticulosis of the sigmoid colon.  The\nwalls of the sigmoid colon are mildly thickened which may be due to\nhypertrophy from chronic diverticulosis, (the colonoscopy dated ___\nwas unremarkable).  No evidence of adjacent fat stranding or a drainable fluid\ncollection.  The appendix is normal.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\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: The patient is status post a left total arthroplasty which causes\nmetallic artifact at this level limiting evaluation.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. Pandiverticulosis without definite evidence acute diverticulitis.  The\nwalls of the sigmoid colon are mildly thickened which may be due to\nhypertrophy from chronic diverticulosis, (the colonoscopy dated ___\nwas unremarkable).\n2. A 5 mm pulmonary nodule is demonstrated in the left lower lobe.\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: Image 14, series 2, there remains a 5 mm subpleural nodule,\noverall benign-appearing and triangle morphology, may be seen with\nsubsegmental atelectasis.  This is unchanged to previous.\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: Spleen measuring 14.2 cm craniocaudal, remains 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Apparent thickening of the stomach, likely due to focal\ncontraction at the time of exam.  There is uncomplicated colonic and sigmoid\ndiverticulosis.  Appendix unremarkable.\n\nPELVIS: Allowing for suboptimal distension and opacification of the bladder,\nthere is progressed bladder wall thickening, with perivesicular fat stranding,\nsuspicious for urinary tract infection.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: There remains a few prominent retroperitoneal lymph nodes, the\nlargest measuring up to 9 mm in short axis and aortocaval region, similar to\nprevious (image 38, series 2).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Metal artifact from a left THA limits assessment of the pelvis.\n\nSOFT TISSUES: Small inguinal fat hernias.",
            "output": "1. Colonic diverticulosis, without evidence of diverticulitis.\n2. There is progressive thickening of the bladder wall, with surrounding\ninflammatory changes, and with a few persisting prominent but overall not\nenlarged retroperitoneal lymph nodes, that could be reactive.  Although in the\nchronic setting, some of these findings may be seen due to chronic outlet\nobstruction given enlargement of the prostate, given the patient's\nsymptomology and progression, infectious cystitis/UTI should be clinically\ncorrelated, and with urinalysis and urine cultures.\n3. There remains a 5 mm subpleural nodule in the LLL.  Although\nbenign-appearing, a ___ year follow-up CT is an option if patient has high risk\nfactors.\n4. 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 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.  Contrast has reached\nthe collecting system on the left before the right, with prominence of the\nright collecting system relative to the left.  The right ureter is mildly\ndilated throughout its course up into the midportion.  No stones or lesions\nare demonstrated within the kidneys or ureters.  There is no evidence of\nsuspicious focal renal lesions.  There are 2 right-sided cortical renal\nhypodensities which measure up to 0.8 cm, too small to characterize by CT but\nconsistent in appearance with benign simple cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is distended.  The duodenum passes the midline\nwithin normal appearing location of the ligament of Treitz.  There are several\nloops of dilated small bowel which contain fecalized enteric contents, with a\nlarge loop of bowel containing feces in the mid abdomen which appears to\ncorrespond with the cecum.  The small bowel is demonstrated filling the right\nmid hemiabdomen, with a slightly swirled appearance to the vascular pedicle\nwhich lies anteriorly (series 2, image 59).  Dilated terminal ileum appears to\ninvaginate into the cecum (series 2, image 63).  Decompressed ascending colon\nis noted up until the hepatic flexure, which point the colon appears within\nnormal limits. the appendix appears to originate from the area of invagination\n(series 2, image 59), and appears fluid-filled and borderline dilated\nmeasuring up to 7 mm (series 601, image 16).\n\nPELVIS: The urinary bladder is distended.  There is a 2 mm calcification seen\nnear the prostatic urethra (series 2, image 88), however this is nonspecific\nfor obstructing stone.  There is small volume intermediate density fluid in\nthe pelvis (series 2, image 83).\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: No acute fractures or suspicious osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Distended and stool-filled cecum with a dilated distal ileum.  There is\ndecompression of the ascending colon which then reconstitutes more distally\nnear the transverse colon.  Additionally, there is prominence of the\nfluid-filled appendix.  Findings are concerning for a bowel obstruction\nsecondary to a cecal volvulus.  Additionally, because of the pattern of the\nsmall bowel displacing the ascending colon, an internal hernia component\nshould also be considered.  The bowel wall enhances normally.  There is small\nvolume free fluid in the pelvis.\n2. Mild delayed nephrogram on the right compared to the left with fullness of\nthe right renal collecting system and mild hydroureter.  No stone is\ndemonstrated.  Findings may be secondary to adjacent bowel\ndilatation/distension.  As the ureter is distended to the level of the bowel\nabnormality in right lower quadrant and is normal inferiorly\n3. Small amount of ascites\n\nNOTIFICATION:  The preliminary findings as well as the updated findings were\ndiscussed with the surgery consult resident by ___, M.D. In person\non ___ at 12:20 pm."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Visualized lungs are otherwise\nwithin normal limits.  Trace 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 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. \nFew subcentimeter hypodensities are too small to characterize, likely\ncompatible with simple renal cysts.  The right ureter is again mildly dilated\nthroughout its course up until the midportion.  No stones or concerning\nlesions are demonstrated within the kidneys or ureters.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is moderately distended and contains enteric\ncontrast material.  Multiple dilated loops of small bowel containing air-fluid\nlevels, with transition point in the right lower quadrant (601:22, 2:65) and\ncollapsed loops of distal bowel, consistent with high-grade obstruction. \nPatient is status post right colectomy with primary anastomosis.  The\nremaining distal colon is collapsed.\n\nPELVIS: Few locules of air within the urinary bladder are likely related to\nrecent instrumentation.  The urinary bladder and distal ureters are otherwise\nunremarkable.  There is small volume of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Unchanged 2 mm calcification seen in the region of the\nprostate.  The prostate and seminal vesicles are otherwise 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: Few locules of air within the subcutaneous soft tissues in the\nanterior abdominal wall, consistent with postsurgical change.  The abdominal\nand pelvic wall is otherwise within normal limits.",
            "output": "1. Multiple dilated loops of small bowel containing air-fluid levels, with\ntransition point located in the right lower quadrant and collapsed loops of\ndistal bowel, consistent with high-grade obstruction.\n2. Redemonstration of mild fullness of the right renal collecting system and\nmild hydroureter extending to the midportion of the right ureter, similar in\nappearance to prior CT abdomen/pelvis from ___.  Again no stone is\ndemonstrated.  Findings may be secondary to adjacent bowel distension.\n3. Few locules of air within the urinary bladder, likely secondary to recent\ninstrumentation.  However correlation with urinalysis should also be\nconsidered to exclude infection.\n4. Small volume free fluid in the pelvis.\n5. Trace right 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 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 (2:66).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium appears heterogeneous, but the uterus is\nbetter assessed on the same day pelvic ultrasound.  Re-demonstrated is a 3.4 x\n3.0 cm hypodense cystic structure in the right 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.  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 explain the patient's\npain.  Normal appendix.\n2. Hepatic steatosis.\n3. Diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "CHEST: The imaged lung bases demonstrate moderate bibasilar atelectasis and a\n3 mm nodule at the right lung base, unchanged from ___. There is a\nlarge hiatal hernia.\n\nABDOMEN:\nLiver is normal in attenuation with no focal hepatic lesion. The gallbladder\nis unremarkable. The pancreas is normal in attenuation with no duct\ndilatation. The spleen is normal in size and attenuation without evidence for\nfocal lesions. The adrenal glands are morphologically normal bilaterally. The\nkidneys enhance symmetrically and display prompt contrast excretion with no\nhydronephrosis.\n\nThere is a large hiatal hernia.  Small bowel loops are normal in caliber\nwithout obstruction. There are numerous sigmoid colonic diverticula. There is\nminimal smooth wall thickening of the dependent wall of the sigmoid colon at\nthe site of extensive diverticulitis seen in ___ (2:68). There is no\npericolonic fat stranding or fluid to indicate acute diverticulitis. No\nmesenteric or retroperitoneal lymphadenopathy. No intra-abdominal free air or\nfree fluid. Small fat containing umbilical hernia is again seen.\n\nPELVIS:  The urinary bladder, uterus and adnexae are unremarkable. There are\nnumerous pelvic phleboliths. There is no free fluid or lymphadenopathy within\nthe pelvis.\n\nVESSELS: The aorta demonstrates mild atherosclerotic calcification without\naneurysmal dilatation. Its major branches are patent.\n\nOSSEOUS STRUCTURES: Small left femoral head bone island is again seen. No\nconcerning osseous lesions are identified.",
            "output": "1. Extensive sigmoid diverticulosis. No evidence for acute diverticulitis.\nMinimal smooth wall thickening in the nondependent wall of the sigmoid colon\nat the site of prior extensive diverticulitis seen in ___ is\nconsistent with sequela of the prior inflammation.\n2. Large hiatal hernia.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with ___\non the telephone on ___ at 3:35 ___, 2 minutes after discovery of the\nfindings."
        },
        {
            "input": "Chest findings are reported separately.\n\nWithin the limitations of a non-contrast examination, no focal liver lesions\nare identified.  There is no biliary dilatation.  The gallbladder is\nmoderately distended with fairly hyperdense material throughout, including\nsmall suspected layering stones.  Motion and streak artifacts limit evaluation\nbut the there is possible stranding about the pancreas, although more likely\ndue to generalized anasarca.  This may be due to pancreatic inflammation\nalthough more likely generalized anasarca.  The spleen is normal in size. \nAdrenals appear normal.  Kidneys show mild atrophy, particularly the left.\n\nThere is a small to medium-sized hiatal hernia.  A couple of duodenal\ndiverticula are noted along the junction between the second and third\nportions.  More distal small bowel is unremarkable.  Sigmoid diverticulosis is\nmoderate to severe.\n\nFatty tumor along the uterine fundus measuring up to 27 mm is consistent with\na lipoleiomyoma.  No adnexal mass.  The bladder appears normal.  No ascites or\nlymphadenopathy.  Diffuse muscular atrophy.  Aorta is nondilated.  Arterial\nvascular calcification is moderately extensive.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Moderate\ndegenerative changes involve lower lumbar facet joints.  Moderate degenerative\nchanges also affect each hip.  A mild-to-moderate superior endplate\ncompression fracture of L3 appears poorly healed.  No comparison for it is\navailable.  Its chronicity is age indeterminate accordingly.",
            "output": "1.  Widespread anasarca.  In that setting, stranding about the pancreas and\ngallbladder is probably not due to regional inflammatory process. Laboratory\ncorrelation regarding possibility pancreatitis could be considered, however. \nDistended gallbladder with hyperdense material including stones, although\nacute cholecystitis seems very doubtful based on these images.\n\n2.  Age indeterminate mild-to-moderate superior endplate compression fracture\nof the L3 vertebral body.  Demineralization.\n\n3.  Uterine lipoleiomyoma, probably not significant clinically.\n\nChest is reported separately."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  There is a 2.4 cm nonenhancing hypodensity in the segment ___\nof liver.  Intra and extrahepatic bile ducts are not dilated.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN: Unremarkable.\nADRENALS: Unremarkable.\nURINARY: The kidneys are unremarkable.\nGASTROINTESTINAL: Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.\nAppendix is unremarkable.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nBilateral adnexal cystic structures measuring 2.8 cm on the left and 2.4cm on\nthe right are likely physiologic. The bladder is unremarkable.\n\nBONES AND SOFT TISSUES:\nSmall sclerotic foci in the L3 right superior articular process and left\nfemoral neck are likely bone islands.",
            "output": "2.4 cm nonenhancing hypodensity in the liver of unclear etiology. Differential\nincludes liver cyst. Please compare with prior imaging to ensure stability. \nIf no prior imaging is available, ultrasound is recommended for further\nevaluation.\n\nRECOMMENDATION(S):  2.4 cm nonenhancing hypodensity in the liver of unclear\netiology. Differential includes liver cyst. Please compare with prior imaging\nto ensure stability.  If no prior imaging is available, ultrasound is\nrecommended for further evaluation."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis of the right lung.  Bronchiectasis of\nthe right lower lung.  There is no evidence of pleural or pericardial\neffusion.  Incidental noting of cardiac pacing leads.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous hypoattenuation on the\nnon-contrast series, likely compatible with mild steatosis.  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 but with expected attenuation throughout. \nThere is no suspicious focal lesion or pancreatic ductal dilation.  There is\nno peripancreatic stranding.  There is a punctate subcentimeter calcification\nposterior to the pancreatic body (03:24), likely vascular in location.  No\npancreatic parenchymal calcification or ductal calcification 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: There is mild bilateral cortical thinning with unremarkable\nnephrogram.  There are multiple stable round homogeneous hypodensities that\nare too small to characterize, but likely represents simple renal cysts. \nThere is a stable 1.1 x 1.2 cm simple renal cyst in the lower pole of the\nright kidney (03:54).  There is a 1 x 0.9 cm nonobstructing stone in the\ninterpolar region of the left kidney (03:30), grossly unchanged from ___.  There is no evidence of suspicious focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post total gastrectomy with Roux-en-Y\nesophagojejunostomy.  There is elevation of the left hemidiaphragm.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Patient status post prior right colectomy.  The colon and rectum\nare within normal limits.  Redemonstration of multiple surgical clips and\nsutures.  Incidental noting of sigmoid diverticula without diverticulitis.\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 except for mild peripheral calcifications 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of chronic pancreatitis.\n2. Additional incidental findings include mild hepatic steatosis, bilateral\nrenal cysts, nonobstructive left renal calculus and sigmoid diverticula."
        },
        {
            "input": "LOWER CHEST: The left hemidiaphragm is again noted to be elevated.  There is\nleft greater than right basilar atelectasis, and right greater than left\nbasilar mild bronchiectasis, possibly related to chronic aspiration.  Coronary\ncalcifications are severe.  Pacer leads 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 or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: Pancreatic parenchyma is mildly atrophic.  No ductal dilation. \nThere is a probable 7 mm cystic structure in the pancreatic body, possibly\nreflecting a small side branch IPMN (05:52).  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 bilaterally.  Bilateral renal cysts are\nre-demonstrated.  Additional subcentimeter hypodensities are too small to\ncharacterize.  Re-demonstrated nonobstructing calculus in the left interpolar\ncollecting system measuring up to 11 mm.  There is no evidence of suspicious\nrenal lesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post total gastrectomy with Roux-en-Y\nesophagojejunostomy.  There is no bowel obstruction.  The remaining small\nbowel is unremarkable.  Patient is status post right hemicolectomy.  The\nremaining colon and rectum are unremarkable with the exception of mild sigmoid\ndiverticulosis.\n\nPELVIS: There is asymmetric trabeculation wall thickening predominantly of the\nright lateral bladder wall and dome, which is unchanged.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate gland 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: Patient is status post right total hip arthroplasty.  No worrisome\nosseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No findings to suggest radiation enteritis or fistula.\n2. 7 mm pancreatic body cystic lesion, possibly a side branch IPMN.  An MRCP\nin ___ years is recommended.\n3. Asymmetric trabeculation and thickening of the right bladder wall and dome\nis unchanged.  This could be secondary to radiation, although if there is\nhematuria or urinary symptoms, correlation with cystoscopy could be performed.\n4. Nonobstructing 11 mm left interpolar renal calculus.\n\nRECOMMENDATION(S):  ___ year follow-up MRCP."
        },
        {
            "input": "At the left lung base, is persistent minor unchanged atelectasis.  Heart is\nborderline in size with coronary calcium, and a single lead pacemaker/ICD\nterminates in the right ventricle.\n\nHypoattenuating liver (attenuation of about 20 Hounsfield units close) is\nconsistent with persistent fatty infiltration.  Within the limitations of a\nnon-contrast examination, no focal liver lesions are identified.  There is no\nbiliary dilatation.  Gallbladder was removed.  Previously mentioned cyst in\nthe pancreatic body for which imaging follow-up has been suggested is not as\nconspicuous on this examination likely due to lack of contrast administration.\nSpleen is normal in size.  Adrenals appear normal.  Each kidney is mildly\natrophic.  Few small bilateral simple renal cysts are noted.  Small\nnonobstructing bilateral renal stones are again identified, the largest\nlocated in the left mid upper pole, again measuring up to 10 mm.  No\nhydronephrosis.\n\nPatient is status post distal gastrectomy with Roux-en-Y (Billroth II). \nRemaining stomach is herniated into the lower chest as seen previously. \nPatient is additionally status post partial ileocolectomy.  The sigmoid shows\nmoderate diverticulosis.\n\nProstate is borderline in size with central hypertrophy.  Seminal vesicles\nappear normal.  Bladder shows stable predominantly right-sided asymmetric wall\nthickening.  Infrarenal abdominal aorta measures up to 23 mm in diameter,\nstable.  Mild diffuse anasarca, but no ascites or free air.  No enlarged lymph\nnodes found.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.  Patient is\nstatus post slight chronic depression of the L1 superior endplate appears\nstable.",
            "output": "No evidence of acute process involving the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There is minimal dependent atelectasis in the right lower lobe\nassociated with mild traction bronchiectasis.  There is persistent elevation\nof the left hemidiaphragm as before.  Partially imaged is a right-sided\ncardiac pacer wire.\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 mild diffuse atrophy of the pancreatic parenchyma without\nmain duct dilation.\n\nSPLEEN: Partially imaged spleen is not enlarged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: No hydronephrosis seen on either side.  There are bilateral exophytic\nsimple renal cortical cysts, that are stable.  Bilateral nonobstructing renal\ncalculi with the largest in the superior pole of the left kidney measuring 1.1\ncm in size (02:13) noted.\n\nGASTROINTESTINAL: There is no bowel obstruction.  A bowel anastomosis is noted\nin the right lower quadrant.  Extensive sigmoid diverticulosis without\nevidence of acute diverticulitis.\n\nPELVIS: There is a Foley catheter within the partially distended urinary\nbladder.  Air within the urinary bladder is likely related to catheterization.\nThere 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.  A right-sided ascending vascular catheter is noted.\n\nBONES: There is an intact right hip prosthesis.  No worrisome osseous lesions\nidentified.  Mild compression deformity of the L1 vertebral body noted.\n\nSOFT TISSUES: There is subcutaneous stranding of fat along the bilateral\nlateral abdominopelvic walls.",
            "output": "1. No retroperitoneal hematoma noted.  There is no intra-abdominal or pelvic\nfree fluid or hemoperitoneum.\n2. Numerous incidental findings as before include an elevated left\nhemidiaphragm, post cholecystectomy status, bilateral nonobstructing renal\ncalculi and simple cortical renal cysts, extensive sigmoid diverticulosis."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis and mild bronchiectasis in the right lower\nlobe.  The left hemidiaphragm is elevated as in the previous study.  There is\nno 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 surgically absent.\n\nPANCREAS: The pancreas is slightly atrophic, similar to the previous study. \nOtherwise, the pancreas demonstrates normal attenuation without focal lesion. \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: Again seen is diffuse cortical thinning bilaterally.  Several simple\ncysts bilateral are largely unchanged.  Nonobstructing stones measuring up to\n1.1 cm in the left interpolar region are again noted (08:40/05:24).\nOtherwise, there is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Postoperative changes of gastrectomy with Roux-en-Y\nesophagojejunostomy are similar to recent studies. Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  Right\nlower quadrant anastomoses appear intact.  Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening or fat stranding.\n\nPELVIS: Evaluation of pelvic structures is limited by streak artifact from\nright total hip arthroplasty prosthesis.  Within this limitation, again\ndemonstrated is asymmetric thickening of the right lateral wall of the urinary\nbladder, similar to slightly increased as compared to the most recent study\n(5:75).  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. Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status post total right hip arthroplasty and prosthesis\nappears anatomically aligned.  Multilevel degenerative changes of the lumbar\nspine with a similar mild compression deformity of the L1 vertebral body. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postoperative changes of ventral hernia repair are stable.  No\nfluid collections or subcutaneous stranding.",
            "output": "1.  No bowel obstruction, fluid collections, or signs of inflammation or other\nacute findings in the abdomen or pelvis.\n2.  Nonobstructing stone in the left kidney measuring up to 11 mm, similar to\nthe prior study.\n3.  Sigmoid diverticulosis without diverticulitis.\n2.  Redemonstration of asymmetric thickening of the right lateral wall of the\nurinary bladder, similar to slightly increased as compared to the most recent\nstudy, may reflect sequela of frequent or chronic catheterization."
        },
        {
            "input": "LOWER CHEST: The heart is mildly enlarged.  There is a partially visualized\nleft-sided pacer with one lead terminating in the left ventricle.  There are\nbibasilar atelectasis with a small right pleural effusion.  There is a stable\nleft hemidiaphragm elevation.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous hypoattenuation 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 stably atrophic.  There is no pancreatic ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is only partially visualized and grossly unremarkable\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are mildly atrophic but symmetric in size.  There is\nredemonstration of bilateral renal nonobstructive calculi measuring up to 1.1\ncm in the left renal interpolar region.  There is no evidence of\nhydronephrosis.  There are bilateral stable renal cysts, grossly unchanged\nfrom prior.\n\nGASTROINTESTINAL: Patient is status post gastrectomy, Roux-en-Y\nesophagojejunostomy and right hemicolectomy.  Anastomoses are intact.  Small\nbowel loops demonstrate normal caliber and wall thickness throughout. There is\nredemonstration of sigmoid diverticulosis without evidence of diverticulitis. \nNo evidence for bowel obstruction.\n\nPELVIS: There is redemonstration of asymmetric right lateral urinary bladder\nwall thickening, potentially related to prior radiation therapy.  There is a 6\nmm calculus in the urinary bladder along the right bladder wall, new in the\ninterval.  There is no free 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 no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a right hip hemiarthroplasty in appropriate position.  There\nis grade 1 retrolisthesis of L3 on L4 with no evidence of pars defect.  There\nis mild degenerative changes of the thoracolumbar spine.  There is unchanged\nmild L1 compression deformity.\n\nSOFT TISSUES: Anterior abdominal wall surgical scarring again noted.",
            "output": "1. No acute intra-abdominal or intrapelvic abnormality identified. \nSpecifically, no evidence of bowel obstruction or colitis.\n2. Sigmoid diverticulosis without evidence of diverticulitis.\n3. Nonobstructive bilateral nephrolithiasis with interval development of a 5\nmm calculus in the urinary bladder.\n4. Unchanged asymmetric right lateral bladder wall thickening which may be\nrelated to prior radiation therapy.  Correlation with urinalysis can be\nconsidered if there is concern for infection.\n5. Hepatic steatosis.\n6. Small right pleural effusion."
        },
        {
            "input": "ABDOMEN:\n\nGASTROINTESTINAL: The visualized colon and small bowel appear normal.  The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A small\namount of the hematoma is 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: Numerous pelvic fractures are unchanged from prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of injury to the urinary bladder.  No contrast extravasation."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  There is calcified atherosclerotic plaques\nof the bilateral coronary arteries and left anterior descending artery,\n(series 3, image 27.\n\nVASCULAR:\n\nThe patient is status post open AAA repair and repair of a  right common iliac\naneurysm with embolization of the right hypogastric artery.  There is no\nevidence of contrast extravasation from either aneurysmal repair.  There is no\nabdominal aortic aneurysm.  There is moderate calcium burden in the abdominal\naorta and great abdominal arteries.  Re-demonstrated, is high-grade occlusion\nof the mid femoral artery, (series 3, image 182).  Again seen, is the\nembolized inferior mesenteric artery with patent superior rectal and left\ncolic arteries, (series 3, image 84,101, 104).  The maximum diameter of the\nabdominal aorta measures 3.4 cm, (series 3, image 95) and previously measured\n3.3 cm on prior.  There is no change in the in caliber of the infrarenal\nabdominal aortic aneurysm status post open fixation.  Again seen, is a focal\naortic dissection that is unchanged when compared to prior (series 3, image\n74).  There is thrombosis of the excluded portion of the repaired right common\niliac measuring up to 1.6 cm, (series 3, image 118) and previously measured up\nto 2.2 cm on prior CT abdomen and pelvis dated ___.  There is\nmild stenosis of at the ostium of the left renal artery by calcified\natherosclerotic plaque.  There is mild stenosis of the ostium the celiac\nartery by atherosclerotic plaque, superior mesenteric and renal arteries are\nwidely patent.  There are mild calcifications of renal arteries.\n\n\n\nABDOMEN:\n\nHEPATOBILIARY: There is a well-circumscribed hypodense lesion in segment II of\nthe liver measuring up to 1.7 cm, (series 3, image 32).  The aforementioned\nhepatic lesion is most consistent with a hepatic cyst.  There is a\nsubcentimeter well-circumscribed hypodense lesion in segment 6 of the liver\ntoo small to characterize on CT, (series 601, image 23).  Otherwise, the liver\ndemonstrates homogenous attenuation throughout.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: The pancreas is unremarkable\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The right and left adrenal glands are remarkable.\n\nURINARY: There multiple well-circumscribed hypodense lesion in bilateral\nkidneys, (series 601, image 34) likely consistent with simple renal cysts. \nThe largest is located in the upper pole of the left kidney and measures up to\n2.6 cm, (601 image 38).  The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of stone, or hydronephrosis. There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is no evidence of bowel obstruction or ascites.  There\nis diverticulosis the sigmoid colon without evidence of thickening or fat\nstranding.  Appendix contains air, has normal caliber without evidence of fat\nstranding.\n\nRETROPERITONEUM: There is no evidence of mesenteric and retroperitoneal\nlymphadenopathy.\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.  There are regions of demarcated, high density material in the right\nretroperitoneum and right hemipelvis consistent with liquefied hematoma or\nseroma, (series 3, images, 88, 101, 138).  In the right retroperitoneum there\nis a hematoma or seroma that measures up to 2.3 cm, (series 3, image 88). \nLateral to the right psoas muscle there is a hematoma or seroma that measures\nup to 4.2 cm, (series 3, image 101).  To the lateral right of the bladder\nthere is a hematoma/seroma measuring up to 3.0 cm, (series 3, image 137). \nThere has been marked interval improvement of the pelvic hemorrhage\ndemonstrated on prior CT and pelvis dated ___.\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. The patient is status post open AAA repair and endovascular repair of a\nruptured right common illiac aneurysm.  There is no evidence of endoleak of\nthe right common iliac aneurysmal repair.  There is no evidence of contrast\nextravasation from the AAA repair.\n2. The aneurysmal caliber measures up to 3.4 cm, unchanged when compared to\nprior.\n3. The excluded thrombosed portion of the right common iliac measures up to\n1.6 cm and is decreased in size when compared to prior CT abdomen and pelvis\ndated ___.\n4. There is an unchanged focal aortic dissection without evidence of\nextension.\n5. There are multiple regions of hematoma or seroma within the right\nretroperitoneum and right hemipelvis."
        },
        {
            "input": "LOWER CHEST:\nThe visualized lung bases are clear.  There is minimal calcification of the\nmitral valve.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The hepatic parenchyma enhances homogeneously.  There is a 1.6\nx 2.0 cm nonenhancing cyst in segment 3 of the liver (05:26).  There is\nunchanged central intrahepatic biliary ductal dilation associated with mild\nuniform dilation of the extrahepatic common duct, likely related to prior\ncholecystectomy.\nThe gallbladder is surgically absent.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation.\nSPLEEN:  There is no splenomegaly or focal splenic lesion.\nADRENALS:  No adrenal nodules..\nURINARY:\nThe lesion in question within the lateral cortex of the right renal interpolar\nregion is hyperdense on the noncontrast exam, with a ___ of 37.8 with no\nenhancement on the postcontrast images (CT ___ 44).  This lesion however\nmeasures 1.0 x 1.1 cm in size compared to a prior of 1.1 x 0.8 cm in size (CT\nabdomen ___ and 0.6 x 0.5 cm (CT abdomen dated ___.\nAgain visualized are unchanged exophytic cortical cysts arising from the lower\npole of the left kidney and multiple peripelvic cysts on both sides.  No\nhydronephrosis.\nGASTROINTESTINAL: There is no bowel obstruction.  Multiple sigmoid diverticuli\nwithout acute diverticulitis.\n\nLYMPH NODES: None there are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Moderate calcified atherosclerotic plaque is noted within the\nabdominal aorta without aneurysmal dilation.\n\nPELVIS:\nThe bladder is moderately distended and has a normal appearance.  The uterus\nis anteverted and appears unremarkable.  No pelvic masses or free fluid in the\npelvis..\n\nBONES AND SOFT TISSUES:\nAgain visualized are 2 intramedullary nails within the left femoral neck, with\nintact hardware.  Multilevel degenerative disc disease and facetal arthropathy\nnoted in the lumbar spine.  No worrisome osseous lesions.",
            "output": "1.  The right renal lesion in question is hyperdense on the noncontrast exam\nand does not appear to enhance, however has steadily increased in size\ncompared to the 2 most recent prior exams dating back to ___. \nWhile this lesion could represent a hemorrhagic or proteinaceous cyst, given\nthe gradual increase in size, confirmation by renal MRI is recommended.\n2.  Multiple incidental findings including bilateral peripelvic renal cysts,\nunchanged mild intra and extrahepatic biliary ductal dilation related to prior\ncholecystectomy, sigmoid diverticulosis, multilevel degenerative changes of\nthe lumbar spine are unchanged.\n\nRECOMMENDATION(S):  Contrast enhanced renal MRI for further characterization.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 15:16 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "LOWER CHEST:  Mild dependent atelectasis is present in the lung bases\nbilaterally.  There is no pleural or pericardial effusion.  A small anterior\nright pericardial cyst is again noted (02:12).\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  There is persistent mild intra and extrahepatic biliary ductal\ndilation, with the extrahepatic CBD measuring approximately 1.6 cm in maximal\ndiameter, unchanged compared to prior exams, and likely due to prior\ncholecystectomy.\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.  Multiple vascular clips along the splenic hilum\nare again noted, unchanged.\nADRENALS:  The right and left adrenal glands are normal in size and shape.\nURINARY: Somewhat lobulated morphology of the kidneys is stable since the\nprior study, with otherwise symmetric enhancement and no evidence of\nsuspicious lesion or hydronephrosis bilaterally.  A punctate hypodensity in\nthe interpolar medial left kidney is too small to characterize (02:37)..\nGASTROINTESTINAL:  The patient is post Roux-en-Y gastric bypass, with intact\ngastro jejunal anastomosis and jejunojejunostomy osseus in the right lower\nquadrant.  Incidental note is made of incomplete bowel rotation, with the\nduodenum falling along the right aspect of the vertebral body, and never\ncrossing midline.  There is a short segment enteroenteric intussusception near\nthe jejunojejunostomy anastomosis (02:49), with no evidence of obstruction. \nEnteric contrast material reaches the level of the splenic flexure of the\ncolon, with moderate fecal loading. The appendix is normal in appearance.\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: 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: Dextro convex lumbar scoliotic curvature is again\nnoted, with associated degenerative changes.  Throughout the lumbar spine.  No\nosseous lesion worrisome for malignancy or infection is noted.  A\nwell-circumscribed is lucent focus in the posterior right iliac bone with\nsclerotic margin is unchanged compared to the prior study from ___,\ncompatible with a benign entity.  A bone island is present in the left iliac\nbone (2:64).  Total hip arthroplasty on the left is unremarkable.",
            "output": "1. No acute pathology in the abdomen or pelvis.\n2. Stable degree of intra and extrahepatic biliary ductal dilation compared to\nprior studies, likely related to previous cholecystectomy.\n3. Changes related to Roux-en-Y gastric bypass are noted, with no evidence of\nbowel obstruction.  Enteric contrast reaches the splenic flexure of the colon.\n\n4. Stable pericardial cyst."
        },
        {
            "input": "LOWER CHEST: There is mild dependent atelectasis.  A right pericardial cyst is\nagain seen.  Otherwise, the heart and pericardium are unremarkable.  There is\nno pericardial effusion.  Note is made of a coarse calcification in the right\nbreast.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Moderate intra and extrahepatic\nbiliary ductal dilatation is unchanged.  Patient is status post\ncholecystectomy  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  Pancreas divisum anatomy is\nre- demonstrated.  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 patient is status post Roux-en-Y gastric bypass, with\nintact anastomoses.  Incidental note is again made of bowel malrotation with\nthe duodenum not crossing midline.  There is no evidence of small bowel\nobstruction, and enteric contrast is seen to the level of the distal\ntransverse colon.  There is moderate fecal loading.  The appendix is normal. \nNo free air or free fluid is present.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: The patient is status post left total hip\narthroplasty.  No concerning lytic or sclerotic lesions are seen.  The\nanterior abdominal wall is unremarkable.",
            "output": "1. No acute process in the abdomen or pelvis to account for the patient's\nsymptoms.\n2. Unchanged degree of intra and extrahepatic biliary ductal dilatation,\nlikely related to post cholecystectomy status.\n3. Status post Roux-en-Y gastric bypass, without evidence of bowel\nobstruction."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The aorto mesenteric distance\nand ankles are approximately 9 mm and 47 degrees, respectively.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\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. \nThere is an IUD in the uterus.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Unremarkable CTA of the abdomen and pelvis.  Specifically, no evidence of SMA\nsyndrome."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 hypointense lesions with heterogeneous rim enhancement are\ndemonstrated within both hepatic lobes.  The largest lesion measures 2.8 cm\nwithin segment 4A/8 (series 5, image 15) and demonstrates mild distortion of\nthe overlying liver capsule.\nThe next largest lesion measures 1.6 cm in segment 4B (series 5, image 19). \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: Left adrenal gland is within normal limits.  Inferiorly there is a\nmildly prominent lymph node not enlarged by CT criteria.  The right adrenal is\nwithin limits..\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts measure up to cm on right (series 5, image 30). \nHypodensities are too small to characterize by CT but statistically likely\nrepresent benign entities.  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: Fiducial markers are seen within the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  Left\nperiaortic lymph nodes inferior to the left adrenal gland, not enlarged by CT\ncriteria.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: No acute fractures.  A sclerotic focus along the right iliac measures\nand 0.9 cm, and may represent a bone island (series 5, image 58).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Numerous indeterminate peripherally enhancing lesions within both hepatic\nlobes, measuring up to 2.8 cm, suspicious for possibly metastases.\n\nRECOMMENDATION(S):  Recommend abdominal MRI for further evaluation of hepatic\nlesions."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar dependent atelectasis without evidence\nof pericardial or pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Adjacent to the gallbladder within the periphery of segment 5,\nthere is a triangular 13 x 22 mm area of hepatic hypodensity, which is\nincompletely characterized, but could represent a transient hepatic arterial\ndifference (2:22).  There is no evidence of additional 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. \nWithin the upper pole of the right kidney is a focal area of cortical scarring\nwhich may be due to prior infection or ischemia.  Subcentimeter hypodensity in\nthe lower right renal pole is too small to characterize by CT, but could be a\ncyst.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is post Roux-en-Y gastric bypass.  Several loops of\nmildly dilated small bowel are identified in the left upper quadrant, with an\narea of focal narrowing (601:19) and adjacent focal area through the mesentery\nwhere the small bowel loops and mesentery appear stretched in the left mid\nabdomen (02:37), suggesting the presence of an internal hernia.  However,\nthere is no evidence of obstruction, as administered oral contrast progresses\nnormally into the colon.  There is no evidence of differential bowel wall\nenhancement.  The colon and rectum are within normal limits.  The appendix is\nnot directly visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of free pelvic fluid.\n\nREPRODUCTIVE ORGANS: An IUD is identified within the endometrial canal. \nBilateral tubal ligation devices are noted.  Adnexa and uterus 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. \nDegenerative changes in the lumbar spine are mild, denoted by anterior\nosteophytes at L3 and L4.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Post Roux-en-Y gastric bypass, with several loops of mildly dilated small\nbowel in the left upper quadrant and focal area of stretching and narrowing of\nthe small bowel and mesentery within the left mid abdomen, inferior to the\nleft upper quadrant dilated loops, suggesting the presence of an internal\nhernia.  No small bowel obstruction however is currently seen as oral contrast\nreaches the colon.\n\n2.  Peripheral 13 x 22 mm area of hepatic hypodensity in hepatic segment 5,\nwhich is incompletely characterized, but could represent a transient hepatic\narterial difference.  If clinically indicated, this could be further evaluated\nby MRI."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report for same-day CT chest for\ncomplete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic lesions are concerning for metastatic disease.\nLesions appear heterogeneously hypoattenuating and appear relatively well\ndefined, the larger which are located in the caudate lobe and segment 4A\nmeasuring 4.0 x 3.4 cm (series 3, image 57) and 2.9 x 2.2 cm respectively. \nScattered smaller hypoattenuating lesions are also concerning for metastatic\ndisease though are too small to accurately characterize.  The hepatic veins\nand portal veins are patent. 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. \nMultiple left renal cysts.  Somewhat low attenuating lesions are too small to\ncompletely characterize, likely additional simple cysts.  No concerning renal\nlesions.\n\nGASTROINTESTINAL: Small bowel loops are unremarkable. No bowel obstruction. \nthe colon and rectum are within normal limits.  The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder is unremarkable.  no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Mild atherosclerotic disease.\n\nBONES/SOFT TISSUES: Widespread osseous lesions as assessed on concurrent chest\nCT and preceding cervical and lumbar spine MRI.  A dominant lytic T11 lesion\nextends into the spinal canal and result in severe spinal canal narrowing with\ncord compression (series 3, image 50).  A dominant destructive lesion in the\nleft iliac bone involving the posteromedial acetabulum demonstrates\nheterogeneous enhancement and measures up to approximately 8.5 x 5.8 cm. \nThere is a pathologic fracture involving the left inferior pubic ramus with\nsome evidence of bridging callus formation.  (Series 3, image 125). \nAdditional dominant lesions include the right pubic bone measuring 2.3 x 2.0\ncm (series 3, image 119), right iliac bone measuring 1.4 x 0.7 cm (series 3,\nimage 96), left sacral ala measuring approximately 2.8 x 2.4 cm (series 3,\nimage 98), and proximal right femur measuring 1.4 x 1.1 cm (series 3, image\n125).  A left hip joint effusion is also noted.",
            "output": "1. Primary malignancy not identified within the abdomen pelvis.  Metastatic\ndisease within the liver and bones as described.  Dominant bony lesions\ninclude a T11 vertebral body lesion with associated spinal canal narrowing\nbetter assessed on MRI from 1 day prior and large destructive enhancing soft\ntissue lesion at the left posterior acetabulum.\n2. Pathologic left inferior pubic ramus fracture with some evidence of\nbridging callus formation, likely subacute.\n3. Enlarged prostate.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:36 pm, less than 30\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis without focal consolidation in the\nvisualized lower lung fields.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, consistent with given\nhistory of cirrhosis.  There is heterogeneous enhancement of the liver without\nsuspicious lesions on this single phase exam.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder shows\ncholelithiasis without distension or wall thickening.  Small to moderate\nvolume, nonhemorrhagic 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: Spleen is enlarged, measuring 16.9 cm in the craniocaudal dimension. \nThere are 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. \nPunctate density is seen in the lower pole of the left kidney, consistent with\nnonobstructing renal calculus.  There is no evidence of focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is noted with tip terminating in the proximal\njejunum.  Stomach is normal in size.  Proximal small bowel is dilated,\nmeasuring up to 3.0 cm in greatest dimension.  There is a small bowel\ncontaining umbilical hernia which shows proximal fecalization of dilated small\nbowel loops and distal decompression (series 601; image 20), consistent with\nincarcerated umbilical hernia with resultant small bowel obstruction.  No\nsurrounding inflammation or convincing suggestion of strangulation.  No\ndefinite pneumatosis.  No free intraperitoneal air.  There is colonic\ndiverticulosis without surrounding inflammation to suggest diverticulitis. \nThe appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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.  Multiple varices are seen throughout the abdomen, most notable in\nthe perisplenic area, consistent with portal hypertension.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is multilevel degenerative change of the visualized thoracolumbar spine,\nsimilar in appearance compared to prior examinations.\n\nSOFT TISSUES: Incidentally noted is gynecomastia.  Soft tissues are otherwise\nwithin normal limits with the exception of small bowel containing umbilical\nhernia, as above.",
            "output": "1. Small-bowel obstruction caused by an umbilical hernia containing an\nobstructed loop of small bowel and fluid with no evidence of ischemia of the\nobstructed loop within the hernial sac or perforation.  No free\nintraperitoneal air or pneumatosis of the obstructed small bowel loops in the\nabdomen.\n2. Cirrhotic morphology of the liver, small to moderate volume, nonhemorrhagic\nascites, and splenomegaly, likely sequela portal hypertension.\n3. Cholelithiasis without suggestion of cholecystitis.  Nonobstructing left\nlower pole renal calculus."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions with overlying relaxation\natelectasis.  The heart is mildly enlarged with a septal pacing lead partially\nvisualized.  Hypodense appearance of the blood pool.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic liver with nodular contour again demonstrated. \nPeriportal edema likely sequela of fluid status.  A TIPS is demonstrated in\nsitu better evaluated on the recent ultrasound.  Stones are demonstrated\nwithin a poorly visualized gallbladder without secondary signs of acute\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: Splenomegaly to 15.3 cm.  Otherwise normal appearing nonenhanced\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 suspicious\nrenal 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.  There multiple gaseous\ndistended loops of small bowel without dilatation.  Normal wall thickness is\nseen throughout.  Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening or fat stranding. The appendix is normal.Moderate\nto large fecal loading.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nmoderate abdominopelvic ascites.\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.  No retroperitoneal hematoma.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Moderately depressed sternal fracture (series 602, image 43.  Numerous\nsubacute appearing anterior rib fractures are demonstrated.  On the right,\nthere are fractures through ribs ___ anteriorly.  The anterior right fourth\nand fifth ribs demonstrate comminuted fractures.  The fourth rib is fractured\nin 2 places.  The left ribs ___ are also fractured anteriorly.  There is some\nbridging callus indicating interval healing.  Rib fractures were previously\ndemonstrated\n\nSOFT TISSUES: There is bilateral gynecomastia.  There is diffuse anasarca.",
            "output": "1. Moderately depressed sternal fracture.\n2. Multiple bilateral anterior rib fractures which appear subacute with callus\nformation.  Ribs ___ on the right and ___ on the left are fractured\nanteriorly.  The right fourth rib is fractured in 2 places.  The fractures are\nmildly displaced.\n3. Redemonstration of cirrhotic liver morphology with third-spacing, large\nvolume ascites and splenomegaly.  The TIPS is better evaluated on the same day\nultrasound.\n4. Diverticulosis.\n5. Hypodensity of the blood pool suggesting anemia."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis and left sided pleural thickening.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver, in particular the right hepatic lobe, demonstrates\nheterogeneous attenuation with areas of ill-defined hypodensities causing a\nnodular contour, consistent with known hepatic metastases.  The gallbladder\nwall is irregular and calcified with an internal calcified stone.  The absence\nof IV contrast limits evaluation for intrahepatic biliary dilatation and\ncholangitis.  Two biliary stents extending from the central intrahepatic bile\nducts to the CBD are present, however it is difficult to assess the patency of\nthe stents.  There is no obvious common bile duct dilatation.  No pneumobilia\nidentified.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 simple renal cysts are identified, the largest of\nwhich measures 3.6 cm in the left lower pole.  There is no hydronephrosis or\nnephrolithiasis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout.  A right inguinal hernia containing fat and simple fluid\n(___).  Diverticulosis of the colon is noted, without evidence of wall\nthickening and fat stranding.  Contrast is retained within some of these small\ndiverticula. Appendix is not visualized. There is no evidence of mesenteric\nlymphadenopathy.  There is a small amount of free intra-abdominal fluid,\nparticularly in ___ pouch.\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 urinary bladder anterior wall appears slightly thickened, but it\nis not fully distended. There is no evidence of pelvic or inguinal\nlymphadenopathy. There is no free fluid in the pelvis.  Multiple pelvic\nphleboliths are present.\n\nREPRODUCTIVE ORGANS: Reproductive organs are unremarkable.\n\nBONES AND SOFT TISSUES: Lower thoracic vertebral body hemangiomas are\nidentified.  Multilevel degenerative changes of the lumbar spine are present. \nNo suspicious osteoblastic or osteolytic lesion identified.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Please note that the absence of IV contrast significantly limits evaluation\nfor vascular parenchymal organ abnormalities, including tumor detection. \nWithin this limitation, there are 2 biliary stents extending from the left/\ncentral intrahepatic bile ducts distally to the CBD, which itself does not\nappear grossly dilated.  It is difficult to assess the patency of the stents. \nThere is no pneumobilia.\n2. The liver, in particular the right hepatic lobe, demonstrates heterogeneous\nattenuation with areas of ill-defined hypodensities, consistent with known\nhepatic metastases.\n3. The gallbladder wall is irregular and calcified with an internal calcified\nstone.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 16:17 on ___, 5 min 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 pneumobilia predominantly\ninvolving the left above the liver.  CBD dilatation has resolved when compared\nwith the previous scan.  The gall bladder is contracted and appears partially\nresected.  History of gallstone are ileus is noted\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  There is stable pancreatic duct dilatation measuring up to  5\nmm 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 peripherally calcified 2.1 cm left midpole renal cyst which\ncorresponds to the known radiofrequency ablation cavity is unchanged.  Other\nthan this, 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. There is extensive\nsigmoid diverticulosis.  No evidence of complication.  No bowel wall mass is\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 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: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are present in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No interval change in the appearances of the peripherally calcified\nablation cavity at the upper pole region of the left kidney.\n2. Interval resolution of extrahepatic biliary dilatation, stable pancreatic\nduct dilatation.  No pancreatic head mass.\n3. Uncomplicated colonic diverticulosis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in the\nabdominal aorta.  The celiac artery and SMA are normal in caliber and patent. \nThere is atherosclerotic calcification at the ostium of the inferior\nmesenteric artery.  There is no evidence of thrombus within the proximal ___.\n\nThere is an IVC filter in place at the level of L2.\n\nLOWER CHEST: There is moderate scattered atelectasis of both lung bases. \nThere are small bilateral pleural effusions, increased since the prior outside\nCT from ___.  Again noted is a calcified granuloma in the left\nlower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation.  No focal lesion is\ndetected.  There is focal fat deposition along the gallbladder fossa.  The\ngallbladder surgically absent.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.\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 normal in size and homogeneous in attenuation.  There is\nno focal lesion.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are symmetric in size with normal bilateral nephrograms..\nThere is a 2.0 x 1.3 cm exophytic cyst at the medial upper pole of the left\nkidney and a 1.7 x 1.0 cm partially exophytic cyst in the interpolar region. \nThere is a 1.3 x 1.0 cm cyst in the anterior interpolar region of the right\nkidney..  There are no urinary tract stones.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is wall thickening and submucosal edema of\nthe distal transverse, descending and sigmoid colon with surrounding\ninflammatory stranding.  The distal rectum is spared.  This distribution is in\nkeeping with ischemic colitis.  There is no pneumatosis or pneumoperitoneum.\n\nThere is no evidence of mesenteric lymphadenopathy.  There is a small amount\nof intra-abdominal ascites.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed by Foley catheter and contains a small\namount of gas.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is a small amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There are multilevel spinal degenerative changes.  There is no\nsuspicious osseous lesion.\n\nSOFT TISSUES: There is a small left fat containing inguinal hernia.  The\nabdominopelvic wall is within normal limits.",
            "output": "1. Wall thickening and submucosal edema of the distal transverse, descending\nand sigmoid colon with surrounding inflammatory stranding. This distribution\nis in keeping with ischemic colitis.  No evidence of thrombosis of the\nproximal ___.\n2. Small amount of abdominopelvic ascites.\n3. Small bilateral pleural effusions.  Moderate scattered atelectasis of both\nlung bases.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:39 pm, 15 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Linear opacities involving the dependent portion of the lungs\ncompatible with subsegmental atelectasis.  No consolidation 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 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. \nStable cyst versus caliceal diverticulum in the upper pole of the left kidney.\nThere is no evidence of significant focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL:  There has been interval placement of a percutaneous\ngastrostomy tube which appears to be intraluminal in position.  There is mild\npneumoperitoneum presumably within normal limits for recent gastrostomy tube\nplacement.  There is mild mural thickening with surrounding stranding/fluid\ninvolving the cecum raising suspicion for developing typhlitis.  Small and\nlarge bowel loops are otherwise 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 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": "1. Inflammatory change isolated to the cecum suspicious for developing\ntyphlitis.  Correlate with neutropenia.\n2. Postprocedural changes related to percutaneous gastrostomy tube placement\nincluding residual pneumoperitoneum.  If there is continued clinical concern\nfor a gastric perforation/leak, a repeat tube check could be obtained."
        },
        {
            "input": "LOWER CHEST: Linear opacities involving the dependent portion right lower lobe\ncompatible with subsegmental atelectasis are again noted.  No consolidation. \nNo 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 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: Percutaneous gastrostomy in place.  No bowel obstruction. \nInterval improvement/near complete resolution of mural thickening and\nstranding around the cecum.  Although there has been some redistribution of\nfree air, the overall quantity is probably unchanged.  No pneumatosis.  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 abdominal or pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Celiac trunk is markedly narrowed and possibly even occluded, as\nseen previously with collateral flow.\n\nBONES: 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 improvement/near complete resolution of prior inflammatory process\nsurrounding the cecum.  Probably unchanged amount of free 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 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimilar to prior, there is mild focal cortical atrophy of the upper pole left\nkidney (08:58), with an associated hypodense lesion compatible with a caliceal\ndiverticulum (4:73).  There is no evidence of suspicious focal renal lesions\nor hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  As before, there is mild fat\ndeposition within the terminal ileal wall, consistent with chronic\ninflammation, and unchanged compared to multiple prior examinations. \nOtherwise, 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 no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.  There is persistent compression of the\nceliac axis by the median arcuate ligament, however, distally there is normal\ncontrast enhancement of its 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. No evidence of metastatic disease in the abdomen or pelvis.\n2. Hepatic steatosis.\n3. Chronic inflammatory change is again noted in the terminal ileum.\n4. Unchanged left upper pole renal caliceal diverticulum.\n5. Please refer to dedicated CT chest performed same date for description of\nintrathoracic findings."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. \nLocule of air within the urinary bladder likely is related to recent\ninstrumentation.  Otherwise, the urinary bladder and distal ureters are\nunremarkable. 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: Patient is status post fixation of a right femoral pathologic\nsubtrochanteric fracture with a lateral plate and multiple screws.  Within the\nmedullary cavity of the proximal right femur adjacent to the surgical screws\nis high dense material compatible with cement.  No evidence of perihardware\nfracture or lucencies.  There is no evidence of acute fracture or dislocation.\nNo new osseous lesions are noted.  There is bilateral sacroiliac degenerative\nchanges as well as multilevel degenerative changes of the lower lumbar spine. \nNo evidence of joint effusion or adjacent soft tissue hematoma.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. No evidence of acute fracture or dislocation of the left hip or pelvis.\n2. Patient is status post fixation of a right proximal femoral fracture\nwithout evidence of hardware complications such as perihardware fracture or\nloosening.\n3. Focus of air within the bladder lumen, likely related to recent\ninstrumentation, but clinical correlation is necessary."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis with scarring at the right lung\nbase.  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. There is interval\nincrease in prominence of the main pancreatic duct within the head of the\nnative pancreas measuring up to 5 mm, previously 3 mm. There is a normally\nenhancing enteric drainage pancreatic transplant in the left mid abdomen\n(02:30).\n\nSPLEEN: Regions of hypodensity within the splenic parenchyma are favored to be\nperfusional, similar from prior. The spleen is normal in size.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic. Left iliac fossa transplant kidney\ndemonstrates normal enhancement and corticomedullary differentiation. A failed\nright iliac fossa transplant kidney is atrophic. Sub-centimeter hypodensities\nin transplant kidney are too small characterize (02:55, 60). No\nhydronephrosis.\n\nGASTROINTESTINAL: Calcifications are again noted around the distal esophagus,\nlikely within lymph nodes. No small bowel obstruction. The colon and rectum\nare unremarkable. The patient is status post resection of an appendiceal\nmucocele without evidence of recurrence. No free fluid in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 4.5 x 2.4 cm elongated cystic structure\nposterior to the right uterus, slightly more prominent in comparison to study\ndated ___ (2:67). A small amount of calcification is again noted\nwithin the uterus, possibly within a fibroid.\n\nLYMPH NODES: Conspicuous periaortic, retroperitoneal lymph nodes are unchanged\nfrom prior.\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: Note is made of rectus diastasis.",
            "output": "1. Patient is status post resection of an appendiceal mucocele without\nevidence of recurrence.\n2. Interval increase in prominence of the main pancreatic duct within the head\nof the native pancreas measuring up to 5 mm, previously 3 mm. Further\nevaluation with MRCP is recommended.\n3. Slight interval enlargement of a cystic structure posterior to the right\nuterus, possibly a hydrosalpinx but incompletely assessed. Repeat evaluation\nwith pelvic ultrasound is recommended.\n\nRECOMMENDATION(S):\n1. MRCP with and without contrast.\n2. Dedicated pelvic ultrasound.\n\nNOTIFICATION:  The impression and recommendations above was entered by Dr.\n___ on ___ at 08:55 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 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 measures 8 mm, within normal limits for patient age.  The\ngallbladder is within normal limits.  There is a moderate amount of simple\nperihepatic fluid.\n\nPANCREAS: There is extensive fatty atrophy of the pancreas.  Otherwise, the\npancreas has normal attenuation throughout, 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.  A 0.5 cm\nhypodensity in the mid spleen near the hilum is too small to characterize but\nunchanged and likely represents a cleft or splenic cyst.\n\nADRENALS: There is mild thickening of the bilateral adrenal glands without\nfocal nodularity.\n\nURINARY: The kidneys are of normal and symmetric size.  A 2.0 cm simple cyst\nin the interpolar region of the right kidney is unchanged.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The patient is status post low\nanterior resection with sigmoidectomy and end-to-end colorectal anastomosis. \nOral contrast has reached the mid descending colon but not the region of the\nanastomosis.  No evidence of bowel obstruction.\n\nThere is small volume pneumoperitoneum, largely adjacent to the diaphragm,\nwith scattered foci throughout the abdomen, all likely postsurgical.  A\nbilobed fluid collection which contains an air-fluid level extends from the\nmid abdomen into the left lower abdomen and pelvis.  The pelvic portion of the\nfluid collection is in close relation to the colorectal anastomosis (2:68). \nAlthough no extraluminal oral contrast is seen, the ingested oral contrast has\nnot yet reached the anastomosis as above.  The superior intra-abdominal\nportion of the fluid collection measures 5.0 x 4.0 x 11.5 cm (2:39, 4:20),\nwhile the inferior intrapelvic portion of the fluid collection measures 4.4 x\n3.0 x 3.9 cm (2:65, 4:28).  Wall thickening of a loop of small bowel in the\nleft abdomen adjacent to the fluid collection (02:43) is nonspecific.\n\nPELVIS: The urinary bladder is partially opacified with excreted contrast from\nprior study.  The distal ureters are unremarkable.  Pelvic free fluid is\ndescribed above.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  No adnexal abnormality is\nseen.\n\nLYMPH NODES: Scattered prominent subcentimeter mesenteric and retroperitoneal\nlymph nodes 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. \nThere is minimal retrolisthesis of L3 on L4, likely degenerative in etiology.\n\nSOFT TISSUES: Scattered retro and extraperitoneal gas, predominantly within\nthe inferior pelvis, is likely postsurgical.",
            "output": "1. Although oral contrast has not reached the colorectal anastomosis, a large\nbilobed abdominopelvic fluid collection with air-fluid level which extends\nfrom the mid abdomen to the colorectal anastomosis in the pelvis is concerning\nfor anastomotic leak.  As rectal contrast is not desired per the surgical\nteam, repeat scan in approximately 2 hours may be helpful for evaluation of\npotential extraluminal oral contrast leakage.\n2. In the absence of intravenous contrast, wall thickening of a short segment\nof small bowel in the left abdomen adjacent to the fluid collection is\nnonspecific.\n3. Small volume pneumoperitoneum and scattered retro/extraperitoneal gas are\nlikely postsurgical.\n\nNOTIFICATION:  Updated findings discussed with ___, MD by ___\n___, MD via telephone at 17:15 on ___, 5 minutes after discovery."
        },
        {
            "input": "LOWER CHEST: Interval increase in small bilateral nonhemorrhagic pleural\neffusions.  Overlying relaxation atelectasis is demonstrated.  No 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.  A 5 mm hypodensity within the right hepatic lobe (series 3, image 30)\nis too small to characterize by CT likely represents a simple cyst or biliary\nhamartoma.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Diffuse fatty atrophy of the pancreas without focal lesion or\nperipancreatic stranding.  No ductal dilatation.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Generalized thickening of the bilateral adrenal glands is unchanged.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is a 2.0 cm\nsimple right renal cyst.  There is no hydronephrosis.  There is no\nnephrolithiasis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Status post low anterior\nresection with a sigmoidectomy and and-and colorectal anastomosis, which is\ngrossly intact.  Previously administered oral contrast has reached the rectum\nno evidence of extraluminal oral contrast.  No bowel obstruction.  There is\ndiverticulosis.\n\nTrace pneumoperitoneum is decreased compared to the prior study.\n\nInterval decrease in size of a retroperitoneal fluid collection within\nair-fluid level which extends from the mid abdomen into the pelvis.  There has\nbeen interval placement of a percutaneous drainage catheter which lies next to\nthe lower sigmoid colon in the area of previously demonstrated pelvic\ncollection which no longer demonstrates persistent fluid at the focal location\nof the drain.\n\nThe more superior portion of the collection measures up to 6.4 cm in the\ntransverse plane and 10.9 cm in the sagittal plane (series 3, image 47, series\n6, image 38) which is substantially improved compared to the prior study which\nmeasured up to 9.5 cm transversely and 12.2 cm in the sagittal plane.\n\nThere is surrounding mesenteric edema with multiple prominent lymph nodes\nwhich are likely reactive measuring up to 0.6 cm.  Overall this is decreased\nin prominence compared to the prior study.\n\nPELVIS: The bladder contains a small focus of air which is likely post\ncatheterization.\n\nREPRODUCTIVE ORGANS: Uterus is not visualized.  No adnexal abnormality is\ndemonstrated.\n\nLYMPH NODES: Multiple prominent mesenteric nodes as described above.  No\npelvic or retroperitoneal lymphadenopathy.\n\nVASCULAR: 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 retrolisthesis of L3 over L4 is unchanged.\n\nSOFT TISSUES: Mild diffuse soft tissue edema.  There is air seen tracking\nwithin the left abdominal musculature, which may be due to prior procedure\nlies a shin.",
            "output": "1. Status post percutaneous drainage of the right pelvic fluid collection,\nwhich appears completely drained.\n2. Substantial decrease in size of the mid abdominal retroperitoneal\ncollection which now measures approximately 6.4 x 10.9 cm (TRV x SAG).\n3. Improved mesenteric thickening and reactive lymphadenopathy.\n4. Small amount of pneumoperitoneum and subcutaneous emphysema are likely\npostsurgical.\n5. Diverticulosis.\n\nRECOMMENDATION(S):  Correlation with drain output and potentially\nrepositioning of the drain under fluoroscopy in the more cranial portion of\nthe collection could be considered if this is warranted"
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions, unchanged from the\nstudy performed ___.  Passive atelectasis is noted bilaterally. \nThere is a small hiatal hernia.  Lung bases, visualized pleural spaces, and\nlower mediastinal structures otherwise unremarkable.\n\nABDOMEN:\n\nSlightly dense material in the rectum and residual large bowel likely reflects\ncontrast.  No obvious extraluminal contrast identified.\n\nPatient is recent status-post low anterior resection.  A colorectal\nanastomosis is identified in the deep pelvis.  There is residual pancolonic\ndiverticulosis.\n\nA right transgluteal pigtail catheter remains in situ (series 3, image 69). \nIt is seen to the right of the anastomotic suture.  Small pocket of fluid\nremains adjacent to the tip of the pigtail catheter, measuring up to 20 mm in\ndiameter (series 5, image 29).\n\nAgain demonstrated is extensive mesenteric edema and fat stranding. Minimal\nintra-abdominal free air remains, improved from prior.\n\nCentrally located mesenteric collection now contains predominantly air, with a\nscant amount of fluid layering dependently.  The dominant component of this\ncollection measures approximately 3.1 x 9.7 cm in AP and transverse dimension\n(series 3, image 55).  It has increased in size when compared to the study\nperformed on ___, where it measured approximate 2.1 x 6.4 cm.  In\ncraniocaudal extent, there is no significant change in dimension (10.8 cm\nversus 10.9 cm).\n\nTo the left of this collection is a very edematous loop of small bowel, with\nmild upstream dilatation (up to 3.9 cm), unchanged from prior, and likely\nreactive in nature.  Dilatation is most likely reflective of ileus.  Findings\nare unchanged from the prior CT.\n\nThere are no new loculated/drainable fluid collections in the abdomen and\npelvis.\n\nLiver is normal in contour.  Again re-demonstrated is a small hypoattenuating\nfocus in the left lobe of the liver (series 3, image 23).  It was seen on the\nremote CT performed in ___, and appears grossly unchanged in size. \nSeveral additional punctate foci of hypoattenuation in the left lobe of the\nliver similarly stable.  Foci are too small to characterize on CT.  Normal\ngallbladder.  No intrahepatic or extrahepatic bile duct dilatation.\n\nThere is again fatty interdigitation throughout the pancreatic parenchyma.  No\nfocal pancreatic lesions are identified on this non-dedicated study.  No main\nduct dilatation.\n\nThere is again diffuse bulkiness of the adrenal glands, without a discrete\nnodule, stable from ___.\n\nThis spleen is not enlarged (8 cm).\n\nAgain re-demonstrated is a simple cyst of the lower pole of the right kidney. \nThere is no hydronephrosis or nephrolithiasis.\n\nUrinary bladder is normal.\n\nPatient is status post hysterectomy.  Vaginal vault is unremarkable.  No\nadnexal mass is identified.\n\nNo inguinal, pelvic, retroperitoneal lymphadenopathy.  Multiple prominent\nmesenteric lymph nodes, likely reactive in nature.  No evidence of interval\nenlargement.\n\nAbdominal aorta mild straight mild atheromatous calcification.  No aneurysmal\ndilatation.\n\nThere is no acute or focal destructive osseous lesions.  Again noted is\ndiffuse subcutaneous soft tissue stranding related to third spacing.  For\nsmall volume residual subcutaneous emphysema, improved from prior.  Midline\nlaparotomy scar is unremarkable.",
            "output": "1. Small volume of residual fluid in right pelvic collection with percutaneous\ndrainage catheter in appropriate position.\n2. Interval increase in size of cental mesenteric collection which now\npredominantly contains air, concerning for ongoing contained leak. No new\ndrainable collection\n3. Focal small bowel ileus adjacent to the mesenteric collection, similar to\nprior study, likely reactive."
        },
        {
            "input": "LOWER CHEST: Trace bilateral pleural effusions, decreased compared prior. \nLeft basilar atelectasis.  There is a small hiatal hernia.  Top normal heart\nsize.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nSmall hypoattenuating focus in the left lobe of the liver is too small too\ncharacterize however appears unchanged (series 2, image 19).  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.  Simple cyst of the\nlower pole of the right kidney measures 2.4 cm and is unchanged.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post low\nanterior resection with colorectal anastomosis in the deep pelvis.  There is\nagain mesenteric edema and fat stranding as seen on prior in the mid lower\nabdomen and pelvis.  There is a centrally located mesenteric collection which\npredominantly contains air and a scant amount of fluid layering posteriorly,\nmeasuring up to 4.0 x 10.0 cm (series 2, image 50), not significantly changed\ncompared prior.  This collection extends towards the colorectal anastomosis as\nseen on prior.  The inflamed small bowel loop adjacent to the collection in\nthe left abdomen has not significantly changed persistent wall thickening and\nmild distention compatible with focal ileus.  There is a large amount of stool\nwithin the distal colon.  The previously seen pocket of fluid adjacent of the\ntip of the pigtail catheter in the right pelvis has resolved.\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 mass.\n\nLYMPH NODES: Prominent reactive nodes adjacent to the mesenteric collection\nare noted.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Mild atherosclerotic calcifications.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A right transgluteal pigtail catheter has been retracted and\nterminates within the right gluteus musculature.",
            "output": "1. No significant change in central mesenteric collection, predominately\ncontaining air extending towards colorectal anastomosis, as seen on prior.\n2. Transgluteal percutaneous drain catheter has been retracted and currently\nterminates within the gluteal musculature.  Previously seen residual fluid\ncollection in the right pelvis has completely resolved.\n3. Unchanged segment of persistently inflamed small bowel in the left abdomen\nadjacent to the mesenteric collection with focal ileus."
        },
        {
            "input": "LOWER CHEST: Lungs are clear without focal consolidation.  There is no pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis a 4 mm hypoattenuating focus in hepatic segment 3, too small to\ncharacterize likely represents a biliary hamartoma or cyst and appears\nunchanged in size and appearance compared to the study from ___\n(2:20).  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is mild fatty atrophy of the pancreas.  There is no evidence\nof focal lesion, within the limitations of an unenhanced scan.  There is no\npancreatic ductal dilation or 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\nthickening of the left adrenal gland without discrete nodule.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.  There is\nredemonstration of a simple appearing hypoattenuating (5 ___ lesion in the\ninferior pole of the right kidney, consistent with a benign renal cyst.  There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness.  The patient is status post low anterior\nresection with colorectal anastomosis in the deep pelvis.  Anastomotic suture\nmaterial is seen in the pelvis.  There has been interval resolution of the\nmesenteric collection previously attributed to an anastomotic leak.  There is\nno residual fluid collection in the abdomen or pelvis.  There is inflammatory\nfat stranding surrounding the anastomosis in the pelvis, likely representing\npost treatment/post surgical change.  There is diverticulosis without evidence\nof diverticulitis.  The appendix is not visualized.  There has been interval\nresolution of the percutaneous transgluteal drainage catheter.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy.  There is no adnexal\nmass.\n\nLYMPH NODES: There multiple prominent mesenteric lymph nodes, not\npathologically enlarged by CT size, which are likely reactive.  There is no\ninguinal, pelvic or retroperitoneal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been interval removal of the right transgluteal\npigtail catheter.  There is soft tissue density along the anterior abdominal\nmidline, which is likely postsurgical.  The abdominal and pelvic wall is\notherwise within normal limits.",
            "output": "1. Interval resolution of the mesenteric collection. Interval removal of the\ntransgluteal percutaneous drainage catheter.\n2. Colonic diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "There is mild dependent atelectasis at the lung bases.  There is no\npericardial or pleural effusion.  The heart size is normal.\n\nThe liver density is within normal limits.  There is no focal hepatic lesion. \nThere is no intra or extrahepatic bile duct dilation.  The patient is post\ncholecystectomy.  No radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is within normal limits.  A well-circumscribed 6 mm\nhypodensity along the anterior spleen is likely a small cyst (series 2, image\n26).\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is moderate colonic diverticulosis.  No focal\ngastrointestinal lesion is detected.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe bladder is decompressed, and appears normal.  The patient is post\nhysterectomy.  No concerning adnexal lesions are detected.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber, with mild to moderate\natherosclerotic calcifications along the infrarenal abdominal aorta and common\niliac arteries.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\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 2 perforators on the left.\n\nLEFT:\nBranching pattern: Type 1\nPerforators:\n1.9 mm, 32 mm to the left and 39 mm below the umbilicus, (series 2, image 120)\n1.7 mm, 15 mm to the left and 44 mm below the umbilicus, (series 2, image 123)\n\nRIGHT:\nBranching pattern: Type 1\nPerforators:\n2 mm, 32 mm to the right and 16 mm below the umbilicus, (series 2, image 110)\n1.9 mm, 29 mm to the right and 65 mm below the umbilicus, (series 2, image\n131)\n\nIncidentally noted is a large superficial varicose extending across midline,\napproximately 12 cm below the umbilicus, in connection with the greater\nsaphenous vein (series 2, image 154).",
            "output": "1. Bilateral ___ vessels detailed above.\n2. No abdominopelvic lymphadenopathy or metastasis.\n3. Colonic diverticulosis."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day\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 hydronephrosis.  There is a wedge-shaped hypodense\narea in the lower pole of the right kidney best seen on sagittal images on\nseries 602, ___ 31.  There several rounded subcentimeter hypodense lesions in\nthe left kidney.  These are too small to characterize but are most consistent\nwith 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 is retroperitoneal lymphadenopathy such as a left\nperiaortic lymph node along the upper pole of the left kidney that measures\n1.3 x 1.2 cm on series 2 ___ 72.  A lymph node at the level of the renal hilum\nmeasures 1.4 x 1.0 cm on series 2 ___ 80..  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. Small infarct in the lower pole of the right kidney is concerning for\nseptic embolus.\n2. Mild retroperitoneal lymphadenopathy likely reactive"
        },
        {
            "input": "PELVIS:  The partially visualized small bowel is unremarkable.  There is\nsigmoid colon diverticulosis without evidence of new or recurrent\ndiverticulitis.  There is persistent mild fat stranding surrounding the\nsigmoid colon, with a pigtail catheter placed where a previous collection was\nseen, now completely resolved.\nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus persists large and lobulated, likely\nassociated to fibroids.  No adnexal abnormality is seen.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again evident is a midline incision in the lower abdominal wall,\nunchanged compared to priors.",
            "output": "1.  Interval resolution of diverticular abscess with a pigtail catheter in\nplace.\n2.  Redemonstration of large lobulated uterus, likely related to fibroids,\ncorrelation with a nonemergent ultrasound of the pelvis is recommended.\n\nRECOMMENDATION(S):  Nonemergent ultrasound of the pelvis to better evaluate\npossible fibroids."
        },
        {
            "input": "Evaluation is limited due to respiratory motion.\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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes from sleeve gastrectomy.\n\nThere has been interval removal of the drain adjacent to the known\ndiverticular abscess with reaccumulation of the abscess now measuring 5.8 x\n5.4 x 7.5 cm (series 5, image 63 and series 8, image 30).  There is thickening\nof the adjacent sigmoid colon and the ascending colon is fluid filled and\nprominent, measuring 5.5 cm.  In addition, there are several prominent loops\nof fluid-filled small bowel in the pelvis (5:40), suggesting of evolving\nileus.\n\nPELVIS: The urinary bladder and distal ureters are unchanged.  There is a\nmoderate amount of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Large lobulated uterus is poorly visualized.\n\nLYMPH NODES: There are a few prominent retroperitoneal and pelvic lymph nodes.\nFor example: There is a 1.0 cm left periaortic lymph node (series 5, image\n35).  There is a 1.1 cm right common iliac lymph node (series 5, image 49). \nThere is a left internal iliac lymph node measuring 0.8 cm in the short axis\n(series 5, image 58).  There is also a left external iliac lymph node\nmeasuring 1.0 cm in short axis (series 5, image 70).\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 stranding of the fat along the tract of the previously\nplace midline drain.",
            "output": "1. Reaccumulating of abscess adjacent to the sigmoid colon, measuring up to\n7.5 cm in maximum diameter.  Status post drain removal on ___.  Patient\nis clinically stable, received antibiotics from Dr. ___ and ___\ncome in as outpatient for drainage placement on ___.\n2. Air-fluid level in the descending colon and prominent loops of fluid-filled\nloops of small bowel in the pelvis, concerning for evolving ileus.\n3. Sigmoid colonic wall thickening, fat stranding, prominent pelvic lymph\nnodes and free pelvic fluid, likely reactive.\n4. Poorly visualized lobulated uterus, similar to prior, possibly fibroids. \nFurther characterization with a"
        },
        {
            "input": "DRAIN AND FLUID COLLECTIONS: Since prior CT of ___, there has been\ninterval placement of a left anterolateral approach pigtail catheter. The\ncatheter is in appropriate position and there has been marked decrease in size\nof the collection which now measures 2.3 x 2.2 x 2.3 cm (4:39, 7:81).\n\nThere is layering fluid within the dependent pelvis, which may show mild\nloculations.  Overall inflammatory changes in the pelvis have increased\ncompared to prior examination.  Few loops of small bowel show short segments\nfluid-filled dilatation, for example in the right hemipelvis measuring up to\n4.8 cm (4:19), which shows mild narrowing of caliber and then continues into a\nsegment of small bowel that shows borderline dilatation of up to 3.2 cm\n(6:55).  Similarly, a short segments of small bowel in the left abdomen (4:21)\ncould be mistaken for a fluid collection, however shows continuation with\ncollapsed segments of small bowel proximally and distally.  This loop is very\nsimilar in position when compared to the prior examination of 5 days ago,\nwhich may relate to fixation secondary to the extensive surrounding\ninflammation.\n\nAn irregular gas and fluid collection is identified in the anterior midline\njust underlying the anterior abdominal wall, measuring approximately 2.4 x 6.1\ncm (4:32).  There is extensive surrounding stranding and mesenteric\ncongestion.\n\nURINARY: The urinary bladder is only minimally distended, and unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is mildly enlarged demonstrating at least one\n3.5 cm fundal fibroid.  Additional heterogeneously enhancing masses adjacent\nto the rectum (4:49) are stable in size and position compared to multiple\nprior examinations and likely relate to exophytic fibroids. A hyperdense mass\nmeasuring 4 cm in the right adnexa is likely also an exophytic fibroid.\n\nLYMPH NODES: Central non enlarged inguinal lymph nodes are identified normal\nreactive.  Reactive appearing lymph nodes are also noted in the\nretroperitoneum.  No pathologically enlarged pelvic or mesenteric lymph nodes\nare identified.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stranding in the midline anterior abdominal wall likely relates\nto scarring secondary to the prior vertical drain otherwise included soft\ntissues of the toe by door unremarkably..",
            "output": "Near-complete resolution of left pelvic collection with pigtail catheter in\ngood position.\n\nSmall new gas and fluid collection in the anterior pelvis."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases are grossly clear, although there is some\nimage degradation due to motion artifact.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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: Assessment somewhat limited particularly at the upper pole where\nthere is motion, but no gross abnormalities.  No hydronephrosis.  The bladder\nis largely collapsed but grossly unremarkable.\n\nGASTROINTESTINAL: Postsurgical changes again seen after sleeve gastrectomy. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement.\nColonic wall is thickened in appearance along the region of the sigmoid, which\nmay be reactive to regional inflammation, or in part due to nondistention. \nThe appendix is normal.\n\nPELVIS: A left lower quadrant percutaneous catheter remains in situ, with the\npigtail curled between a uterine fibroid and the sigmoid colon.  There is no\nresidual fluid seen in this region.  There is trace pelvic free fluid present.\n\nREPRODUCTIVE ORGANS: Uterine fibroid is seen, with a dominant anterior\nexophytic fibroid which measures approximately 7 cm and has mass effect along\nthe bladder, as well as a dominant posterior right exophytic fibroid which\nmeasures approximately 4.2 cm.  Anterior intramural fibroid measures\napproximately 4.5 cm.\n\nIn the left adnexal region is a fluid density structure which measures 4.5 x\n8.8 x 2.9 cm (series 602, image 104; series 2, image 136), previously 3.8 x\n2.2 x 2.6 cm, with what appears likely to be an enhancing follicle along the\ninferior aspect of it (series 2, image 143).  This is not well characterized,\nbut along the periphery of this lesion (series 602, image 107) there is\nsuggestion on sagittal reformatted images that it may represent a hydrosalpinx\nadjacent to the left ovary.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy evident.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Subcutaneous edema is seen in the infraumbilical portion of the\npannus, but otherwise soft tissue structures are grossly unremarkable.",
            "output": "1. Fluid density structure seen in the left adnexal region is nonspecific but\nhas a relatively thin wall, not typical for abscess.  This might represent\nhydrosalpinx, particularly given the regional inflammatory process.\n2. Left lower quadrant pigtail catheter remains in situ, with the pigtail\npositioned between the sigmoid colon and a uterine fibroid.  No residual fluid\nis seen at the site of the pigtail.\n3. Trace pelvic free fluid is within physiologic limits for age.  No drainable\ncollection identified.\n4. Lobulated fibroid uterus.\n\nRECOMMENDATION(S):  Contrast enhanced MRI of the pelvis may be considered if\nneeded for characterization of the loculated l"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 suspicious focal lesion.  There is mild intra and extrahepatic\nbiliary dilatation, likely secondary to 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.\n\nADRENALS: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Postop changes of sleeve gastrectomy noted.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement. Rectal\ncontrast has been administered and is seen traversing past the sigmoid\nanastomosis and into the proximal colon.  There is no evidence of anastomotic\nleak.  The appendix is surgically absent.\n\nPELVIS:  There is moderate volume pelvic free fluid.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus, including large\nanterior exophytic and posterior right exophytic fibroids..  No adnexal\nabnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES:\nThere is a pocket of fluid density within the pelvis anterior to the uterus\nwhich appears to track into the anterior abdominal wall and measures\napproximately 2.1 x 3.3 x 10.0 cm (AP by TV by CC).  This pocket of fluid\ntracks near small bowel loops but appears to be extraluminal.  There is\nsuggestion of rim enhancement.  This fluid collection tracks into the anterior\nabdominal wall and skin surface with an additional multiloculated component\nseen within the anterior abdominal wall.\n\nAdditional inflammatory changes are noted including subcutaneous fat stranding\nand thickening of the rectus abdominus muscles.  There is small volume pelvic\nfree fluid which may communicate with the multiloculated collection described\nabove.",
            "output": "1. Rectal contrast has been administered and is seen traversing through the\nsigmoid anastomosis and visualized to the level of the cecum.  No evidence of\nleak at the sigmoid anastomosis.\n2. Pocket of fluid density with subtle rim enhancement within the anterior\npelvis anterior to the uterus measuring approximately 2.1 x 3.3 x 10.0 cm (AP\nby TV by CC).  This fluid tracks into the anterior abdominal wall and skin\nsurface with an additional multiloculated component in the anterior abdominal\nwall.  This finding most likely represents an abscess, however difficult to\nconfidently exclude an entero-cutaneous fistula without oral contrast. \nModerate volume pelvic free fluid which may communicate with the above\ndescribed"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Status post sleeve gastrectomy.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\nUnchanged appearance of mild fat stranding surrounding the sigmoid colon with\na mural abscess measuring 3.4 x 3.4 cm (2:59), relatively unchanged compared\nto prior study.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Large lobulated appearance of the uterus, likely\nassociated to fibroids.  The ovaries are not adequately 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: Midline incision in the lower abdominal wall, unchanged.",
            "output": "1. Unchanged appearance of mild diverticulitis in the sigmoid colon associated\nwith a small unchanged diverticular abscess measuring up to 3.4 cm.  This\nabscess is wedged between the uterus and the sigmoid colon with loss of fat\nplanes with both these organs.\n2. Stable postoperative appearance of sleeve gastrectomy.\n3. Large lobulated appearance of the uterus, likely related to fibroids.  The\ndiverticular abscess closely abuts the lobulated uterus.  The ovaries are not\nwell visualized separately and if additional characterization of the uterus\nand adnexa are desired, consider pelvic MRI.\n\nRECOMMENDATION(S):  Pelvic MRI for the finding described in impression 3."
        },
        {
            "input": "The right hip demonstrates reduction of previous dislocation. There is a\nfracture involving the posterior aspect of the acetabulum, extending to the\nposterior superior aspect. This appears comminuted with a dominant fragment\nparalleling the posterior and posterior superior acetabulum. This curvilinear\nfragment measures 2.7 cm transverse, 3.1 cm craniocaudal, 4 mm anterior to\nposterior. This fragment is mildly displaced, by about 5 mm. There is a\nfurther smaller fragment displaced posterior to the ischium (series 3, image\n57). There is slight posterior positioning of the right femoral head with\nrespect to the acetabulum presumably related to the presence of the posterior\nacetabular fracture.\n\nThere is no evidence of femoral neck fracture. No aggressive focal bone lesion\nis identified.\n\nSome soft tissue swelling posterior to the right hip is demonstrated.\nThickening of the right piriformis muscle is seen\n\nThere is sigmoid colon diverticulosis without evidence of diverticulitis.\nThere is contrast in the bladder presumably related to recent IV contrast\nadministration.",
            "output": "Comminuted posterior acetabular fracture."
        },
        {
            "input": "LOWER CHEST: Please refer to the separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nVASCULAR:  There is no abdominal aortic aneurysm. Again seen is GDA\ninvolvement by the pancreatic adenocarcinoma.  The hepatic vasculature is\npatent. No SMA or celiac involvement seen. Stable linear soft tissue anterior\nand separate from the SMA, posterior to the pancreas on series 3, image 121. \nThe distal abdominal bi-iliac stent is redemonstrated.\n\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates a few minute hypodense stable lesions\ntoo small to characterize, for example on series 3, image 117.  No new hepatic\nlesions are demonstrated.  There is expected pneumobilia post CBD stent. \nCholecystectomy changes are redemonstrated.\n\nPANCREAS: The poorly defined pancreatic mass anterior to the head, involving\nthe GDA measures 3 cm, not significantly changed when measured similarly. \nStable trace main ductal dilatation is demonstrated.  A dominant dorsal duct\nis again seen.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: The kidneys are unremarkable except for a few minute hypodense\nlesions too small to characterize (series 3, image 143).  A stable minute\nright angiomyolipoma is noted.  No hydronephrosis.\n\nGASTROINTESTINAL: There is moderate distension of the stomach up to the\nduodenum at the level of the pancreatic mass.  Adjacent fiducials are again\nnoted.  There is no intestinal obstruction or ascites.\n\nLYMPH NODES: There is a stable subcentimeter lymph node tracking along the\ndistal SMV.  No enlarged abdominal or pelvic lymph nodes are demonstrated.\n\nPELVIS: There is no free fluid in the pelvis.  Post hysterectomy changes again\nnoted.\n\nBONES: No worrisome osseous lesions.\n\nSOFT TISSUES: Post right upper quadrant abdominal wall incision changes again\nseen.",
            "output": "1. Stable exam without new metastatic disease.\n2.  Gastric outlet obstruction to the level of the pancreatic mass."
        },
        {
            "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.  Mild pneumobilia is\nrelated to a patent CBD stent in situ (series 2, image 115).\n\nMild prominence of the main pancreatic duct is slightly improved since the ___ examination, measuring up to 3.5 mm.  A pancreatic head mass is\nagain seen, with soft tissue encasing the distal CBD, extending through the\npancreaticoduodenal groove, spanning approximately 3 cm, grossly unchanged in\ncomparison to the ___ examination.  Early takeoff of the right\nhepatic artery from the celiac trunk is again seen, and the there is continued\nsoft tissue encasement, unchanged from prior (series 2, image 120, series 602,\nimage 61).  Encasement of the GDA and a proximal left hepatic artery is again\ndemonstrated (series 2, image 122, 119).  There is continued soft tissue\ncontact against the main portal vein, without significant narrowing (series\n602, image 57).  The SMA, SMV, and splenic vein remain patent.\n\nThe spleen size is within normal limits.  Accessory spleen is unchanged.  The\nadrenal glands are normal in size and shape.  The kidneys are normal in size\nand enhance symmetrically, without hydronephrosis.  The stomach and\nintra-abdominal and intrapelvic loops of small and large bowel remain normal\nin caliber.\n\nThere is no new abdominopelvic lymphadenopathy.\n\nExtensive soft and calcific atherosclerotic plaque are again demonstrated\nthroughout the abdominal aorta, without flow limiting stenosis.  Bi-iliac\nstents appear patent.\n\nThe bladder is mildly distended, and appears normal.  The patient is post\nhysterectomy.  No concerning adnexal lesions are detected.\n\nThere are no osseous lesions concerning for malignancy or infection.",
            "output": "1. Unchanged appearance of a pancreatic head mass.  Continued encasement of\nthe left and right hepatic arteries and GDA, and contact against the main\nportal vein without attenuation.\n2. Slightly improved pancreatic duct dilation.\n3. No new abdominopelvic metastasis.\n4. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits.  Again seen is a 4 mm hypodense\nlesion within hepatic segment III (series 2, image 116), which is unchanged\nover multiple prior examinations dating back to ___, most compatible with\na cyst.  No new or concerning hepatic lesion is detected.  Mild intrahepatic\nbile duct dilation is unchanged from the prior examination from ___. \nNo ductal stones are seen.  A CBD stent seen on the ___ examination\nhas been removed.\n\nThe pancreas demonstrates normal density and bulk.  Mild pancreatic duct\ndilation is minimally improved since ___, currently measuring up to 3\nmm (series 2, image 120).  Again seen is an infiltrating soft tissue mass\nextending from the pancreatic head throughout the porta hepatis (series 2,\nimage 124).  There is an early takeoff of the right hepatic artery from the\nceliac trunk (series 2, image 115), which courses posterior to the main portal\nvein (series 2, image 119).  This artery, as well as the common hepatic\nartery, GDA, and proximal left hepatic artery, are all encased (series 2,\nimage 119).  The main portal vein remains patent and normal in caliber, with\ncontinued encasement by the soft tissue mass (series 602, image 60).  The SMA\nremain separate.  No vascular attenuation or thrombosis is seen.\n\nThe spleen size within normal limits.  A 1 cm accessory spleen is unchanged\n(series 2, image 115).\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  No focal gastrointestinal lesion is detected.\n\nModerate plaque is demonstrated throughout the abdominal aorta (series 2,\nimage 129), without flow limiting stenosis.  There are bilateral iliac stents\nin situ (series 2, image 156).  No dissection is detected.\n\nA 1.2 cm gastrohepatic node is unchanged (series 2, image 114).  There is no\nnew abdominal or pelvic adenopathy.  There is no ascites.\n\nThe bladder is decompressed, and appears grossly normal.  The uterus is not\nvisualized, possibly post hysterectomy.  No concerning adnexal lesions are\ndetected.\n\nThere are no osseous lesions concerning for malignancy or infection..",
            "output": "1. Slight interval decrease in caliber of the main pancreatic duct, now\nmeasuring 3 mm.\n2. Unchanged extensive soft tissue extending from the pancreatic head\nthroughout the porta hepatis, encasing multiple vessels as detailed above.  No\nevidence of disease progression.\n3. Unchanged 12 mm gastrohepatic node.  No new abdominopelvic lymphadenopathy.\n4. Interval removal of a CBD stent.  Unchanged mild intrahepatic bile duct\ndilation.\n5. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "VASCULAR:\n\nThere is early takeoff of the right hepatic artery from the celiac trunk.  The\ninfiltrative pancreatic head mass encases almost the entirety of the common\nhepatic artery, right hepatic artery, left hepatic artery, gastroduodenal\nartery.  In addition, the proximal left gastric artery is partially encased\n(4:94).  This is similar in extent and involvement compared to prior.  The\nmain portal vein and SMV are patent but circumferentially encased, similar to\nprior.  The SMV is patent.  The SMA is not significantly case is normal in\ncaliber.\n\nThere is no abdominal aortic aneurysm.   There is extensive calcified and\nnoncalcified atherosclerotic disease, similar to prior.  Bilateral common\niliac stents are again visualized and appear patent.\n\nLOWER CHEST: Please refer to separately dictated CT chest report from the same\nday for full description of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain demonstrated, there is a round hypodensity segment III, which has been\nstable on multiple prior exams likely represents cyst (4:93).  Otherwise,\nthere is no evidence of focal lesions.  There is mild diffuse intrahepatic\nbiliary dilatation, similar to prior exams.  The gallbladder surgically\nremoved.  The common bile duct persistently measures approximately 6 mm,\nsimilar prior (4:2).\n\nPANCREAS: Again demonstrated, is a infiltrating soft tissue pancreatic head\nmass, extending into the porta hepatis soft tissues and encasing multiple\nvessels.  The mass itself is difficult to measure due to ill-defined margins\nappears grossly similar in size and extent compared to prior.  The pancreas\ndemonstrates normal enhancement and bulk.  There is persistent diffuse\npancreatic ductal dilatation measuring up to 4 mm, similar to prior (4:98).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\nGASTROINTESTINAL: There are surgical clips or fiducials abutting the lesser\ncurvature of the distal stomach, similar prior.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Colonic diverticulosis without evidence of acute diverticulitis.\n\nLYMPH NODES: Again demonstrated, are mildly enlarged lymph nodes in the porta\nhepatis and celiac axis regions, measuring up to 1.1 cm, similar to prior\n(4:91).  There are few prominent periaortic lymph nodes, however unchanged\ncompared to prior not pathologically enlarged by CT size criteria.\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.  Redemonstration of ill-defined pancreatic head mass with unchanged\ninfiltrative soft tissue extension into the porta hepatis, encasing multiple\nvessels, as described above.  No evidence of disease progression.\n2. Unchanged mild diffuse pancreatic ductal dilatation.\n3. Unchanged celiac axis and porta hepatis lymph nodes.  No evidence of new or\nworsening abdominopelvic lymphadenopathy.\n4.  Please refer to separately dictated CT chest report from the same day for\nfull description of intrathoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThe patient is status post endovascular repair abdominal aortic aneurysm that\nextends to the iliac arteries bilaterally.  There is no evidence of endoleak. \nThere is no abdominal aortic aneurysm. There are separate left and right\nhepatic arteries that originate from the celiac trunk, (series 3 image 121),\n(series 416 image 11).  There are prominent nodes and fat stranding adjacent\nto the trifurcation the celiac artery decreasing the ability to discern the\npancreatic mass involvement with the left and right hepatic arteries, (series\n3 image 119).  A follow-up MRI pancreas is recommended to further characterize\nvascular involvement.  There is moderate calcium burden in the abdominal aorta\nand 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 hepatomegaly measuring up to 22 cm.  The\nliver demonstrates homogenous attenuation throughout. There is no evidence of\nfocal lesions.  There is evidence of intrahepatic dilatation and interval\nplacement of a common bowel duct ___, (series 3, image 130).  The gallbladder\nis within normal limits, without stones or gallbladder wall thickening.  A\ncommon bile duct stent is demonstrated, (series 611, image 63).\n\nPANCREAS: Adjacent to the head of the pancreas is an ill-defined \nisoattenuating soft tissue lesion, (series 3, image 137) that measures\napproximately up to 1.7 cm.  At the neck of the pancreas there is ductal\ndilatation up to 5 mm (Series 3, image 133) that tapers and disappears as it\nenters the pancreatic head.  Due to the ill-defined, nature of the pancreatic\nlesion a pancreatic MRI is recommended to further characterize the pancreatic\nmass.  The pancreatic duct is well visualized extending to the tail but\ndemonstrates normal caliber, (series 3, image 124).  The pancreas has normal\nattenuation throughout\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right adrenal gland is unremarkable.  There is an ill-defined\n1.5 cm soft tissue lesion extending from the left adrenal gland, (series 3,\nimage 117) of unknown etiology however unlikely metastasis cannot be excluded.\nThe lesion is amenable to follow-up on MRI.\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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.  There are multiple phleboliths within the pelvis, (series 3, image\n213).\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. There is an ill-defined, 1.7 cm isodense soft tissue lesion adjacent to the\nhead of the pancreas, that corresponds to endoscopic ultrasound findings. \nHowever, due to the ill-defined nature of the pancreatic lesion, a pancreatic\nMRI is recommended to further characterize pancreatic mass.  The pancreatic\nMRI is also recommended to further characterize vascular involvement of the\npancreatic mass.\n2. The left and right hepatic arteries originate from the celiac axis.\n3. There an ill-defined 1.5 cm soft tissue lesion extending from the left\nadrenal gland that is amenable to follow up on MRI.\n4. Please refer to separate report of CT chest performed on same day for\ndescription of thoracic findings."
        },
        {
            "input": "Contrast injected into the rectum with no evidence of contrast leak. \nEnd-to-side anastomosis appears intact.  There is a right lower quadrant\nileostomy again noted.\n\nThere are midline postsurgical changes.\n\nThere is no free fluid within the pelvis or peritoneal stranding.\n\nThere is mild atherosclerotic calcifications of the distal abdominal aorta. \nThere are no pelvic or inguinal adenopathy.  There are degenerative changes of\nthe lower lumbar spine and bilateral SI joints with no acute osseous\nabnormalities.",
            "output": "1. No evidence of contrast leak post end-to-side colonic anastomosis."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Interval increase in size of a large hiatal hernia which\nmeasures 10 cm in greatest dimension, previously 9 cm.  The walls of the\nhiatal hernia appears thickened which may be secondary to collapse.  No\ndefinite evidence of gastric volvulus.  Otherwise, the stomach is\nunremarkable.  Status post partial colectomy and small bowel resection with\nunremarkable colonic anastomosis in the pelvis, (series 2, image 59).  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Moderate colonic diverticulosis without evidence of wall\nthickening or fat stranding. The appendix is not visualized.  No pericecal fat\nstranding or fluid collection to suggest acute appendicitis.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  The bilateral adnexae\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. \nMild multilevel degenerative changes of the lumbar spine.\n\nSOFT TISSUES: Postsurgical and injection site changes along the anterior\nabdominal wall unchanged.  The previously described soft tissue nodularity\nanterior to the right iliopsoas muscle is not demonstrated on current study.",
            "output": "1. No acute pathology in the abdomen and pelvis.\n2. Moderate colonic diverticulosis without evidence of acute diverticulitis.\n3. Moderate to large hiatal hernia.\n4. Stable postsurgical changes following partial colectomy and small bowel\nresection."
        },
        {
            "input": "LOWER CHEST: There is subsegmental atelectasis in the lung bases.  No\npericardial or pleural effusion is identified.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is an unchanged 1.2 cm hypoattenuating lesion in segment II, too small\nto completely characterize, but likely reflecting a cyst or hemangioma (series\n10, image 11).  The portal veins and hepatic veins appear patent.  There is an\naccessory left hepatic artery arising from the left gastric artery.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  There is\nvicarious excretion of contrast within the gallbladder from the CT performed 1\nday 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: There is a large hiatal hernia.  There is a trace small\nbowel Richter's hernia in the anterior abdominal wall (series 10, image 51). \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement.\nThere is an ileo ileal anastomosis in the right lower quadrant.  There is a\ncolonic anastomosis in the pelvis.  There is enteric contrast throughout the\ncolon from the CT exam performed 1 day prior, precluding adequate assessment\nfor extravasation of intravenous contrast.  There is colonic diverticulosis. \nThe appendix is normal.\n\nPELVIS:  Patient appears status-post hysterectomy and salpingo-oophorectomy.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: There is a trace, nonobstructive, small-bowel containing\nRichter's hernia in the anterior abdominal wall and a small, fat containing\nparaumbilical hernia in the anterior abdominal wall.  Soft tissue nodules in\nthe anterior abdominal wall likely reflect postsurgical changes and/or\nmedication injection.",
            "output": "1. Enteric contrast material administered 1 day prior throughout the colon,\nwhich precludes adequate assessment for extravasation of intravenous contrast.\n2. No evidence of active extravasation in the proximal GI tract.\n3. Ileoileal anastomosis in the right lower quadrant.  No evidence of bowel\nobstruction.\n4. Colonic diverticulosis.\n5. Large hiatal hernia."
        },
        {
            "input": "ABDOMEN:\n\nThe liver is within normal limits. No focal liver lesions. The portal and\nhepatic veins are patent. No intra or extrahepatic duct dilatation.  The\ngallbladder is unremarkable.\n\nThe kidneys are within normal limits. No hydronephrosis. The adrenals and\nspleen are unremarkable. The pancreas is within normal limits.\n\nThere is diffuse fecal loading throughout the colon. The colon is otherwise\nunremarkable.  The appendix is normal.  No fat stranding or inflammatory\nchange within the right lower quadrant.  The small bowel is within normal\nlimits. No free air or fluid within the abdomen or pelvis.  No mesenteric or\nretroperitoneal adenopathy.  The abdominal aorta is of normal caliber.\n\nThe lung bases are clear.  The visualized portion of the heart and pericardium\nis unremarkable.\n\nPELVIS:\n\nThere is a 1.7 cm corpus luteal cyst within the right ovary (2:63).  The\novaries are otherwise unremarkable. The uterus is retroverted but is otherwise\nunremarkable. The bladder is within normal limits. No pelvic adenopathy.\n\nOSSEOUS STRUCTURES:\n\nThe osseous structures of the abdomen and pelvis are within normal limits.",
            "output": "No evidence of appendicitis. No inflammatory change in the right lower\nquadrant."
        },
        {
            "input": "LOWER CHEST: The partially assessed lung bases are clear. There is no pleural\nor pericardial effusion.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation. The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\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: The stomach is moderately distended without obvious intraluminal mass or\nwall thickening. The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction. The appendix is not definitively\nvisualized, but there is no fat stranding or free fluid in the right lower\nquadrant to suggest acute appendicitis. There is colonic diverticulosis\nwithout evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber, with no atherosclerotic\ncalcifications. There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "Normal CT of the abdomen and pelvis."
        },
        {
            "input": "LOWER CHEST:  Please refer to separate report of CT chest performed on the\nsame day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:  5 mm hypoenhancing lesion in liver segment VI (03:49) is too\nsmall to fully characterize but unchanged and isodense to liver on delayed\nphases, likely a hemangioma. No new liver lesion is identified. There is\nlayering hyperdensity within the gallbladder on noncontrast images, likely\nrelated to prior IV contrast administration at outside hospital. However, no\npneumobilia is identified. The gallbladder and bile ducts are otherwise\nunremarkable.\n\nPANCREAS:  The pancreas is normal.\n\nSPLEEN:  The spleen is normal.\n\nADRENALS:  The adrenal glands are normal.\n\nURINARY:  12 mm hypodensity in the lower pole of the right kidney is\nconsistent with a simple cyst. The kidneys are otherwise unremarkable. The\nureters are normal.  There is a 3 mm nonobstructing stone in the upper pole of\nthe left kidney.\n\nGASTROINTESTINAL: The patient is status post proctectomy.  Rectosigmoid\nanastomosis appears intact. No evidence of local recurrence. The stomach,\nsmall bowel, and remaining large bowel are unremarkable. The appendix is\nnormal.\n\n PERITONEUM / RETROPERITONEUM / SOFT TISSUES:  No retroperitoneal or\nmesenteric lymphadenopathy.  No pneumoperitoneum or free abdominal fluid. No\nabdominal wall hernia. Normal abdominal and pelvic wall superficial soft\ntissues.\n\nVASCULAR:  Normal intra-abdominal systemic vasculature. Normal portal\nvasculature.\n\nPELVIS: Normal bladder.   The uterus is fibroid. No inguinal or pelvic\nsidewall lymphadenopathy. No free pelvic fluid.  No inguinal hernia.\n\nBONES: No worrisome osseous lesion.  Heterogeneous sclerotic appearance of the\nsacrum is similar to the prior exam and consistent with postradiation change.",
            "output": "1.  Stable appearance status post proctectomy. No evidence of new or recurrent\nmalignancy in the abdomen or pelvis.\n\n2.  Nonobstructing 3 mm left renal stone."
        },
        {
            "input": "ABDOMEN:\n\nMultiple lung nodules are identified at the visualized lung bases, some\ndemonstrating interval enlargement including a left lower lobe lung nodule\n(5:4) which measures 1 cm, previously measuring 7 mm.  Please refer to the CT\nchest study from the same day for complete details on present findings.\n\nFew hepatic nodules are again identified, including a 9 mm hypodense nodule in\nsegment 4B (2:70), previously measuring 1.2 cm. A small 9 mm nodule is\nidentified in segment all 5 (2:74, previously measuring 1.6 cm). A subtle 6 mm\nnodule is identified in segment ___ (2:73). This is less conspicuous compared\nto prior study.  No intrahepatic or extrahepatic biliary ductal dilatation.\nThe hepatic veins and portal veins are patent query. The pancreas is\nunremarkable. 2 nodules in the medial and lateral limb of the right adrenal\ngland are again identified in keeping with metastatic deposits.\nLow-attenuation lesion in the left adrenal gland measures 2.6 x 2.1 cm,\nsimilar in size allowing for differences in measurement technique. Spleen is\nslightly enlarged measuring 13.7 cm. Tiny hypodense foci are identified within\nthe right kidney, too small to characterize, however likely related to simple\ncysts, stable since the prior study. No hydronephrosis. The patient is status\npost left nephrectomy. No definite residual or recurrent mass is seen in the\nnephrectomy bed. No focal soft tissue abnormalities identified. No ascites. No\nmesenteric or retroperitoneal lymphadenopathy.\n\nPELVIS:\n\nUrinary bladder is unremarkable.  Prostate gland and seminal vesicles are\nunremarkable.  No pelvic free fluid. A left inguinal hernia is again\nidentified containing loops of small bowel.  No evidence of bowel obstruction.\nNo inguinal or pelvic lymphadenopathy.\n\nOSSEOUS STRUCTURES:\n\nNo new lytic osseous or blastic lesions are identified. Posterior spinal\nhardware is identified at the L2 -L4 levels, with stable prominent lytic\nlesion involving the L3 vertebral body.",
            "output": "1. Multiple lung nodules at the visualized lung bases, some demonstrating\ninterval enlargement. Please refer to the CT chest report from the same day\nfor complete details on thoracic findings.\n2. Interval regression of the previously identified hepatic nodules, as\ndescribed above.\n3. Stable bilateral adrenal masses in keeping with metastases.\n4. No definite recurrence or residual disease in the left nephrectomy bed."
        },
        {
            "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: Bilateral lung bases are clear.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: 6.4 x 3.5 cm wedge-shaped area of arterial hypoenhancement is\nidentified becomes mostly isoenhancing in the venous phase, except small\nportion in the periphery.\n\nADRENALS: The right and left adrenal glands 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 is resected.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small free fluid in\nthe 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 4.6 cm area of hypoenhancement in the spleen is likely splenic infarct."
        },
        {
            "input": "PELVIS:  There is small volume simple free fluid in the pelvis (04:47). There\nis small volume pelvic sidewall lymphadenopathy, including 9 mm right external\niliac, 1 cm short axis left obturator lymph node. There is apparent thickening\nalong the wall of the rectosigmoid junction with irregular serosal enhancing\ncontour, suggestive of overlying peritoneal infiltration. Some scattered\nnodules enhancing in the pelvis may also reflect areas of nodular peritoneal\nenhancement. The urinary bladder is unremarkable. The rectum is filled with\nstool and air throughout, with no focal wall thickening or evidence of\nobstruction.\nThere is hypodense fluid within the right iliopsoas bura (4:76).  Diffuse soft\ntissue anasarca is present.\n\nA 5.3 x 7.5 x 10.3 cm intermediate density (30 ___ heterogeneous mass expands\nthe right gluteal musculature, with surrounding fat stranding (4:62, 602b:48).\nThere is no evidence of active arterial extravasation or and it is difficult\nto exclude some partial enhancement of this. The process also extends to the\nright ischial tuberosity and hamstring origin which appears asymmetrically\nexpanded, uncertain if this represents background tendinopathy or involvement\nby this process. There is also slow slight focal hypodensity and cortical ill\ndefinition of the subjacent right ischial tuberosity cortex.\n\nThe pelvic vasculature is unremarkable, with no evidence of flow-limiting\nstenosis or occlusion.\n\nThe osseous structures are unremarkable. No focal lesion worrisome for\nmalignancy is identified.",
            "output": "1. Intermediate density collection expanding the right gluteal musculature\nwith surrounding fat stranding and extension to the right hamstring origin,\nwhere there is minimal subjacent ischial tuberosity cortical lucency. This\ncould reflect an organizing hematoma but differential considerations in this\npatient with known malignancy on chemotherapy include infection or\nnecrotic/hemorrhagic soft tissue metastasis. Clinical correlation is\nrecommended, as well as comparison to any available prior imaging.  Further\nassessment with MRI may help characterize.\n2. Small volume simple pelvic free fluid and pelvic lymphadenopathy, with\nthickening of the rectosigmoid junction, and enhancing peritoneal nodules\nwhich are concerning for malignant peritoneal infiltration.\n3. Hypodense fluid within the right iliopsoas bursa, non-specific."
        },
        {
            "input": "CT PELVIS: Within the right gluteal musculature, there is a 7.4 x 3.7 rim\nenhancing fluid collection, previously 13.0 x 6.1 cm on ___,\nsmaller. Foci of air within the collection are likely related to the recent\ncatheter. A 1.6 x 1.5 cm rim enhancing lesion with adjacent cortical erosion\nof the right ischial tuberosity (4:93) and surrounding enhancement is more\norganized than on ___, concerning for another small abscess with\nbony involvement/osteomyelitis, less likely a metastatic lesion given the\nshort interval progression. Of note, the right ischial tuberosity was intact\non ___. Hypodense fluid in the right iliopsoas bursa (4:90) is\nunchanged.\n\nIntrapelvic loops of small and large bowel are not obstructed. Hyperdensities\nwithin the large bowel are likely related to ingested material. The urinary\nbladder is unremarkable.  Intra- pelvis ascites has increased from ___. Serosal and peritoneal nodules with omental thickening are similar to ___ (e.g. 07:25, 30). Pelvic and inguinal lymph nodes are not\nenlarged by CT size criteria and are unchanged from ___, though\nthey are more prominent than on ___. Additionally, left para aortic\nsoft tissue at the bifurcation (7:7) is new compared to ___. The\nuterus is difficult to visualize.\n\nOther than at the right ischial tuberosity, no other osseous lesions\nsuspicious for infection or malignancy is identified. There is diffuse body\nwall edema.",
            "output": "1.  Interval decrease in size of the right gluteal abscess since ___ after drainage with persistent rim enhancing fluid collection.\n2.   1.5 cm rim enhancing lesion at the right ischial tuberosity and\nincreasing subjacent cortical irregularity at the right ischial tuberosity is\nconcerning for another small abscess with osteomyelitis. Given the short\ninterval progression, this is unlikely to represent a metastatic lesion.\n3.  Peritoneal and serosal nodules with omental thickening compatible with\nmetastatic disease. Interval increase in ascites.\n4.  Pelvic and left periaortic lymph nodes are more prominent than on ___, though pelvic nodes are not enlarged by CT size criteria, rasing the\npossibility of metastatic involvement.\n\nNOTIFICATION:  The updated findings were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 10:16 AM."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Mild subpleural fibrosis in the\nright middle and lower lobe may be due to prior radiation.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout.  The\nliver is slightly nodular with hypertrophy of the caudate lobe, more\npronounced than on ___, and increased subcapsular retraction and\ndelayed enhancement consistent with fibrosis, in keeping with known cirrhosis.\nThe findings have progressed since ___.  Mild peripheral intrahepatic\nbile duct dilation in the atrophied segment is likely related to the volume\nloss.  Elsewhere, there is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits, without stones or\ngallbladder wall thickening.\n\nSPLEEN:  The spleen is mildly enlarged to 14.5 cm. No focal splenic lesion is\nidentified.\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.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction.  There is large colonic fecal loading. Diverticula are\nseen in the sigmoid colon without inflammatory changes.  Nodular, serosal\nhyperenhancement along the rectum and sigmoid colon is more apparent than on ___, concerning for serosal implants.\n\nMESENTERY AND RETROPERITONEUM: Retroperitoneal lymphadenopathy has\nsignificantly progressed since ___. For example, a left para-aortic\nnodal conglomerate is 3.0 x 2.5 cm, previously 1.7 x 1.4 cm (4:66) in the\naxial plane. Numerous peritoneal deposits and omental caking are again noted\nas seen on prior pelvic CTs and have significantly progressed from ___, the largest measuring 3.9 x 2.0 cm in the right upper quadrant (e.g.\n4:70, 72, 84, 96, 100, 105). Moderate intra-abdominal ascites has increased\nfrom ___, similar to ___.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\n\nPELVIS:  Implants are noted on the bladder serosa (10:36), but the bladder is\notherwise unremarkable. Pelvic lymphadenopathy has worsened since ___\nand similar to ___. For example, a right pelvic sidewall\nconglomerate is 2.2 x 1.9 cm (4:97), previously 1.3 x 0.6 cm.  Left pelvic\nsidewall lymph nodes are also larger (4:101).  Free fluid in the pelvis is\ncontiguous with the abdomen. The uterus is not well visualized.\n\nBONES AND SOFT TISSUES: A drainage catheter is seen within the right gluteal\nsubcutaneous tissues with near complete resolution of the previously seen\nfluid collection, previously 7.4 x 3.7 cm, now 2.4 x 1.2 cm (4:109). A small\nrim enhancing fluid collection adjacent to the right ischial tuberosity with\nadjacent osseous destruction is 1.4 x 1.8 cm, previously 1.5 x 1.6 cm,\nunchanged, with slightly increased surrounding enhancement. No new osseous\nlesion is identified.",
            "output": "1.  Significant progression of metastatic disease in the abdomen and pelvis\nsince CT Torso ___ with peritoneal, omental and serosal implants.\n2. Near complete resolution of the right gluteal fluid collection with\ndrainage catheter in place. Stable tiny fluid collection with osseous\ndestruction of the right ischial tuberosity concerning for small abscess and\nosteomyelitis, unchanged from ___.\n3.  Progression of cirrhosis since ___ with mild splenomegaly. \nModerate ascites has increased from ___ and may be related to\ncirrhosis or malignant ascites given the serosal implants as above.  Patent\nmain portal vein.\n4.  CT Chest reported separately."
        },
        {
            "input": "There is trace left pleural effusion with dependent left lower lobe\natelectasis.  Heart size is normal. There is no pericardial effusion.\nEsophageal varices are again noted.\n\nThe liver is nodular, consistent with known history of cirrhosis and\ndemonstrates slightly heterogeneous enhancement without a focal lesion. The\nportal vein is patent. Mild periportal edema is noted. A 5 mm stone is seen\nwithin the gallbladder which is mildly distended. There is no gallbladder wall\nedema.  No intra or extrahepatic biliary duct dilatation is demonstrated.\n\nSplenomegaly is again noted, measuring approximately 16 cm. The pancreas and\nright adrenal gland are unremarkable. Slightly thickened left adrenal gland is\nagain seen without focal nodules.\n\nBoth kidneys are normal. There is no hydronephrosis. The bladder is normal.\n\nTortuous vasculature is noted in the anterior abdominal wall and perisplenic\nregion, and given history of cirrhosis and portal hypertension these are\nlikely venous collaterals.\n\nThe abdominal aorta is of normal caliber. Large amount of simple free fluid is\nalso seen in the abdomen and pelvis.\n\nThe stomach and bowel loops are normal without evidence of obstruction.\nPatient is status post partial colectomy with colorectal anastomosis. There is\nmild diverticulosis without evidence of diverticulitis.\n\nThere is no mesenteric, retroperitoneal, or pelvic sidewall lymphadenopathy.\n\nThere are no acute bony abnormalities are present. No concerning lytic or\nsclerotic osseous abnormalities.",
            "output": "1.  Known cirrhosis with findings of portal hypertension including\nsplenomegaly, esophageal varices as well as perisplenic and mesenteric\ncollaterals and large amount of ascites.\n2.  Small left pleural effusion.\n3.  Cholelithiasis without specific evidence of acute cholecystitis.\n4.  No acute traumatic injury identified within the abdomen or pelvis."
        },
        {
            "input": "CT abdomen:\n\nEvaluation of visceral organs is limited due to lack of intravenous contrast. \nThere is a small nonhemorrhagic left pleural effusion, slightly increased\nsince ___ exam. Adjacent compressive atelectasis is noted. Heart is\ntop-normal in size without pericardial effusion.\n\nThe liver demonstrates nodular contour compatible with known history of\ncirrhosis.  There is no evidence of intrahepatic biliary ductal dilatation.\nThe gallbladder is nondistended.  A gallstone is re- demonstrated.  The spleen\nremains enlarged measuring 21.2 cm.  Multiple perisplenic and mesenteric\nportosystemic collaterals are again noted.  The pancreas demonstrates\nhomogeneous attenuation.  The adrenal glands are unremarkable. The kidneys\ndemonstrate no evidence of hydronephrosis.\n\nVisualized small and large bowel loops are normal in caliber without evidence\nof bowel obstruction.  There is large amount of ascites, unchanged since\nprior. There is no evidence of intra-abdominal free air. Intra-abdominal aorta\nand is branches demonstrate calcified atherosclerotic disease without evidence\nof aneurysmal changes.  There is no evidence of retroperitoneal hematoma.\n\nCT pelvis: The bladder, rectum and sigmoid colon are unremarkable. Large\namount of free fluid is noted. There is no free air.  Intra-pelvic loops of\nsmall large bowel are unremarkable. There is no pelvic wall or inguinal\nlymphadenopathy. Vascular calcifications are present. Anasarca is noted.\n\nOsseous structures: No suspicious lytic or sclerotic lesion is seen.",
            "output": "1.  No evidence of retroperitoneal hematoma.\n2.  Known cirrhosis with large amount of ascites, splenomegaly and\nportosystemic collaterals.\n3.  Small nonhemorrhagic left pleural effusion, slightly increased since\n___.\n4.  Cholelithiasis without evidence of acute cholecystitis.\n\nNOTIFICATION:  Findings discussed with Dr. ___ at 5:20pm ___."
        },
        {
            "input": "LOWER CHEST:\nThere is moderate pleural effusion on the right, slightly increased in size\ncompared to prior. Adjacent compressive atelectasis the posterior right lung\nbase is noted.\n\nABDOMEN:\n\nGENERAL:  There is moderate-sized ascites, slightly increased compared to\nprior. There is no intra-abdominal free air.\nHEPATOBILIARY:  The liver contour is nodular, consistent with known history of\ncirrhosis. There is no biliary duct dilation.\nThe gallbladder contains single hyperdense gallstone.\nPANCREAS: Unremarkable.\nSPLEEN:  Splenomegaly.  Spleen measures 22.7 cm.\nADRENALS:  Unremarkable.\nURINARY: The kidneys are unremarkable.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.  Circumferential\nsurgical suture material is noted at the sigmoid colon.\nAppendix is unremarkable.\nLYMPH NODES: Enlarged gastrohepatic lymph nodes measuring upto 1.3cm (2:22)\nare likely reactive.  There are prominent retroperitoneal lymph nodes.\nVASCULAR:  There is portosystemic collaterals including perisplenic and\nmesenteric varices. Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder and prostate are unremarkable.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  Anasarca is again noted.",
            "output": "1.  No evidence of diverticulitis.\n2.  There is slightly increased amount of moderate ascites and right-sided\npleural effusion compared to ___.\n3. Liver cirrhosis, portosystemic collateralization, and splenomegaly.\nAnasarca."
        },
        {
            "input": "LOWER 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.  \nAgain demonstrated, is a 5.5 x 5.8 cm right hepatic lobe lesion previously\ndemonstrated hemangioma. Otherwise,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 demonstrates\nintraluminal high density material likely representing vicarious excretion of\nIV contrast from recent angiogram 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.  A small accessory spleen is visualized.\n\nADRENALS: There is a small right adrenal nodule which is stable and likely\nrepresents an adrenal adenoma.  Otherwise, the left adrenal gland is normal.\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.  There is a stable misty appearance of\nthe mesentery.\n\nPELVIS: The urinary bladder contains IV contrast from recent angiogram.  The\ndistal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains brachytherapy seeds. Otherwise,\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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the visualized thoracolumbar spine are\nnoted.\n\nSOFT TISSUES: There is stranding in the right inguinal soft tissues from\nrecent intervention.  No drainable fluid collections.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute abdominopelvic process within limitations of this\nnoncontrast study.\n2. Specifically, no evidence of retroperitoneal hematoma.  No evidence of\nabdominopelvic hematoma otherwise.\n3. Extensive atherosclerotic disease.\n4. Stable right adrenal gland nodule likely consistent with an 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: Trace bilateral pleural effusions, with subsegmental atelectatic\nchanges at both lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates normal contour and morphology.  There is\nslightly heterogeneous attenuation in the right lobe, secondary to a\nthrombosed peripheral branch of the right portal vein (06:37).  In addition,\nthere are branching tubular hypodensities within the cranial portions of\nsegments ___  of the liver, either representing thrombosed peripheral portal\nvenous branches, or mildly dilated segmental bile ducts (04:41).  There is a\n2.2 cm arterially enhancing lesion in segment ___ of of the liver (04:55) with\ncentral hypoattenuation, which remains indeterminate.  A 1 cm hypodensity in\nthe left lobe of the liver is too small to characterize, however likely\nrepresents a cyst/biliary hamartoma.  A CBD the stent has been inserted, in\nsatisfactory position.  There is no central biliary duct dilatation.\n\nSlightly irregular appearance of the gallbladder wall, which contains layering\nsludge/debris.  There is evidence of fundal adenomyosis.\n\nThere is ill-defined fat stranding/soft tissue infiltration at the hepatic\nhilum, without a measurable lesion.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 uncomplicated diverticulosis of the\nentire colon.  There 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.  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 patient has had recent left inguinal hernia repair, with\nSurgicel material still visible.  Small fat containing umbilical hernia.",
            "output": "1. Post ERCP with common bile duct stent in place, in satisfactory position.\n2. There is thrombosis of a peripheral branch of the right portal vein, as\nwell as ill-defined branching opacities in the left lobe of the liver, either\nrelated to thrombosed peripheral portal vein branches, or mild segmental\nbiliary dilatation.\n3. Ill-defined soft tissue infiltration/fat stranding along the hepatic hilum,\nwithout measurable lesion.  While a component of this may be related to recent\nERCP, an underlying lesion such as an infiltrative cholangiocarcinoma is of\nconcern, as majority of this finding was present prior to ERCP.\n4. No pancreatic or periampullary lesion.\n5. Hyperenhancing 2.2 cm lesion in the right lobe of the liver, with central\nhypoattenuation.  While this could represent a benign entity such as an FNH, a\nremains incompletely characterized on the current study.\n\nRECOMMENDATION(S):  Further evaluation of the above findings with MRCP is\nrecommended."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear aside from minimal basal\natelectasis.  The imaged heart is unremarkable.\n\nAbdomen: The liver enhances normally without focal concerning lesion.  Main\nportal vein is patent.  No biliary ductal dilation.  Gallbladder is normal\nwithout radiopaque gallstones.  The pancreas enhances normally without signs\nof inflammation or focal abnormality.  The spleen is normal.  The adrenals are\nnormal bilaterally.  The kidneys enhance symmetrically and excretion of\ncontrast is prompt and equal.  Duplication of the left renal collecting system\nis noted bilaterally.  No hydronephrosis or focal renal abnormality. \nIncidental note is made of left renal parapelvic cysts.  The abdominal aorta\nis normal in course and caliber.  A retroaortic left renal vein is noted.  No\nretroperitoneal or mesenteric adenopathy.  No free air or free fluid.  The\nstomach and duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. The\nappendix is normal.  The colon contains a mild fecal load.  Diverticulosis\nwithout diverticulitis noted.  The uterus and adnexal regions appear normal. \nNo free pelvic fluid.  The urinary bladder is mildly distended and appears\nnormal.  No pelvic sidewall or inguinal adenopathy is noted.\n\nBones: No worrisome lytic or blastic osseous lesion is seen. Bilateral pars\ndefects at L5 noted with grade 1 anterolisthesis of L5 on S1.  There is\nmoderate associated degenerative disc disease at L5-S1.",
            "output": "1. Diverticulosis without diverticulitis.\n2. Normal appendix.\n3. L5 spondylolysis with grade 1 anterolisthesis and moderate degenerative\ndisc disease at L5-S1.\n4. Duplicated bilateral renal collecting systems."
        },
        {
            "input": "LOWER CHEST: Bilateral dependent atelectasis.  1.6 cm left lower lobe\nthin-walled pneumatocele (5:2).  At the base of the lingula, there is\nperipheral subsegmental bronchial wall thickening with peribronchial\ninterstitial opacity, which may represent atelectasis/scarring versus active\ninflammatory small airways disease.\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: There is mild fatty replacement of the pancreatic parenchyma, most\npronounced in the head and uncinate process.  Main pancreatic duct is not\ndilated.\n\nSPLEEN: The spleen is normal in size without evidence for focal lesions on\nthis single phase 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 solid renal lesions or hydronephrosis.  There is a 4\nmm nonobstructive stone in the right mid kidney.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The duodenum does not cross the midline.  The small bowel is\nlocated entirely within the right sided abdomen with the majority of the colon\nin the left abdomen, along with abnormal position of the SMA and SMV,\nconsistent with congenital bowel malrotation.  There is no bowel obstruction. \nThere are no acute inflammatory changes involving the bowel.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium measures 9 mm (series 6, image 34).  No\ngross adnexal mass.\n\nLYMPH NODES: There is a 2.1 x 2.0 x 4.9 cm (TV by AP by CC) left para-aortic\nsoft tissue mass likely representing a nodal conglomerate.  A 1.2 x 1.2 x 2.4\ncm (TV by AP by CC) right para-aortic node is also noted.  Additional\nprominent retroperitoneal lymph nodes are also noted.  Multiple prominent\nmesenteric lymph nodes are noted.  Haziness in the periportal fat is likely\nsecondary to shotty lymph nodes.\n\nThere is a 5.5 x 6.1 x 5.5 cm (TV by AP by CC) soft tissue mass encasing the\nleft external iliac vein and artery (series 5, image 63) extending to the\ninguinal area (series 6, image 15), most likely representing a nodal\nconglomerate. There is a 0.9 cm round lymph node adjacent to the left common\nfemoral vein is seen on same day ultrasound.  No right pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Severe atherosclerotic\ndisease is noted. No IVC thrombus.  There is no flow in the left external\niliac vein which may be due to thrombus or external compression from the mass.\nThere is nonocclusive thrombus in the left common femoral vein and visualized\nproximal femoral vein (series 6, image 19). The left external iliac artery is\nalso encased by the mass, although patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.",
            "output": "1. 5.5 x 6.1 x 5.5 cm mass, probably nodal conglomerate, encasing left\nexternal iliac artery and vein, and extending to the inguinal region.  The\nleft external iliac vein is compressed at the level of the mass, with\nnonocclusive thrombus superior to the mass..  There is nonocclusive thrombus\nin the left common femoral vein and visualized proximal femoral vein. Left\nexternal iliac artery is patent.\n2. Additional nodal conglomerate in the retroperitoneum.  Probable shotty\nlymphadenopathy in the periportal region.  Prominent mesenteric and left\ninguinal lymph nodes.  Overall findings are highly suspicious for a neoplastic\nprocess including lymphoma.\n3. No IVC thrombus.\n4. Thickened endometrium for patient's age.\n5. Malrotation of the small and large bowel.  No bowel obstruction\n\nRECOMMENDATION(S):\n1. Tissue diagnosis of the left external iliac/inguinal mass.\n2. Outpatient pelvic ultrasound for better assessment of the endometrium.\n3. Outpatient surgical consultation regarding the patient's malrotation, if\nnot previously performed.\n\nNOTIFICATION:  Electronic preliminary report was provided by Dr. ___\non FRI ___ 9:13 AM."
        },
        {
            "input": "PELVIS: There is a contrast filled bladder containing a Foley catheter. \nContrast material and extraluminal gas is seen extending from the left side of\nthe bladder dome tracking along the left retroperitoneum, posterior to the\ndescending colon, compatible with extraperitoneal bladder rupture (series 2A:\nImage 25).  In particular, contrast is noted to be tracking in underneath the\nperitoneal lining on the sagittal images (series 602B: Image 43).\n\nThe partially visualized small and large bowel are collapsed.  A 5.3 cm cystic\nlesion is partially noted in the left kidney, incompletely evaluated on this\nexam.  Small amount of free pelvic fluid is noted in the deep pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is resected.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen along the lumbosacral spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extraperitoneal bladder rupture with contrast material seen extending along\nthe left retroperitoneal space.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 3:33 am, 1 minutes after discovery of\nthe findings.\n\nThe findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 9:47 am, 10 minutes after discussion of the\nfindings with attending radiologist and update of the final read."
        },
        {
            "input": "GASTROINTESTINAL: Visualized small bowel loops demonstrate normal caliber and\nwall thickness throughout.  Visualized portions of the colon and rectum are\nwithin normal limits.  The appendix is normal.\n\nPELVIS: Foley catheter tip terminates in the membranous portion of the urethra\nwith no inflation of the balloon.  Debris and/or hemorrhage is noted along the\ndependent wall of the bladder.  A small pocket of heterogeneous fluid is noted\ntracking up from the bladder along the left pelvic sidewall, and along the\ninferior left flank, improved from prior exam.  Air in the anterior portion of\nthe bladder is likely due to Foley catheterization.  There has been an\ninterval decrease in free fluid in the pelvis with small amount of fluid\nremaining at midline and adjacent to the cecum in the right lower quadrant.\n\nREPRODUCTIVE ORGANS: Patient is 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.  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. Foley catheter terminates in the membranous urethra without inflation of\nballoon and may benefit from repositioning.\n2. Interval improvement of pelvic sidewall and left flank retroperitoneal\nfluid.  Decrease in free fluid in the pelvis with small residual free fluid at\nthe midline and adjacent to the cecum in the right lower quadrant.  No\nevidence of urinoma.\n\nRECOMMENDATION(S):  Consider repositioning of Foley catheter, which terminates\nin the membranous urethra.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:53 am, 45 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: 4 mm perifissural sub solid opacity in the left lingular region,\nlikely represents atelectasis or an intraparenchymal lymph node.  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: Fatty infiltration of the uncinate process (02:36), unchanged from\nprior CT studies done ___ and ___.  The pancreas otherwise 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 spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia, similar compared to most recent\nprior but increased in size from ___.  Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. The colon and rectum\nare within normal limits. The appendix is not visualized, but no secondary\nsigns of appendicitis 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the thoracolumbar spine, with grade 1\nanterolisthesis of L4 on L5. Overall, similar in appearance from ___.\n\nSOFT TISSUES: Note is made of 2 cm injection granuloma in the right buttock\n(02:43).",
            "output": "1. Moderate hiatal hernia similar compared to most recent prior, but increased\nin size from ___.\n2. No acute intra-abdominal or intrapelvic process process."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  A 4 mm left lower lobe nodule is\nunchanged from prior (series 2:20).  Subsegmental atelectasis 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 is within normal limits.\n\nPANCREAS: Fatty infiltration of the uncinate process is unchanged from prior\nstudies dating back to ___.  The pancreas otherwise has normal attenuation\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: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Large hiatal hernia small bowel loops demonstrate normal\ncaliber and wall thickness throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding.\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. \nModerate degenerative change in the visualized thoracolumbar spine is overall\nunchanged, including grade 1 anterolisthesis of L4 on L5\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  A 1.4 cm\neggshell calcified structure in the right gluteal region likely represents an\ninjection granuloma or sequela of prior trauma.",
            "output": "1. No acute process within the abdomen or pelvis.\n2. Moderate dorsal spondylosis, overall unchanged from prior study in\n___.  No acute 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 unenhanced liver demonstrates homogenous attenuation\nthroughout.  Multiple re- demonstrated hypodensities within the liver, which\nappear grossly unchanged from ___.  There is no evidence of intrahepatic or\nextrahepatic 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 is fatty replaced throughout, without evidence of focal\nlesions or pancreatic ductal dilatation.\n\nADRENALS:  The right and left adrenal glands are normal.\n\nURINARY: Enhanced kidneys are unremarkable without evidence of calculus.\nPeripelvic cysts are seen, bilaterally.\n\nGASTROINTESTINAL:  Patient is status post sigmoidectomy. The site of\nanastomosis appears patent and there is no evidence of contrast leakage.\nAppendix contains 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:  There is no abdominal aortic aneurysm.  There is minimal calcium\nburden seen within a normal caliber aorta. The main portal vein, splenic vein\nand SMV are patent.\n\nPELVIS: Pelvic structures are obscured by beam hardening artifact from\nbilateral hip arthroplasties.\n\nBONES AND SOFT TISSUES:  Interval improvement of the inflammatory changes seen\nwithin the anterior abdominal wall. There is mild anterolisthesis of L3 on L4\ndue to degenerative changes. Degenerative changes are noted without suspicious\nosseous lesions.  Bilateral hip arthroplasties are noted.",
            "output": "1.  No acute intra-abdominal process.  No findings to explain the patient's\nsymptoms.\n\n2.  Interval improvement of the inflammatory changes seen within the anterior\nabdominal wall in comparison 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. \nMultiple subcentimeter hypoenhancing lesions in the liver are too small to\ncharacterize but statistically likely reflects cysts or hamartomas.  A single\nhypoenhancing lesion in segment 5 measures 1.3 cm (02:34).  This is\nindeterminate in appearance on CT imaging but unchanged compared to multiple\nprior studies dating back to ___ consistent with a benign etiology.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas demonstrates atrophic changes 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. \nBilateral cortical renal hypodensities measure up to 0.8 cm and similar in\nappearance to the prior study, likely representative of benign entities. \nBilateral parapelvic cysts are unchanged.  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 patient is\nstatus post left and transverse hemicolectomy, with contrast passing to the\nrectum.  There is a tortuous course of the postsurgical distal colon/rectum,\nhowever this does not appear significantly changed from the prior CT from\n___.  Multiple areas of focal thickening without obstruction or\ndemonstrated (series 2 image 66, 67).  At 1 anastomosis there is marked\nnarrowing of the lumen, this may be exaggerated by peristalsis but correlation\nwith endoscopy is recommended (2:67).  The appendix is normal.\n\nPELVIS: Metal artifact from bilateral total hip arthroplasty partially\nobscures views of the urinary bladder and distal ureters, which appear overall\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are not well\nvisualized secondary to overlying artifact.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAn old rib fracture is demonstrated at the lateral aspect of the right eighth\nrib.  Bilateral total hip arthroplasties are demonstrated without evidence of\nperihardware complication.\n\nSOFT TISSUES: There is a small fat containing right inguinal hernia.",
            "output": "1. The patient is status post left hemicolectomy and transverse colectomy,\nwith contrast passing to the rectum.  There is narrowing with mild mural\nthickening of focal segments of the distal postsurgical colon.  No evidence of\nobstruction.  Recommend correlation with endoscopy.\n2. There is a tortuous course of the postsurgical distal colon/rectum, however\nthis does not appear significantly changed from the prior CT from ___.  No evidence of diverticulitis.\n\nRECOMMENDATION(S):\nCorrelation with lower endoscopy."
        },
        {
            "input": "LOWER 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 mildly distended, with\nlayering hyperdensity, which could reflect hyperdense sludge, tiny gallstones,\nor vicarious excretion of previously administered 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 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. The colon and\nrectum are within normal limits.\n\nPELVIS: A Foley catheter is seen within the bladder.  Air within the bladder\nis secondary to instrumentation.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not well visualized.  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.  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 abdominopelvic malignancy.\n2. Please refer to the separate report of the chest CT performed on the same\nday for thoracic characterization."
        },
        {
            "input": "LOWER CHEST:  Trace nonhemorrhagic pleural effusions with adjacent\natelectasis.  Heart size is normal, and 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 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 3.5 cm\nsimple cyst in the interpolar region of the right kidney.  A 1 mm stone is\nseen in the interpolar region of the left kidney (601b:37).  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.  A few scattered diverticuli are\nseen in the ascending colon (601b:35), without evidence of diverticulitis. \nColon and rectum are otherwise within normal limits.  Appendix is not\nvisualized, but there are no secondary signs of appendicitis.  No free fluid\nor free air within the abdomen.\n\nPELVIS: Bladder is well distended.  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. No atherosclerotic disease is\nnoted.\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.\n2.  Non-obstructing 1 mm left midpole renal stone."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The portal and hepatic veins\nare patent.  There is some narrowing of the portal vein as it approaches the\nconfluence, worsened compared to the prior study (series 3, image 44). \nHowever, the portal vein remains patent.  There is also mild narrowing of the\nSMV near the confluence.  There is no evidence of pseudoaneurysm or vessel\nocclusion.\n\nLOWER CHEST: The lung bases are clear. The visualized heart and pericardium\nare unremarkable.\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: Multiple homogeneous fluid collections are present along the\npancreas and superior to the pancreas, consistent with pseudocysts.  The\nlargest collection is along the pancreatic body measuring 9.9 x 2.5 cm (series\n3, image 39).  Enhancing pancreatic parenchyma is also present.  The\nvisualized 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.\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 is not visualized. There is no evidence of mesenteric\nlymphadenopathy.  Increased density and slight nodularity of the omentum\nanteriorly may represent the sequela of pancreatitis.  A small amount of\nperisplenic fluid is present.\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. A small amount of free fluid\nis present in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is normal in size.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Evolution of pancreatitis with multiple pancreatic and peripancreatic\ncollections with resultant  narrowing of the portal vein at the confluence. \nAlthough these collections have the appearance of pseudocysts, given the\nfindings of acute necrotizing pancreatitis on the prior study, these\ncollections would be classified as walled off necrosis based on the ___\nclassification."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 focal renal lesions 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 previously described left adnexal cyst is now multiloculated and\nenhancing in appearance with adjacent fat stranding (series 2: Image 59).  In\naddition, the surrounding descending colon and sigmoid colon is thickened,\nmost likely secondary to the surrounding inflammatory process.  The urinary\nbladder and distal ureters are unremarkable.  There is a hypoattenuating 1.4\ncm cyst in the region of the urethra (series 2: Image 79).  There is trace\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.  The right ovary\nis 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.  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. Inflammatory changes now seen in association with the previously identified\ncystic left adnexal structure.  Findings raise concern for tubo-ovarian\nabscess.  There is most likely secondary inflammation of the adjacent colon\ngiven proximity.  Though not excluded, this is less likely a primary colonic\nsource of inflammation with secondary abscess formation.\n2. Cystic structure in the region of the urethra, potentially ureteral cyst\nversus a vaginal 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 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 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. 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: Patient is status post TAH.  The right ovary is normal. \nThere is a cystic left ovarian mass measuring 5.3 x 4.8 cm with layering dense\ncomponents consistent with hemorrhagic cyst seen on same-day pelvic\nultrasound.\n\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 adnexal cyst measuring up to 5.3 cm consistent with hemorrhagic cyst\nseen on same-day pelvic ultrasound.\n2. No findings of abscess, diverticulitis, or nephrolithiasis demonstrated."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 hypodensities measuring up to 5 mm in segment 8 (05:12) are\nincompletely characterized, but likely represent hepatic cysts or biliary\nhamartomas.  There is mild central pneumobilia, likely related to recent ERCP\nand stent placement.  A biliary stent appears to be in appropriate position\nterminating in second portion of the duodenum.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is minimally\ndistended and contains small amount of air, likely related to recent\nprocedure.  No stones are visualized.  There is mild circumferential\ngallbladder 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. \nA subcentimeter hypodensity in the right interpolar kidney is too small to\ncharacterize, but statistically likely represents 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.  There is no\nextraluminal extravasation of contrast.  There is no evidence of perforation. \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 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.  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. Mild nonspecific gallbladder wall edema.  Consider ultrasound if there is\npersistent concern for acute cholecystitis.\n2. Patient is status post ERCP with biliary stent placement, which appears to\nbe in appropriate position.\n3. 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with oral contrast and food bolus. \nCircumferential thickening of the distal antrum or pylorus, which may\nrepresent spasticity.  small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding. The appendix is\nnot visualized, but 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 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.  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.",
            "output": "1. Apparent circumferential thickening of the distal antrum or pylorus, which\nmay represent spasticity, may be related to gastric distention.\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 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: There are duplex collecting systems bilaterally.  Patient is status\npost left percutaneous nephrostomy tube, which appears in appropriate\npositioning.  There is no hydronephrosis bilaterally.  No evidence for\ncollection, including flank abscess.  The ureter is mildly prominent on the\nleft with haziness around the proximal portion.  There is a 6 mm left UVJ\nstone, as seen on the prior CT scan from ___.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is\ndiverticulosis without diverticulitis.  Otherwise, the colon and rectum are\nwithin normal limits. The appendix is not visualized.\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: There 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 left percutaneous nephrostomy tube without evidence for abscess\nformation.  There is resolution of the previously seen hydronephrosis.\n2. Persistent 6 mm left UVJ stone with mild prominence and haziness of the\nproximal left ureter."
        },
        {
            "input": "LOWER 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: There is left percutaneous nephrostomy tube with its pigtail in the\nleft renal pelvis.  There is mild stranding of the proximal left ureter.  The\nkidneys are of normal and symmetric size.  There is no suspicious 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. Diverticulosis of the colon is\nnoted, without evidence of wall thickening or fat stranding. The appendix is\nnot visualized.\n\nPELVIS: The previously noted left ureterovesicular stone is no longer present.\nTrace air in the bladder, suggesting sequela of recent instrumentation.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "The previously noted stone at the left ureterovesicular junction is no longer\npresent.  There are no new radiopaque urinary stones."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 concerning focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  There is a tiny right\nhepatic lobe hypodensity which too small to characterize by CT but\nstatistically is almost certainly benign.  The gallbladder is almost\ncompletely decompressed (series 601, image 13).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left 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 renal cortical cysts measure up to 2.6\ncm and are benign appearing.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Normal stomach and small bowel.  No bowel obstruction.  No\nascites.  The colon and rectum are within normal limits.  The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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 an old fracture through spinous process of the S1 vertebral\nbody.  No acute osseous findings.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic findings.  No biliary dilatation or evidence of\npancreatic mass."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  129 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare no diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is not visualized.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nProstate is normal\n\nSKELETAL:\nThere is no evidence of worrisome lesions in the abdomen pelvis.",
            "output": "1. Normal CT of the abdomen 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 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.  It has enlarged, measuring 14.5 cm, previously\n13.5 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.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  Known\nhypodensity in the left lower renal pole is not identified without IV\ncontrast.  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 in caliber with fluid within much of the colon but no wall\nthickening.  The appendix 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.  No CT findings to explain the patient's fever.  Small and large bowel are\nnormal in caliber and while the colon is fluid-filled there is no wall\nthickening or obstruction.  No fluid collections identified.\n\n2.  Progressing splenomegaly.\n\n3.  Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  Specifically, the deep inferior\nepigastric vessels are widely patent.\n\nLOWER CHEST:  There is a 2 mm subpleural nodule at the right base (7:11). \nMinimal left basilar atelectasis or scarring.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse hypoattenuation of the hepatic parenchyma is consistent\nwith hepatic steatosis. There are no concerning liver lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary ductal dilatation.  The\ngallbladder is contracted and contains a large gallstone.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 extrarenal pelvises. There is no evidence of stones, focal renal\nlesions, 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.\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 bilateral adnexa are normal.\n\nBONES:  There is moderate convex levoscoliosis centered at the upper lumbar\nspine.  There is mild degenerative change at the symphysis pubis.  There are\nno lytic or sclerotic lesions concerning for malignancy.  There is no acute\nfracture.\n\nSOFT TISSUES:  There is a small fat containing umbilical hernia (5:45) with\nmild diastasis recti.  Otherwise, the abdominal and pelvic wall are within\nnormal limits.",
            "output": "1. Widely patent deep inferior epigastric vessels.  Rectus abdominis muscles\ndemonstrate adequate bulk bilaterally without fatty atrophy.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n3. Cholelithiasis within a contracted gallbladder."
        },
        {
            "input": "LOWER CHEST: For supradiaphragmatic findings, please see report from dedicated\nCT of the chest from same date.\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.\nAgain noted is a multi lobed right parapelvic cyst, unchanged since the prior\nexaminations.  A smaller simple cyst is also seen in the interpolar region of\nthe right kidney. No suspicious focal renal lesions are identified. 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 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 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. No CT findings suspicious for  malignancy in the abdomen or pelvis.\n2. Stable right renal parapelvic cyst."
        },
        {
            "input": "VASCULAR: No evidence of active extravasation or pseudoaneurysm formation. \nAdjacent to the walled-off necrosis described in further detail below, the\nsplenic artery, common hepatic artery, superior mesenteric artery, splenic\nvein, superior mesenteric vein, and inferior mesenteric vein are patent. \nThere is, however, focal attenuation of the superior mesenteric vein and mid\nsplenic vein adjacent to the walled-off necrosis (series 12, image 62).  No\nabdominal aortic aneurysm.  Mild to moderate atherosclerosis.\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 is resected.\n\nPANCREAS: There is evidence of necrotizing pancreatitis with replacement of\nmost of the pancreatic parenchyma by walled-off necrosis now status-post cyst\ngastrostomy.  Few islands of enhancing pancreatic parenchyma demonstrate\nunchanged punctate and coarse calcifications, most prominent in the pancreatic\nhead.  The dominant portion of the walled-off necrosis measures up to 12.0 x\n5.7 cm, previously 12.2 x 5.6 cm.  This dominant portion appears to\ncommunicate inferomedially with another portion of walled-off necrosis\nmeasuring 3.7 x 3.4 cm, previously 3.5 x 3.3 cm.  There is no evidence of\nhematoma formation.  There is no evidence of active extravasation or\npseudoaneurysm 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 normal and symmetric in size and nephrogram.  Right\nrenal cysts characterized on prior CT as simple fluid in attenuation are\nunchanged, measuring up to 7.6 cm, 3.6 cm, 3.3 cm (series 7, images 90, 91,\nand 100).  No hydronephrosis or nephrolithiasis.\n\nGASTROINTESTINAL: There is diffuse wall thickening of the lesser\ncurvature/inferior stomach and first through proximal third portions of the\nduodenum, adjacent to the walled-off necrosis, not significantly changed\ncompared to the prior examination.  Is also a segment of colonic wall\nthickening at the splenic flexure abutting the dominant portion of the\nwalled-off necrosis, not significantly changed compared to prior examination. \nSmall bowel loops otherwise are normal in caliber and wall thickness.  There\nis extensive sigmoid and descending colon diverticulosis without focal wall\nthickening or adjacent fat stranding.  The appendix is normal.  Colon and\nrectum are within normal limits.  A 1.4 cm portal caval lymph node is\nunchanged (series 12, image 68).  Retroperitoneal lymph nodes are otherwise\nsubcentimeter in size.\n\n\nPELVIS: There is a Foley catheter.  The bladder is decompressed with few\nlocules of intraluminal gas.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatomegaly.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small, fat containing ventral hernias.",
            "output": "1. No evidence of hematoma, active extravasation, or pseudoaneurysm formation.\n2. Pancreatic walled-off necrosis status-post cyst gastrostomy appears\nunchanged compared to 2 days prior.  Inflammation of the adjacent stomach,\nduodenum, and: Appears unchanged.  Reactive lymphadenopathy is unchanged. \nAttenuation of the adjacent superior mesenteric and splenic veins is\nunchanged.\n3. Extensive diverticulosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:25 am, approximately 30\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 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 is atrophic with multiple foci of calcifications within\nthe pancreatic head, uncinate process, body, and tail, consistent with chronic\npancreatitis.  The previously seen walled-off necrosis are no longer\nvisualized and there has been interval removal of the cyst gastrostomy tube.\n\nWithin the anterior aspect of the pancreatic head, there is a 1.2 x 1.1 x 2.1\ncm rounded region of hypodensity (series 2, image 38 and series 300, image\n30), not seen on prior contrast CT, which may represent a small pancreatic\npseudocyst or other new cystic lesion.  Of note, there was a similarly\nreported finding within the pancreas on outside hospital CT performed on ___ at ___, however, the images are not\navailable for comparison.  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. \nRedemonstration of several right-sided exophytic simple renal cysts, with the\nlargest located in the lower pole and measuring up to 8.3 cm, previously 7.6\ncm.  Again seen is mild perinephric stranding around the bilateral kidneys. \nThere is no evidence of focal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: There has been interval removal of cyst gastrostomy tube. \nThe stomach is unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. Diverticulosis of the entire colon\nis noted, without evidence of wall thickening and fat stranding. The appendix\nis normal.\n\nPELVIS: The urinary bladder is unremarkable.  There is no free fluid in the\npelvis.  Redemonstration of a dropped clip within 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 is no evidence of worrisome osseous lesions or acute fracture. \nRedemonstration of bilateral L5 spondylolysis with grade 1 L5 on S1\nspondylolisthesis.\n\nSOFT TISSUES: Redemonstration of a small fat containing ventral hernia (Series\n2, image 31).",
            "output": "1. Atrophic pancreas with multiple foci of parenchymal calcification,\nconsistent with chronic pancreatitis.  The previously seen peripancreatic\nfluid collections are not visualized on current exam.\n2. New 1.2 x 1.1 x 2.1 cm region of hypodensity within the pancreatic head,\nwhich may represent a small pseudocyst or other new cystic pancreatic lesion.\n\nRECOMMENDATION(S):  Recommend MRCP for further evaluation of the new cystic\nstructure located at the pancreatic head."
        },
        {
            "input": "LOWER CHEST: Imaged lung fields show no consolidation.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver has homogeneous attenuation.  No biliary ductal\ndilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas body and tail are atrophic and scattered calcifications\nare again seen, likely reflecting sequela of chronic pancreatitis, similar to\nthe previous study.  A cyst in the head of the pancreas measuring 12 mm is\nsimilar in size compared to the previous MRI most recent CT (03:35).  There is\nno pancreatic ductal dilatation.  Minimal stranding is noted around the head,\noverall similar to the previous study.\n\nSPLEEN: The spleen is not enlarged.  No focal lesions.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Again seen are several cysts in the right kidney, the largest in the\nlower pole measuring up to 8.3 cm (3: 53).\n\nGASTROINTESTINAL:\n\nPELVIS: The urinary bladder is moderately distended.  The distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is mildly enlarged.  The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There is no lymphadenopathy in the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ncalcifications is noted.\n\nBONES: Mild compression deformity of the L5 vertebral body is largely\nunchanged.  Multilevel degenerative changes are again noted with grade 1\nanterolisthesis of L5 over S1.  Otherwise, there are no worrisome lesions or\nacute fractures.\n\nSOFT TISSUES: The soft tissues are unremarkable.",
            "output": "Sequela of chronic pancreatitis with largely unchanged cystic focus in the\npancreatic head measuring up to 12 mm."
        },
        {
            "input": "ABDOMEN:\nLack of IV contrast limits evaluation, especially of the solid visceral organs\nand vascular structures.\n\nLUNG BASES:\n\nUnremarkable.\n\nHEPATOBILIARY: Unremarkable.\n\nGALLBLADDER: Tiny gallstone.  No gallbladder wall thickening.\n\nPANCREAS: Unremarkable.\n\nSPLEEN: Unremarkable.\n\nKIDNEYS: There is mild fullness of the left renal collecting system versus\nparapelvic cysts.  Mild fullness of the right renal renal pelvis.  No renal\ncalculi.  No hydroureter.  Question punctate 1 mm calculus in the distal\naspect right ureter (series 2, image 59), versus artifact.\n\nADRENALS: Unremarkable\n\nVASCULAR: Normal caliber aorta with moderate aortoiliac calcific plaque.  IVC\ngrossly unremarkable.\n\nNODES: None pathologically enlarged.\n\nGASTROINTESTINAL: There is borderline thickening of the appendix,\napproximately 8 mm, with very minimal adjacent fatty stranding (series 601b,\nimage 31).  Terminal ileum unremarkable.  Sutures at the sigmoid rectal\njunction appears unremarkable.  There are multiple sigmoid diverticuli,\nwithout acute inflammation.\n\nSmall hiatal hernia.  Apparent wall thickening of the gastric antrum and\ngastroduodenal junction, although difficult to confirm due to under\ndistention.  A single short loop of small bowel in the left upper quadrant\nthat is slightly distended without air-fluid level, probable normal or mild\nileus.\n\nPELVIS:\n\nFREE FLUID: None.\n\nGENITOURINARY: Bladder is grossly unremarkable.  Prostatomegaly.\n\nADDITIONAL FINDINGS: \n\nPeriumbilical stranding, likely postsurgical.\n\nBONES: Moderate degenerative changes lumbar spine",
            "output": "Borderline thickening of the appendix with possible minimal adjacent fatty\nstranding.  Findings are equivocal for acute appendicitis.  Correlate with\npatient's symptoms.\n\nApparent wall thickening of the gastric antrum and gastroduodenal junction,\nalthough could in part be due to underdistention.  Correlate with patient's\nsymptoms and with endoscopy if clinically indicated.  Small hiatal hernia.\n\nSigmoid diverticulosis, without acute inflammation.\n\nMinimal cholelithiasis.\n\nMild fullness of the left renal collecting system versus parapelvic cysts. \nMild fullness right renal pelvis.  Question punctate 1 mm calculus distal\nright ureter.\n\nProstatomegaly\n\nDiscussed with Dr. ___ on ___ at 15:52"
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nLIVER:  The liver is normal in size. There is no evidence of intra or\nextrahepatic biliary ductal dilatation.\n\nGALLBLADDER: The patient is status post cholecystectomy with clips in the\ngallbladder fossa.\n\nSPLEEN: The spleen is normal in size.  A 2 mm punctate calcification within\nthe spleen is most likely related to prior granulomatous disease.\n\nPANCREAS: The pancreas is normal appearing with no evidence of peripancreatic\nfat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS:  The kidneys show no evidence of hydronephrosis or suspicious mass\nlesion.  There is a 2.9 x 2.8 cm simple cyst arising from the upper pole of\nthe left kidney.  The ureters are normal and symmetrical in their course to\nthe bladder.\n\nBOWEL:  There is a small hiatal hernia. The stomach is grossly normal. There\nis mild circumferential bowel wall thickening involving the terminal and\ndistal ileum as well as diffusely involving the entire colon with sparing of\nthe rectum. There is an additional area of circumferential small bowel wall\nthickening adjacent to a site of prior end-to-side anastomosis in the right\nlower quadrant (2: 49). Additionally, there is very minimal stranding adjacent\nto the thickened bowel wall.  Scattered diverticula are noted within the\ncolon. No evidence of bowel obstruction.\n\nVESSELS: The abdominal aorta is not aneurysmal.\n\nLYMPH NODES: Note is made of few prominent lymph nodes centered in the right\nlower quadrant seen best on the coronal view (series 601b, image 30), likely\nreactive. There are no pathologically enlarged retroperitoneal or mesenteric\nlymph nodes by CT size criteria.\n\nPELVIS: The bladder is unremarkable. The rectum are normal appearing. There is\nno pelvic sidewall lymphadenopathy\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. Mild circumferential bowel wall thickening involving the terminal and\ndistal ileum as well as involving the entire colon as well as an additional\nsegment of small bowel in the right lower quadrant adjacent to an anastomosis.\nFindings are consistent with mild enterocolitis, possibly infectious or\ninflammatory in etiology.\n2. Intravenous contrast extravasation as described.\n\nNOTIFICATION:   Information regarding the contrast extravasation were\ncommunicated to Dr. ___ at 18:50 via telephone on ___ by Dr.\n___.\n\nUpdated findings were communicated to Dr. ___ telephone at 20:20 on\n___ by Dr. ___."
        },
        {
            "input": "Findings are limited by the lack of IV contrast.\n\nLower Thorax: Please see CT scan of the chest from same day for further\ndetails.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\n\nLiver: The liver is grossly normal with no focal lesion.\n\nGallbladder and Biliary System: The patient is status post\ncholecystectomy.There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: There is splenosis, as previously described (03:57 ).\n\nKidneys and Adrenals:  The right kidney and adrenal gland have been surgically\nremoved with multiple clips in the right retroperitoneum. There is no evidence\nof local adjacent recurrence.\n\nBowel: There is unchanged malrotation within the third and fourth stages of\nduodenum not crossing midline. The cecum is seen on the right in the midline\nwith the majority of the small bowel loops seen lateral to the cecum and\nterminal ileum.  There is no evidence of bowel obstruction.\n\nPelvis: The urinary bladder is unremarkable. The uterus and ovaries have been\nsurgically removed.\n\nLymph Nodes: There is no significant mesenteric, pelvic, inguinal or\nretroperitoneal lymphadenopathy.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "No evidence of metastatic renal cell carcinoma or local recurrence on this\nnoncontrast examination."
        },
        {
            "input": "A small right pleural effusion with adjacent atelectasis is noted. The\nvisualized lung bases are otherwise clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.  There is azygos continuation of\nthe inferior vena cava.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.  The\nliver is diffusely fatty without focal suspicious lesion.  Annular pancreas is\nnoted, better assessed on prior contrast enhanced CT examinations. The left\nadrenal gland is thickened without focal suspicious lesion. Within the left\nkidney, there is a 1.5 cm hypodense lesion within the interpolar region\n(3:38), incompletely characterized and slightly increased in size as compared\nto ___. A second, sub cm hypodensity within left kidney is too small the\ncharacterize but stable from prior examination.\n\nThe patient is status post cholecystectomy. Splenosis is again noted,\nunchanged from prior examination. The patient is status post radical right\nnephrectomy and adrenalectomy, with multiple surgical clips noted along the\nsurgical bed. There is no soft tissue mass within the right nephrectomy bed to\nsuggest local recurrence.\n\nThe patient is status post right subcostal hernia repair, with expected\npostsurgical changes, subcutaneous foci of air, and a subcutaneous drain noted\nalong the right flank. There is no organized fluid collection identified.\nRedemonstrated is malrotation, with the third and fourth portions of the\nduodenum failing to cross the midline. The cecum is again noted on in the mid\nright abdomen with the majority of small bowel loops identified lateral to\nthis point. The stomach, small bowel, and large bowel are without dilation or\nwall thickening.  However, there is apparent focal pneumatosis involving the\ncecum (06:19), which may be postsurgical in nature although early ischemia\ncannot be excluded. There is no overt retroperitoneal lymphadenopathy by CT\nsize criteria. There is no free abdominal fluid or pneumoperitoneum. The aorta\nand its major branches contain calcifications.\n\nPELVIS:\n\nThe urinary bladder is distended but otherwise unremarkable. The sigmoid colon\nand rectum are grossly unremarkable. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nthroughout the visualized thoracolumbar spine. No focal lytic or sclerotic\nlesion concerning for malignancy.",
            "output": "1. Focal pneumatosis of the cecum, which may be postsurgical in nature or\nrelated to early ischemia. No evidence of portal venous gas, pneumoperitoneum,\nbowel obstruction, or free intra-abdominal fluid.\n2. Status post right subcostal hernia repair with postsurgical changes and a\nsubcutaneous drain noted along the right flank. No organized fluid collection\nis identified.\n3.  1.5 cm hypodensity within the interpolar region of the left kidney, mildly\nincreased in size as compared to ___ and incompletely characterized on\nthis non-enhanced examination. Recommend contrast-enhanced MRI for further\nevaluation.\n4. Annular pancreas and small bowel malrotation, unchanged appearance from\nprior examinations.\n\nNOTIFICATION:  Findings were conveyed by Dr. ___ to Dr. ___\n___ pager at 09:40 on ___."
        },
        {
            "input": "CHEST:\n\nThere is a triangular 2 mm subpleural pulmonary nodule in the left lower lobe,\nconsistent with an intrapulmonary lymph node (2:4).  The lower chest is\notherwise unremarkable.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion. The\npatient is status post cholecystectomy.  The biliary tree is normal. The\npancreas is normal, without focal lesion or duct dilation. The spleen is\nnormal in size, without focal lesion. The adrenal glands are normal. The\nkidneys enhance normally and excrete contrast briskly. There are no solid\nrenal lesions or hydronephrosis. The stomach and duodenum are normal.\n\nThe small bowel and large bowel are normal in caliber, without wall thickening\nor mass. Acute angulation of the small bowel in close proximity to the uterus\nsuggestive of adhesions secondary to tubal ligation (602b:40). The appendix is\nair-filled and normal.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The uterus is normal in size and\nenhancement. No adnexal abnormality bilaterally.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "No acute abdominal or pelvic process to explain patient's symptoms."
        },
        {
            "input": "VASCULAR:\nNo abdominal aortic aneurysm.  There is severe calcium burden in the abdominal\naorta and great abdominal arteries with calcified and noncalcified plaque. \nBilateral single renal arteries are patent.  The celiac axis, SMA and major\nbranches are patent.  The splenic artery is patent.  The IMV is prominent and\ntortuous, similar to the prior exam.\n\nThere is active extravasation of intravenous contrast in the transverse colon\n(series 604B, image ___.\n\nLOWER CHEST:  The visualized lower lungs and airways are clear.  No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence 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.  An accessory splenule is at the hilum (series\n604b, image 60).\n\nADRENALS: The 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, concerning focal renal lesions, or hydronephrosis.  An\n1-cm left upper renal pole fluid attenuation, nonenhancing well-circumscribed\nround lesion is consistent with a simple cyst, unchanged (series 604b, image\n77).  Other smaller renal cortical are seen bilaterally.  There are no\nurothelial lesions in the kidneys or ureters.  No perinephric abnormality.\n\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is active extravasation of intravenous\ncontrast in the transverse colon (series 604B, image ___.  There is diffuse\ndiverticulosis.  A moderate sized right inguinal hernia contains a loop of\nbowel without evidence of incarceration or strangulation (series 604b, image\n31).  Colonic bowel wall enhances normally.  The rectum within normal limits. \nCalcified mesenteric lymph nodes in the right mid abdomen are unchanged\n(series 2, image 36; series 604b, image 43).  No evidence of mesenteric\nlymphadenopathy.  No free air or bowel 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 prostate is enlarged, similar to the prior exam.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture. \nMulti-level degenerative changes in the visualized lower thoracic spine as\nwell as lumbosacral spine are moderate to severe with loss of intervertebral\ndisc height, vacuum phenomenon, Schmorl's nodes, and anterior posterior\nosteophytes.  Degenerative changes are most prominent at L1-L2, L4-L5, and\nL5-S1.  Mild retrolisthesis of L5 on S1 is unchanged.  Relative increased\nanterior intervertebral disc height of L2- L3 is also unchanged.\n\nSOFT TISSUES: Prior left inguinal hernia repair.  Moderate to large right\ninguinal hernia containing bowel.",
            "output": "1.  Active extravasation of intravenous contrast into the transverse colon,\nlikely from diverticulosis.\n\n2.  Severe diverticulosis without diverticulitis.\n\n3.  Moderate to large right inguinal hernia containing large bowel, similar\nthe prior exam without evidence of complication.\n\n4.  Prostatomegaly.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 11:45 ___, at the time of discovery."
        },
        {
            "input": "VASCULAR:\nThe celiac axis, SMA, ___, bilateral renal arteries, bilateral common iliac\narteries and their major branches are patent\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal 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\nLIVER: The liver demonstrates homogenous attenuation throughout. There is no\nevidence of focal lesions.  There is small volume upper abdominal ascites.\n\nBILIARY: Patient is post cholecystectomy.  A percutaneous pigtail cystostomy\ncatheter terminates within a fluid collection in the gallbladder fossa, which\nis substantially smaller (03:49).  Local inflammatory changes are again noted.\n\nA CBD catheter is in situ, with the distal and terminating in the distal\ndescending duodenum.  Moderate volume pneumobilia is suggestive of with stent\npatency.\n\nPANCREAS: The pancreas is partly atrophic.  There is no main pancreatic ductal\ndilatation or evidence of mass 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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small and large bowel loops are normal in caliber.  There is\nno abnormal bowel wall thickening or evidence of ischemia.  The colon is\nfluid-filled, compatible with history of diarrhea.  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: 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. No evidence of colitis or bowel ischemia.  Fluid-filled colon is consistent\nwith history of diarrhea.\n2. Percutaneous pigtail catheter terminates within a fluid collection in the\ngallbladder fossa, which is substantially smaller compared to ___.\n3. No new acute findings in the abdomen or pelvis."
        },
        {
            "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 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 diffuse\nwall thickening/\"thumbprinting\" of the colon with mild pericolonic fat\nstranding, compatible with infectious or inflammatory colitis.  The appendix\nis 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 ovaries are unremarkable.\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 suspicious osseous lesion or acute fracture.  Note is made\nof a small herniation pit in the right femoral head neck junction.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Diffuse wall thickening/\"thumbprinting\" of the colon with mild pericolonic\nfat stranding, compatible with infectious or inflammatory colitis.\n2. Normal appendix.\n3. Small amount of free fluid in the pelvis."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis, without pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, 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\nnonspecific 9 mm hypodensity in the periphery of the spleen is incompletely\ncharacterized, but likely a splenic hemangioma or cyst (05:19).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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\ncolon is collapsed, with foci of air in the periphery, suggesting absence of\nwall thickening (7:25).  Air is identified throughout the remainder of the\ncolon and in the rectum.  The appendix is not visualized.  No suspicious fluid\ncollection or free intraperitoneal air.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The patient is post recent myomectomy, with a small\namount of adjacent fat stranding and free pelvic fluid.  The remaining uterus\nmeasures 10.2 x 7.2 x 6.8 cm, appearing heterogeneous enhancement, with poor\ndefinition of the endometrium, likely reflecting a mixture of multiple\nmyotomies and other underlying fibroids.  No concerning adnexal masses are\ndetected.\n\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.  No significant\ndegenerative changes identified.\n\nSOFT TISSUES: Soft tissue stranding of the midline lower abdomen correlates\nwith history of recent myomectomy and postsurgical changes.",
            "output": "1.  No bowel ileus or obstruction.  No free air or focal fluid collections.\n2.  Heterogeneous appearance of the uterus, reflecting prior and recent\nmyomectomies and possible additional fibroids.  The endometrium is not well\nvisualized.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 17:30 on ___, immediately after discovery."
        },
        {
            "input": "LOWER CHEST:  There are trace bilateral pleural effusions with adjacent\ncompressive atelectasis.  The imaged portion of the heart is unremarkable.\nThere 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 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 appear thickened, without focal nodules.\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.  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 bladder is decompressed by a Foley catheter.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Few calcifications are seen within the prostate gland,\nwhich does not appear 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: A tiny umbilical hernia containing fat is noted.",
            "output": "1. No evidence of hydronephrosis or nephrolithiasis.\n2. Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis without pericardial or\npleural effusion.  There is an unchanged epicardial lymph node measuring up to\n1.4 cm (2:5).\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 post right nephrectomy.  Previously described\nsubcentimeter nodularity in the surgical bed (02:35) is similar in appearance.\nA subcentimeter hypodensity in the left upper renal pole is too small to\ncharacterize by CT, statistically likely a cyst.  There is no evidence of left\nperinephric abnormality 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A left adnexal cystic structure measures up to 5.9 cm,\nsimilar in appearance to that 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes in the lumbar spine are moderate to severe.  There is\nmild anterolisthesis of L4 and L5 and mild retrolisthesis of L5 on S1\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is unremarkable.",
            "output": "1.  No acute intra-abdominal or intrapelvic inflammatory process to explain\nthe patient's symptoms.\n\n2.  5.9 cm cystic left adnexal mass is unchanged since ___.  ___\nyear follow-up pelvic ultrasound was recommended at that time.\n\n3.  Post right nephrectomy, with an unchanged subcentimeter soft tissue\ndensity in the surgical bed.\n\n4.  Unchanged 1.4 cm enlarged epicardial lymph node.\n\nRECOMMENDATION(S):  Follow-up pelvic ultrasound is due in ___."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.  There is moderate calcium\nburden in bilateral renal arteries, both of which remain patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is mild prominence of the central\nintrahepatic bile ducts, related to previous 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 stones, focal renal lesions.  There is mild left\nhydronephrosis, with transition adjacent to surgical clips along the left\npelvic sidewall from previous lymph node dissection.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Right inguinal hernia containing a portion of the\ncecum, and possibly the appendix, without evidence obstruction. There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is distended.  There are multiple surgical clips\nseen along the pelvic sidewalls, related to prior lymph node dissection.\n\nREPRODUCTIVE ORGANS: The patient has had a prior prostatectomy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral inguinal hernias, fat containing on the left.  The\nright inguinal hernia contains a portion of the cecum, and possibly the\nappendix, without evidence obstruction.\n\nInflatable penile prosthetic device in place, with the a reservoir again seen\nbeneath the left rectus muscle.",
            "output": "1. Mild calcium burden in the abdominal aorta and mesenteric branches. \nBilateral femoral and iliac arteries are patent.\n2. Mild left hydroureteronephrosis, likely secondary to previous lymph node\ndissection, with transition seen adjacent to surgical clips along the left\npelvic sidewall."
        },
        {
            "input": "There is no acute fracture. Degenerative changes are noted in the lower lumbar\nspine, see dedicated examination. Degenerative changes of SI joints are also\nnoted with partial fusion on the left. Proximal femora are unremarkable. Minor\ndegenerative changes noted at the femoroacetabular joints. Chondrocalcinosis\nis noted at the pubic symphysis which is intact.\n\nLarge amount of stool seen within the rectum which is distended. Uterus is not\nseen. Bladder diverticulum seen anterolaterally on the right. Calcification\nwithin the pelvis on the right may be ovarian. Remaining portions of the bowel\nare unremarkable. Scattered atherosclerotic calcifications noted within a\nnormal caliber distal aorta. 1.5 by 1.5 cm rounded density in the right\ninguinal region could be fluid within an inguinal hernia.",
            "output": "No acute fracture."
        },
        {
            "input": "VASCULAR:\n\nThe inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 2 perforator on the right\nand 3 perforators on the left.\n\nLEFT:\nBranching pattern: Type 3\nPerforators:\n1 mm and at the level of umbilicus toward the umbilicus medial\n1 mm, and at the level of umbilicus extends laterally\n1 mm, and at the level of umbilicus extends superiorly\nRIGHT:\nBranching pattern: Type 2\nPerforators:\n1 mm mm, at the level of the umbilicus extending to the umbilicus and then\nlateral.\n1 mm, and at the level of umbilicus extends superiorly\n\nThe aorta is normal in caliber with no evidence of aneurysmal dilatation or\nsignificant atherosclerotic disease.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\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: Changes of post right mastectomy noted.",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is medial and measures 1 mm. The largest perforator on the left is\nmedial and measures 1 mm."
        },
        {
            "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: 5 mm nonobstructing calculus within the lower pole of the right\nkidney.  No hydronephrosis.  Right-sided extrarenal pelvis.  14 mm fat density\nlesion within the anterior bladder wall may represent an intramural lipoma.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Portions of the small and large\nbowel along the left hemiabdomen are excluded from the field of view or\nobscured by artifact related to body habitus.  For there is inflammatory\nstranding noted within the small bowel mesentery in the left lower quadrant\ncentered around several loops of small bowel (distal jejunum/proximal ileum)\nwhich demonstrate small outpouchings, suggestive of small bowel diverticula. \nThe epicenter of this area of fat stranding appears centered around an\ninflamed diverticula and appears to demonstrate punctate foci of gas (axial\nseries 9, image 119; coronal series 11, image 44).  There is no evidence of\nmechanical obstruction.  No evidence of arterial blush or delayed venous\npooling to suggest a site of active intestinal hemorrhage.  No organized fluid\ncollection.  The large bowel is unremarkable.  Rim calcified lesion adjacent\nto the descend colon (coronal series 11, image 25) may represent sequelae of\nprior torsed epiploic appendage.  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: Left lower quadrant mesenteric fat\nstranding as described above.\n\nVASCULAR: No abdominal aortic aneurysm. Moderate atherosclerotic\ncalcification.\n\nBONES: Mild degenerative changes of the thoracolumbar spine.  No suspicious\nosseous lesion.\n\nSOFT TISSUES: Unremarkable.",
            "output": "1. Small bowel diverticulitis at the distal jejunum/proximal ileum. No\ndrainable fluid collection.\n2. No evidence of active intestinal hemorrhage.  Please note that portions of\nthe large and small bowel within the left hemiabdomen are excluded from the\nfield of view and obscured by artifact related to the patient's body habitus.\n3. Right-sided nephrolithiasis."
        },
        {
            "input": "LOWER 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 rim-enhancing hypoattenuating lesions in the\nliver, which are new or larger in size since ___, suspicious for\nworsening metastatic disease. For example, a segment VIII lesion measures 1.4\ncm maximal diameter (2:59), previously 1.0 cm. Another segment VIII lesion\nmeasures 1.2 x 1.1 cm (2:58), increased in size. A segment ___ lesion measures\n1.3 x 1.3 cm (2:57), increased in size. A hypoattenuated lesion in the dome of\nthe right lobe measures 1.1 x 1.0 cm (2:54), increased in size.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: Pancreatic ductal dilatation, parenchymal atrophy, and an\nill-defined rim enhancing mass in the pancreatic body measuring 1.0 cm in\nmaximal diameter (601b:37) are unchanged since ___.  There is no\nperipancreatic stranding.\n\nSPLEEN: Hypoattenuating peripheral lesions in the spleen, measuring up to 0.7\ncm, are unchanged from the prior exam, likely cysts.  The spleen is not\nenlarged.\n\nADRENALS: The heterogeneously enhancing mass in the right adrenal gland\nmeasures up to 3.2 cm, unchanged (2:67).  The left adrenal gland is surgically\nabsent.\n\nURINARY: The left kidney is surgically absent.  There is no soft tissue in the\nleft nephrectomy bed.  The right kidney is unchanged in appearance, with\nmultiple simple cysts measuring up to 5.2 cm in the lower pole.  There is no\nhydronephrosis or new focal renal lesion.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  A paraumbilical\nhernia containing a normal loop of small bowel is again seen.  Suture lines in\nthe ascending colon indicating prior anastomosis, which is unremarkable in\nappearance.  Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple brachytherapy seeds are identified in the\nprostate.\n\nLYMPH NODES: Surgical clips are identified in the left para-aortic\nretroperitoneum.  There is no retroperitoneal lymphadenopathy.  Enlarged node\nalong the course of the SMV measures up to 1.1 cm in short axis (2:88),\nunchanged.  There is no pelvic or lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES:  Extensive osseous metastatic disease, most prominently in the pelvis,\nis minimally changed. For example, there is an expansile lesion involving the\nright iliac bone measuring a 0.8 x 5.2 cm (2:107) with expansion to the\nneighboring gluteal and iliacus muscles, unchanged in size. An expansile\nlesion in the left ischial tuberosity measures 5.5 x 4.9 cm (2:134), unchanged\nin size.  Circumscribed sclerotic lesion in the anterior L2 vertebral body is\nsimilar to the prior study (602b:48).  Multilevel degenerative changes of the\nlumbar spine are mild-to-moderate in severity, with grade 1 retrolisthesis of\nL5 on S1.  A lytic lesion in the superior plate of S1 has enlarged from 1.0 cm\nto 1.7 cm (602b:48).  Lytic lesions at the superior endplate of L3 and in T12\nhave also enlarged.\n\nSOFT TISSUES: As mentioned above, a paraumbilical hernia containing a loop of\nnon this small bowel is again seen.  There is intramuscular extension of\ntumor, as above.",
            "output": "1.  Compared with the CT torso from ___, there has been\nprogression of disease, denoted by extensive new or enlarging liver\nmetastases.\n\n2.  Slight worsening of extensive osseous metastatic disease, including the\nknown right iliac and left ischial lesions extending into the surrounding soft\ntissues.  However, multiple spinal osseous lytic lesions have enlarged,\nincluding at the T12, L3, and S1 vertebral bodies.\n\n3.  Persistent pancreatic ductal dilatation, parenchymal atrophy, and an\nill-defined rim enhancing mass in the pancreatic body, unchanged in size.\n\n4.  Unchanged heterogeneously enhancing right adrenal mass.\n\n5.  Unchanged mesenteric lymphadenopathy.\n\nNOTIFICATION:\n The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 6:11 ___, 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. 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.  There is a\n1.4 cm hypodense lesion with peripheral enhancement at the superior aspect,\nlikely 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. \nThere is a 7.3 x 8.1 cm cyst arising from the lower pole of the left kidney,\nas well as multiple additional bilateral subcentimeter hypodensities, too\nsmall to characterize.  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 grossly 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. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is an anterior wedge deformity of T9, which appears chronic.  There is\ndextroscoliosis of the thoracolumbar spine, with associated degenerative\nchanges.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. 8.1 x 7.3 cm renal cyst arising from the lower pole of the left kidney. \nAdditional bilateral subcentimeter renal hypodensities are too small to\ncharacterize by CT.\n2. Anterior wedge deformity of T9 appears chronic, likely related to\ndegenerative change."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: A 1 cm hypodense lesion in liver segment ___ is unchanged. Additional\nsubcentimeter hypodense lesions in segment II are too small to characterize.\nIrregular appearance of the left portal veins is again seen, including focal\nectasia. There is no large thrombosis visualized in the portal veins.\nPartially calcified ligamentum teres is again noted. Gallstones are seen in\nthe gallbladder without signs of acute cholecystitis.\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:  Bilateral adrenal glands appear thickened without  focal lesions.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no hydronephrosis. Cysts are again seen in the left kidney,\nthe largest measuring 2.8 cm TV x 2.7 cm AP x 2.2 cm CC.\n\nGI: Patient is status post right hemicolectomy. The stomach and bowel loops\nare normal without wall thickening or signs of obstruction. There is no free\nair or free fluid in the abdomen.\n\nRETROPERITONEUM: The aorta is normal in caliber. The IVC is normal appearing.\nSeveral prominent retroperitoneal lymph nodes are again seen, not enlarged and\nnot pathologic appearing.\n\nCT PELVIS: The bladder wall appears uniformly thickened without focal lesions.\nThe prostate is enlarged with multiple brachytherapy seeds. There is no pelvic\nfree fluid.  There are several common iliac and external iliac chain lymph\nnodes that appear slightly more prominent compared to prior studies, however\nthey are not pathologically enlarged (for example a common iliac node \nmeasuring 9 mm, previously 7.4 mm, on image 2:60).\n\nThe right deep femoral vein demonstrates early enhancement compared to the\nleft. Otherwise, there is no venous size asymmetry. This finding is concerning\nfor underlying AV malformation or AV fistula. No large thrombosis is seen in\nthe veins.\n\nOSSEOUS STRUCTURES: Multilevel degenerative changes are seen in the\nlumbosacral spine. No focal lesion suspicious for malignancy present.",
            "output": "1.  Early enhancement and dilation of the right deep femoral vein, concerning\nfor AV malformation or AV fistula distally.\n2.  No suspicious intra-abdominal or pelvic masses concerning for malignancy.\n3.  Prominent but benign-appearing retroperitoneal, common iliac and external\niliac chain lymph nodes, with no mass effect on surrounding vasculature.\n4.  Cholelithiasis without signs of acute cholecystitis.\n5.  Focal ectasia in left portal vein with no visualized clot.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 3:19 ___, 5 minutes after the images were reviewed."
        },
        {
            "input": "BONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is hyperdensity and expansion involving the right iliacus\nand iliopsoas muscle extending to the level of the lesser trochanter (for\nexample 3:35, 3:74).  Small amount of fluid tracks along the right psoas\nmuscle and right iliacus muscle.  There is also stranding within the fascial\nplanes of the proximal right thigh (3:108).\nThere is diffuse sarcopenia.  The right rectus abdominal muscles or are\nparticularly atrophic, and there is hernia mesh.  There is a fat containing\nleft inguinal hernia.\n\nPELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are in place in the prostate gland.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.",
            "output": "Right iliacus and iliopsoas hematoma.  No pelvic fracture identified."
        },
        {
            "input": "SOFT TISSUES: Redemonstration of right iliacus and iliopsoas hematoma.  On the\narterial phase post-contrast scan, there are 3 small foci of probable contrast\nextravasation, corresponding to contrast pooling on the delayed phase (4,\n5:69, 82, 96).  These measure 6 mm, 3 mm, and about 1 cm respectively.  These\nare all in the iliopsoas muscle.\n\nThere is moderate predominantly calcified atherosclerotic disease of the\nimaged aorta, iliac and femoral vessels.  These vessels are grossly patent.\n\nPELVIS: The imaged intrapelvic bowel is unremarkable.  There is scarring of\nthe imaged left inferior renal pole.  The urinary bladder and distal ureters\nare unremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy.\nAs previously described, there is trace free fluid tracking along the right\niliacus and psoas muscles.\n\nREPRODUCTIVE ORGANS: Brachytherapy seeds are redemonstrated in the prostate\ngland.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.",
            "output": "Redemonstrated right iliacus and iliopsoas hematoma, with 3 small foci of\nactive contrast extravasation/contrast pooling identified in the iliopsoas\nmuscle (4,5:69, 82, 96)."
        },
        {
            "input": "Imaged bowel loops appear normal.  Suture material in the right lower quadrant\nis noted.  Hernia mesh is noted along the right lower quadrant anterior body\nwall as on prior.  Partially visualized kidneys notable for nonspecific\nperinephric stranding and partially imaged renal cortical hypodensities which\nmay represent cysts.  The abdominal aorta is moderately calcified though\nnormal in caliber.  Multiple fiducials are noted within the prostate.  Median\nlobe hyperplasia of the prostate resultant bladder base indentation appearing\nsimilar to prior.  No pelvic hematoma is seen.  There is a small fat\ncontaining left inguinal hernia.\n\nBones: Intervally resolved hematoma in the right iliopsoas and iliacus\ndistribution.  There is new heterotopic ossification at the site of hematoma\nmedial to the right femoral head neck junction.  Generalized body wall edema\nis noted.",
            "output": "Resolved hematoma in the right iliacus and iliopsoas distribution with new\nheterotopic ossification medial to the right femoral head neck junction."
        },
        {
            "input": "LOWER CHEST: Visualized lung bases demonstrate bibasilar opacities, likely\natelectasis, although infection can't be excluded.  There is no pleural or\npericardial effusion.\n\nABDOMEN:  The study is somewhat limited by patient motion.\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nMultiple hypodensities are seen in the liver, some of which are too small to\ncharacterize and others of which are simple cysts/biliary hamartomas.  No\nsuspicious liver lesion is identified.  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.  Multiple peripelvic cysts are seen in the kidneys\nbilaterally.  A cortical hypodensity in the left kidney is too small to\ncharacterize, most likely a cyst.\n\nGASTROINTESTINAL:  The patient is status post ileocecectomy and appendectomy. \nThe colon is very tortuous and redundant.  The sigmoid colon is located in the\nright upper quadrant anterior and superior to the liver and is dilated to 8.8\ncm.  There is no twisting of the sigmoid mesentery and this likely represents\nabnormal location of the sigmoid without volvulus.  The ileocolic anastomosis\nis located within the right inguinal hernia, which also contains fat and\nmesenteric vessels.  There is no bowel wall edema or fluid to suggest bowel\nischemia.  The ileocolic anastomosis is decompressed with dilation of small\nbowel just proximal to the anastomosis to 4.9 cm with fluid and no oral\ncontrast.  The findings suggest a low grade small bowel obstruction with\ntransition point at the ileocolic anastomosis as it goes into the right\ninguinal hernia.  The stomach and proximal jejunum are not dilated. The rectum\nis decompressed.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small presacral\nedema. Prostate is unremarkable.\n\nBONES AND SOFT TISSUES: The bones are markedly diffusely demineralized.  A\ncomminuted left femoral fracture with anterior displacement of the femoral\nshaft relative to the femoral head and surrounding hematoma are similar to ___ pelvic CT.  There is mild surrounding subcutaneous edema.  Multilevel\ndegenerative change is seen throughout the thoracolumbar spine with multiple\nvertebral compression fractures. There is anterolisthesis of L5 on S1. \nSubcutaneous edema is noted in the right gluteal soft tissues without\nunderlying osseous erosion (5:87).",
            "output": "1.  Wide mouth right inguinal hernia containing mesenteric fat and vessels and\nthe ileocolic anastomosis.  Findings suggest low grade small bowel obstruction\nwith transition point at the decompressed ileocolic anastomosis as it enters\nthe inguinal hernia. No evidence of bowel ischemia.\n2.   Bibasilar opacities in the lung may represent atelectasis but infection\ncannot be excluded.\n3.   Comminuted and displaced left femoral fracture with surrounding hematoma\nis unchanged from CT ___.\n4.   Marked demineralization of the thoracolumbar spine with multilevel\ndegenerative change and compression fractures.\n5.  Abnormal location of the sigmoid colon in the right upper quadrant without\nevidence of volvulus.\n\nNOTIFICATION:  The updated findings were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 2:42 ___, 10\nminutes after discovery of the findings."
        },
        {
            "input": "Pre-procedure CT images of the pelvis were obtained in supine and right\nlateral decubitus positions.  At the time of scanning, patient's INR resulted\nat 2.3, and the procedure was aborted.\n\nThere is extensive retroperitoneal gas and stranding, as seen on diagnostic CT\nof the abdomen/pelvis from ___.  Findings are concerning for\nnecrotizing retroperitoneal infection.",
            "output": "1. Aborted CT-guided drainage secondary to elevated INR, which resulted at the\ntime of pre-procedure scanning.  Extensive retroperitoneal gas and stranding,\nas seen on diagnostic CT of the abdomen/pelvis from ___,\nconcerning for necrotizing retroperitoneal infection."
        },
        {
            "input": "LOWER CHEST: 1 mm right middle lobe subpleural nodule (series 2, image 6).  No\npleural effusions.\n\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The liver parenchyma enhances homogeneously.  Punctate calcific\ndensity at the dome (02:12) is unchanged.\nThe gallbladder is partially distended with no radiopaque calculi within it or\npericholecystic inflammation.\nPANCREAS: There is mild atrophy of the pancreatic parenchyma without main duct\ndilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  There are no adrenal nodules.\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is no bowel obstruction.  Right lower quadrant end\ncolostomy noted as before.  There is no leak of orally ingested positive\ncontrast into the abdomen or pelvis.\n\nLYMPH NODES: There are subcentimeter short axis gastrohepatic, precaval and\npara-aortic lymph nodes that do not meet criteria for pathologic enlargement.\nLikely reactive lymph nodes in the right lower quadrant mesentery.\nVASCULAR: Mild calcified atherosclerotic plaque is noted within the abdominal\naorta and its branches, no aneurysmal dilation.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.\nThere is a rim enhancing collection in the pelvis located between the urinary\nbladder, vaginal stump and rectal stump (series 602, image 49) measuring\napproximately 6.8 by 3.1 by 2.3 cm in size that is significantly smaller in\nsize compared to the prior exam dated ___.\nAlso noted is improvement in inflammatory soft tissue stranding surrounding\nthis fluid collection, that was noted on the prior exam.  There is no leak of\norally ingested contrast into this collection.\n\nBONES AND SOFT TISSUES:\nThe midline pelvic wall is wide open, new compared to the prior exam.\nThere is extensive inflammatory a soft tissue thickening and 2 thin rim\nenhancing fluid collections at the junction of the subcutaneous fat and\nperitoneum in the right lower quadrant (series 2, image 54 and 51, enclosing a\ntiny locule of air).  Extensive subcutaneous stranding of fat is also noted in\nthis region.  The inflammatory fat stranding is seen encasing and adhering\nunderlying contrast opacified nondilated bowel loops.\n\nDegenerative disc disease at L5-S1 level noted.  No worrisome osseous lesions\nidentified.",
            "output": "1. Interval decrease in rim enhancing fluid collection in the pelvis located\nbetween the vaginal stump, rectal stump and the urinary bladder.\n2. Wide open midline pelvic wall with extensive subcutaneous fat stranding and\ninflammatory stranding between the subcutaneous fat and the peritoneal lining\nin the right lower pelvis.  2 small rim enhancing fluid collections enclosing\ntiny locules of free air are seen within this inflammatory soft tissue\nstranding.\n3. There is no extravasation/leak of orally ingested contrast from the small\nbowel loops into either of the above described collections or into the\nperitoneal cavity.\n4. Right lower quadrant colostomy is intact."
        },
        {
            "input": "LOWER CHEST: 1 mm right middle lobe subpleural nodule is unchanged (2:1). \nOtherwise, visualized lung 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 calcification near the hepatic dome is unchanged.  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: Mild atrophy of the pancreas is again seen.  Otherwise, the pancreas\nhas normal attenuation throughout, 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 1.3 cm simple cyst in the interpolar region of the right kidney is\nunchanged.  There is no evidence of suspicious focal renal lesions or\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post proctosigmoidectomy with end\ncolostomy in the left paramidline abdomen.  There is a parastomal hernia which\ncontains new loops of nonobstructive small bowel.  The stomach is\nunremarkable.  Overall, the degree of inflammatory changes about the abdomen\nhas improved.  Thickening and subtle stranding about the small bowel on the\nmid right abdomen could be chronic (02:51).  Within this region between the\nsmall bowel and ventral abdominal wall, there is a 2.8 x 0.5 x 1.1 cm fluid\ncollection with hyperdense rim (2:51, 601:22), slightly increased in\nconspicuity.  Mildly distended fluid-filled loops of small bowel are\nnonspecific.  No evidence of obstruction.  The appendix is not visualized.\n\nPELVIS: The prior rim enhancing collection within the pelvis located between\nthe urinary bladder, vaginal stump, and rectal stump is no longer seen.  Air\nwithin the region is likely within adjacent bowel.  The urinary bladder and\ndistal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Interval increase in size a 0.7 cm left para-aortic lymph node is\nnonspecific, likely reactive (2:314).  There are multiple scattered prominent\nsubcentimeter lymph nodes throughout the abdomen which do not meet CT size\ncriteria for pathologic enlargement and are unchanged.  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. \nMinimal retrolisthesis of L5 on S1 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Overall improved appearance of extensive intra-abdominal and pelvic\ninflammatory changes without findings to suggest diverticulitis.  However,\nprominence of thickening and subtle stranding about the small bowel within the\nmid right abdomen is of unclear significance and is likely chronic, although\nan acute on chronic presentation cannot be excluded.  Additionally, there is a\ntiny 2.8 x 0.5 x 1.1 cm fluid collection with hyperdense rim between the deep\nright ventral abdominal wall and adjacent small bowel which has slightly\nincreased in conspicuity, and is favored to represent an abscess, but is not\ndrainable.\n2. Interval resolution of pelvic fluid collection previously seen between the\nbladder, vaginal stump fat, and rectal stump.\n3. Parastomal hernia containing new loops of nonobstructed small bowel."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion. A tiny pulmonary cyst is noted in\nthe left upper 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.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 lesion in the interpolar region of the right kidney measures 25\nHounsfield units on these postcontrast images, indeterminate but possibly a\nsimple cyst. Additional subcentimeter hypodensities are too small to\ncharacterize but statistically likely represent simple renal cysts.  No\nhydronephrosis. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. There is a left lower quadrant\nileostomy. There is a small bowel containing parastomal hernia (04:49).\nPatient is status post ___ pouch reversal with an intact appearing\ncolonic anastomosis and no evidence of leak.  Previously described phlegmonous\nchanges along the right anterior chest wall are largely resolved with some\nresidual scarring (4:60). No intra-abdominal abscess.\n\nPELVIS: Urinary bladder is decompressed and not well evaluated.  There is no\nfree fluid in the pelvis. No pelvic abscess.\n\nREPRODUCTIVE ORGANS: No adnexal masses identified.\n\nLYMPH NODES: No lymphadenopathy 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: Postsurgical changes in the anterior abdominal wall as described\nabove.",
            "output": "1. Status post ___ reversal. No evidence of leak.\n2. No intra-abdominal abscess.\n3. Left lower quadrant ileostomy with a small bowel containing peristomal\nhernia, smaller from prior."
        },
        {
            "input": "VASCULAR:\n\nThe infrarenal abdominal aorta is ectatic measuring up to 2.1 cm.  No evidence\nof abdominal aortic aneurysm.    There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  There is mild-to-moderate\nnarrowing of the origins of the celiac artery and SMA due to calcified and\nnoncalcified atherosclerotic plaque.  Otherwise, the major intra-abdominal\nbranch vessels appear patent\n\nLOWER CHEST: Dependent atelectasis within the lower lobes bilaterally.  No\nfocal consolidations.  No pleural or pericardial effusion.  Severe coronary\nand aortic annular calcifications are visualized.\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.  Sludge layering dependently within the\ngallbladder.  No evidence of acute cholecystitis.\n\nPANCREAS: Mild fatty replacement of the pancreas.  No focal lesions.  No\nductal dilatation.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Small splenule 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 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 is not visualized.  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: The visualized reproductive organs are unremarkable.\n\nBONES: Patient is status post bilateral total hip arthroplasties, which are\nunremarkable in appearance, but slightly limits evaluation of the pelvis due\nto streak artifact.  Severe degenerative changes are seen within the lumbar\nspine including mild S-shaped scoliosis.  Moderate compression deformity of\nthe L4 vertebral body with sclerosis is unchanged compared to prior.  Milder\ncompression deformity involving the T12 vertebral body is also unchanged. \nNote is made of a chronic appearing left inferior pubic ramus fracture. There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple fat containing ventral hernias.  Calcified granuloma\nwithin subcutaneous fat overlying the right gluteal muscles.",
            "output": "1. No acute abnormalities within the abdomen or pelvis.  The stomach is\nunremarkable in appearance.  Extensive atherosclerosis with mild-to-moderate\nnarrowing at the origin of the celiac artery and SMA, however all of the major\nintra-abdominal branch vessels appear patent.\n2. Sludge layering within the gallbladder.\n3. Unchanged mild-to-moderate compression deformities involving T12 and L4. \nChronic appearing left inferior pubic ramus fracture."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  There is artifact emanating\nfrom embolization coils within gastroesophageal varices.  There is unchanged\nappearance of a linear hypodensity within hepatic segment VII projecting from\nthe intrahepatic IVC (03:32), likely a chronically thrombosed accessory right\nhepatic vein.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver appears shrunken and nodular in contour, consistent\nwith cirrhosis.  Peripheral wedge-shaped areas of hypoenhancement in the right\nhepatic lobe are again demonstrated, likely related to perfusional differences\nand evolving infarct.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  TIPS appears patent.  The gallbladder is contains stones,\nwithout evidence of gallbladder wall thickening or pericholecystic fluid. \nThere is a small amount of perihepatic ascites 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 moderately enlarged, measuring up to 18.7 cm in\ncraniocaudal dimension.  The spleen shows normal attenuation throughout,\nwithout evidence of focal lesions.  Trace perisplenic ascites 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 stones, concerning focal renal lesions, or\nhydronephrosis.  Few tiny hypodensities within the bilateral kidneys are too\nsmall to characterize, though likely compatible with simple renal cysts. \nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.  Few\nmildly prominent retroperitoneal lymph nodes are not pathologically enlarged\nby CT size criteria.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is trace free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\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. Patent appearing TIPS stent.\n2. Cirrhotic liver morphology with sequela of portal hypertension, including\nmoderate splenomegaly and small volume ascites, improved from prior study.\n3. Unchanged appearance of a linear hypodensity within hepatic segment VII,\nlikely representing a chronically thrombosed accessory right hepatic vein.\n4. Cholelithiasis.\n5. Fat-containing umbilical hernia"
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\n\n LOWER CHEST: Clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.  No biliary ductal\ndilatation.\n\nPANCREAS: The native pancreas is mildly atrophic.  No main pancreatic ductal\ndilatation.  The transplant pancreas with associated duodenal stump an enteric\ndrainage is noted in the right lower quadrant.  Locule peripancreatic fluid\nand a region of parenchymal fluid attenuation adjacent to the duodenal stump\nmeasuring 2.8 x 1.7 cm (3:123) is unchanged.  However now demonstrates a in\nenhancing rim concerning for abscess.  This is in continuation with the\ndrainage catheter tract.  Surrounding edematous change around the pancreas\nappears mildly more prominent than on the prior study.  Status post removal of\nanterior approach drainage catheter.  There is rim enhanced fluid along the\ntract of the drainage catheter with the largest area measuring 1.5 cm which\nmay represent an abscess, too small for drainage.  There is mildly increased\nperipancreatic fluid/ascites along the right pericolic gutter and right pelvic\nsidewall and in the anterior abdomen.  There is hypoenhancement of part of the\npancreas such as on series 3, ___ 116.  This is overall stable compared to ___.  There is edema of the pancreas likely due to the adjacent areas of\ninfection.\n\nSPLEEN: Not enlarged.  No splenic lesion.\n\nADRENALS: Unremarkable bilaterally.  No adrenal lesions\n\nURINARY: The native kidneys are moderately atrophic with a few subcentimeter\ncortical hypodensities, likely representing cysts.  Nonobstructing right renal\ncalculi measuring 0.3 cm.  Nonobstructing left renal calculus measuring 0.2\ncm.  No hydronephrosis.\n\nLeft iliac fossa renal transplant.  Status post removal of stents within the\ntransplanted kidney ureter.  There is similar peripancreatic fluid/stranding\naround the transplanted kidney.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The bowel is normal caliber. \nPostoperative changes are noted in the anorectal region from known imperforate\nanus repair.\n\nPELVIS: The bladder is moderately distended with fluid and air.  Air is likely\nrelated to recent instrumentation. Mild wall thickening is similar to the\nprior study.  Unremarkable prostate and seminal vesicles.\n\nPERITONEUM/RETROPERITONEUM: Mild fluid in the pelvis and anterior abdomen as\ndescribed above.  No pneumoperitoneum.\n\nLYMPH NODES: Multiple subcentimeter mesenteric and retroperitoneal lymph nodes\nare noted.  Similar appearing inguinal lymph nodes.\n\nVASCULAR: The aorta is normal caliber.  Mild atherosclerotic calcifications of\nthe aorta.  Transplant renal artery and renal vein appear patent.  Status post\nremoval of right femoral central venous catheter.  The transplanted pancreas\narterial and vein appear patent.\n\nBONES: Osteophyte dot in the related to known renal osteodystrophy are\nre-demonstrated.  No suspicious osseous lesions.\n\nSOFT TISSUES: Midline abdominal scar.",
            "output": "1. Transplanted pancreas in the right lower quadrant with  patent vasculature.\nAreas of necrosis are identified these are not significantly changed from\nprior study.  There is edema involving the pancreas likely due to infectious\nprocess as described in 2.  And 3 of the impression.\n2. Status post removal of anterior approach drainage catheter.  There is rim\nenhanced fluid along the tract of the drainage catheter with the largest area\nmeasuring 1.5 cm which may represent an abscess, too small for drainage.\n3. Stable fluid collection adjacent to the duodenal stump measuring 2.8 x 1.7\ncm (3:123) is unchanged and in continuity with the drainage catheter tract. \nThis may also represent a small abscess.  As it now has a defined, enhancing\nwall\n4. Status post left iliac fossa renal transplant with patent vasculature and\nsimilar surrounding fluid/stranding.\n5. The bladder is moderately distended with fluid and air. Air is likely\nrelated to recent instrumentation.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 11:24 am.\n\nAdditional findings in regards to impression 1.  And 3.  Were discussed\n___, M.D. by ___, M.D. on the telephone on ___ at\n12:29 pm, 5 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Clear\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 contracted\n\nPANCREAS: The native pancreas is mildly atrophic.  No main ductal dilatation.\nThe transplant pancreas is visualized in the right lower quadrant.  In the\ninterval, a catheter drain was positioned in the right lower quadrant in the\npreviously-described peripancreatic collection adjacent to the duodenal stump.\nThis collection is now completely resolved.  no new fluid collection.  We\nagain see a trace fluid in the right lower quadrant at the level of the\npelvis.\n\nSPLEEN: The spleen shows normal size and 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 kidney's are atrophic with a few subcentimeter cortical\nhypodensities likely representing cysts.  No hydronephrosis.  Stability of a 3\nmm nonobstructive renal calculus in the right and probably 2 mm on the left\nside.  The transplant kidney in the left lower quadrant is normal in\nappearance.  There is no hydronephrosis.  Diminished fluid/stranding around\nthe transplant kidney.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Postop changes\nfrom an imperforated anus.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple subcentimeter mesenteric and retroperitoneal lymph nodes\nare noted which are globally unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.  Transplanted renal and pancreas arteries and veins are patent.\n\nBONES: Bone changes related to the known renal osteodystrophy.  No suspicious\nosseous lesions.\n\nSOFT TISSUES: Midline abdominal scar",
            "output": "1. The collection around the transplant pancreas is  completely resolved.\n2. Status post renal transplant without any sign of complication.\n3. Bone changes related to the known renal osteodystrophy."
        },
        {
            "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: There is a trace right pleural effusion.  There is no\nconsolidation or suspicious pulmonary nodule.\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 native pancreas is mildly atrophic without main ductal\ndilatation.  The transplant pancreas is closely surrounded by bowel limiting\nevaluation of fluid collection.  Within this limitation, there is no drainable\nfluid collection.  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: Both native kidneys are mildly atrophic without evidence of contrast\nexcretion.  Sub-centimeter hypodensities in both native kidneys are too small\nto characterize.  The left iliac fossa transplant kidney is re-demonstrated. \nThere are sub-centimeter hypodensities in the transplant kidney which are too\nsmall to characterize.  Fullness of the renal pelvis of the transplant kidney\nis unchanged from ___.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is not visualized.\n\nLYMPH NODES:\nThere is no mesenteric or retroperitoneal lymphadenopathy.  There is no pelvic\nor inguinal lymphadenopathy.\n\nPELVIS: Mild bladder wall thickening is unchanged from CT ___. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is not enlarged.\n\nBONES: Sclerotic foci in the bilateral iliac bones are unchanged from ___.\n\nSOFT TISSUES: Soft tissues stranding in the midline anterior abdominal wall is\ncompatible with postsurgical changes.",
            "output": "1. No focal fluid collection within the abdomen or pelvis.\n2. Mild fullness of the left lower quadrant transplant kidney is unchanged\nsince ___.\n3. No collection identified at the transplant pancreas 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 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: There is a similar degree of fatty atrophy of the native pancreas,\nwithout focal lesion, main pancreatic ductal dilatation, or peripancreatic\nstranding in the native pancreas.\n\nThe pancreas transplant is visualized in the mid pelvis.  There is increased\natrophy of the pancreas transplant compared to the prior study from ___.  No definite organized fluid collection within the limitations of a\nnoncontrast enhanced scan.\n\nSPLEEN: Mild splenomegaly at 13.6 cm.  The spleen is homogeneous in\nattenuation.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Both native kidneys are mildly atrophic.  Subcentimeter hypodensities\nin the native kidneys are too small to characterize by CT.  The left iliac\nfossa renal transplant appears similar to prior, without evidence of\nhydronephrosis.  Perinephric stranding is chronic, previously seen on CT from\n___.  No perinephric fluid collection.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. There is fluid throughout the\ncolon, suggesting diarrhea.  No pericolonic fat stranding or definite bowel\nwall thickening within the limitations of a nonenhanced scan.  There is\ncolonic diverticulosis without evidence of acute diverticulitis.\n\nPELVIS: The urinary bladder is unremarkable.  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. \nSclerotic foci in the bilateral iliac bones is unchanged.\n\nSOFT TISSUES: Compared to the prior study, there are new parumbilical\nabdominal wall defects, containing loops of nonobstructed bowel.  Mild\nstranding in one of these areas is noted (series 2:52).",
            "output": "1. Increased fatty atrophy of the pancreas transplant.  No intra-abdominal\nfluid collection.\n2. Chronic inflammatory stranding around the left iliac fossa renal\ntransplant, unchanged dating back to ___.\n3. New complex paraumbilical hernia containing fat and nonobstructed bowel.\n4. 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.  A\nfew scattered subcentimeter hypodense lesions in the liver are too small to\ncharacterize.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is within normal limits.  Vicarious excretion of\nintravenous contrast is noted within the gallbladder lumen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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.  There is no evidence of focal mass\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 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. \nRedemonstration of posterior L3-S1 fusion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No specific evidence of malignancy in the abdomen or pelvis.\n2. Few scattered high subcentimeter hypodense lesions in the liver are too\nsmall to characterize, but statistically likely represent cysts or biliary\nhamartomas.\n3. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "Lung Bases:  Imaged lung bases notable for mild atelectasis.  The imaged\nportion of the heart is unremarkable.\n\nAbdomen: The liver, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber.  No lymphadenopathy, free air or free fluid is seen.  The stomach\nand duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThickening of the colonic wall is most notable along the descending colon and\nto a lesser extent in the sigmoid colon.  Mild adjacent fat stranding is noted\nand findings are concerning for colitis.  The appendix is top-normal in size\nthough likely normal given similar appearance on prior exam.  Mildly prominent\nmesenteric lymph nodes are likely reactive.  No free air or extraluminal fluid\ncollection.  Uterus and adnexal regions appear normal.  No free fluid. \nUrinary bladder is decompressed.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "Colitis most notable along the descending and sigmoid; differential\nconsiderations include infectious or inflammatory colitis, less likely\nischemia."
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal hepatic lesions. The portal\nand hepatic veins are patent. The gallbladder is nondistended with no stones.\nThe pancreas is normal in attenuation with no surrounding stranding. Spleen is\nhomogeneous in attenuation with no focal lesions. The adrenal glands are\nmorphologically normal bilaterally. The kidneys enhance symmetrically and\ndemonstrate prompt contrast excretion. There is no hydronephrosis. No renal\nstones are identified.\n\nThe distal esophagus, stomach, and small bowel are normal in caliber. The\ncecum is a displaced into the dependent portion of the pelvis. The large bowel\nis normal in caliber. There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes. No intra-abdominal free air or free fluid.\n\nPELVIS:  The urinary bladder is decompressed. Prostate and seminal vesicles\nare unremarkable. Within the distal aspect of the rectum there is a\nhemicircumferential soft tissue mass at the anterior wall of the rectum\nmeasuring 4.1 cm in transverse dimension, 3.5 cm in craniocaudal dimension,\nand 2.4 cm in AP dimension (3:115, 601b:48). Lower edge of the mass is\napproximately 6.8 cm above the anal verge (series 602b, image 41). Degree of\nmuscular invasion is not determinable by CT, however there is an ill-defined\nright perirectal lymph node which appears enlarged and slightly spiculated,\nmeasuring 17 x 16 mm (03:107), with blurring of the mesorectal fat between the\nupper aspect of this mass and this lymph node (series 601b, image 48). No free\nfluid is noted in the pelvis.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: Partially sclerotic focus in the left iliac wing (3:90)\nlikely represents a bone island, not demonstrating any aggressive features.",
            "output": "1.  Hemi-circumferential soft tissue mass along the anterior aspect of the mid\nrectum, weight the inferior border approximately 6.8 cm above the anal verge,\nwith suspected invasion into the the right superior these are rectal fat and\ninvolvement of an adjacent perirectal lymph node.  Stage T3, N1 by imaging.\n2. No evidence of distal metastatic disease in the abdomen or pelvis.\n3. Sclerotic focus in the left iliac wing likely represents a bone island,\nhowever attention on followup is recommended."
        },
        {
            "input": "PELVIS:\n\nURINARY: The kidneys are partially visualized and 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:  There is an ileostomy in the right lower quadrant with\nexpected postoperative changes within the subcutaneous tissues.  The partially\nvisualized small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Sutures are seen in the lower pelvis at the surgical\nsite with expected postoperative changes.  There is no evidence of tumor\nrecurrence.  The partially visual colon is otherwise 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a sclerotic focus in the right acetabulum that likely represents a\nbone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Sutures at rectal surgical site with expected postoperative changes, but no\nevidence of tumor recurrence.  No fiducial seeds are visualized.\n2. Expected postoperative appearance of right lower quadrant ileostomy without\nany evidence of 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 few cortical hypodensity less than 5 mm too small to be\ncharacterize.  There is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: S/p low anterior section with colorectal anastomosis with no\nsigns of locoregional recurrence.  No bowel obstruction.  There is also bowel\nanastomotic suture in the right lower quadrant with no signs of complication. \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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 low anterior resection with no signs of locoregional recurrence\nnor metastases in the abdomen and pelvis.\n-Please refer to separate chest CT 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. \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 redemonstration of subcentimeter hypodense lesions in the left\nkidney, unchanged and too small to characterize.  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 patient is\nstatus post low anterior resection and colorectal anastomosis with expected\npostsurgical changes.  There is no evidence of local recurrence.  Otherwise,\nthe 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: 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 are mild degenerative changes of the lumbar spine, most prominent\nat L1-L2.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia (series 2, image\n85).",
            "output": "1. Status post low anterior resection without evidence of local recurrence or\nabdominopelvic metastasis or lymphadenopathy.\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 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 solid renal lesions or hydronephrosis.  Stable 0.6 cm\nhypodense lesion in the left midpole is too small to characterize but likely\nrepresents a renal cyst (2; 68).  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Suspected duodenal\ndiverticulum.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Patient is status post low anterior resection of\nthe rectum with colorectal anastomosis and expected postsurgical changes. \nThere is no evidence of local recurrence.  The appendix 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 no 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 rectal low anterior resection without evidence of local\nrecurrence or metastatic disease in the abdomen or pelvis."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase):  Hypoattenuating mass in the\npancreatic head.  The uncinate process also is relatively hypoattenuating and\nof lower attenuation than expected for normal pancreatic tissue.  This may\nreflect edema and perfusional changes versus malignant involvement.  The body\nand tail of the pancrease at atrophic.  Abuts the posterior wall of the\ngastric antrum and ___ portion of duodenum.\nSize (maximal axial dimension in cm):  5.6 x 4.5 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: present. \nThere is a biliary stent in good position with associated pneumobilia suggests\npatency.\n\nArterial evaluation\n\nSMA involvement: present\nSolid soft-tissue contact:  Greater than 180 degrees\nIncreased hazy attenuation/stranding contact:  Greater than 180 degrees\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: present\n\nCeliac Axis involvement: present\nSolid soft-tissue contact: Less than 180 degrees\nIncreased hazy attenuation/stranding contact:  Less than 180 degrees\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: present\nSolid soft-tissue contact:  Greater than 180 degrees\nIncreased hazy attenuation/stranding contact:  Greater than 180 degrees\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: Absent\n\nVariant anatomy: replaced right hepatic artery\nVariant vessel contact:  absent\nDegree of solid soft-tissue contact:  Less than 180 degrees\nDegree of increased hazy attenuation/stranding contact:  Less than 180 degrees\nFocal vessel narrowing or contour irregularity:  Absent\n\n\nVenous evaluation\n\nMPV involvement: present\nDegree of solid soft-tissue contact:  Greater than 180 degrees\nDegree of increased hazy attenuation/stranding contact:  Less than 180 degrees\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\n\nSMV involvement: present\nDegree of solid soft-tissue contact:  Greater than 180 degrees, thrombosed\nDegree of increased hazy attenuation/stranding contact:  Greater than 180\ndegrees\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: mesenteric root collaterals\n\nSplenic vein occluded near the SMV.\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules:  Absent.  Pericolonic fatty infiltration as\nwell as infiltration of the small bowel mesentery is likely related to venous\nengorgement from portal hypertension resulting from SMV occlusion.\nAscites: present\nSubcentimeter lymph nodes:  Celiac, porta hepatis\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\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.  There is a thinly stent in good position. \nMild amount of pneumobilia.  The degree of intrahepatic biliary ductal\ndilatation has improved since MR dated ___.\n\nPANCREAS: See above.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 in the pelvis are mildly hyperemic, this\nmay be related to enteric phase of contrast enhancement as well as portal\nhypertension from SMV occlusion.  Mild thickening of the ascending colon, also\nlikely related to some venous engorgement.  A colonic anastomosis in the left\nlower quadrant appears unremarkable.  The remaining bowel is within normal\nlimits.  ___ stranding in the right pericolic gutter, as well as mild\nmesenteric stranding and engorgement also likely related to venous\nobstruction/portal colopathy.  There is numerous hypodense mesenteric lymph\nnodes.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nNumerous retroperitoneal collaterals are seen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small volume ascites\nin the pelvis.\n\nREPRODUCTIVE ORGANS:  Patient appears to be post hysterectomy.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are several midline hernias/wall defects, containing fat\nas well as portions of the transverse colon.  An incisional hernia containing\nsmall bowel is seen in the infra umbilicus location.",
            "output": "Pancreatic head/neck mass; please see full description of staging above.\n\nOccluded SMV with likely resultant portal hypertension and vascular congestion\nof the mesentery, small bowel and right colon."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Large hypoattenuating\ninfiltrative lesion in the pancreatic head/neck likely invading the posterior\nwall of the gastric antrum and proximal duodenum to the level of the major\npapilla.  The body and tail of the pancreas are atrophic with distal main\npancreatic ductal dilation up to 4 mm.\nSize (maximal axial dimension in cm): 5.5 x 4.4 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: Grossly patent\ncommon hepatic/ common bile duct stent with an associated pneumobilia\nsuggesting patency.\n\nArterial evaluation\nSMA involvement: Present\nSolid soft-tissue contact: Greater than 180 degrees\nFocal vessel narrowing or contour irregularity: Absent\nExtension to first SMA branch: Present\n\nCeliac Axis involvement: Present\nSolid soft-tissue contact: Less than 180 degrees\nIncreased hazy attenuation/stranding contact: Greater than 180 degrees\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: Present\nSolid soft-tissue contact:  Greater than 180 degrees\nFocal vessel narrowing or contour irregularity:  Present\nExtension to celiac axis: Present\nExtension to bifurcation of right/left hepatic artery: Absent, replaced left\nhepatic artery\n\nVariant anatomy: Replaced left hepatic artery arising from the left gastric\nartery.  Small right inferior hepatic vein.\nVariant vessel contact:  Absent\n\nVenous evaluation\nMPV involvement: Present\nDegree of solid soft-tissue contact:  Greater than 180 degrees\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nNarrowing and tethering near its confluence with the splenic vein (series 4,\nimage 108)\n\nSMV involvement: Present\nDegree of solid soft-tissue contact:  Greater than 180 degrees\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nPresent\nExtension to first draining vein:  Present\nThrombus within vein: Likely present, chronic\nVenous collaterals: Present\n\nExtrapancreatic evaluation\nLiver lesions: likely benign biloma as described below\nPeritoneal or omental nodules: Absent\nAscites: Present, large volume\nOther extrapancreatic disease (invasion of adjacent structures): Gastric\nantrum and proximal duodenum to the level of the papilla.\n\nVASCULAR:\nAs above, the confluence of the main hepatic portal and splenic veins is\nmarkedly attenuated by adjacent pancreatic malignancy.  The splenic vein is\nchronically thrombosed.  There is occlusive thrombus of the right anterior\nhepatic portal vein as well as nonocclusive thrombus of the left hepatic\nportal vein.  Numerous portosystemic collateral vessels are present within the\nupper abdomen.\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Incidental note is made of a\nsmall right inferior hepatic vein.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY:  A 2.1 x 1.3 cm hypoattenuating, multi lobulated lesion in\nhepatic segment VIII is decreased in attenuation and better defined compared\nto the prior CT obtained ___.  No new focal lesion.  The hepatic\nparenchyma enhances somewhat heterogeneously, particularly in the peripheral\nright hepatic lobe.  Mild intrahepatic biliary ductal dilatation and\npneumobilia are unchanged.  The common hepatic/ common bile duct stent appears\ngrossly patent, though the distal tip is not completely located within the\nduodenum, appearing to terminate at the papilla. The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.  Large volume\nascites is similar compared to the prior examination.\n\nPANCREAS:  As above, there is a large hypoattenuating infiltrative lesion in\nthe pancreatic head/neck likely invading the posterior wall of the gastric\nantrum proximal duodenum to the level of the major papilla. e this lesion\nencases the proximal celiac artery, SMA, and SMA branches.  It also encases\nand the splenic, superior mesenteric vein, and hepatic portal vein confluence\nresulting in marked attenuation of the splenic and proximal hepatic portal\nveins and occlusion of the proximal superior mesenteric and inferior\nmesenteric veins.  The body and tail of the pancreas are atrophic with distal\nmain pancreatic ductal dilation up to 4 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 shape, morphology,\nand enhancement.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis. Few, punctate, bilateral,\nhypoattenuating lesions are too small to completely characterize, but\nstatistically likely reflect simple cysts. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  Small esophageal varices are present.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nEvidence of partial colectomy includes a suture line in the left lower\nquadrant.  Mild diverticulosis is noted.  The colon and rectum are otherwise\nwithin normal limits.  Appendix contains air, has normal caliber without\nevidence of fat stranding.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There are prominent, but not pathologically enlarged\nretroperitoneal lymph nodes.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is large volume\nabdominal ascites.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple ventral hernias containing fat and fluid and a single\nventral Richter's hernia containing a small portion of nonobstructing\ntransverse colon.",
            "output": "1. Large, infiltrative pancreatic head/neck mass with apparent invasion of the\ngastric antrum and proximal duodenum to the superior aspect of the major\npapilla.\n2. The primary lesion encases multiple mesenteric vessels including the\nsuperior mesenteric and celiac arteries.  The involved superior mesenteric and\ninferior mesenteric veins are proximally occluded, either by chronic\nthrombosis or external compression.  The involved proximal portions of the\nsplenic and main hepatic portal veins are significantly attenuated.\n3. There is right anterior hepatic portal vein occlusion as well as\nnon-occlusive thrombus in the proximal left hepatic portal vein.\n4. A previously identified right hepatic lobe hypoattenuating lesion now\nappears to be more like fluid in attenuation and is more well-circumscribed\ncompared to prior examinations suggesting biloma formation status-post\ncholangitis.  Hepatic metastasis is unlikely.\n5. No evidence of nodal metastatic disease.\n6. A common hepatic/bile duct stent appears mildly superiorly displaced with\nits distal tip projecting over the major papilla and medial duodenum wall.\n7. Multiple ventral hernias including a small, non-obstructing Richter's\nhernia of the transverse colon."
        },
        {
            "input": "Note is made of the presence of intravenous contrast from recent contrasted\nenhanced examination performed at an outside institution.\n\nLOWER CHEST: There is bibasilar atelectasis.  The lower lung fields are\notherwise unremarkable.  Coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously hypodense, consistent with hepatic\nsteatosis with a region of focal sparing adjacent to the gallbladder fossa. \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 hypodense lesion in\nthe upper pole of the left kidney likely represents a small cyst.  Smaller\nhypodense lesion at the lower pole the right kidney 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.  There are scattered colonic\ndiverticula without evidence of acute diverticulitis.  The appendix is normal.\n\nPELVIS: The urinary bladder is decompressed with Foley.  Excreted contrast\nmaterial is seen within the bladder.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  There are 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.  Mild-to-moderate\natherosclerotic disease is noted.\n\nBONES: There is mild retrolisthesis of L5 on S1, likely degenerative in\nnature.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No evidence of traumatic injury in the abdomen or pelvis.\nFatty liver."
        },
        {
            "input": "Lower Chest: Please see separately dictated CT chest from today\n\n\nAbdomen and Pelvis:\n\nHepatobiliary: There are no hepatic abnormalities.  Previously seen\ngallbladder wall below team a has resolved.  There is no pericholecystic\nstranding.  No evidence of bile duct dilatation.\n\nSpleen: Normal\n\nAdrenals: Normal\n\nKidneys, Bladder, Ureters: Normal kidneys.  No hydronephrosis.  Foley catheter\nin the bladder.\n\nPancreas: While there is diffuse subcutaneous edema suggesting fluid overload,\nthere is suggestion of mild peripancreatic edema about pancreatic tail,\nclinically correlate as findings may represent acute pancreatitis.  No\nperipancreatic organized fluid collection.\n\nGastrointestinal: Enteric tube tip is in the distal stomach.  There is rectal\ntube in place.  There is stable fatty infiltration of the wall of the\ndescending, rectosigmoid colon, likely sequela of prior inflammatory or\ninfectious colitis, no definite evidence of acute process.  .  Normal\nappendix.  No bowel dilatation.  No free air, no free fluid.\n\nLymph Nodes: No adenopathy\n\nPelvis: No free fluid\n\nReproductive Organs: No abnormality\n\nVascular: Minimal atherosclerotic changes\n\nSoft Tissues: Diffuse soft tissue edema\n\nBones: There are mild degenerative changes in the lumbar spine.  There is\nbenign bone island in the left hip.",
            "output": "Suggestion of acute pancreatitis involving pancreatic tail.\nDiffuse soft tissue edema."
        },
        {
            "input": "LOWER 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: There is a small hiatal hernia.  Postsurgical changes\nrelated to partial gastrectomy are again noted.  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 grossly\nunremarkable.\n\nLYMPH NODES: A 1.2 x 1.1 cm hypoattenuating nodule the left periaortic region\n(5:71) is unchanged since at least ___ and again may represent a benign\nlymphatic malformation.  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. \nModerate multilevel degenerative changes in the lumbar spine are unchanged.\n\nSOFT TISSUES: There is a tiny fat containing umbilical hernia.",
            "output": "1. No evidence of disease recurrence or metastatic disease in the abdomen or\npelvis.\n2. Please refer to dedicated CT chest performed on the same day for detailed\ndescription of intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: There is atelectasis at the left lung base.  There is a small\nhiatal hernia.  Otherwise the visualized lung fields are unremarkable.\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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Postsurgical changes\nrelated to partial gastrectomy are redemonstrated.  The stomach is\nincompletely distended, which limits evaluation.  Within this limitation, no\nabnormality visualized in the remaining stomach.  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: Redemonstrated 0.9 cm hypoattenuating nodule in the left\nperiaortic region is unchanged since ___ (series 5, image 34) and may\nrepresent a benign lymphatic malformation.  No retroperitoneal or 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: There is a small fat containing umbilical hernia.  Otherwise,\nthe abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of disease recurrence or metastatic disease in the abdomen or\npelvis.\n2. Please refer to separately dictated report of the chest performed on the\nsame day for the findings above the diaphragm."
        },
        {
            "input": "LOWER CHEST:\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  Small calcified granuloma is noted at the hepatic dome.  The\nliver is unremarkable.\nThe gallbladder is unremarkable.\nPANCREAS: Unremarkable.\nSPLEEN:  Unremarkable.\nADRENALS:  Unremarkable.\nURINARY: The kidneys are unremarkable.\nGASTROINTESTINAL:  Stomach and duodenum are unremarkable.\nColon and small bowel loops demonstrate normal caliber.\nAppendix is unremarkable.\nLYMPH NODES: No lymphadenopathy.\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is unremarkable.  Uterus is mildly enlarged, measuring 8.7 x 5.7 x\n6.6 cm, with heterogeneous enhancement of myometrium.  Decreased enhancement\nof myometrium near the fundus does not have clear correlate on the ultrasound\nobtained on the same day.  There is probable right corpus luteum.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "1.  No evidence of appendicitis.\n\n2.  Uterus is mildly enlarged with heterogeneous enhancement of myometrium,\nwhich may be related to recent history of pregnancy. Decreased enhancement of\nmyometrium near the fundus does not have clear correlate on the ultrasound\nobtained on the same day."
        },
        {
            "input": "LOWER CHEST: A 3 mm nodule at the right lung base (2:3) is stable.\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: An 8 mm calculus is noted within the left renal sinus, previously\nmeasuring 11 mm.  There are 2 fragments of stones within the lower pole of the\nleft kidney measuring 2 mm each (2:67).  No 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.\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.\n\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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Decreased size of nonobstructing right renal pelvis calculus now measuring\n8 mm.  Fragmented calculi in the lower pole of the right kidney measuring up\nto 2 mm.\n2. Fibroid uterus.\n3. Extensive atherosclerotic disease of the aorta.\n4. 3 mm pulmonary nodule.\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___"
        },
        {
            "input": "LOWER CHEST: There is a 3 mm nodule at the right lung base (2:6), stable\ncompared to CT abdomen ___ and likely an intrapulmonary lymph\nnode.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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: There is a 5mm renal calculus in the lower pole of the right kidney,\npreviously measuring 8 mm on ___, with no evidence of\nobstruction.  A previously seen second right renal renal calculus is no longer\nseen.  There are punctate calcifications of the upper left kidney, which could\nreflect punctate calculi versus medullary nephrocalcinosis..  No bladder\ncalculi seen.  Multiple calcifications in the pelvis are unchanged compared to\nthe prior study and consistent with phleboliths.\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.\n\nPELVIS: There is a small amount free fluid in the pouch of ___.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged consistent with fibroids as seen\non the prior contrast enhanced study.  No adnexal mass seen within the\nlimitations of the noncontrast technique.\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.  There is severe\natherosclerotic disease.\n\nBONES: There 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 nonobstructing calculus in the lower pole the right kidney measuring\n5 mm.  A previously seen calculus in the right renal pelvis is no longer\napparent.  Punctate calcifications in the left kidney may reflect tiny\nnonobstructing calculi versus medullary nephrocalcinosis.\n2.  Fibroid uterus\n3.  Severe atherosclerotic disease of the aorta.\n4.   Stable 3 mm pulmonary nodule.  No specific follow-up recommended.\n\nRECOMMENDATION(S):\n For an incidentally detected single ground-glass nodule smaller than 6mm, no\nCT 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. \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. \nBilateral subcentimeter renal hypodensities are demonstrated and are too small\nto characterize though likely represent renal cysts.  There is no evidence of\nsolid renal lesions or 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 in caliber.\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 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 abnormality identified.  Stomach is\nrelatively collapsed.  Please note that CT is not sensitive in detecting\ngastritis."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  Celiac axis and SMA are patent.  The\n___ is patent but diminutive.  Patient is status post harvest of the left\ngreater saphenous vein with associated postsurgical changes including\nsubcutaneous emphysema along the left lateral groin and adjacent to left\ngreater saphenous vein (3:221).  There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries.  Main portal vein, SMV, and\nsplenic vein are patent.\n\nLOWER CHEST: Lungs are notable for moderate bibasilar atelectasis.  Trace\nbilateral, left greater than right non hemorrhagic pleural effusions are\nnoted.  Patient is status post median sternotomy with associated postsurgical\nchanges including pneumomediastinum.  The heart is mildly enlarged without\npericardial effusion.  Status post aortic valve replacement.  Coronary artery\ncalcifications are noted.  2 epicardial pacer leads are noted.  Limited\nevaluation of pulmonary arteries is worrisome for focal subsegmental filling\ndefect within the left lateral basal segment of left lower lobe (3:5).\n\nABDOMEN:\nHEPATOBILIARY: 0.6 cm hypodensity within segment 7 is too small to\ncharacterize and unchanged since ___.  The liver is diffusely hypodense\nconsistent with hepatic steatosis.  The liver otherwise demonstrates\nhomogenous attenuation throughout. There is no evidence of worrisome lesions. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: Diffuse pancreatic atrophy noted. 1 cm pancreatic tail cystic lesion\nwith coarse calcifications is noted.  (3: 58).  The pancreas otherwise has\nnormal attenuation throughout, without evidence of focal lesions or pancreatic\nductal dilatation. There is no peripancreatic stranding.\n\nSPLEEN: Multiple subtle triangular-shaped hypodensities noted along the\nperiphery of the spleen are worrisome for splenic infarcts (03:39).  No\nperisplenic fluid collection.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal cysts are noted largest measures 6.1 x 4.9 cm\ninterpolar region of the right kidney (3:62) and 5.1 x 5.1 cm within the left\nupper pole.  The kidneys otherwise are of normal and symmetric size with\nnormal nephrogram. There is no evidence of stones, worrisome renal lesions, 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.  Extensive ascending, transverse, sigmoid and\ndescending colonic diverticulosis is seen without evidence of acute\ndiverticulitis.  Colon and rectum are otherwise within normal limits. \nAppendix is not visualized, however no secondary signs of acute appendicitis.\nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nSmall amount of pneumoperitoneum is expected post surgery.\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: Hydrocele is present.The prostate and seminal vesicles\nare otherwise normal.\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. No evidence of mesenteric ischemia.  Patent celiac axis, SMA with patent\nbut diminutive ___.\n2. One definite subsegmental left lower lobe pulmonary embolus.\n\n3. Status post median sternotomy with associated postsurgical changes\nincluding pneumoperitoneum and pneumomediastinum.\n4. Diverticulosis without evidence of acute diverticulitis.\n5. Possible small splenic infarcts.\n6. Hepatic steatosis.\n7. Trace bilateral nonhemorrhagic pleural effusions with compressive\natelectasis.\n8. 1 cm pancreatic tail apparent cystic lesion with coarse calcifications.\n\nRECOMMENDATION(S):  Close attention on follow-up CT is recommended of the\npancreatic cystic lesion.  If no follow-up CT is planned within a year then\nconsider MRCP.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:31 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases are clear.  No pleural effusion.\nThe visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is surgically\nabsent with clips in the gallbladder fossa. No focal fluid collection in the\ngallbladder fossa. Again seen is a 9 mm radiopacity along the inferior edge of\nthe liver, unchanged from ___. The portal vein, SMV, and splenic\nvein are patent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  A stable\n0.9 cm (02:28) hypodensity within the upper pole of the right kidney is too\nsmall to characterize and stable from previous examination. No hydronephrosis\nor hydroureter identified.  No renal or proximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia.   The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. Colonic diverticulosis is present without\nevidence of acute diverticulitis. The appendix is normal without evidence of\nacute appendicitis.  Stable 0.7 cm radiopacity anterior to the right psoas\nmuscle (2: 47).\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  The iliac arteries are normal in\ncourse and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, or pneumoperitoneum. A small fat containing umbilical\nhernia again noted.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. The uterus and right ovary are unremarkable. The left ovary is not\nvisualized.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  No CT evidence to explain patient's symptoms.\n2.   Diverticulosis without evidence of acute diverticulitis.\n3.   Stable small fat containing umbilical hernia."
        },
        {
            "input": "LOWER CHEST: Patient is status post coronary bypass grafting with native\ncoronary arteries demonstrating extensive calcification.  Heart size is mildly\nenlarged with mild aortic valvular calcifications.  Sternotomy wires are\nnoted.  Visualized lung fields are within normal limits.  There is no evidence\nof pleural or pericardial effusion on limited assessment.\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 not visualized.\n\nPANCREAS: The pancreas is atrophic 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, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with a normal\nnephrogram.  A simple appearing cyst is noted in the upper pole of the right\nkidney.  9 mm hypodense lesion extending from the upper pole of the left\nkidney is of indeterminate etiology with internal density of 80 ___.  There is\nno hydronephrosis.  There is no nephrolithiasis or perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is noted with fluid seen in the distal\nesophagus suggestive of reflux.  Remainder of the stomach is unremarkable. \nSmall bowel appears unremarkable with no small bowel obstruction.  There is a\nlarge amount of stool in the ascending colon with a prominent stool ball in\nthe hepatic flexure.  There is mild associated fat stranding at the hepatic\nflexure which raises the possibility of early stercoral colitis (601:28). \nThere is distal decompression of the large bowel (602:19).  Rectum is\nunremarkable.\n\nPELVIS: The urinary bladder is distended.  The distal ureters are\nunremarkable.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no lymphadenopathy within the abdomen or pelvis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is intervertebral disc calcification at the level of L4-L5. \nThere is no acute fracture or concerning osseous abnormalities\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large volume stool in the ascending colon most prominent at the hepatic\nflexure where there is a large stool ball with mild associated surrounding fat\nstranding, findings which raise the possibility of early stercoral colitis. \nLarge bowel is completely decompressed distal to this stool ball in the\nhepatic flexure.\n2. Indeterminate 9 mm hypodense lesion in the upper pole of the left kidney. \nFurther evaluation with dedicated renal ultrasound on a non-emergent basis is\nrecommended.\n\nRECOMMENDATION(S):  Nonemergent renal ultrasound for further assessment of the\nleft upper pole renal lesion."
        },
        {
            "input": "LOWER CHEST: There are metastatic nodules within bilateral lower lung fields\nmeasuring up to 2.2 cm within the right lower lobe, 11.4 cm within the left\nlower lobe.  visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is extensive hypoattenuating liver metastases throughout\nthe liver with conglomeration predominantly within the dome and right hepatic\nlobe.  No definite intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is non-thickened and appears normal.  No cholelithiasis. \nExtensive abdominopelvic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  No peripancreatic stranding.\n\nSPLEEN: Sub-centimeter hypodensity within the superior aspect of the spleen\nlikely represents a splenic cyst or hemangioma.  Top normal splenic size\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. \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. Evaluation of the\ncolon and rectum are limited due to extensive ascites and lack of oral\ncontrast.  There is an anastomotic staple line within the transverse colon. \nAppendix is not visualized.\n\nPELVIS: The urinary bladder is decompressed.  The distal ureters are\nunremarkable.  Again, there is extensive abdominopelvic ascites.\n\nREPRODUCTIVE ORGANS: The uterus appears surgically absent.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.  No pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: The abdominal aorta is tortuous.  Mild atherosclerotic disease is\nnoted.  The left portal vein appears attenuated relative to the right.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small right fat containing inguinal hernia.  Evidence of omental\ntumor invasion with extension into the umbilicus.  The abdominal and pelvic\nwall is within normal limits.",
            "output": "1. There is extensive hypoattenuating liver metastases throughout the liver\nwith conglomeration predominantly within the dome and right hepatic lobe.  No\ndefinite area of biliary dilatation.\n2. There is tumor attenuation of the left portal vein relative to the right.\n3. Evidence of metastatic disease within bilateral lower lung fields, multiple\npulmonary nodules.  No pleural effusions.\n4. Extensive abdominopelvic ascites."
        },
        {
            "input": "LOWER CHEST: 3 mm nodule in the right lower lobe (series 2, image 20). \nOtherwise, the lung bases are clear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nScattered innumerable hypodensities throughout the liver, the largest\nmeasuring 5.4 cm in the left lobe of the liver, likely represent cysts or\nbiliary hamartomas.  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: There is mild to moderate hydronephrosis of the right kidney with a\ndilated ureter and a 5 mm obstructing stone seen at the distal ureter (series\n2, image 148).  The left kidney contains a nonobstructing 5 mm stone in the\nlower pole.  No evidence of hydronephrosis of the left kidney.  There is a\npunctate nonobstructing stone in the lower pole of the right kidney.  The\nbladder is unremarkable.  No suspicious lesions seen, within limitations a\nnonenhanced scan.\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 not\nvisualized.\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. A5 mm obstructing right distal ureteral stone causing upstream\nmild-to-moderate hydroureteronephrosis.\n2. Additional nonobstructing bilateral renal calculi as above.\n3. 3 mm right lower lobe nodule.\n\nRECOMMENDATION(S):\nFor 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___"
        },
        {
            "input": "CHEST: Aside from mild bibasilar atelectasis, the lungs are clear with no\neffusion or consolidation.  7mm left lower lobe nodule is unchanged from last\nmonth.  Follow up CT in ___ year is recommended.  The heart is normal in size\nwith no pericardial effusion.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal lesions or intrahepatic\nbiliary dilatation. The gallbladder is non-distended with no stones. The\npancreas is normal with no surrounding stranding. The spleen is enlarged,\nmeasuring 15 cm in craniocaudal dimension, with areas of hypoattenuation,\nsimilar to the prior CT from ___, possibly representing infarcts. The\nadrenal glands are normal bilaterally. The kidneys enhance and excrete\ncontrast normally with no hydronephrosis.\n\nThe stomach and small bowel are normal in caliber proximally, distally, there\nare few fecalized loops of small bowel, indicating delayed transit,\nparticularly in the distal ileum. In the cecum there is a hyperdense object\nwhich correlates to a capsule endoscope. There is a considerable amount of\nstool in the right colon. Remainder of the colon is decompressed. There is no\nmesenteric or retroperitoneal lymphadenopathy, or free air or free fluid.\n\nPELVIS:  The urinary bladder is well distended, normal-appearing. The prostate\nand seminal vesicles are unremarkable. There is no free fluid in the pelvis.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: The patient recently underwent sacral biopsy and there is\nno concerning soft tissue changes abutting the left iliac bone, in the region\nof the biopsy tract.  Small midline lytic lesion appears unchanged.",
            "output": "1.  Moderate amount of stool in the right colon, as well as a capsule\nendoscope in the proximal portion of the cecum.\n2.  No identifiable intra-abdominal source of infection.\n3.  No abscess or concerning soft tissue changes adjacent to the sacrum or\nleft iliac bone, along the path of recent biopsy.\n4.  ___ year follow up chest CT for left lower lobe nodule is recommended."
        },
        {
            "input": "Lungs and Heart: There are small bilateral pleural effusions and bibasilar\natelectasis.  The heart and pericardium are normal.\n\nLiver, Gallbladder: Few hypodensities in the liver are unchanged compared to\n___ and are consistent with hepatic cysts.  No new focal hepatic\nlesion is identified. The liver is normal in size. The gallbladder is absent.\nThe spleen is normal. The pancreas is normal, and is similar in appearance to\nthe prior study. There is no evidence of focal pancreatic lesion. The\nbilateral adrenal glands, kidneys and ureters are normal and unchanged in\nappearance. Multiple renal hypodensities are unchanged and are consistent with\ncysts.\n\nThe distal esophagus, stomach, small bowel the large bowel are do grossly\nnormal on this noncontrast study. There is sigmoid diverticulosis with no\nevidence of diverticulitis.\n\nThe abdominal aorta is normal in caliber and shows minimal mural\ncalcification.\n\nThere is no free air identified in the abdomen or pelvis.\n\nCT pelvis: There is a small focus of air in the bladder, however there is no\nevidence of bladder wall thickening- Correlate with recent Foley catheter\nplacement or instrumentation. The rectum is normal appearing. There is no\npelvic sidewall lymphadenopathy.\n\nThere is a small presacral hematoma which may be related to recent pelvic\nfracture, as well as lateral soft tissue swelling about the left hip. There is\na fracture involving the left superior and inferior pubic rami. There are no\nsuspicious lytic or sclerotic osseous lesions identified.",
            "output": "1. Small presacral hematoma, likely related to recent pelvic fracture as well\nas lateral soft tissue swelling about the left hip.\n2. Fractures involving the left superior and inferior pubic rami.\n3. Small focus of air within the bladder. Correlate with recent catheter\nplacement or instrumentation."
        },
        {
            "input": "LUNG BASES:  Please see dictation for separately reported CT Chest\nexamination.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion.  There is\nmild diffuse intrahepatic biliary ductal dilation, not appreciably changed\nfrom prior.  There is no evidence of obstructing mass. The portal vein is\npatent.  Pancreas divisum is again noted.  Otherwise, the pancreas enhances\nhomogeneously without peripancreatic stranding or ductal dilation.  There is\nno splenomegaly or focal splenic lesion.  The adrenal glands are unremarkable.\nA 7 mm left kidney interpolar region cystic focus, in addition to several\nsmaller cystic lesions in the right lower pole, are indeterminate by CT, too\nsmall to characterize but stable since prior from ___.  Otherwise,\nthere is normal symmetric renal enhancement bilaterally.  There is no\nhydronephrosis.\n\nThe stomach is filled with contrast.  The duodenum is unremarkable. \nNon-dilated small bowel loops are normal in caliber without evidence of wall\nthickening or obstruction.  The colon is unremarkable.\n\nThere is moderate atherosclerotic calcification most prominent infrarenal\nabdominal aorta and at the aortoiliac bifurcation.  There is no evidence of\nabdominal aortic aneurysm or dilation.  Dense calcified plaque at the origin\nof the SMA and the right renal artery appears to at least moderately narrowed\nthe vessel lumina (series 3, image 61 and 64).  The distal SMA is widely\npatent and right renal artery.  The remaining abdominal aortic major branches\nare unremarkable and widely patent.\n\nRetroperitoneal and mesenteric lymph nodes measuring up to 8 mm not meet CT\nsize criteria for lymphadenopathy.  There is no free intraperitoneal air or\nfluid.  Diffuse haziness of the mesentery is noted, likely secondary to a\ngeneralized mildly edematous state.\n\nCT PELVIS:\nThere is mild pelvic floor descent; otherwise the imaged pelvic organs are\nunremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is mild diffuse subcutaneous soft tissue edema.  There is mild\ndegenerative change of the imaged thoracolumbar spine.  Grade 1 L5-S1\nanterolisthesis is likely degenerative.  Multifocal sclerotic foci involving\nseveral vertebral bodies, including a 5 mm focus in the inferior endplate of\nL4 (series 11, image 36), as well as a 6 mm focus in the left T12 pedicle (see\nseries 11, image 40), are not appreciably changed since most recent prior from\n___, but are new since more remote prior from ___, concerning\nfor multifocal osseous metastasis.",
            "output": "1. Multifocal thoracolumbar spine sclerotic foci measuring up to 6 mm, new\nsince CT from ___, concerning for osseous metastases.  Correlation\nwith bone scan is recommended.\n2. Please see separate report for intrathoracic findings from same-day CT\nchest.\n\nNOTIFICATION:     The impression and recommendation above was entered by Dr.\n___ on ___ at 13:31 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider.\n\nRECOMMENDATION(S):  Bone scan for correlation with multifocal osseous\nthoracolumbar spine sclerotic foci, as above."
        },
        {
            "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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 intermediate density lesion in the upper pole of the left\nkidney (series 2, image 28), which likely represents a hyperdense cyst. \nMultiple additional subcentimeter hypodensities are too small to characterize.\nNo hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  The\ncolon and rectum are within normal limits.  The appendix is markedly dilated,\nmeasuring up to 21 mm in diameter (602b:23), with surrounding fat stranding,\nconsistent with acute appendicitis.  There is no adjacent free air or fluid\ncollection.\n\nPELVIS: Urinary bladder is well distended.  There is no free fluid in the\npelvis.\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.  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. Markedly dilated appendix measuring up to 21 mm with adjacent fat\nstranding, consistent with uncomplicated acute appendicitis.\n2. A 17 mm intermediate density lesion in the upper pole of the left kidney\nlikely represents a hyperdense cyst.  A nonurgent renal ultrasound could be\nconsidered for confirmation.\n\nNOTIFICATION:  Updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 1:50 ___, 3 minutes after\ndiscovery of the findings."
        },
        {
            "input": "CT of the abdomen:\nThe liver demonstrates homogeneous enhancement. A 3 mm hypodensity in segment\nV (6:64), is too small to characterize.  There is a 7 mm hypodensity in\nsegment 4A (06:57), incompletely characterized.  A vague hypodensity along the\nfalciform ligament (06:57), most likely reflects oval focal fatty deposition\nor perfusional abnormality.  There is no evidence of intrahepatic or\nextrahepatic biliary ductal dilatation. The portal vein is patent. The\ngallbladder is incompletely distended. There is no gallbladder wall edema or\npericholecystic fluid collectionto suggest acute inflammation. The spleen is\nnormal in size. Pancreas demonstrates homogeneous enhancement without ductal\ndilatation or peripancreatic fluid collection. The adrenal glands are normal. \nThere is a 6 x 11 mm node immediately medial to the left adrenal gland (6:64).\nThe kidneys demonstrates homogeneous enhancement without evidence of\nhydronephrosis or suspicious renal masses.\n\nSmall large bowel loops are normal in caliber without evidence of bowel wall\nthickening or obstruction.  There is no retroperitoneal or mesenteric\nlymphadenopathy. Intra-abdominal aorta demonstrates calcified atherosclerotic\ndisease without aneurysmal changes.  There is no free air free fluid within\nthe abdomen.\n\nCT of the pelvis:\n\nThe bladder, rectum, and sigmoid colon are unremarkable. The prostate gland is\nenlarged measuring 4.3 x 4.2 cm with heterogeneous enhancement. There is no\npelvic wall lymphadenopathy.  There is no free or free fluid within the\npelvis.\n\nOsseous structures: No suspicious lytic or sclerotic bony lesion is seen.",
            "output": "1. Hepatic hypodensities, as described above, may represent biliary\ncysts/hamartomas. However, metastasis cannot be excluded given patient's\nhistory.  Recommend liver US for further characterization.\n2. No evidence of osseous metastatic disease."
        },
        {
            "input": "LOWER CHEST: Included lower chest shows bilateral dependent atelectasis and\nmild vascular congestion.  There is moderate cardiomegaly, and epicardial\nleads are noted.  Coronary arterial calcifications are present.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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.  A splenule is noted at the splenic hilum.\n\nADRENALS: The left adrenal gland is normal in size and shape.  A 1.7 cm right\nadrenal adenoma is stable since ___.\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 tiny 1-2 mm\nlow-density lesions in the left kidney are too small to characterize, however\nstatistically most likely benign.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: There has been recent placement of a percutaneous endoscopy\ngastrostomy tube that appears to be in adequate position.  The stomach is\nunder distended.  Loop of small bowel inferior to the site of gastrostomy show\nair-filled prominence with few air-fluid levels, without frank distention. \nThis may relate to mild ileus secondary to the pneumoperitoneum.  The colon is\nunder distended and unremarkable. The appendix is normal.\n\nPELVIS AND PERITONEUM: There is no free fluid in the abdomen or pelvis. \nModerate pneumoperitoneum is identified predominantly in the upper abdomen.\n\nREPRODUCTIVE ORGANS: Prostate gland is mildly enlarged measuring up to 4.9 x\n3.7 cm in axial ___.  Seminal vesicles appear symmetric.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.  Few prominent mesenteric\nlymph nodes are likely reactive.\n\nVASCULAR: Moderate atherosclerotic disease is present.  A left iliac stent is\npresent, patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe degenerative changes are present throughout the included\nthoracolumbar spine, most severe between L4 and S1.  Sternotomy wires are\npartially visualized.\n\nSOFT TISSUES: Small amount of subcutaneous emphysema and interfascial gas is\nnoted in the anterior upper abdominal wall, within normal limits for recent\nPEG placement.",
            "output": "1. Moderate upper abdominal pneumoperitoneum may be postprocedural versus\nrelated to a mechanical leak from the PEG tube.  The PEG tube appears to be in\nsatisfactory position.  No evidence of bowel injury.  Mildly prominent small\nbowel loops in the anterior upper abdomen most likely relate to mild ileus\nsecondary to the pneumoperitoneum.\n2. No other acute intra-abdominal/pelvic findings.  No ascites.  No evidence\nof bowel obstruction."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is a tiny pleural tag at\nthe right lung base, stable.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nThe liver is normal in attenuation with no focal lesions. The gallbladder is\nsurgically absent. There is mild central intrahepatic biliary dilatation.  The\npancreas is normal with no peripancreatic fat stranding or fluid collections. \nThe spleen is normal in size and homogeneous in attenuation.  The left adrenal\ngland is mildly thickened, as before. The right adrenal gland is normal in\nsize and morphology. The kidneys enhance symmetrically and display prompt\ncontrast excretion with no focal lesions, hydronephosis, or radioopaque\nstones.\n\nThe patient is status post Roux-en-Y gastric bypass with oral contrast\nrefluxing into the afferent limb, seen in the stomach and the duodenal bulb. \nThere is no dilatation of the afferent limb, or signs of duodenitis.  Fluid\nand air and seen in the excluded stomach with no gastro-gastric fistula\nidentified.  There is a small hiatal hernia.  Remainder of the small bowel is\nnormal in caliber with no evidence of obstruction.  At the terminal ileum,\njust before the iliocecal valve, there is a small diverticulum, unchanged\nsince the prior studies. In the large bowel, there are numerous right-sided\ndiverticula, with no evidence of diverticulitis. The patient is status post\nappendectomy.  A few scattered diverticular seen in the descending and sigmoid\ncolon, with no evidence of diverticulitis.  The colon is thin-walled with no\npericolonic stranding to suggest colitis. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no intraabdominal\nfree air or free fluid.\n\nPELVIS: The bladder is not well distended, but grossly normal.  The uterus and\novaries are not seen, presumably surgically absent. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nVESSELS: The aorta is normal in caliber with significant atherosclerosis, and\nits major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Reflux of oral contrast into the afferent limb filling the duodenum and\ninto the stomach, but no signs of duodenitis or dilation of the afferent limb.\n\n2.  Mild central intrahepatic biliary dilatation can be seen after\ncholecystectomy.\n\n3.  Colonic diverticulosis without diverticulitis."
        },
        {
            "input": "Lung bases are clear. There is no pleural effusion.\n\nThe liver enhances homogeneously without focal lesions. Mild intra and extra\nhepatic biliary dilatation is slightly more prominent compared to the prior\nexamination however the CBD tapers the ampulla. The patient is status post\ncholecystectomy. Mild prominence of the pancreatic duct without frank\ndilatation is unchanged. The pancreas enhances homogeneously without focal\nlesions the spleen and adrenal glands are unremarkable. The kidneys enhance\nand excrete symmetrically without concerning lesions or hydronephrosis.\n\nPatient is status post Roux-en-Y gastric bypass. There is no evidence of\nobstruction. The colon is notable for diverticulosis without diverticulitis.\nThere is no mesenteric or retroperitoneal lymphadenopathy. There is no intra\nabdominal free air or fluid.\n\nAbdominal aorta is of normal caliber with scattered calcifications. Portal\nvein, splenic vein, and SMV are patent.\n\nBladder and terminal ureters are unremarkable. There is no pelvic free fluid.\nThere is no pelvic or inguinal lymphadenopathy. The uterus is not visualized.\n\nNo concerning lytic or blastic osseous lesions identified. Degenerative\nchanges are noted in the spine.",
            "output": "1. Mild intra and extrahepatic biliary dilatation, similar to the prior\nexamination, likely due to post cholecystectomy state.\n\n2.  Diverticulosis without diverticulitis.\n\n3.  Status post gastric bypass without evidence of obstruction."
        },
        {
            "input": "LOWER CHEST: Left greater than right lower lobe atelectasis are unchanged. \nSevere partially imaged aortic valve and mitral annulus calcification.\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 contains\ngallstones without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is mildly atrophic with no focal lesions or pancreatic\nductal dilation identified.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A left adrenal lateral limb adenoma (9 Hounsfield units) measures\n2.8 x 2.6 cm.  A left adrenal medial limb adenoma (3 Hounsfield units)\nmeasures 1.6 x 1.5 cm.  The right adrenal gland is normal in size and shape.\n\nURINARY: The kidneys are slightly atrophic, but symmetric in size and\nnephrogram.  No focal lesions identified.  No hydronephrosis.\n\nGASTROINTESTINAL: Moderate hiatal hernia. Small bowel loops are unremarkable.\nNo bowel obstruction.  Diverticulosis of the colon is noted, without evidence\nof wall thickening and fat stranding.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is unremarkable.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is anteverted.  There is a locule of gas in\nthe endometrium.  There are coarse calcifications in the bilateral ovaries,\nraising the possibility of small dermoids.\n\nLYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.  Extensive atherosclerotic disease.\nIncidental 8 mm noncalcified splenic artery aneurysm.  An IVC filter is noted.\n\nBONES/SOFT TISSUES: Asymmetric prominence of the right psoas, iliacus, and\niliopsoas muscles suggest poorly defined hematoma formation. There are small\nfoci of avid contrast enhancement equal to that of the blood pool in the lower\npsoas (series 6, image 99) and right iliopsoas (series 6, image 122) measuring\n5 mm and 3 mm, respectively.  Small to moderate volume retroperitoneal\nhematoma has only minimally increased.  Within the extra muscular portion of\nthe retroperitoneal hematoma, there is no evidence of separate pseudoaneurysm\nor active extravasation.  There is no aggressive osseous lesion or acute\nfracture.  Chronic appearing L1 compression deformity with 5 mm osseous\nretropulsion.  Chronic appearing L4 compression deformity with no osseous\nretropulsion.  Status-post L4-L5 laminectomy.  Multiple chronic appearing\nbilateral lower rib fractures.  Small, fat containing umbilical hernia.",
            "output": "1. Tiny right psoas and iliopsoas pseudoaneurysms.  The intramuscular\nhematomas appear essentially unchanged.  The extra muscular retroperitoneal\nhematoma appears minimally increased.  No evidence of extramuscular\nextravasation or pseudoaneurysm.\n2. Unchanged left greater than right lower lobe atelectasis.  Difficult to\nexclude pneumonia in the appropriate clinical setting.\n3. Chronic appearing L1 and L4 compression deformities with 5 mm osseous\nretropulsion of L1.\n4. Incidental left adrenal adenomas.\n5. Incidental 8 mm splenic artery aneurysm."
        },
        {
            "input": "LOWER CHEST: There are bibasilar opacities, left greater than right, likely\natelectasis.  There is a small left pleural effusion.  Heart is markedly\nenlarged.  There are extensive coronary atherosclerotic calcifications.  There\nis no evidence of pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Mild periportal hypoattenuation may be\nsecondary to fluid resuscitation.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is surgically absent.  Clips\nabout the medial right hepatic lobe are likely related to 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. \nRe-demonstrated is a 1.9 cm heterogeneous, solid renal mass in the upper pole\nof the left kidney (02:20), previously characterized as an angiomyolipoma,\nstable.  There is no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Percutaneous gastrostomy tube in appropriate position.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout, and are predominantly fluid filled,\nsimilar to prior.  The colon is diffusely mildly distended with air and fluid\nto the rectum, similar to prior.  No bowel obstruction.  The appendix is not\ndefinitively visualized, although no secondary signs of appendicitis are seen.\n\nPELVIS: Bilateral bladder diverticula are again seen, measuring up to 5.3 cm\non the right and 4.4 cm on left.  Air within the lumen of the bladder is\npresumably due to recent instrumentation.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality\nidentified.\n\nLYMPH NODES: A 2.5 cm retrocrural cystic structure at the aortic hiatus\n(02:21) is unchanged, possibly a dilated lymphatic structure.  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 are subacute fractures of the posterior and lateral right tenth\nthrough twelfth ribs.  There is no evidence of worrisome osseous lesions or\nacute fracture.  There is unchanged minimal anterolisthesis of L3 on L4.\n\nSOFT TISSUES: There punctate densities in the bilateral breasts, better\nassessed on the previous mammogram.  The abdominal and pelvic wall is\notherwise unremarkable.",
            "output": "1. No evidence of bowel obstruction or ileus.\n2. Subacute fractures of the posterior and lateral right tenth through twelfth\nribs.\n3. Air within the bladder lumen, presumably from recent instrumentation.  If\nthere is no such recent clinical history, however, and correlation with\nurinalysis is suggested is findings would be concerning for infectious\ncystitis.\n4. Unchanged bilateral bladder diverticula.\n5. Bibasilar atelectasis with small left pleural effusion.\n6. Stable 1.9 cm left renal angiomyolipoma.\n7. Punctate densities in the bilateral breast better assessed on prior\nmammograms."
        },
        {
            "input": "LOWER CHEST: No pleural effusion.  No pericardial effusion.  There is mild\ndependent atelectasis similar to the prior study.  Moderate cardiomegaly.\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 adrenal gland is unremarkable.  The left adrenal gland is\nnot well visualized.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 1.9 cm heterogeneous, solid renal mass in the upper pole of the\nleft kidney (series 5, image 26).  There is no definite bulk fat within this\nmass.  No hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is no bowel obstruction,\nhowever there are prominent loops of small bowel with fecalization.  For\nexample, a jejunal loop in the left hemiabdomen measures up to 3 cm and\ngradually tapers distally (series 6, image 17).  Findings could suggest\nenteritis.  The colon and rectum are unremarkable.  The appendix is not\nvisualized.\n\nPELVIS: There are bilateral bladder diverticula measuring up to 4.3 cm. There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a calcified fibroid in the uterus (series 5,\nimage 6061).\n\nLYMPH NODES: A 2.6 cm retrocrural cystic structure at the aortic hiatus\n(series 5, image 17) may represent a dilated lymphatics.  There is no bulky\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.",
            "output": "1. No bowel obstruction, but prominent small bowel loops with fecalization\ncould suggest enteritis.\n2. 1.9 cm heterogeneous, solid left renal mass, concerning for renal cell\ncarcinoma."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  A patent aorto-bifem stent graft is\nre-demonstrated in unchanged position.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  The celiac axis, SMA,\nsingle bilateral renal arteries, ___ are all patent.  Bilateral common iliac\nartery stents are patent.\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Incidental note is made of a small 1.1 cm\nduodenal lipoma, unchanged from prior.  Diverticulosis without evidence of\nacute diverticulitis.  The appendix is not visualized, likely surgically\nabsent.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains calcified fibroids.  No abnormal\nadnexal masses.\n\nBONES: There 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 symptoms.\n2. Patent bilateral iliac stents in unchanged position.\n3. Diverticulosis without acute diverticulitis\n4. 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: 1 cm left hepatic lobe cyst is unchanged.  There is no new\nlesion.  The liver demonstrates homogenous 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: 2 right sided and one left-sided adrenal nodules are seen measuring\nup to 1.1 cm right, unchanged from prior 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: There is a nasogastric tube in place.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits.\nModerate fecal loading is noted.  The appendix is normal.\n\n2.6 x 3.8 cm right lower quadrant hypodense mass is unchanged from prior exam.\nAn adjacent nodular structure in the right lower quadrant seen best on series\n11 image 59 measuring 12 x 14 mm could represent a diverticulum versus nodule\nand attention on follow-up advised.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  The previously seen pelvic peritoneal implants on\nMR dated ___ are not seen on this exam.\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 finding in the abdomen and pelvis.\n2. Stable 2.9 x 4.0 cm hypodense mass in the right lower quadrant.  Small\nadjacent nodule versus diverticulum.  Continued attention on follow-up.  No\nadditional masses or adenopathy.\n3. on the same day for description of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  Replaced right hepatic artery\nnoted.\n\nThere is severe atherosclerotic narrowing at the origin of the celiac artery\n(image 35, series 3A).\n\nThe superior mesenteric artery is widely patent.\n\nThere is mild to moderate atherosclerotic narrowing at the origin of the left\nrenal artery and moderate atherosclerotic narrowing at the origin of the right\nrenal artery.\n\nThe internal iliacs are severely atherosclerotic and demonstrate near complete\nocclusion on the left and complete occlusion on the right, with distal\nreconstitution.\n\nThere is moderate atherosclerotic narrowing of the external iliacs\nbilaterally.\n\nNo active contrast extravasation into the bowel or otherwise.\n\nLOWER CHEST: There are small to moderate bilateral effusions with overlying\natelectasis.  Trace pericardial effusion noted.\n\nABDOMEN:\n\nTrace ascites noted.\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.  Mild gallbladder wall thickening is\nnonspecific in the setting of ascites.  Replaced right hepatic artery 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: No concerning splenic lesions.  Small infarct noted at the superior\nmargin of the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 4.9 cm simple cyst noted in the left kidney.  Additional\nsubcentimeter hypoattenuating lesions are statistically most likely to\nrepresent cysts.  No concerning renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Edema in the antrum/pylorus of the stomach is compatible\nwith the patient' known ulcer.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout. Colon and rectum are within normal\nlimits, noting a small rectal telangectasia, wihtout evidence for active\nextravasation appendix contains air, has normal caliber without evidence of\nfat stranding.  There is no evidence of mesenteric lymphadenopathy.  No\nevidence for active extravasation.  Coils are seen within distal branches of\nthe right colicky artery compatible with recent embolization.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Foley catheter noted in a collapsed urinary bladder.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nBONES: No concerning osseous lesions, noting multilevel chronic compression\ndeformities of the lumbar spine.  Subchondral sclerotic changes in the femur\nare likely related to avascular necrosis.  Severe compression deformity with\nanterior wedging is noted at L1.  There is severe disc narrowing at L4-L5 and\nL5-S1 with advanced endplate degenerative changes as well as marginal\nosteophytosis.\n\nSOFT TISSUES: Extensive stranding throughout the subcutaneous tissues is\ncompatible with anasarca.",
            "output": "1. No evidence for active contrast extravasation into the bowel or otherwise.\n2. Severe atherosclerotic narrowing at the origin of the celiac artery.\n3. Bilateral femoral avascular necrosis.\n4. Small to moderate bilateral pleural effusions.\n5. Moderate anasarca."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: Hypodense area in the segment II/IVb is likely focal fatty change. \nSubcentimeter segment VII hypodense lesion is likely a cyst. There is no\nintrahepatic biliary duct dilation. The portal vein is patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\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: The adrenal glands are normal.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesions or no hydronephrosis.\n\nGI: Stomach and small bowel loops are normal. There is diffuse colonic wall\nthickening extending from the cecum continuously to the rectum. Numeric\nmesenteric lymph nodes are seen near the cecum, likely reactive. There is no\nfree fluid or free air in the abdomen.\n\nRETROPERITONEUM: The aorta is normal in caliber. Small 6 mm lymph node\nanterior to the right psoas muscle is likely also reactive (image 2:52).\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall lymphadenopathy.\nThere is small amount of pelvic free fluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.\nSacroiliac joints are normal.",
            "output": "Diffuse colitis, differential includes inflammatory (such as ulcerative\ncolitis) or infectious bowel disease.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 11:59 AM, 2 minutes after the images were reviewed."
        },
        {
            "input": "LOWER CHEST: Linear atelectasis in the lingula is incidentally noted. \nVisualized lung fields are otherwise within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  11\nmm hypodense lesion with peripheral nodular puddling of contrast at the right\nliver dome is compatible with a hemangioma (5:6).  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. \n10 mm simple cyst arises from the upper pole of the left kidney. \nSubcentimeter hypodensity within the lower pole of the left kidney is too\nsmall to fully characterize.  There is no renal calculi 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 grossly 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.  Dilated left gonadal vein with prominent left-sided pelvic varices\nare 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. No acute abnormality identified to account for the patient's symptoms.\n2. Dilated left gonadal vein with prominent left-sided pelvic varices can be\nseen with pelvic congestion syndrome but clinical correlation is necessary.\n3. 11 mm right hepatic dome hemangioma."
        },
        {
            "input": "CHEST:  Please see the separate formal report dictated by the cardiothoracic\nimaging section. Briefly, bilateral pleural effusions with adjacent\natelectasis and a moderate-sized pericardial effusion are noted.\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 normal. The small and large bowel are unremarkable in\nappearance without dilation or wall thickening. The appendix isair-filled and\nnormal in appearance. There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free abdominal fluid or pneumoperitoneum. The aorta and\nits major branches are grossly patent.\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.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of acute intra-abdominal process.\n\n2. Bilateral pleural effusions and pericardial effusion. For further details,\nplease see the separate chest CT report dictated by the cardiothoracic imaging\nsection."
        },
        {
            "input": "LOWER CHEST: A right PICC terminates at the bottom of the right atrium (5:27).\nA prosthetic aortic valve is present. There is no evidence of pericardial\neffusion. Bibasilar atelectasis and small bilateral pleural effusions are\npresent.  Mild gynecomastia is 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.  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 2.3 cm\nround right parapelvic cyst is present.  There is no hydronephrosis.  There is\nno nephrolithiasis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates within the stomach.  The stomach\nis unremarkable.  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 normal.\n\nPELVIS: Evaluation of the pelvis is mildly limited by artifact from right hip\narthroplasty.  The urinary bladder and distal ureters are unremarkable.  There\nis no free fluid in the pelvis.  Air in a decompressed bladder likely due to\nFoley placement.\n\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: Right total hip arthroplasty with heterotopic bone formation in the\nposterior gluteal and sacral soft tissue (3:69).  There is no concerning\nosseous lesion or fracture.  Extensive degenerative changes of the lumbar\nspine are present.  Incidentally noted is a sclerotic focus in right iliac\ncrest consistent with a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No abdominal or pelvic hematoma.\n2. Small bilateral pleural effusions.\n3. Right PICC terminating at the bottom of the right atrium; pullback advised.\n\nRECOMMENDATION(S):  Pullback of the the right PICC to the upper caval-atrial\njunction.\n\nNOTIFICATION:  Positioning of the PICC was discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 7:42 ___, 20 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. \nSeveral subcentimeter well-defined low attenuating lesions, some of which are\nlobulated likely represent hepatic cysts.  The largest measures up to 3.3 x\n2.3 cm in the left hepatic lobe, with either fine internal septation versus\ntwo adjacent 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 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 suspicious\nrenal 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. Few scattered colonic\ndiverticula without evidence of acute diverticulitis.  The appendix is normal.\n\nPELVIS: Apparent bladder wall thickening may be secondary to underdistention,\nthough correlation with urinalysis is recommended.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Several coarse calcifications are noted 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Apparent bladder wall thickening could be secondary to under distension,\nthough correlation with urinalysis is recommended to evaluate for infectious\ncystitis.\n2. Otherwise, no urolithiasis or acute process within the abdomen or pelvis.\n3. Colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "PELVIS:\n\nGASTROINTESTINAL:  The visualized small bowel loops demonstrate normal caliber\nand wall thickness throughout.  The visualized colon and rectum are within\nnormal 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. \nScrotal pearls on the right correlate with US findings from the same day.\n\nLYMPH NODES:  There is no pelvic lymphadenopathy.  Mildly enlarged and\nmorphologically normal left inguinal lymph nodes are likely reactive.\n\nVASCULAR:  No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small, shallow fat containing inguinal hernia on the\nleft.  A small fat containing umbilical hernia is seen.",
            "output": "1. Small fat containing inguinal hernia on the left.  Minimally prominent,\nlikely reactive left inguinal lymph nodes.\n2. Incidental note of small fat containing umbilical hernia."
        },
        {
            "input": "LOWER 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 is 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 adrenal gland is normal in size and shape.  In the lateral\nlimb of the left adrenal gland, a 12 mm nodule measures 85 Hounsfield units\n(04:38).  This appears stable from prior MRI performed in ___ where there was\ndrop in signal out of phase relative tip to inphase images compatible with\nintralesional fat and an adenoma (series 4, image 15 on that study).\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.  Dense residual oral contrast remains in the\nentire colon, significantly dense in the descending and sigmoid colons where\nthere is substantial surrounding streak artifact which dramatically limits\nassessment of the adjacent structures.  No evidence of active extravasation\nwithin the small bowel although limited assessment in the left abdomen.\nAssessment for active extravasation within the colon is not feasible due to\nthese constraints. Pancolonic diverticulosis is noted without evidence of\ndiverticulitis.  However there appears to be mucosal hyperenhancement and\nsurrounding fat stranding adjacent to the rectum. Additionally, a focal area\nof apparent asymmetric wall thickening with slight resemble an apple-core\nlesion near the rectosigmoid junction is incompletely assessed (4:111;\n604:92).\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: Evidence of prior TURP.\n\nVASCULAR: There is a replaced right hepatic artery from the SMA (04:52).  No\nabdominal aortic aneurysm.  There is minimal calcium burden in the abdominal\naorta and great abdominal arteries.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nExtensive degenerative changes in the spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Findings raise concern for proctitis or possibly an underlying rectal mass.\nConsider sigmoidoscopy or colonoscopy to further evaluate.\n2. Pancolonic diverticulosis.\n3. Residual dense oral contrast throughout the colon precludes assessment for\nactive extravasation in the colon. No bowel obstruction or evidence of active\nextravasation in the small bowel within the limits of the study."
        },
        {
            "input": "LOWER CHEST: Mild bibasal atelectasis, otherwise visualized lung fields are\nwithin normal limits.  Mild cardiomegaly.  No pericardial effusion. Moderate\ncalcification of the coronary arteries and aortic annulus.  No pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Stable central intrahepatic and\nextrahepatic biliary dilatation.  The common bile duct measures up to 12 mm. \nThe gallbladder is surgically absent with surgical clips within the\ngallbladder fossa..  Inferior to the right hepatic lobe is a dropped clip.\n\nPANCREAS: The pancreas is diffusely atrophic and fatty replaced.  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. \nCortical defect at the inferior pole of the left kidney is likely sequela of\nprior infarct.  There is no evidence of solid renal lesions or hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Multiple small bowel and end\nto  side sigmoid anastomosis are noted as well as multiple surgical clips\nwithin the pelvis.  Small bowel is normal in caliber.  There are few colonic\ndiverticula without evidence for acute diverticulitis.  The appendix is\nnormal.\n\nPELVIS: The urinary bladder is unremarkable.  There is trace mesenteric fluid\nwithin the abdomen.\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: Mild facet arthropathy.  Moderate multilevel degenerative include\nintervertebral disc space narrowing, endplate sclerosis and vacuum phenomena.\nDisc space narrowing at L3-L4, has progressed since study dated ___.  Stable grade 1 anterolisthesis of L3 on L4.\nSOFT TISSUES: The patient is status post prior ventral hernia repair with mesh\nin place.  No evidence of hernia recurrence.",
            "output": "1. Distended fluid-filled loops of small bowel in the setting of trace free\nfluid is nonspecific but may represent mild enteritis.\n2. Status post multiple bowel surgeries without evidence of bowel obstruction.\n3. Few scattered colonic diverticula without evidence of acute diverticulitis.\n4. Stable chronic intrahepatic and extrahepatic biliary dilatation may be\nsecondary to cholecystectomy changes."
        },
        {
            "input": "CHEST: Emphysema is noted at the imaged lung bases with areas of subsegmental\natelectasis. The imaged portion of the heart is unremarkable.\n\nABDOMEN: Noncontrast appearance of the liver, spleen, gallbladder, pancreas\nand adrenal glands is normal. The kidneys appear unremarkable without stones\nor hydronephrosis. There is nonspecific bilateral perinephric stranding.  The\nleft proximal ureter appears dilated (2:52), but tapers to normal along the\nmid segment and no obstructing lesion is identified.\n\nPELVIS:  The small and large bowel are normal in caliber, without signs of\nileus or obstruction. The appendix is normal. There is no ascites or\npneumoperitoneum. The abdominal aorta is normal in course and caliber. Mild\natherosclerotic calcifications are noted in the left common iliac artery.\n\nMUSCULOSKELETAL:  Minimal degenerative changes are noted in the lumbar spine,\nwith a prominent anterior osteophyte at the level of L4. There are no lytic or\nsclerotic lesions that are concerning for malignancy. No fracture is\nidentified.",
            "output": "No hydronephrosis or renal/ ureteral stone. Mildly prominent left proximal\nureter without distal obstruction identified, possibly congenital."
        },
        {
            "input": "CHEST: The imaged lung bases are clear with no consolidative opacity or\npleural effusion. The heart is normal in size with no pericardial effusion.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver again demonstrates a subcentimeter hypodensity\nin hepatic segment VII (04:15), stable from ___, likely representing\na cyst or biliary hamartoma. The remainder of the liver is normal in\nattenuation with no focal hepatic lesions. There is no intrahepatic biliary\ndilatation. The gallbladder is decompressed, with no radiopaque stones\nvisualized. The pancreas is normal in bulk and attenuation. The spleen is\nnormal in attenuation in size and there is a small accessory spleen. The\nadrenal glands are morphologically normal bilaterally. The kidneys are normal\nin size with no hydronephrosis or stones. There is an extrarenal pelvis on the\nleft.  Minimal residual ureteral dilatation is noted on the right, vastly\nimproved compared to the prior study of ___.\n\nThe distal esophagus, stomach, and small bowel are normal in caliber. The\nappendix is normal and the large bowel is normal in caliber without signs of\ncolitis. There scattered sigmoid diverticula, without evidence of\ndiverticulitis. Prominent retroperitoneal lymph nodes at the periaortic\nstation in the region of the left renal vein measure up to 7 mm in short axis,\nunchanged from ___. No new pathologically enlarged lymph nodes are\nappreciated.\n\nPELVIS:  The urinary bladder is symmetrically thick-walled, possibly secondary\nto chronic outlet obstruction. The prostate is mildly enlarged and contains\nfiducial seeds. There is no pelvic sidewall or inguinal lymphadenopathy.\nFat-containing left inguinal hernia is noted. No free fluid in the pelvis.\n\nVESSELS: The aorta is normal in caliber with mild calcium burden.\n\nOSSEOUS STRUCTURES: Multilevel degenerative changes of the lumbar spine are\nunchanged from ___, including superior endplate compression deformities of L2\nand L3, mild anterolisthesis of L4 on L5, and mild retrolisthesis of L5 on S1.\nThe right acetabulum demonstrates considerable sclerosis and subchondral cyst\nformation, however the degree of degenerative changes are unchanged from ___.\nNo concerning sclerotic or lytic lesions to suggest metastatic disease.",
            "output": "1.  Stable hepatic segment VII hypodensity is likely representing a cyst or\nbiliary hamartoma.\n2.  Stable mildly prominent retroperitoneal lymph nodes since ___.\n3.  No evidence of metastatic disease within the abdomen or pelvis. No\nconcerning osseous lesions.\n4.  Stable symmetrically thick-walled bladder, possibly secondary to chronic\noutlet obstruction.\n5.  Mild prostatomegaly."
        },
        {
            "input": "Optimal evaluation of organ pathology and vasculature is limited without the\nbenefit of intravenous contrast.\n\nLOWER CHEST:\nVisualized lung bases are clear.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  Again identified is a 6 mm hypodensity at the hepatic dome\n(series 2, image 7), unchanged, not completely characterized.\nThe gallbladder is not well-distended.\nPANCREAS: The pancreatic parenchyma demonstrates a homogeneous attenuation\nwithout main duct dilation.\nSPLEEN:  No splenomegaly..\nADRENALS:  No adrenal nodules.\nURINARY:  There is new (compared to ___ bilateral moderate\nhydronephrosis and hydroureter.  The ureters are dilated in their entire\nextent up to the ureterovesical junction likely secondary to severe concentric\nwall thickening of the urinary bladder from bladder outlet obstruction. \nBilateral perinephric fat stranding is likely related to obstruction.\nGASTROINTESTINAL:  No bowel obstruction.\nLYMPH NODES: There are enlarged celiac axis, left para-aortic lymph nodes\nmeasuring up to 12 mm in short axis (series 2, image 14, 21, 25- 32).\nVASCULAR: Mild atherosclerotic calcification of the abdominal aorta and its\nbranches without aneurysmal dilation.\n\nPELVIS:\nThe bladder is minimally distended secondary to presence of a Foley catheter. \nDespite underdistention, there is significant concentric wall thickening of\nthe bladder, also a new finding compared to ___, likely related to\nchronic bladder outlet obstruction.  Non dependent air within the bladder is\nrelated to presence of a Foley catheter.\nThere are 3 fiducial markers within the prostate.  CT has limited sensitivity\nin evaluation of a prostatic mass.\n\nBONES AND SOFT TISSUES:\nNo suspicious lytic or blastic bone lesions identified.  There is chronic\nsuperior endplate compression of L2 and L3 vertebrae.  Moderate degenerative\nchanges of both hip joints noted.\nThere is a small fat containing left inguinal hernia.",
            "output": "1. There is new (compared to CT from ___ bilateral moderate\nhydronephrosis and hydroureter.  The ureters are dilated in their entire\nextent up to the ureterovesical junction.  Given the lack of intravenous\ncontrast it is difficult to ascertain if the obstruction is caused by\nextensive bladder wall thickening or progression of prostatic mass.\n2. There is worsening diffuse bladder wall thickening likely related to\nchronic bladder outlet obstruction.  The bladder is present the decompressed\nby a Foley catheter.\n3. There are enlarged celiac axis, retroperitoneal (left para-aortic) lymph\nnodes measuring up to 12 mm in short axis.  These are slightly larger than the\nprior CT dated ___.\n4. Please note that CT has limited sensitivity in optimal characterization of\na prostatic mass and a prostate MRI may be considered to look for local\nprogression.\n5. No suspicious osseous metastases.\n\nRECOMMENDATION(S):  MRI pelvis is a more sensitive exam to look for local\nprogression of the prostatic mass.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:43 ___, 10\nminutes after discovery of the findings."
        },
        {
            "input": "Partially imaged lung bases are clear. There is no pleural effusion.\n\nCT abdomen: Liver enhances homogeneously without concerning lesions or biliary\ndilatation. Gallbladder, spleen, pancreas, and adrenal glands are within\nnormal limits. Kidneys enhance and excrete symmetrically without concerning\nlesions or hydronephrosis.\n\nStomach is partially decompressed and nondilated loops of small bowel are\nnormal. The colon is unremarkable.  The appendix is fluid-filled and measures\n7 mm at the base and 9 mm at the tip (601b:26) with possible mildly hyperdense\nappendicolith at the base (601b:22).  There is no overt wall thickening or\nadjacent fat stranding. There is no intra-abdominal free air or fluid. There\nis no mesenteric or retroperitoneal lymphadenopathy. Abdominal aorta is of\nnormal caliber.\n\nCT pelvis: Bladder, terminal ureters are within normal limits. The uterus\ncontains an IUD. There is no pelvic free fluid or lymphadenopathy.\n\nBone window:  No concerning lytic or sclerotic osseous lesion is present. \nOsteitis condensans ilia noted.",
            "output": "The appendix is fluid-filled and dilated up to 9 mm at the tip without wall\nthickening or adjacent stranding.  Findings are indeterminate for appendicitis\nand should be correlated with clinical examination.\n\nNOTIFICATION:     Findings were discussed by Dr. ___ with Dr.\n___ (ED core attending), on ___ at 12:50 pm, via telephone."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\nThe liver contains multiple hepatic cysts, including some with rim\ncalcification. The intervening hepatic parenchyma is normal in attenuation. \nThe portal, splenic, and superior mesenteric veins are patent. Pancreas is\nnormal. The spleen is homogeneous in attenuation.  The adrenal glands are\nnormal bilaterally. The kidneys contain multiple cysts bilaterally, some of\nwhich are hyperdense, possibly representing hemorrhage or proteinaceous\ncontent. Compared to the noncontrast study from 1 day prior, the lesions\nappear similar in density, none appearing to enhance. No suspicious masses are\nidentified. Transplant kidney in the right lower quadrant contains a cyst in\nthe interpolar region, and enhances normally with contrast seen draining from\nthe collecting system into the bladder. Some thickening of the urothelium in\nthe hilum and proximal ureter without obstruction, likely chronic (c/w ___\nCT).. Visualized loops of bowel are normal in caliber with no evidence of\nobstruction. No pathologically enlarged mesenteric or retroperitoneal lymph\nnodes. No intra-abdominal free air or free fluid. A small pocket of simple\nfluid in the right lower anterior abdominal wall is again seen, measuring\napproximately 3.5 x 2 x 5.4 cm.\n\nPELVIS: The urinary bladder is normal appearing.  A small amount of simple\nfree fluid is seen in the pelvis.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Multiple hyperdense renal cysts bilaterally, likely representing\nhemorrhagic or proteinaceous components, with no evidence of enhancement\ncompared to the noncontrast CT from 1 day prior.\n2. Transplanted kidney in the right lower quadrant with contrast seen draining\nfrom the collecting system into the bladder.  Some thickening of the\nurothelium in the hilum and proximal ureter without obstruction, likely\nchronic (c/w ___ CT).\n3. Simple fluid collection in the anterior abdominal wall in the right lower\nquadrant, measuring 3.5 x 2 x 5.4 cm. This is unchanged since at least ___."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Moderate coronary artery\ncalcification.\n\nABDOMEN:\n\nHEPATOBILIARY: Redemonstration of multiple hepatic cysts, some of which are\ncalcified.  Overall, not significantly changed compared to prior CT dated ___.  Otherwise, the liver demonstrates homogeneous attenuation\nthroughout.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is not identified.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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: Innumerable cysts seen within the kidneys bilaterally.  Similar to\nprior, few are hyperdense, representing hemorrhagic or proteinaceous cysts. \nOverall, no significant change in distribution of cysts.  Additionally,\nmultiple bilateral calcifications are seen within the kidneys.  No\nhydronephrosis.  Subtle left perinephric stranding along the lower pole of the\nkidney and throughout the course of the left ureter.\n\nPatient is status post renal transplant.  The transplant kidney seen in the\nright iliac fossa contains a 1.8 x 1.7 cm cyst.  No nephrolithiasis or\nhydronephrosis noted.\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 or 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: Uterus is not visualized.  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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel degenerative changes with intervertebral disc space\nnarrowing, subchondral sclerosis, osteophyte formation, most prominent at\nL2-L3.  Mild retrolisthesis of L2 on L3, likely chronic.  There is no evidence\nof worrisome osseous lesions or acute fracture.  Serpentine sclerosis seen at\nthe right femoral head compatible with avascular necrosis, new since ___. \nThere is no collapse of the articular surface.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits besides a\nfat containing umbilical hernia.",
            "output": "1. Nonspecific asymmetric subtle perinephric stranding along the lower pole of\nthe left kidney and left ureter.  Recommend correlation with urinalysis for\npossible infectious etiology.  Otherwise, no acute findings within the abdomen\nor pelvis to explain patient's symptoms.\n2. Multiple punctate bilateral renal stones identified.  No hydronephrosis.\n3. Redemonstration of innumerable cysts in the liver and bilateral kidneys,\ncompatible with known polycystic kidney disease."
        },
        {
            "input": "LOWER CHEST:Mild dependent atelectasis at the right lung base is noted. There\nis a 3 mm nodule in the peripheral left lower lobe at the superior most slice\nof the provided images.  There is no evidence of pleural or pericardial\neffusion.  Elevation of the left hemidiaphragm 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 biliary dilatation.  The\ngallbladder contains gallstones without wall thickening or surrounding\ninflammation. Multiple stones are seen within the common bile duct, the\nlargest of which measures 1.0 cm.  The common bile duct measures up to 13 mm\nand the hepatic duct measures 6 mm.\n\nPANCREAS: There is mild fatty replacement of the pancreas.  There is a 2.1 x\n3.0 cm fluid density lesion in the tail of the pancreas, incompletely\nevaluated on this non-contrast 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: Moderate cortical thinning bilaterally.  Multiple, bilateral renal\ncysts, some of which demonstrate a partially calcified rim.  The largest renal\ncyst located in the right interpolar region and measures 4.1 x 4.6 cm.  There\nis no evidence of suspicious renal lesions within the limitations of an\nunenhanced scan.  There is no hydronephrosis.  There is no nephrolithiasis.\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 and bilateral adnexae are grossly 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: Moderate degenerative changes in the thoracolumbar spine including\ngrade 2 anterolisthesis of L3 on L4 and grade 1 anterolisthesis of L2 on L3,\nmultilevel vacuum disc, multilevel disc space narrowing, and multilevel\nanterior bridging osteophytes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Choledocholithiasis without evidence of intrahepatic biliary dilatation. \nThe common bile duct measures up to 13 mm.\n2. 2.1 x 3.0 cm fluid density lesion within the pancreas is better evaluated\non subsequent MRCP from ___, and likely represents an IPMN.  As\ndocumented in that report, recommend follow-up MRCP in 6 months.\n3. 3 mm lung nodule in the peripheral left lower lobe.  See recommendation\nbelow.\n4. Elevation of the left hemidiaphragm.\n5.   Sigmoid diverticulosis.\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 ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "CT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.  Patient is status post hysterectomy and bilateral oophorectomy.\n\nSOFT TISSUES:  There is hernia. The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. No inguinal hernia.\n2. Normal appearance of the pelvis."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.  The imaged heart is within\nnormal limits.\n\nAbdomen: The unenhanced appearance of the liver is normal.  Gallbladder is\nsurgically absent.  The spleen is normal.  The adrenal glands are normal\nbilaterally.  The pancreas is unremarkable.  The kidneys appear atrophic.  The\nabdominal aorta is normal in course and caliber with minimal atherosclerotic\ncalcification.  No retroperitoneal lymphadenopathy or hematoma.  The stomach\nand duodenum appear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  Colonic diverticulosis is noted without\nevidence of diverticulitis.  Large calcified uterine fibroids are noted\nsimilar to prior, the largest measuring up to 7.7 cm in maximal diameter. \nThere are no adnexal masses.  No free fluid is seen.  The urinary bladder is\npartially distended appearing normal.  No inguinal or pelvic sidewall\nadenopathy is seen.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.    There is a\ngrade 1 anterolisthesis of L4 on L5 without associated pars defects.  No\nworrisome bony lesion is seen.",
            "output": "No acute findings.  Chronic findings include Large uterine fibroids,\ndiverticulosis without diverticulitis, atrophic kidneys.  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 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 suspicious\nrenal 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 and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly within\nnormal limits.\n\nLYMPH NODES: There are some prominent mesenteric lymph nodes without discrete\nenlargement by size criteria, measuring up to 5 mm in the short axis (series\n2, image 75).  No retroperitoneal lymphadenopathy by size criteria.  A\nreactive appearing lymph node near the left renal vein measures 0.9 cm in the\nshort axis.  Additionally, there is mild stranding of the mesentery.  Findings\nare most likely reactive.\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 solid mass lesion or evidence of tumor, no lymphadenopathy within the\nabdomen or pelvis to indicate metastatic or primary malignant process.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "GASTROINTESTINAL: Limited evaluation of the unenhanced on opacified small and\nlarge bowel shows in a gross abnormalities.\n\nPELVIS: The urinary bladder is decompressed with a Foley catheter within. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is absent.  At the introitus, in the region\nthe vaginal cuff and vagina, there is a persistent, mass measuring 3.9 x 5.5\nby 5.9 cm.  The central portion of the mass is hypodense, likely representing\nnecrosis.  A portion of this mass abuts the base of the bladder and\nasymmetrically surrounds the urethra.  This appears to have increased in size\nsince the previous examination, when it measured approximately 3.2 x 4.7 x 5.3\ncm.  The PET-CT depicts market FD avidity throughout the mass.\n\nLYMPH NODES: No enlarged lymph nodes are identified.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUES: Midline anterior abdominal wall scarring is noted. \nThere are no suspicious osseous lesions.",
            "output": "1. Enlarging mass at the introitus abutting the base of the bladder, which may\nbe causing mass effect on the base of the bladder and urethra.  Evaluation,\nhowever, is limited due to the lack of intravenous contrast and decompressed\nbladder.  Clinical correlation is recommended.\n\nNOTIFICATION:  These results were discussed with the clinical team at the time\nof interpretation by Dr. ___, MD."
        },
        {
            "input": "LOWER CHEST: There is mild left basilar atelectasis.  The imaged heart and\npericardium are normal.  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 adrenal gland is normal.  Again seen is a 2.6 x 1.9 cm\nwell-circumscribed left adrenal nodule containing areas of bulk fat suggestive\nof benign adrenal myelolipoma.\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 and moderate left hydronephrosis and moderate proximal left\nhydroureter.  No radiopaque stones identified.  No perinephric 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 normal.\n\nPELVIS: The bladder is decompressed by a Foley catheter.  No pelvic free\nfluid.  Uterus is absent.  Unchanged appearance of the centrally\nhypoattenuating pelvic mass at the introitus abutting the base the bladder,\nwhich again may be causing mass effect on the base of the bladder and urethra.\nFurther evaluation remains limited given the lack of intravenous contrast.\n\nLYMPH NODES:  Numerous small retroperitoneal lymph nodes are present,\nincluding a cluster of small left para-aortic lymph nodes.  Inferior to the\nleft renal vein.  There is 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.  Small fat containing umbilical hernia.  Mild anterolisthesis\nis noted at L4 upon L5, with transitional lumbosacral vertebral body anatomy\nnoted.\n\nMild asymmetric enlargement and surrounding fat stranding of the left psoas\nmuscle appears new from ___, and spans an area of approximately 4.7 x\n2.6 cm.  Multiple small retroperitoneal lymph nodes are seen within this\nregion.",
            "output": "1.  Slight asymmetrical enlargement and surrounding fat stranding of the left\npsoas muscle appears new from ___.  This may represent a subacute or\nsmall retroperitoneal bleed, alternatively abscess or tumor infiltration could\nalso be considered, given adjacent para-aortic lymphadenopathy.  It is notable\nthat the degree of left psoas enlargement is not expected to be sufficient to\ncause a drop in hemoglobin level.\n2.  Persistent mild right and moderate left hydronephrosis and moderate\nproximal left hydroureter.  No stones identified.\n3.  Unchanged appearance of the mass at the introitus abutting the base of the\nbladder, which may be causing mass effect on the base of the bladder and\nurethra.  As before, evaluation is limited given lack of intravenous contrast.\n4.  Left adrenal myelolipoma.\n\nNOTIFICATION:  Wet read was discussed with Dr. ___ by Dr. ___\ntelephone at 21:14 on ___, approximately 30 min 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 a 6.2 x 4.9 x 4.3 cm cm hypodense lesion in the right hepatic lobe\n(series 601, image 36, series 2, image 25), with heterogeneous multi septate\nappearance of the rim.  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.  There is\ndiverticulosis more prominent along the ascending and transverse 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 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 diffuse bridging anterior and posterior osteophytosis, consistent\nwith diffuse idiopathic skeletal hyperostosis (DISH).  No acute fractures. \nReversal of the normal lumbar lordosis is noted.  Laminectomy changes are\ndemonstrated at L2-L4.  There is a mild retrolisthesis of L5 over S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "6.2 cm hypodense cystic lesion in the right hepatic lobe.  In light of upper\nabdominal pain with fever and elevated white count, findings are most\nconcerning for abscess.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:41 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen:  The hyperenhancing area in the liver segment ___ at the periphery\ncould be due to altered perfusion or artifactual. The spleen, adrenal glands,\ngallbladder, and pancreas appear unremarkable. Kidneys are symmetric in size\nwithout hydronephrosis. There is a nonobstructing renal stone measuring 5 mm\nin the lower pole of the right kidney, and a 5 mm stone in the lower pole of\nthe left kidney.  There is no ureteral or bladder calculus.  The abdominal\naorta is normal in course and caliber.  No lymphadenopathy, free air or free\nfluid is seen.  The stomach and duodenum appear unremarkable.\n\nPelvis: Given the paucity of intra-abdominal fat, the bowel is grossly\nunremarkable. Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. Bladder is unremarkable. Uterus is absent. The appendix is not\nvisualized.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "There are bilateral nonobstructing renal calculi and no ureteral stone. No\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.  1.3\ncm area of hyperenhancement in the right hepatic lobe, most likely corresponds\nto a hemangioma.  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. \nSubcentimeter hypodensity in the left upper pole posteriorly is too small to\ncharacterize.  There is no evidence of focal 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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: Posterior fusion via bilateral pedicle screws and fusion rods spanning\nL5 through S1.  No other acute fractures or suspicious bone lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominal or pelvic findings to explain patient's symptoms."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nAbdomen: The liver, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber.  No lymphadenopathy, free air or free fluid is seen.  The stomach\nand duodenum appear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  Fecal loading of the colon is mild to\nmoderate.  No free air or free fluid.  The urinary bladder is moderately\ndistended appearing normal.  The prostate is unremarkable.  No pelvic sidewall\nor inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "No acute findings.  Normal appendix."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nNoncontrast evaluation of the intra-abdominal solid organs is limited.\n\nThe liver, spleen, gallbladder, and bilateral adrenal glands are normal. The\npancreas is atrophic but otherwise normal.\n\nThe right kidney is atrophic and contains multiple nonobstructive renal\ncalculi, the largest in the lower pole measuring 1.3 x 0.7 cm, extending from\na lower pole calyx into the renal pelvis, as before.  There is nonspecific\nsurrounding perinephric fat stranding and surgical clips from prior partial\nnephrectomy and lymph node dissection. The left kidney is atrophic and\ncontains a 8.3 x 7.7 cm cyst off the upper pole.  There are 2 nonobstructive\nleft renal calculi, at the lower pole measuring 1.9 x 1.3 cm, and at the\ninterpolar region, measuring 4 mm. The ureters are normal in caliber.\n\nThe distal esophagus and stomach are normal. The small and large bowel are\nnormal in caliber with no wall thickening. The appendix isnot visualized.\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nThere is no intraabdominal free air or free fluid.\n\nPELVIS: The urinary bladder is collapsed. The prostate and seminal vesicles\nare unremarkable. There is no pelvic side-wall or inguinal lymphadenopathy by\nCT size criteria. No free pelvic fluid is identified.\n\nVESSELS: The aorta is normal in caliber.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Several bilateral nonobstructive renal calculi, relatively similar in size and\nlocation to ___."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural effusion.\n\nLIVER: The liver is homogeneous without a focal lesion. The non-distended\ngallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is atrophic but otherwise unremarkable.\n\nADRENALS: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The right kidney is atrophic and contains multiple nonobstructing\nstones. The largest of these, in the lower pole, measures 1.0 x 0.8 cm,\nextending from the lower pole calix into the renal pelvis and unchanged from\nthe prior study (3:39 and 5:43).  The stone demonstrates internal attenuation\nof 267 ___ (6:24). Since the prior study, there has been migration of 2 stones\ninto the upper renal pelvis, one measures 8 mm and the other measures 6 mm\n(3:36, 3:37, and 5:37). Again seen is nonspecific perinephric fat stranding\naround the right kidney, and surgical clips from prior partial nephrectomy and\nlymph node dissection.\n\nThe left kidney is also atrophic and contains a 8.7 x 7.8 cm simple cyst off\nthe upper pole (05:40), previously 8.3 x 7.7 cm. There is a 1.6 x 1.0 cm\nnonobstructing lower pole stone, demonstrating an internal attenuation of 541\n___ (5:30).\n\nNo evidence of bilateral hydroureter or hydronephrosis.\n\nGI:The stomach is mildly distended and has no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith mild atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.  No\nevidence of bladder stones.No pelvic wall or inguinal lymph node enlargement\nby CT size criteria is seen.There is no pelvic free fluid.\n\nBONES: No focal lesion suspicious for malignancy.Multilevel, multifactorial\ndegenerative changes of the thoracolumbar spine are visualized.",
            "output": "1. Since ___, there has been migration of 2 stones into the upper right\nrenal pelvis. No significant change in the size and position of the multiple\nother bilateral nonobstructive renal calculi.\n\n2. No evidence of hydronephrosis, hydroureter, or bladder stones."
        },
        {
            "input": "LOWER CHEST: Stable moderate left and new small right pleural effusions are\nnoted.  There is associated compressive atelectasis at the bases bilaterally. \nLungs otherwise clear.  Extensive coronary artery calcifications, mitral\nannular, and aortic valvular calcifications are noted.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Nodular contour of the liver is consistent with cirrhosis. \nPost ablation changes in segment 7 and segments ___ are noted.  No evidence of\nnew focal lesions on this non tailored exam.  There is increased moderate\nvolume nonhemorrhagic perihepatic ascites.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains\ngallstones but is otherwise unremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  Known cystic lesions within\nthe pancreatic tail are better seen on prior MRI.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  Scattered\nsubcentimeter hypodensities are 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. \nArea of chronic scarring at the upper pole of the right kidney is noted,\nunchanged.  Subcentimeter hypodensity in the lower pole the right kidney may\nreflect a cyst.  There is no evidence of solid 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. Extensive\ndiverticulosis of the sigmoid and descending colon without evidence of\ndiverticulitis.  Appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall to moderate free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications within the prostate likely reflect\nsequela of prior inflammation or 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.  Moderate atherosclerotic\ndisease is noted.\n\nSoft a G ovarian sees are redemonstrated.  Extensive calcifications of the\nsplenic artery 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.  Severe\nbilateral symmetric gynecomastia is noted.",
            "output": "1. Expected post ablation changes within the liver with increased moderate\nvolume nonhemorrhagic perihepatic ascites.\n2. No acute intra-abdominal process.\n3. Stable moderate left and new small right pleural effusion with associated\nbibasilar atelectasis."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings. Small bilateral pleural\neffusions and trace pericardial effusion are new from ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.\nMultiple liver lesions have increased in size or are more apparent since ___. For example, a 1.6 cm lesion in segment V/VIII (2:60) is\npreviously not seen. A 1.4 cm partially rim enhancing lesion in the caudate\nlobe was previously 0.7 cm. There is no evidence of intrahepatic or\nextrahepatic 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. An accessory spleen is seen.\n\nPANCREAS: A 2.5 x 1.5 cm hypoattenuating mass in the pancreatic head (2:65) is\nunchanged. The mass encases the main portal vein/ SMV confluence with\nnarrowing, but the vessels remain patent. It also encases the celiac\nbifurcation and the hepatic and splenic arteries, similar to prior. The\nsplenic vein is not seen, likely chronically thrombosed. An adjacent 2.4 x 2.1\ncm centrally necrotic celiac node was previously 2.3 x 2.5 cm, stable (2:62). \nThere is atrophy of the remaining pancreas with main pancreatic duct dilation.\n\nADRENALS: The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.\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: A centrally necrotic celiac node is unchanged,\nas above. No new lymphadenopathy is identified. There is no free fluid and no\nfree air.\n\nVASCULAR: The abdominal aorta is normal in caliber with mild atherosclerotic\ncalcifications along its course. Incidentally noted is a retro-aortic left\nrenal vein.\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. Prostate is unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. There is further loss of vertebral body height of the L1 vertebral\nbody with compression deformity. Degenerative changes seen in the\nthoracolumbar spine. Abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable pancreatic mass and necrotic celiac lymph node compared to ___.\n2.  Interval progression of metastatic liver disease.\n3. Further loss of L1 vertebral body height with compression deformity.\n4. CT Chest reported separately."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions, moderate on the right, and small on\nthe left have increased from ___.  Enhancing bibasilar\nconsolidations likely represent atelectasis, also new.  Heart is newly\nenlarged, without a pericardial effusion.  Coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is heterogeneously hypoattenuating.  While this may\nrepresent fatty infiltration with relative sparing of the gallbladder fossa\n(02:37), normal attenuation was seen on the recent CT performed on ___.  In addition, there has been interval development of new cardiomegaly\nsince the recent study on ___.  Findings together suggest hepatic\ncongestion, rather than fatty infiltration.  There is a 1.6 cm cyst in the\nright hepatic lobe (303:17).  There is no evidence of intrahepatic biliary\ndilatation. Mild prominence of the CBD is likely within normal limits for\npatient's age.  The gallbladder is within normal limits.\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 1.2 cm hypodensity in the spleen (303:19), which is a\nnonspecific finding.\n\nADRENALS: The 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 is a 2 cm parapelvic cyst in the interpolar region\nof the left kidney.  Multiple additional subcentimeter hypodensities are too\nsmall to characterize, but statistically likely represent additional cysts. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the body of the stomach. \nPatient is status post right hemicolectomy and loop jejunostomy.  Small and\nlarge bowel loops are normal in caliber, without evidence of obstruction. \nResidual contrast in small and large bowel from prior fluoroscopic\nexamination. Post appendectomy.  Small amount of mesenteric edema and ascites\nis minimally increased from the prior study.\n\nPELVIS: Foley catheter noted in the urinary bladder, resulting in luminal air.\nBladder wall is diffusely thickened.  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: Abdominal aorta is heavily calcified, but not aneurysmal.  Celiac\nartery is patent.  Heavy atherosclerotic calcifications are noted at the\norigin of the SMA, which is otherwise patent.  Bilateral renal arteries and\nSMA are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nThere is apparent defect along the medial aspects of the bilateral L1\ntransverse processes, which may represent accessory ribs or chronic fractures\n(02:27).\n\nSOFT TISSUES: Evaluation the soft tissues is notable for mild generalized\nsubcutaneous edema in the pelvis, similar to the prior exam. There is a 2 cm\nlipoma in the right gluteus minimus muscle (303:70).",
            "output": "1. No focal fluid collection in the abdomen or pelvis. Small volume ascites.\n2. Non-specific bladder wall thickening.  Recommend correlation with\nurinalysis to exclude cystitis.\n3. Heterogeneously hypoattenuating liver is felt to represent hepatic\ncongestion given normal attenuation in ___ along with interval\ndevelopment of new mild cardiomegaly.\n4. Moderate right and small left pleural effusions with adjacent atelectasis\nare new from ___."
        },
        {
            "input": "LOWER CHEST: Re- demonstration of bilateral nonhemorrhagic pleural effusions,\ntrace on the right and small on the left, decreased since the prior study. \nThere is adjacent compressive atelectasis, and a large hiatal hernia\ncontaining the gastric fundus and body.\n\nABDOMEN:\n\nHEPATOBILIARY: Millimetric hypodensity in segment VII is unchanged and E small\nto characterize by CT.  No new focal hepatic lesion since the prior study. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: Diffuse fatty atrophy of the pancreas is unchanged.  A 0.5 cm\nhypodensity in the pancreatic tail is unchanged since ___.  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 2.3 cm simple cyst in the upper pole of the left kidney is unchanged.  Right\nrenal hypodensity is subcentimeter in size and too small to characterize by\nCT, but also likely a cyst (2:41).  There is a small right extrarenal pelvis. \nNo evidence of hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The gastrojejunal tube is appropriately placed with a small\namount of adjacent free intraperitoneal air, fluid, and air in the left rectus\nmuscle (2:35, 36), likely related to recent G-tube exchange.  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.\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 to severe\natherosclerotic disease is noted.\n\nBONES: Severe compression deformity of the T12 vertebral body is unchanged. \nThere is mild lumbar levoscoliosis and multilevel degenerative changes, most\npronounced at L4-L5.\n\nSOFT TISSUES: Except for postprocedural changes in the region of the\ngastrojejunostomy tube, the abdominal and pelvic soft tissues are\nunremarkable.",
            "output": "1.  Small amount of free intraperitoneal air, fluid, and a locule of air in\nthe left rectus muscle, adjacent to the GJ tube, is likely related to recent\ntube exchange.\n\n2.  New left inguinal hernia containing loops of nondilated sigmoid colon.  No\nevidence of surrounding inflammatory change, wall thickening, or obstruction.\n\n3.  Persistent bilateral nonhemorrhagic pleural effusions, trace on the right\nand small on the left.  These have slightly decreased since the prior study.\n\n4.  Persistent large hiatal hernia containing the gastric fundus and body."
        },
        {
            "input": "The bases of the lungs are clear.  Cardiac pacing wires are noted. There is no\npleural or pericardial effusion.\n\nThe liver, spleen, pancreas, kidneys and bilateral adrenal glands are normal. \nThere is no hydronephrosis.\n\nPatient is status post gastric sleeve resection. There is no evidence of bowel\nobstruction. The appendix is normal. There is no free fluid or free air.\n\nThe aorta is normal in caliber with moderate atherosclerotic plaque burden.\n\nThere is no mesenteric, retroperitoneal, pelvic sidewall, or inguinal\nlymphadenopathy.  Uterus is not seen. Bladder is relatively decompressed.\n\nThere is no acute bony abnormality. Mild retrolisthesis of L5/S1 is noted.",
            "output": "1. Status post sleeve gastrectomy. No evidence of bowel obstruction. No free\nair or free fluid.\n2.  Normal appendix."
        },
        {
            "input": "LOWER CHEST: A 4 mm lingular nodule is stable (2:6).  There is minimal\nbibasilar atelectasis.  No 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: The kidneys are of normal and symmetric size with normal nephrogram. \nA 1.5 cm left interpolar cyst is stable.  There is probably a thin septation. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is sigmoid\ncolonic 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: 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Normal appendix.  No specific acute findings to explain the patient's right\nlower quadrant pain.\n2. Enlarged fibroid uterus.\n3. Colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "LOWER CHEST: Scattered foci of ground-glass are likely related to atelectasis.\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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There multiple fluid distended loops of small bowel\ncontaining air-fluid levels.  While there is no abrupt transition point,\nseveral decompressed small bowel loops are also seen (series 601, image 21). \nOn series 601, image 21, slightly thickened small bowel is seen which is\nnonspecific.  Fluid distension of the cecum and ascending colon noted, with\nrelative decompression distally.  The appendix 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 grossly 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.  There is a duplicated 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": "Multiple fluid-filled fluid distension of small bowel and ascending colon\nwithout discrete transition point.  Findings most likely reflect\ngastroenteritis though given relative thickening of a small-bowel loop, the\npossibility of inflammatory bowel disease is not entirely excluded."
        },
        {
            "input": "LOWER CHEST: Atelectasis in the lung bases is mild.  No pericardial or pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Several subcentimeter hypodensities in the right hepatic lobe\nare too small to characterize by CT, but statistically likely hepatic cysts or\nbiliary hamartomas.  The liver otherwise demonstrates homogeneous attenuation\nthroughout.  There is no evidence of concerning 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 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 subcentimeter hypodensity in the left upper pole is too small to\ncharacterize, but statistically likely to be a cyst.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is distended with oral contrast.  A small\nventral hernia appears to contain a dilated, short segment loop of\nfluid-filled small bowel, with 2 adjacent transition points at the hernia neck\nwhich measures 13 mm wide (602b:34), but no evidence of mural hypoenhancement\nor mural thickening.  There is, however, no upstream small bowel dilatation. \nRemainder of small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  There is a heavy colonic stool burden, with a rectal\nstool ball measuring 4.9 cm.  No evidence of dilated bowel loops to suggest\nobstruction.  The appendix is normal.\n\nPELVIS: There is impression upon the superior urinary bladder by the severely\nenlarged, fibroid uterus.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is enlarged, with multiple exophytic fibroids\nextending to the level of the umbilicus (___:35).  The uterus itself abuts\nthe rectum anteriorly (2:62).  The largest fibroid measures approximately 5.6\nx 5.3 cm, abutting the superior surface of the bladder (602b:27).  A couple of\nthe fibroids are calcified.  A 3.4 cm left adnexal cystic structure is likely\nphysiologic, if the patient is still menstruating.\n\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 left inguinal hernia containing fat.",
            "output": "1.  Small ventral hernia appearing to contain an obstructed, small segment\nloop of fluid-filled small bowel.  There is, however, no upstream small bowel\nobstruction or specific signs for ischemia.\n2.  Severely enlarged, fibroid uterus, causing mass effect upon the adjacent\nsuperior bladder and anterior rectum.\n3.  3.4 cm left adnexal cyst, likely a functional ovarian cyst if the patient\nis still menstruating.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 23:00 on ___, 5 min after discovery."
        },
        {
            "input": "LOWER CHEST: There are new areas of patchy opacification as well as\nground-glass opacities involving both lung bases, with subtle ill-defined\nnodules imaged at the lower aspect of both upper lobes, these are concerning\nfor superinfection.  There are newly developed bilateral small pleural\neffusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse and severe decreased attenuation\ncompatible with steatosis without evidence of focal lesion.  There is no\nevidence of intrahepatic or extrahepatic biliary dilation.  The gallbladder is\nwithin 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.  Mild wall thickening involving\nthe second and third loop of the duodenum.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Redemonstration of\ndiffuse colonic wall thickening involving the entire colon.  Is there is\ndiffuse and moderate ascites in the abdomen and pelvis which has slightly\ndecreased when compared with prior.\n\nPELVIS: There is a Foley catheter within the bladder the urinary bladder and\ndistal ureters are unremarkable.  Small volume free fluid is seen in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus and both ovaries 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.  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 is\nmild diffuse anasarca.",
            "output": "1. Newly developed areas of airspace disease within the lungs concerning for\nmultifocal pneumonia.\n2. Small bilateral pleural effusions.\n3. Diffuse colonic wall edema which is either related to ascites or pancolitis\nin the appropriate clinical scenario.  Underlying etiologies are infectious or\ninflammatory, less likely ischemic given the lack of atherosclerotic disease\nor other known underlying etiologies.\n4. Severe hepatic steatosis and moderate volume ascites."
        },
        {
            "input": "LOWER CHEST: Mild interval increase of bilateral pleural effusion now\nmild-to-moderate with secondary lower lobe atelectasis.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver again demonstrate diffuse and severe decreased\nattenuation compatible with steatosis without evidence of focal lesion.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is collapsed and shows wall thickening likely related to the\nsystemic condition.\n\nPANCREAS: 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 homogeneous and measures 9.1 cm.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable.\n\nGASTROINTESTINAL: There is a nasogastric tube with the distal tip just below\nthe cardia.  No small bowel obstruction.  Again noted is diffuse wall\nthickening of the colon which is unchanged since prior CT of ___. \nNo pneumatosis.  No pneumoperitoneum.  No abnormal distension.\n\nPELVIS: The urinary bladder is collapsed on a Foley catheter.  Interval\nworsening of the ascites now moderate to severe, previously moderate.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Again seen prominent perihepatic lymph nodes reaching 14 mm\n(series 2, image 32) as well as a gastrohepatic lymph node measuring 8 mm\n(series 2, image 29).\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: Diffuse subcutaneous edema.",
            "output": "1. Diffuse pancolitis unchanged since prior.  No megacolon.  No pneumatosis.\n2. Interval worsening of the ascites and bilateral pleural effusions.\n3. Hepatic steatosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:10 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Small left and trace right dependent pleural effusions are\ndecreased in size.  No pericardial effusion is seen.  Mild dependent\natelectasis in the bilateral lung bases, left greater than right, is improved.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely steatotic.  There is no evidence of\nfocal lesions.  The portal and hepatic veins are patent.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is mostly collapsed and contains excreted contrast material from\nprior examination.  Edema of the gallbladder wall is most likely related to\nthird spacing.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable.  Small and large bowel\nloops are normal in caliber.  There has been interval improvement in colonic\nwall thickening involving the descending and sigmoid portions.  Thickening of\nthe ascending and transverse colonic wall persists and appears similar.  No\npneumatosis or pneumoperitoneum.  The colon is fluid-filled.  Moderate to\nlarge volume abdominopelvic ascites is similar.\n\nPELVIS: The urinary bladder is collapsed around a Foley balloon.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Prominent periportal node measuring 1.2 cm (02:28) and\ngastrohepatic node measuring 0.8 cm (02:26) are unchanged.  There is no pelvic\nor 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 subcutaneous edema.",
            "output": "1. Interval improvement in colonic wall thickening involving the descending\nand sigmoid portions, however wall thickening of the ascending and transverse\ncolon persists.  Findings suggest partly resolving pancolitis.  No megacolon\nor pneumatosis.\n2. Redemonstration of moderate to large volume abdominopelvic ascites, hepatic\nsteatosis and diffuse subcutaneous edema, similar to prior."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER:  There are 4 hypodense lesions in the liver, 3 of them are previously\nseen on ultrasound and was characterized to be hemangiomas. The largest one is\nin segment III of the liver measuring 16 mm x 20 mm. The other hypodense\nlesion is in segment VII (image 4:20) and is most likely a hemangioma as well.\nThere are no intrahepatic biliary duct dilation. The portal vein is patent.\nThe nondistended gallbladder is within normal limits, without wall thickening\nor pericholecystic fluid.\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: 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: The stomach is within normal limits. There is no evidence of bowel wall\nthickening or bowel obstruction. The appendix is not well visualized, however\nthere is no evidence of periappendiceal inflammatory changes. There is colonic\ndiverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta is normal in caliber with no aneurysmal dilatation.\nThere is no retroperitoneal or mesenteric lymph node enlargement by CT size\ncriteria.\n\nCT PELVIS: The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. No evidence of diverticulitis.\n2. Four hypodense liver lesions, 3 consistent with hemangiomas, largest of\nwhich is in segment III measuring 16 mm x 20 mm., and 1 likely a small cyst"
        },
        {
            "input": "CHEST:   Interval improvement of left lower lobe atelectasis since ___. New pleural-based nodule along side the superior segment of the left\nlower lobe (series 4: Image 37) is due to increased extrapleural fat. Please\nrefer to separate report of CT chest performed on the same day for description\nof the thoracic findings.\n\nABDOMEN:  The liver demonstrates homogenous attenuation throughout.  There is\nno evidence of focal lesions; stable position of the fiducial markers in the\nleft and right hepatic lobes since previous CT.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The wall of the gallbladder\nfundus is thickened, unchanged since ___, this my represent\nadenomyosis or post-radiation changes.  Close attention is recommended in the\nnext follow-up.\n\nPatient has had IVC surgery for IVC leiomyosarcoma, the IVC graft is unchanged\nsince ___.  A small filling defect adjacent to the stent is seen\nwhich may represent a  small mural thrombus (4:55 and 7:30), less likely local\nrecurrence.  In the differential diagnosis a mixing artifact. Correlation with\nMRI is recommended.\n\n2 cm target-shaped intramuscular lesion with mild rim-enhancing is in the\nright upper lateral abdominal wall (4:64) and is concerning for possible\nmetastatic lesion, less likely post surgical changes.  This lesion can be\nfurther characterized with dedicated MRI abdomen.\n\nNodular appearance of post-surgical changes in the right anterior abdominal\nwall warrants attention in next scheduled follow-up (4:68).\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. The adrenals glands\nare unremarkable bilaterally.\n\nThe kidneys are of normal and symmetric size with normal nephrogram.  There is\nno evidence of stones or hydronephrosis. Bilateral kidney cysts are unchanged\nsince prior CT, the largest in the superior pole of the left kidney measuring\n1.7 cm (04:59). Stomach, small and large bowel loops are unremarkable.\n\nThere is no evidence of retroperitoneal, mesenteric, pelvic or inguinal\nlymphadenopathy.\n\nThe abdominal aorta demonstrates mild atherosclerosis.\n\nPELVIS:  The urinary bladder and distal ureters are unremarkable.  Uterus and\nadnexal are unremarkable; uterus contains IUD. There is no free fluid or air\nin the abdomen.\n\nBONES AND SOFT TISSUES:  There are no bony lesions suspicious for malignancy\ninfection.  Bilateral sacroiliitis is unchanged.",
            "output": "1. 2cm right upper lateral abdominal wall lesion which may represent a\nmetastatic lesion vs postsurgical changes, correlation with MRI is\nrecommended.\n2. Small filling defect within IVC stent likely a small mural thrombus, less\nlikely local recurrence or mixing artifact, correlation with MRI is\nrecommended.\n3. Nodular appearance of right anterior abdominal wall, most likely represent\npostsurgical changes.  Attention on follow-up is recommended.\n4. Thickening of gallbladder fundus can represent adenomyosis or\npost-radiation changes."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small to moderate sized hiatal hernia. There is\nslightly distorted morphology of the stomach likely due to changes after prior\ngastric banding.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The colon and rectum are within normal\nlimits. The appendix is not visualized; however, no secondary signs of\nappendicitis are present.\n\nPELVIS: The urinary bladder is distended but is otherwise normal in\nappearance.  The distal ureters are unremarkable.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is a 3.1 x 2.6 x 3.3\ncm ovoid, well-circumscribed predominantly fatty lesion within the left ovary,\nlikely representing a mature ovarian teratoma (02:71).\n\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 abdominopelvic abnormality.\n2. Small to moderate-sized hiatal hernia.\n3. 3.3 cm fat containing left ovarian mass likely represents a mature ovarian\ncystic teratoma."
        },
        {
            "input": "LOWER CHEST: Trace of bilateral pleural effusions with linear atelectasis on\nthe right side.  There are other ground-glass opacities diffusely throughout\nboth lungs concerning for superimposed infection/aspiration\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  The\nliver contour is slightly nodular in keeping with known cirrhosis.  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 show mild\ndistention reaching up to 3.6 cm with fluid air levels.  No transitional\npoint.  The colon is collapsed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Large amount\nof ascites.\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. No signs of intra-abdominal bleed.\n2. Large amount of ascites in keeping with known cirrhosis.\n3. Small-bowel distention with no transitional point likely related to an\nileus.\n4. Bilateral lower lung ground-glass opacities concerning for superimposed\ninfection/aspiration."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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.  Colon is normal. \nThe rectum appears within normal limits without evidence of perirectal\nabscess.  There is no perirectal fat stranding.  No presacral 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: 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 finding to explain the patient's symptoms.  Specifically, no perirectal\nabscess."
        },
        {
            "input": "ABDOMEN:\n\n\n\nThe liver is within normal limits. No focal liver lesions.  The portal and\nhepatic veins are patent. No intra or extrahepatic duct dilatation. The\ngallbladder is unremarkable.\n\n\n\nThere are subcentimeter hypodensities within the upper pole of the left kidney\nthat are too small to further characterize. The kidneys are otherwise\nunremarkable. No hydronephrosis. The adrenals and spleen are within normal\nlimits. The pancreas is unremarkable.\n\n\n\nThe small and large bowel are unremarkable. No free air or fluid within the\nabdomen or pelvis. No mesenteric or retroperitoneal adenopathy.  The abdominal\naorta is of normal caliber. Note is made of an uncomplicated fat-containing\nperiumbilical hernia.\n\n\n\nPlease see the chest CT report for details of the chest.\n\n\n\nPELVIS:\n\n\n\nThe patient is status post hysterectomy. Surgical clips are noted within the\nleft hemipelvis.  The bladder is within normal limits. There is a mildly\nprominent 1.2 cm left inguinal lymph node (5:106), which appears to retain its\nnormal fatty hilum. Note is made of a calcified soft tissue density within the\nsubcutaneous fat of the left buttock, consistent with a buttock granuloma.\n\n\n\nOSSEOUS STRUCTURES:\n\n\n\nMultilevel degenerative change is noted throughout the lower thoracic and\nlumbar spine.  Moderate degenerative change is noted at both sacroiliac\njoints. No concerning sclerotic or lytic lesions are identified within the\nosseous structures of the abdomen or pelvis.",
            "output": "No evidence of malignancy within the abdomen or pelvis."
        },
        {
            "input": "The suprapubic catheter has been pulled back and the tip now lies\nanteroinferior to the bladder.  The bladder is filled with urine but not\nsignificantly distended.  There are few locules of gas in the overlying soft\ntissues, likely postprocedural.  There is no pelvic fluid collection.\n\nA small fat containing periumbilical hernia is noted.  There are multiple\nprominent subcentimeter inguinal and iliac lymph nodes, likely reactive in\nrelation to the known inflammatory process (the patient is admitted for\nFournier's gangrene).",
            "output": "1. The suprapubic catheter has become displaced from the bladder.  This was\ndiscussed with Dr. ___, referring resident.  Arrangements were made\nfor replacement of the catheter under general anesthesia tomorrow, ___.\n\nNOTIFICATION:  Findings were discussed with Dr. ___, referring\nresident by ___ NP, immediately after the study was completed."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Mitral annular calcifications\nare dense and coronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRe-demonstrated is a 1.7 cm hypodensity in the left hepatic lobe with\nperipheral nodular enhancement, consistent with a hemangioma.  Additional\nscattered subcentimeter hypodensities are too small to characterize, but\nunchanged likely represent hepatic cysts or biliary hamartomas.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains dependent stones without wall thickening or adjacent fat stranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without pancreatic\nductal dilatation.  A 9 mm cyst within the pancreatic body is unchanged\n(05:21).  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.  Re-demonstrated are multiple bilateral\nhypodensities measuring up to 1.4 cm in the left upper pole, which are too\nsmall to characterize, but statistically likely represent simple cysts.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  There are multiple loops of\nmildly distended fluid filled small bowel measuring up to 3.1 cm in the left\nupper quadrant.  There is a focal area of narrowing in the mid abdomen\n(05:45), however, mildly distended loops are seen proximal to this.  There is\na loop understood distended bowel in the left mid abdomen which demonstrates\nquestionable wall thickening.  While this can be seen in the setting of\nunderdistention, it could be due to enteritis given associated mesenteric\nstranding localizing to this region.  Re-demonstrated is a large ventral\nhernia with a wide neck which again contains a long segment of transverse\ncolon without evidence of obstruction.  There is mild fluid adjacent to this\nloop of bowel which is new.  Otherwise, the colon and rectum are within normal\nlimits. The appendix is not visualized.  However, there are no secondary signs\nto suggest acute appendicitis.  There is no evidence of pneumoperitoneum. \nSmall amount of fluid seen adjacent to the liver and spleen which is new since\nprior.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall amount of simple free fluid in the pelvis which is new.\n\nREPRODUCTIVE ORGANS: Calcified fibroids are noted.  The endometrium is mildly\nprominent measuring up to 1.1 cm.  No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is an unchanged 3.7 cm infrarenal abdominal aortic aneurysm. \nExtensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate multilevel degenerative changes as evidenced by loss of\nintervertebral disc space height, endplate sclerosis and vacuum phenomena. \nDegenerative changes also noted at the hips, left greater than right.\n\nSOFT TISSUES: Aside from the previously mentioned large ventral wall hernia,\nthe anterior abdominal soft tissues are unremarkable.",
            "output": "1. Multiple loops of mildly distended fluid filled small bowel with\nquestionable area of wall thickening (versus underdistention) and mesenteric\nfat stranding seen in the left upper quadrant may represent enteritis.\n2. Re-demonstrated is a large ventral hernia with a wide neck which again\ncontains a long segment of transverse colon without evidence of obstruction.\n3. New small perihepatic, perisplenic and pelvic free fluid.\n4. Mildly prominent endometrium measuring up to 1.1 cm.  Consider a nonurgent\npelvic ultrasound for further evaluation if clinically indicated.\n5. The gallbladder likely contains stones without secondary signs of\ncholecystitis.\n6. Unchanged left hepatic lobe hemangioma and 9 mm pancreatic body cyst."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: A 2.5 cm of left lobe lesion which has been shown to represent\na hemangioma is stable in size.  2 other liver lesions, a 0.8 cm segment 4\nlesion and an 0.8 segment 6 lesion have remained stable in size since ___ and\nare likely to represent cysts or hemangiomas.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  There is biliary sludge\nwithin the gall bladder.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 suspicious\nrenal 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, 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: There are multiple calcified uterine fibroids.  The\nuterus and adnexa are otherwise normal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerosis.  There is an infrarenal\nabdominal aortic aneurysm measuring 3.7 cm in short axis.  There is a right\ncommon femoral aneurysm which has remained stable in size since the CT scan of\n___.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a large anterior abdominal wall hernia with herniation\nof  an unobstructed loop of the transverse colon   6 x 4.5 cm hernial defect.",
            "output": "1. Large anterior abdominal wall hernia with herniation of the transverse\ncolon through a 6 x 4.5 cm defect.  No mass or mesh is seen deep to this area\nas suggested on the recent ultrasound scan.\n2. Stable right common femoral aneurysm."
        },
        {
            "input": "LOWER CHEST: Please refer to separately dictated CT chest report from the same\nday for full description of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are scattered calcified granulomas likely secondary to prior\ngranulomatous exposure.  Otherwise, 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: There are scattered calcified granulomas likely secondary to prior\ngranulomatous exposure.  Otherwise, 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.  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 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 uterus and bilateral adnexae are grossly 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.  Relative hypodensity of the\naortic blood pool is suggestive of anemia.  Extensive atherosclerotic disease\nis noted.\n\nBONES: Posterior spinal fusion hardware is visualized without evidence of\ncomplications in the lumbar spine.  Otherwise, multilevel degenerative changes\nof the visualized thoracolumbar 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. No acute abdominopelvic process within limitations of this noncontrast\nstudy.\n2. Sequelae of prior granulomatous exposure in liver and spleen.\n3. Extensive atherosclerotic disease.\n4. Diverticulosis without evidence of acute diverticulitis.\n5. Please refer to separately dictated CT chest report from the same day for\nfull description of intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of intrathoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nAgain seen are scattered punctate calcifications throughout the liver, likely\nsequelae of old granulomatous disease.  Otherwise 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 is normal in size and homogeneous in attenuation.  Again\nseen are scattered punctate calcifications throughout the spleen, likely\nsequelae of old granulomatous disease.  Otherwise there is no evidence of\nfocal lesions..\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is absent.  The left kidney demonstrates normal size\nand nephrogram..  There is no hydronephrosis.  Note is made of a small left\nextrarenal 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 sigmoid\ndiverticulosis, without findings of acute diverticulitis.  The colon is\notherwise 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.  Severe atherosclerotic\ndisease is noted.  Portal veins are patent.\n\nBONES: There is no suspicious osseous lesion.  Again seen is posterior fusion\nfrom L2-S1 with paired rods and pedicle screws.  Alignment is unchanged, with\nslight retrolisthesis L1 and L2, and slight anterolisthesis of L2 on L3, L3 on\nL4 and L4 on L5.  There is also mild lumbar levocurvature there is depression\nof the inferior endplate of the T11 vertebral body, new compared to CT of the\nabdomen/pelvis from ___, likely degenerative in nature.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute findings in the abdomen or pelvis to explain symptoms right-sided\nabdominal pain.  No evidence of local recurrence or metastatic disease.\n2. Depression of the inferior endplate of the T11 vertebral body, new compared\nto CT of the abdomen/pelvis from ___, likely degenerative in nature."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is  evidence\nof steatosis:  75 ___ on contrast scan (normal >100HU)There is no evidence of\nfocal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is contains a gallstone as previously.\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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is umbilical hernia, unchanged since ___.  There is no subcutaneous\nsolid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nUterus and adnexae are normal\n\nSKELETAL:\nThere is no evidence of worrisome lesions.",
            "output": "1. No lymphadenopathy or other mass in the abdomen pelvis\n2. Liver steatosis.\n3. Cholelithiasis and umbilical hernia, with no interval change since ___"
        },
        {
            "input": "Visualized loops of small and large bowel within the pelvis are without wall\nthickening or abnormal dilation.  Bladder is moderately distended.  Uterus is\nnot well visualized.  Heavy atherosclerotic calcifications are seen within the\ninferior abdominal aorta and bilateral iliac branches, without evidence of\naneurysmal dilation in the visualized portions.\n\nOsseous structures are diffusely demineralized.  Within this limitation, there\nis no evidence of an acute fracture.  A 5 mm sclerotic focus in the right\nsuperior pubic ramus (2:71) is unchanged, most likely a bone island.  A\nlucency in the left iliac bone is also unchanged, likely bone graft donor\nsite. Patient is status post total left hip arthroplasty, which is without\nevidence of fracture or periprosthetic lucency.  No evidence of dislocation\nbilaterally.\n\nDegenerative changes are present within the visualized lumbosacral spine,\nincluding severe facet arthropathy.",
            "output": "1.  No evidence of acute pelvic/hip fracture or dislocation.  Please note that\nthe presence of diffusely demineralized bones limits the evaluation for subtle\nfractures.\n2.  Status post left total hip arthroplasty, without evidence of prosthetic\nfailure."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Coronary artery calcifications\nare severe.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nbiliary dilatation.  The cystic duct appears slightly dilated up to 9 mm, but\nno definite stones are seen (02:24, 601:25).  The gallbladder demonstrates\nmild hyperdense sludge without evidence of 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. \nBilateral renal cortical hypodensities, some of which are too small to\ncharacterize are demonstrated.  A right lower renal pole lesion measures up to\n2.0 x 2.2 cm and is intermediate density (02:33).  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 large\nvolume stool in the rectum with mild wall thickening and minimal evidence soft\ntissue stranding.  Otherwise, the colon appears within normal limits.  The\nappendix is normal.\n\nPELVIS: The urinary bladder is decompressed with Foley catheter in place. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted in the uterus.  No\nadnexal abnormalities are demonstrated.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The infrarenal abdominal aorta is ectatic measuring up to 2.5 x 2.3\ncm with moderate intraluminal thrombus (02:39).  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the lumbar spine is most severe at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nPreviously described right gluteal abscess on prior MR pelvis performed ___ is no longer seen.",
            "output": "1. Large stool burden in the rectum is associated with mild wall thickening\nand minimal soft tissue stranding.  Findings may be seen in the setting of an\nearly stercoral colitis.\n2. The cystic appears dilated, but no definite intraluminal stones are seen. \nRecommend further evaluation dedicated abdominal ultrasound.\n3. Right lower pole renal cortical cystic lesion measures up to 2.2 cm and\ndemonstrates intermediate density.  This may be further evaluated on the\nabdominal ultrasound.\n4. Mild ectasia and intramural thrombus of the infrarenal abdominal aorta.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:56 am, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lower chest: Limited view of lung bases is notable for diffuse areas of\nground-glass opacification and mild interlobular septal thickening, relatively\nunchanged compared to the prior examination, probably reflecting mild\npulmonary edema.  A small left pleural effusion is also unchanged.  Moderate\ncardiomegaly is stable.\n\nCT abdomen: Evaluation of intra-abdominal organs is limited by lack of\nintravenous contrast.  Noncontrast enhanced appearance of the liver,\ngallbladder, spleen, and adrenal glands is unremarkable. The pancreas is not\nwell evaluated. Bilateral native kidneys are severely atrophic, unchanged.\nTransplanted kidney in the right lower quadrant does not show hydronephrosis.\n\nThe stomach is partially expanded with ingested material some of which appear\nhyperdense.  There is an anastomotic site in the left mid abdomen associated\nwith the pancreatic transplant.  The small bowel at the site is newly dilated\nup to as much as 7.5 cm in diameter with hyperdense content.  Generally\nshortly following the site, bowel caliber is normal but with some prominent\nfluid content.  There is no highly discrete transition point but some degree\nof obstruction is possible immediately beyond the anastomosis.  Stool and air\nare present, and mildly prominent, through the colon, which is not dilated. \nSome colonic contents, particularly on the left, appear hyperdense measuring\napproximately 58 Hounsfield units (2:57).\n\nThere is no intra-abdominal free air or fluid.  There is no lymphadenopathy. \nSevere diffuse atherosclerotic calcifications are present throughout the\narterial system.  The aorta is of normal caliber without aneurysmal\ndilatation.\n\nCT pelvis: The bladder is collapsed. There is no pelvic or inguinal\nlymphadenopathy. There is no pelvic free fluid.\n\nBone windows: No suspicious lytic or sclerotic osseous lesion is identified.",
            "output": "1.  No evidence of retroperitoneal hematoma.\n\n2.  Hyperdense contents within stomach and more distal bowel; this would\ncommonly be due to recent administration of hyperdense medication but blood\nproducts within the lumen are a possible reason.\n\n3.  Findings concerning for some degree of bowel obstruction, possibly\npartial, along the distal side of anastomoses associated with the pancreatic\ntransplant.  An ileus would also be a differential diagnosis.  The dilated\nloop is visible on the scout view and possibly amenable to follow-up using\nradiography, although CT with enteric contrast and long preparation may be\nhelpful to evaluate further if the possibility of small bowel obstruction is a\nclinical concern.\n\n3.  Moderate cardiomegaly and mild pulmonary interstitial edema; extensive\nvascular calcification.\n\nFinal report discussed with Dr. ___ on ___ by telephone."
        },
        {
            "input": "Interlobular septal thickening of the visualized lung bases in addition to\nsmall right larger than left pleural effusions, likely representing CHF with\ninterstitial edema. Partially visualized pacer leads in mechanical valves.\n\nMottled appearance of the liver is demonstrated with patchy enhancement is\nnoted, similar to ___ study. Ill-defined 1.7 x 0.9 cm hyperenhancing\nwedge-shaped focus within segment 4B, similar to prior, possible transient\nperfusion anomaly. Patent portal veins with periportal edema. Decompressed\ngallbladder with marked gallbladder wall thickening. The native pancreas is\natrophic.\n\nSubcentimeter anterior splenic hypodensity, too small to characterize,\npossible cyst or hemangioma. Normal adrenals.\n\nMarkedly atrophic bilateral calcified native kidneys.\n\nIngested material within the stomach. Stool is demonstrated throughout the\ncolon. Enteroenteric left lower quadrant anastomosis again seen. Mild\nthickening of scattered small bowel loops, nonspecific finding.\n\nPatient is post pancreatic and renal transplant. 1 cm renal cyst. No\nhydronephrosis. There is homogeneous enhancement of the pelvic pancreatic\ntransplant, without increased. Pancreatic stranding.\n\nSevere calcification of abdominal aorta and branches. Mild retroperitoneal and\nmesenteric stranding head is noted is noted, possibly secondary to third\nspacing.\n\nDecompressed bladder. Mild pelvic stranding is noted. Mild prominence of\nretroperitoneal nodes, largest 8 mm left periaortic, possibly reactive.\n\nNo suspicious osseous lesions. Dehiscence of the inferior sternum with\nsternotomy wires is again noted.",
            "output": "-Normal CT appearance of the pancreatic pelvic graft with homogeneous\nenhancement and no significant peripancreatic inflammation.\n-Probable interstitial edema of the lung bases.\n-Mottled appearance of the liver with periportal edema, possibly secondary to\nright heart dysfunction.\n-Edematous decompressed gallbladder wall and generalized mildly edematous\nappearance of intraperitoneal and retroperitoneal spaces, as detailed above,\npossibly secondary to third spacing.\n-Marked calcific arterial atherosclerosis.\n- Other findings as detailed above."
        },
        {
            "input": "There is mild atelectasis of the lung bases.  Mild peripheral fibrosis is\nincidentally noted (series 2, image 5).  The heart size is top-normal.  There\nis no pericardial or pleural effusion.  A cardiac device is partially\nvisualized.\n\nThe liver density is within normal limits.  A punctate right hepatic lobe\ncalcified granuloma is present (series 2, image 16).  No definite duct\ndilation is seen.  The patient is post cholecystectomy.  No ductal stones are\ndetected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is normal.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size, without hydronephrosis.\n\nThere is a small hiatal hernia (series 2, image 19).  The intra-abdominal and\nintrapelvic loops of small and large bowel are normal in caliber.  There is a\nmoderate amount of colonic stool.\n\nThere is a large collection extending throughout the left posterior pararenal\nspace extending to the left pelvis, with a small component in the left lower\nintraperitoneal cavity (series 2, image 68, 78, 57).  A fluid-hematocrit level\nis present.  This is most compatible with an acute hematoma, spanning at least\n22 cm cranio-caudally, with 2 main components, the superior component within\nthe left posterior pararenal space measuring 12.0 x 8.6 cm (series 2, image\n58), in the left pelvic component measuring 9.9 x 7.4 cm (series 2, image 78).\nThere is also expansion of the left rectus muscle (series 2, image 79), which\nappears to communicate with the left pelvic collection at the inferior portion\n(series 2, image 85).  There is minimal mass effect on the left psoas muscle,\nwhich appears to be separate from the collection.  There is rightward mass\neffect on the bladder, which is moderately distended (series 2, image 77).\n\nExtensive atherosclerotic calcifications are seen throughout the splenic\nartery, abdominal aorta, and iliac branches.\n\nThere are moderate degenerative changes throughout the thoracolumbar spine,\nwithout spondylolisthesis.  There are no osseous erosions concerning for\nmalignancy or infection.",
            "output": "1. Large acute hematoma, with fluid-hematocrit level, extending throughout the\nleft posterior pararenal space and into the left extraperitoneal pelvis, with\na small intraperitoneal component.  There is also a hematoma of the left\nrectus muscle in communication with the pelvic component, possibly\nrepresenting the bleeding source.  Alternately the bleed could be arising from\nan iliac branch.  Consider CTA or angiogram to assess for the source.\n2. Rightward mass effect on the bladder, with moderate distension, but without\nhydronephrosis.  Correlate with any symptoms of early bladder outlet\nobstruction.\n3. Small hiatal hernia.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:00 am, 3 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Again seen is a large left abdominal and pelvic hematoma, first visualized on\nthe noncontrast CT performed earlier on the same day.  There is active\narterial extravasation demonstrated within the superior portion of the\nhematoma (series 301, image 173).  The exact source is unclear.  The two\nfavored sources are tributaries from the left inferior epigastric or left deep\ncircumflex artery.  The hematomas overall similar in appearance to the\nnoncontrast examination.  There is continued rightward mass effect on the\nbladder, which remains moderately distended.\n\nContrast-enhanced views of the liver, pancreas, spleen, and adrenal glands are\nwithin normal limits.  There is a focal cortical defect at along the upper\npole of the right kidney, likely the sequela of prior infection or infarction\n(series 303, image 94).\n\nPlease refer to the prior CT report regarding the remainder of the\nabdominopelvic findings.",
            "output": "Active arterial bleeding is seen within the superior component of a large\nleft-sided abdominopelvic hematoma.  The exact source is unclear, however the\nfavored sources are tributaries from the left inferior epigastric or left deep\ncircumflex arteries."
        },
        {
            "input": "There is a small new left-sided pleural effusion and a trace one on the right\nwith minor new associated atelectasis at each lung base.  Mild suspected\nvascular congestion.  Heart is borderline in size.  Patient is status post\naortic valve replacement and there is a dual lead pacemaker/ICD device, as\nseen previously.  Again noted is mild dilatation of the ascending aorta which\nmeasures up to 45 mm in diameter.\n\nThe patient is status post cholecystectomy.  There is no biliary dilatation. \nSmall calcification in the right lobe of the liver.  Pancreas appears normal. \nSpleen is normal in size and appearance.  Adrenals appear normal.  Persistent\nnephrograms in each kidney suggest retained contrast from recent injections on\n___.  This study shows new mild to moderate left-sided\nhydroureteronephrosis with dilatation of the ureter to the left pelvic\nsidewall where there is probably a degree of mild obstruction that is\nassociated with large hematoma.  Coils have been deployed along the left\nepigastric artery since the prior CT.  Retroperitoneal hemorrhage measures up\nto maximal 132 x 94 mm in maximum axial extent which is very similar to prior\nmaximal measurements of 134 x 87 mm allowing for small differences in\norientation and redistribution.  The hematoma appears heterogeneous including\nsmall air-fluid levels which suggests poorly clotting blood, however.  There\nis also new mild-to-moderate hydronephrosis of the right kidney perhaps also\nexplain by mass effect although perhaps impart by ongoing diuresis.\n\nThe stomach is nondistended.  Small bowel is unremarkable.  Quantity of stool\nalong the colon is mildly prominent.\n\nUterus and adnexa are unremarkable.  A Foley catheter terminates in a\ncollapsed bladder which is splayed toward the right by mass effect associated\nwith a large left pelvic sidewall component of the retroperitoneal hemorrhage,\nwhich measures up to 100 x 77 mm in axial ___ (3:86), very similar to\nprior measurements of 98 x 73 mm.  Vascular calcification is moderately\nextensive.  There is no lymphadenopathy.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.",
            "output": "1.  Stable extent of retroperitoneal hemorrhage.  Small changes might be\ndifficult to detect, however, owing to its markedly irregular shape. \nPersistent heterogeneity including small air-fluid level suggests poorly\nclotting blood.\n\n2.  New bilateral hydronephrosis, left greater than right, with persistent\nnephrograms suggesting retained contrast and possibly sequela of mass-effect\nfrom large retroperitoneal hemorrhage extending into the pelvis.\n\n3.  Status post interval left epigastric artery embolization.\n\n4.  New small left-sided pleural effusion.\n\n5.  Dilation of the ascending aorta noted with prior aortic valve replacement."
        },
        {
            "input": "LOWER CHEST: Atelectasis is seen at the right lung base.  There is a small\nleft and trace right pleural effusion.  There is no evidence of pericardial\neffusion.  Extensive coronary artery and thoracic aortic atherosclerotic\ncalcifications are noted.  The interventricular septum appears hyperdense\ncompared to the blood pool suggestive of anemia.  Contrast is seen in the\ndistal esophagus which could represent reflux.\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 punctate calcification is again seen within the right hepatic lobe\nmay (2; 22).  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is mildly 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: 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 which has improved compared to prior.  Bilateral\ndouble-J ureteral stents are seen.  The right double-J stent is in correct\nposition.  The proximal portion of the left double-J stent coils in the\nproximal ureter (601; 50).  There is no nephrolithiasis.  There is a\nheterogeneous left retroperitoneal hematoma which measures approximately 12.5\nx 12.6 x 24 cm and extends from inferior to the left kidney into the pelvis\ninvolving the lower left anterior abdominal wall musculature, similar to\nprior.  Embolization coils are seen in the expected area of the left inferior\nepigastric artery.\n\nGASTROINTESTINAL: There is a small hiatal hernia, otherwise the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  There is mild dilation of the proximal, transverse, and\ndescending colon with fluid seen within these loops without evidence of\nobstruction.  Stool is seen in the sigmoid colon and rectum.  The appendix is\nnot visualized.\n\nPELVIS: A foci of air seen within the bladder which is likely secondary to\nrecent intervention.  A moderate amount of hemorrhage is seen within the\npelvis.  There is evidence of prior embolization.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits.  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.  Extensive atherosclerotic\ndisease is noted.  The IVC is flattened.\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. Mild dilation of the colon suggestive of ileus.  No evidence of\nobstruction.\n2. Grossly stable left retroperitoneal hematoma.\n3. Interval improvement in bilateral hydronephrosis. The proximal pigtail of\nthe left double-J stent coils in the proximal ureter.  The right double-J\nstent is seen in place.\n4. Collapsed IVC and findings of anemia are suggestive of hypovolemia due to\nblood loss.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 4:22 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 homogeneous attenuation throughout.  A\npunctate hyperdensity within the right hepatic lobe (02:44) is again seen,\nlikely a tiny calcified granuloma.  There is no evidence of new focal lesions\nwithin 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 is mildly atrophic but otherwise 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.  There is trace fluid about the inferior splenic\ntip which extends superiorly from the left pararenal fascia.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Irregularity of the\nposterior cortex of the right kidney may represent sequela of prior surgery or\ninfection.  There is no evidence of focal renal lesions within the limitations\nof an unenhanced scan.  Bilateral double-J ureteral stents are again seen. \nThe right stent appears well placed.  The left double-J stent is again seen\nwithin the region of the left extrarenal pelvis, similar to prior, and is\nlikely adequately positioned (2:67).  No frank hydronephrosis.  There is no\nnephrolithiasis.\n\nAgain seen is a left retroperitoneal hematoma which appears to lie posterior\nto the posterior pararenal fascia.  This hematoma remains largely\nheterogeneous with hyperattenuating areas similar in configuration, and has\nslightly increased in size measuring 14.0 x 13.4 x 16.0 cm along the abdominal\naspect (2:82, 601:32), previously 12.6 x 12.5 x 14.1 cm.  The hematoma extends\ninferior to the left kidney into the pelvis, involving the lower left rectus\nsheath, similar to prior, and measures similarly within its pelvic portion\n(2:108, 601:35).  There is persistent mass effect on the left kidney and\npelvic structures, including the bladder and uterus.  Metallic embolization\ncoils are seen in the expected region of the left inferior epigastric artery.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThe colon and rectum are unremarkable.  Specifically, previously dilated loops\nof colon are now normal in diameter.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is displaced by the retroperitoneal hematoma but\nis otherwise unremarkable.  The distal ureters, including portions of the\nbilateral double-J ureteral stents, are unremarkable.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is laterally displaced by the retroperitoneal\nhematoma, but otherwise appears unremarkable.  No adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patient is status post left inferior epigastric artery coil and\nGel-Foam embolization as well as left deep circumflex iliac artery Gel-Foam\nembolization ___.  There is no abdominal aortic aneurysm.  Mild\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic coccygeal deformity is unchanged.\n\nSOFT TISSUES: A small fat containing umbilical hernia is again seen.  Diffuse\nanasarca, similar to prior.",
            "output": "1. Interval increase in size of left retroperitoneal hematoma extending from\nthe abdomen into the pelvis.  Specifically, the abdominal portion of the\nretroperitoneal hematoma has increased in size measuring 14.0 x 13.4 x 16.0\ncm, previously 12.6 x 12.5 x 14.1 cm, while the pelvic portion of the hematoma\nis not significantly changed.  Without intravenous contrast, however,\nevaluation for source of bleeding cannot be assessed.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nNOTIFICATION:  Findings discussed with ___, MD by ___, MD\nvia telephone at 14:24 on ___, 5 minutes following discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Trace left greater than right pleural effusions are similar. \nThere is subjacent passive atelectasis.  No pericardial effusion.  Pacemaker\nleads are re-demonstrated in the heart.  Severe coronary artery calcifications\nare present.  There is a mechanical heart valve.\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 left kidney is malrotated as seen previously.  Enhancement is\nsymmetric.  Re-demonstrated cortical scarring at both upper poles.  Bilateral\nnephroureterostomy tubes remain in place, coiled in the bladder.  No\nhydronephrosis.  No suspicious renal lesions.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. A\nlarge amount of stool is present throughout the colon and rectum.  Presacral\nstranding is nonspecific.  The appendix is not definitely seen.\n\nRETROPERITONEUM: Re-demonstration of a left retroperitoneal hematoma, which\nmeasures up to 12.8 x 12.6 x 24.5 cm, previously 13.4 x 14.0 x 25.9 cm using a\nsimilar measurement technique.  As before, this hematoma extends along left\nretroperitoneum and into the pelvis.  There are embolization coils presumably\nin the left inferior epigastric artery.  There is no area of active contrast\nextravasation on the arterial phase.  No pooling of contrast is seen on the\nportal venous phase.\n\nPELVIS: The urinary bladder is decompressed, with Foley catheter and the\ndistal and of bilateral nephroureterostomy tubes.  There is no evidence of\npelvic or inguinal lymphadenopathy.  There is trace free fluid in the pelvis\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal mass is\nappreciated.\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. Little change in size of a left-sided retroperitoneal hematoma measuring up\nto 12.8 x 12.6 x 24.5 cm.  The presence of hyperdense components on the\ncurrent examination is suggestive of more recent interval bleeding, however no\nactive arterial contrast extravasation is detected.\n2. Bilateral nephroureterostomy tubes in situ without hydronephrosis.\n3. Trace left greater than right pleural effusions are unchanged."
        },
        {
            "input": "CHEST:\nThere is minimal bibasilar atelectasis. The heart is normal in size and there\nis no evidence of pericardial effusion.\n\nABDOMEN:\nThe liver is normal in appearance and without focal abnormality. The portal\nvenous system is patent. No evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder, pancreas, spleen, and bilateral adrenal glands\nare normal. The kidneys are of normal and symmetric size with normal\nnephrogram. No evidence of stones, or hydronephrosis. Multiple hypodensities\nare seen in the left kidney; the largest one measures 1.7 x 1.0 x 1.2 cm (TV x\nAP x CC) and likely represents a cyst. The others are too small to\ncharacterize. No urothelial lesions are seen within the kidneys or ureters.\n\nThe stomach is grossly unremarkable in appearance. Within the lower abdominal\nmesentery, there is a spiculated mass measuring 3.2 x 2.0 x 4.1 cm (3b:167)\nwith areas of calcification.  There is tethering of small bowel towards this\ncentral mass, and is associated with dilation of small bowel loops to a\nmaximum of 3.0 cm in diameter as well as wall thickening. However, there is no\nevidence of bowel obstruction on this examination. The appendix is air-filled,\nand is without abnormal wall thickening or dilation. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches contain\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\n\nPELVIS:\nThe bladder, sigmoid colon, and rectum are grossly unremarkable. The uterus is\nenlarged and appears heterogeneous, likely the representing a fibroid uterus.\nThere is no pelvic side-wall or inguinal lymphadenopathy by CT size criteria.\nNo free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:\nMultilevel degenerative changes are seen throughout the visualized\nthoracolumbar spine. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Desmoplastic reaction in the lower abdominal mesentery associated with\ntethering of small bowel loops towards a central spiculated soft tissue mass\ncontaining  calcification.  These findings are consistent with a carcinoid\ntumor. Additionally, the tethered dilated loops of small bowel show associated\nbowel wall thickening but no evidence of obstruction. No evidence of\nmetastatic disease at this time.\n2. Fibroid uterus.\n\nNOTIFICATION:  Finding #1 was entered into the Critical Results dashboard on\n___ at 5:49PM."
        },
        {
            "input": "LOWER CHEST: Subsegmental bibasilar atelectasis noted.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The hepatic metastases are stable to mildly worse.  For example\na 2.8 cm left hepatic metastasis not significantly changed from 2.7 cm\npreviously; a 2.7 cm left metastasis on series 5, image 20 was previously 1.9\ncm; a 2 cm metastasis anterior to the inferior vena cava was previously 1.2\ncm.  A stable right hepatic metastasis measuring 1 cm is seen in the right\nhepatic lobe and a stable 1.3 cm metastasis is seen in the left hepatic lobe.\n\nPANCREAS: The pancreas appears within normal limits.\n\nSPLEEN: There is a new perisplenic implant measuring 1.2 cm at the hilum.  The\nspleen is otherwise unremarkable.\n\nADRENALS: Stable 1.5 cm left adrenal nodule.  The right adrenal gland is\nunremarkable.\n\nURINARY: The kidneys demonstrate bilateral stable hypodense lesions too small\nto characterize and cysts, stable.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Subtotal colectomy, end ileostomy and rectal stump are again\nnoted.  There is no bowel obstruction.  The peritoneal implants are worse. \nFor example, 3.5 and 4.3 cm pelvic implants were previously 2.9 and 3.5 cm,\nrespectively.  Numerous implants in the mesentery and region of the paracolic\ngutters are worse, for example 1.7 cm implant previously 0.9 cm, multiple\nimplants on series 5 image 44, measuring up to 1.4 cm, previously up to 0.9\ncm.  Similarly multiple implants along the bladder on series 5, image 53\nmeasuring up to 1.5 cm were previously measuring up to 1 cm.\n\nPELVIS: There is no free fluid in the pelvis.  The periuterine implants are\nworse.  Again seen is a moderate amount of air in the vagina, of uncertain\netiology.  No column of air between the rectum to suggest fistula although\nthis study is not tailored for this purpose.\n\nLYMPH NODES: Stable retroperitoneal adenopathy.  For instance 1.1 cm inter\naortocaval lymph node, previously 1.1 cm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The hepatic vasculature is\npatent..\n\nBONES: No worrisome osseous lesions are demonstrated.  Stable sclerotic\nlesions dating back to ___.\n\nSOFT TISSUES: There are new subcentimeter right subdiaphragmatic implants. \nLeft end ileostomy changes and subcutaneous pelvic stable are again noted.",
            "output": "1. Interval progression of disease when compared to CT ___.\n2. Moderate amount of air in the vagina.  The etiology is not elucidated on\nthis exam although possibly incidental and/or due to an element of vaginal\nstenosis."
        },
        {
            "input": "LOWER 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 hypoattenuation when compared to\nthe spleen which is suggestive of diffuse 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 adrenal glands is of normal station size.  The left\nadrenal is surgically absent.\n\nURINARY: Stable postsurgical changes following left nephrectomy with no\nevidence of local disease recurrence.  Interval decrease in nodular soft\ntissue thickening at the left diaphragmatic crus, just be low the celiac\ntrunk, (series 3, image 67).  There are a few well-circumscribed hypodensities\nthroughout the right kidney which are likely renal cysts.  The largest is\nlocated at the interpolar region of the right kidney measuring up to 24 mm\nwith a density of 23 ___ units may represent a proteinaceous or\nhemorrhagic renal cyst (series 2, image 77).  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 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. \nAgain seen are sclerotic foci are demonstrated at the left femoral head, left\ninferior pubic ramus and right iliac bone likely representing bone islands. \nMild degenerative disc disease at T12 - L2.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.  There is a\nsmall fat containing umbilical hernia.",
            "output": "1. Stable postsurgical changes following radical left nephrectomy with no\nevidence of local recurrence.\n2. No evidence of metastatic disease or lymphadenopathy in the abdomen and\npelvis.\n3. Please refer to same-day CT chest for description 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 attenuation throughout. \nThere is no evidence of focal lesions.  Focal area of hypodensity along the\nfalciform ligament likely focal fatty infiltration or perfusion abnormality. \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: Hypodense bilateral adrenal nodules measuring 1.6 cm on the right\nand 1 cm on the left are unchanged since ___ and are consistent\nwith adrenal adenomas.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  Scarring along\nthe posterior aspect of the interpolar region of the right kidney. \nNonobstructing right renal calculi measuring 7 mm and 5 mm noted in the right\nlower and interpolar regions respectively.\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.\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: Degenerative changes are seen in the lumbar spine.  Grade 1\nretrolisthesis of L2 on L3 and L5 on S1.  Healing anterolateral sixth and\nseventh rib fractures\n\nSOFT TISSUES: Non-specific subcutaneous nodules in the anterior abdominal\nwall, may represent injection sites.",
            "output": "1. No acute intra-abdominal or pelvic process to explain patient's fever.\n2. Nonobstructing right renal calculi.\n3. Stable bilateral adrenal adenomas.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: Partially imaged left lower lobe density measuring 5.2 x 4.0 cm\npreviously measured 4.2 x 5.1 x 5.0 cm, increased in size (2; 6).  Bibasilar\natelectasis is seen, left greater than right.  There is no evidence of pleural\nor pericardial effusion.  The heart is enlarged, unchanged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nFocal hypodensity along the falciform ligament likely represents focal fatty\ninfiltration/sparing.  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.  Stable mildly dilated main pancreatic duct, measuring 4 mm in\ndiameter is seen.  No CT signs of pancreatitis.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Bilateral adrenal adenomas are unchanged.\n\nURINARY: Cortical scarring is seen on the right kidney.  The kidneys are\notherwise of normal and symmetric size with normal nephrogram.  5 mm and 6 mm\nnonobstructing right renal calculi are seen in the interpolar region and lower\npole, respectively.  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. 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 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.  The abdominal aorta is\ntortuous.  Mild atherosclerotic disease is noted.  Multiple pelvic phleboliths\nare seen.\n\nBONES: Degenerative changes are seen in the lumbar spine.  Grade 1\nretrolisthesis of L2 on L3 and L5 on S1 is seen.  Anterolateral slightly\ndisplaced left rib fracture is noted, with no callus formation, suggesting\nlikely subacute chronicity (2; 11).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of new acute intra-abdominal or intrapelvic process to explain\nthe patient's symptoms.\n2. Slightly displaced left rib fracture with no callus formation is likely\nsubacute.\n3. Minimal interval increase in size of partially imaged left lower lobe mass\nconsistent with the known lung cancer.\n4. 5 mm and 6 mm nonobstructing right renal calculi.\n5. Diverticulosis without evidence of diverticulitis.\n6. Stable bilateral adrenal adenomas."
        },
        {
            "input": "LOWER 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.\nThere is no evidence of focal renal lesions 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.  There is a moderate amount of\nfree fluid in the pelvic cul-de-sac.\n\nREPRODUCTIVE ORGANS: Within the right adnexa, there is re- demonstration of\nthe known large complex solid and cystic mass lesion involving the right ovary\n(6:106, 9:23), better characterized on the recent MRI pelvis.  As described on\nthe recent MRI, there is significant thickening of the round ligament with\nenhancing soft tissue extending into the right inguinal ligament (6:114).\n\nThere is a moderate amount of free fluid in the pelvis with multiple enhancing\nperitoneal nodules in the cul-de-sac (6:111).  Soft tissue nodules anterior to\nthe lower uterine segment abutting the bladder dome were also seen on the\nrecent MRI (6:113).\n\nThere are multiple large omental masses extending into the bilateral paracolic\ngutters, left greater than right.  On the left, the heterogeneously enhancing\nmass measures 4.9 x 2.5 cm (6:94). The mass on the right abuts the appendix\nand Measures 3.2 x 1.1 cm (6:92).\n\nLYMPH NODES: A conglomerate of enlarged, centrally hypodense retroperitoneal\nlymph nodes, predominantly in the paracaval, para-aortic, and aortocaval\nstations, throughout the entire abdomen are present ___, 9:23). An\nenlarged right internal iliac node measures 1.8 x 1.0 cm (6:102).  There is no\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No appreciable\natherosclerotic disease is noted.\n\nOf note, the infrarenal inferior vena cava is compressed by severe\nretroperitoneal lymphadenopathy. However, it appears patent superior to the\nrenal veins, without evidence of thrombus on the delayed 3 min phase.\n\nBONES: There 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 the known large complex solid and cystic mass\ninvolving the right ovary, with associated extension into the round ligament\nand right inguinal canal, suspicious for a primary ovarian neoplasm.\n\n2.  Multiple enhancing soft tissue peritoneal nodules in the cul-de-sac and\npericolic gutters, large omental nodules, and retroperitoneal lymphadenopathy,\nconcerning for peritoneal carcinomatosis and omental caking.\n\n3.  Extensive retroperitoneal lymphadenopathy, likely partially necrotic,\ncauses compression of the infrarenal inferior vena cava, without evidence of\nthrombus on the 3 min delayed 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. 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.  Again seen is a 9 mm splenule at the lower splenic\npole, (series 4, image 62).\n\nADRENALS: The 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 interpolar region of the right kidney in a 6 mm well-circumscribed\nhypodensity too small to characterize CT but is likely a renal cyst.  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. 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: Stable postsurgical changes following hysterectomy,\nbilateral salpingo-oophorectomy and total omentectomy.  No evidence of local\nrecurrence\n\nLYMPH NODES: There is a conglomerate of right external iliac lymph nodes\nmeasure 1.9 x 1.8 cm, (series 4, image 101) and previously measured 1.4 x 1.1\ncm on most recent CT abdomen and pelvis dated ___.  Interval\nincrease in size of a conglomerate of right common iliac lymph nodes measuring\n2.0 x 1.8, (series 4, image 87).  interval increase in size of left aortic\nlymph nodes, (series 4, image 65) which currently measures up to 1.0 cm and\npreviously measured 8 mm.  There is no mesenteric lymphadenopathy.  There are\nother more conspicuous para-aortic lymph nodes there do not meet CT criteria\nfor lymphadenopathy, (series 4, image 81).\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: Stable low or midline incisional scar and rectus diastasis.",
            "output": "1. Stable postsurgical changes following abdominal hysterectomy, bilateral\nsalpingo-oophorectomy total omentectomy.  No evidence of local recurrence in\nthe surgical bed.\n2. Interval increase of right common iliac, right external iliac and left\nperiaortic lymphadenopathy.\n3. Please refer to same-day CT chest for detail report 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: 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.  A 10 mm 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. \nNo interval change of 6 mm simple renal cyst in left 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 sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.\n\nPELVIS: Patient is status post hysterectomy, bilateral salpingo-oophorectomy. \nThere is no evidence of recurrent disease along the surgical bed.  The bladder\nis distended.\n\nLYMPH NODES: Seen again are multiple enlarged right iliac lymph nodes that\nhave remained stable in size.  Right common iliac lymph node measuring 1.6 x\n1.9 cm, previously 2.2 x 1.5 cm.  Right external iliac node measuring 1.5 x\n2.0 cm, previously 1.9 x 1.8 cm.  Seen again is a left periaortic lymph node\nmeasuring 1.7 x 1.1 cm, previously 1.1 x 1.8 cm.  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: Postsurgical change along the anterior abdominal wall.",
            "output": "1. No evidence of disease recurrence along the surgical bed in the pelvis.\n2. Stable right iliac and left periaortic lymphadenopathy\n3. Please refer to same-day CT chest for thoracic Findings."
        },
        {
            "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 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 tiny 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 subcentimeter cortical hypodensity in the right lower pole is too small to\ncharacterize, however is not significantly changed from prior and likely\nrepresents a cyst.  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: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: A 11 mm aortocaval lymph node is increased in size from prior,\npreviously measuring up to 7 mm (13:30).  Additional periaortic and right\ncommon iliac lymphadenopathy is not significantly changed.  There is no\nmesenteric lymphadenopathy.  A 16 mm right pelvic sidewall lymph node\ncontaining punctate calcification is not significantly changed (6:102).  No\nnew pelvic sidewall lymphadenopathy.  There is no inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. No atherosclerotic disease is\nnoted.  The portal vein, splenic vein, and 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. An 11 mm aortocaval lymph node is increased in size from prior, previously\nmeasuring up to 7 mm.  Additional periaortic, right common iliac and right\npelvic sidewall lymphadenopathy is not significantly changed.\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.  2.7\nx 2.0 cm hypoattenuating lesion in the hepatic segment II (series 5, image 55)\ncorresponding to a FDG avid lesion on recent PET-CT is concerning for\nmetastatic disease, difficult to directly compare the size given technique\ndifferences.  1.4 x 1.2 cm hypoattenuating lesion (series 5, image 70) in\nsegment IVb is new since PET-CT from ___, concerning for new\nmetastasis.  Multiple additional sub 2 cm hypoattenuating lesions throughout\nthe liver are incompletely characterized but unchanged compared to ___ and non FDG avid, likely representing cysts (for example, series 5, image\n53, 57, 59).  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 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.  There are\nbilateral inguinal hernias containing nonobstructed small bowel loops on the\nleft and colon on the right.  There is large stool burden throughout the\ncolon.  Otherwise 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 prostate is surgically absent.\n\nLYMPH NODES: There are scattered prominent retroperitoneal and mesenteric\nlymph nodes.  For example, multiple left para-aortic lymph nodes measure up to\n8 mm (series 5, image 57, 59, 64, and 65).  A mesenteric lymph node measures\n0.6 cm (series 5, image 68).  Pelvic and inguinal lymph nodes are not\nenlarged.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Major tributaries of the abdominal aorta and portal venous system\nare patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the thoracolumbar spine are mild.\n\nSOFT TISSUES: Bilateral inguinal hernias as described above.",
            "output": "1. 2.7 x 2.0 cm hepatic segment II metastasis corresponds to the FDG avid\nlesion on recent PET-CT.\n2. New 1.4 x 1.2 cm hypoattenuating lesion in the segment IVb is concerning\nfor new metastasis and disease progression.\n3. Additional sub 2 cm hypoattenuating hepatic lesions are incompletely\ncharacterized but were all present and non-FDG avid on the ___\nPET, likely representing cysts.\n4. Bilateral inguinal hernias containing nonobstructed small bowel loops on\nthe left and colon on the right.\n5. Large stool burden throughout the colon.\n6. Please see separate report performed same day for evaluation of 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. \nThere has been interval decrease in size of few hypoattenuating liver lesions.\nFor instance, a hypoattenuating lesion in hepatic segment II measures 1.9 x\n1.6 cm (2:57), previously measuring 2.7 x 2.0 cm.  A subtle hypodense lesion\nwithin hepatic segment IVb measures 4 mm (2:69), previously measuring 1.4 x\n1.2 cm.  A hypodense lesion within the left hepatic lobe measures 7 mm (2:59),\npreviously measuring 10 mm.  Few additional subcentimeter hypodensities within\nthe liver are too small to characterize, but unchanged in size compared to\nprior study and most likely representing cysts (series 2, images 54, 55, 58,\n59, 63, 65).  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 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. The colon and\nrectum are within normal limits. The appendix is not visualized, however no\nsecondary signs of inflammation 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 is not visualized.\n\nLYMPH NODES: There is stable appearance of few soft tissue nodules in the\nright posterior pericolonic space, with the largest measuring up to 8 mm\n(2:81), unchanged from prior study.  Few additional scattered subcentimeter\nretroperitoneal and mesenteric lymph nodes are also unchanged from the prior\nstudy, most notably including a left mesenteric lymph node measuring 6 mm\n(2:70) and a left periaortic lymph node measuring 6 mm (2:60).  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: There are bilateral inguinal hernias containing nonobstructed\nloops of small bowel on the left and colon on the right.  The abdominal and\npelvic wall is within normal limits.",
            "output": "1. Interval decrease in size of few hypoattenuating liver metastases as\ndescribed above.\n2. Stable appearance of few soft tissue nodules in the right posterior\npericolonic space, with the largest measuring up to 8 mm\n3. Few scattered subcentimeter retroperitoneal and mesenteric lymph nodes,\nunchanged from the prior study.\n4. Stable appearance of few subcentimeter hypodensities within the liver which\nare too small to characterize, but unchanged in size compared to prior study\nand most likely representing cysts.\n5. Bilateral inguinal hernias containing nonobstructed loops of small bowel on\nthe left and colon on the right.\n6. 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\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nRedemonstrated are multiple hypoattenuating liver lesions throughout the left\nand right hepatic lobes.  For example, there is a poorly defined 1.5 x 1.4 cm\nhypodense mass in hepatic segment II, previously measuring 1.6 x 1.9 cm on the\nprior study (2:117).  Unchanged 4 mm hypodense lesion in hepatic segment IVb\n(2:142).  Hypodense hepatic segment II lesion measures 8 mm, previously 7 mm\n(2:118).  Additional subcentimeter hypodensities within the liver are too\nsmall to characterize but appear unchanged compared to the prior study and\nlikely represent hepatic cysts.  There is mild prominence of the intrahepatic\nbile ducts.  There is no intrahepatic ductal dilatation.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nGeographic hypodensities in the mid and upper pole left kidney are nonspecific\nand may reflect prominent calices (2:118, 125).  There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  There is a 3 mm\nnonobstructing calculus in the lower pole of the left kidney.  Apparent\nbladder wall thickening is likely due to underdistention.  The bladder is\notherwise unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is not visualized, however there are no\nsecondary signs of inflammation volume right lower quadrant of the abdomen.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post prostatectomy.\n\nLYMPH NODES: Redemonstrated soft tissue nodularity in the posterior right\npericolic space measuring up to 7 mm (2:161), previously 8 mm.  Additional\nsubcentimeter retroperitoneal and mesenteric lymph nodes are not significantly\nchanged from the prior study, including a left mesenteric node that measures 8\nmm (2:144).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  There is an accessory right inferior hepatic vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are bilateral inguinal hernias containing nonobstructed\nloops of small bowel on the left and colon on the right.  The abdominal and\npelvic wall is otherwise within normal limits.",
            "output": "1. Redemonstrated hypoattenuating liver metastases as described above, some of\nwhich appear more cystic, not significantly changed in size compared to most\nrecent prior.\n2. Stable appearance of several soft tissue nodules in the right posterior\npericolonic space measuring up to 7 mm.  Several scattered subcentimeter\nretroperitoneal mes"
        },
        {
            "input": "LOWER 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. \nThere is a 1.0 cm hypodense lesion in the left lateral segment on series 2 ___\n108 there is decreased in size, previously measuring 1.3 cm.  There are\nadditional hypodense lesions that have a different appearance being more\nhypodense and having better defined borders such as on series 2 ___ 110. \nThese lesions are 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 kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  The previously\nidentified areas of geographic hypodensities are no longer present.  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: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\nThere is a 6 mm soft tissue nodule in the right perirenal space on series 2\n___ 145.  This is stable in size.  An 8 mm nodule at the level of the iliac\ncrest on the right series 2 ___ 150 is also stable a mesenteric lymph node on\nseries 2 ___ 137 measures 0.7 cm, previously 0.6 cm.  Other small\nretroperitoneal lymph nodes are within normal limits such as a 0.6 cm left\npara-aortic lymph node on series 2 ___ 126.  Additional small mesenteric lymph\nnodes are seen on series 2 ___ 148 measuring up to 5 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: There are bilateral inguinal hernias containing small bowel. \nThere is no evidence for obstruction.",
            "output": "1. A liver lesion in the left lateral segment is decreased in size now\nmeasures 1.0 cm previously 1.3 cm.  No new lesions seen\n2. The remaining liver lesions are stable in size and have a different\nappearance that is most consistent with cysts or biliary hamartomas.  These\nwere identified on prior study from ___ and are unchanged\n3. Two subcentimeter retroperitoneal soft tissue nodules in the right\nperinephric space are stable\n4. Bilateral inguinal hernias containing small bowel without evidence for\nobstruction\n5. Stable mesenteric and retroperitoneal lymph nodes not meeting CT criteria\nfor pathologic enlargement\n6. Please refer to chest CT report from the same day for description of\nintrathoracic findings"
        },
        {
            "input": "PELVIS: There is a Foley catheter within the bladder, otherwise the urinary\nbladder and distal ureters are unremarkable.  There is no free fluid in the\npelvis.  There is moderate wall thickening of the sigmoid colon and rectum.\n\nREPRODUCTIVE ORGANS: The reproductive organs are unremarkable.\n\nLYMPH NODES: There is pelvic lymphadenopathy measuring up to 1.5 cm. \nProminent inguinal lymph nodes measure up to 1.2 cm.\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: Stranding along the anterolateral aspect of the left thigh is\nbetter assessed on the CT lower extremity from the same date.",
            "output": "1.  Stranding along the anterolateral aspect of the left thigh, concerning for\nhematoma is better assessed on CT lower extremity from the same date.\n\n2.  There is moderate wall thickening of the sigmoid colon and rectum,\nconsistent with proctocolitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung there is mild dependent atelectasis in the\nbilateral lower lobes.  There is no evidence of pleural or pericardial\neffusion.  Postsurgical changes from esophagectomy and gastric pull-through\nare noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a hypoattenuated focus in segment VI measuring 1.2 cm (2:61) with\nprogressive fill-in on delayed phase, likely representing a cavernous\nhemangioma.  There is no new liver lesion.  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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postsurgical changes from esophagectomy and gastric\npull-through are again noted.  Small bowel loops are unremarkable.  There is\nmild colonic diverticulosis without evidence of diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  There are surgical clips in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is surgically absent.\n\nLYMPH NODES: There are multiple sub-centimeter mesenteric lymph nodes, not\npathologically enlarged by CT size criteria.  There is no retroperitoneal,\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: There is a small fluid containing right inguinal hernia.",
            "output": "1. No abdominopelvic lymphadenopathy or metastasis.\n2. Mild colonic diverticulosis.\n3. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Coronary artery calcifications noted. \nAortic valve calcifications.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Ill-defined and\nheterogeneously hypo attenuating\nSize (maximal axial dimension in cm): 2.9 x 2.2 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\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 ___ 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\nGastroduodenal artery involvement:  Present (___:53)\nSolid soft-tissue contact:  >180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity:  present\n\nVariant anatomy: Independent origin of the hepatic artery off the aorta, with\nstenosis proximally due to atherosclerotic disease.  Otherwise conventional\nhepatic arterial anatomy.\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\n___ 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):  Present,\nthere is loss of fat plane between the mass and duodenum.   (04:51)\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is diffuse moderate to severe intra\nand extrahepatic biliary dilatation.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.\n\nPANCREAS:  Pancreatic ductal dilatation and pancreatic atrophy in the\npancreatic 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:  1.2 cm simple cyst in the upper pole the right kidney.  Other tiny\nscattered hypodensities bilaterally are too small to accurately characterize\nbut also likely cysts.  There is no evidence of stones, focal renal lesions,\nor hydronephrosis. 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.   \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.  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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nVASCULAR:  Extensive atherosclerotic disease of the abdominal aorta and major\nbranches.",
            "output": "1. Pancreatic head mass with near circumferential involvement of the distal\nSMV and extending to the portal confluence, with significant SMV narrowing and\nirregularity in this region.  There is also near circumferential involvement\nof the gastroduodenal artery with vessel narrowing and irregularity.  There is\nloss of fat plane between the mass in the first portion the duodenum\nconsistent with involvement.\n2. There is abrupt narrowing of the pancreatic and common bile ducts, with\nmoderate diffuse pancreatic ductal dilatation and pancreatic atrophy, as well\nas moderate to severe intra and extrahepatic biliary dilatation.\n3. Independent origin of the hepatic artery off the aorta, with stenosis\nproximally due to atherosclerotic disease. Otherwise conventional hepatic\narterial anatomy."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Hypo attenuating and\nill-defined\nSize (maximal axial dimension in cm): 3.0 x 2.2 cm, not significantly changed\n(7:117).\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: 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\nGastroduodenal artery involvement:  Present (7:118))\nSolid soft-tissue contact:  >180\u00b0\nIncreased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity:  present\n\nVariant anatomy: There is in the tendon origin of the hepatic artery off the\naorta again with mild stenosis at the origin secondary to atherosclerotic\ndisease.  Arterial anatomy is otherwise conventional.\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: 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: 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, focally nearly compressed as on prior examination (7:117).\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): There remains\nloss of fat planes between the pancreatic mass and adjacent first and second\nportion the duodenum (7:118).\n\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: 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 wedge-shaped area of geographic hyper enhancement\nperipherally in hepatic segment VIII (7:90) likely represents a transient\nhepatic attenuation difference.  The background hepatic parenchyma\ndemonstrates homogenous attenuation throughout. There is no evidence of\nsuspicious focal lesions.  There is expected pneumobilia with mild prominence\nof the central intrahepatic biliary ducts with CBD stent in place.  The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: As described in the above pancreatic cancer staging table.  The main\npancreatic duct is again dilated to a maximum of 5 mm, appearing similar to\nthe prior examination with prominent atrophy of the remainder of the pancreas.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 right upper pole simple renal cyst is unchanged.  There is no evidence of\nstones, focal solid renal lesions, or hydronephrosis. There are no urothelial\nlesions in the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL:  Hiatal hernia is small.  Stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are within normal limits.  Appendix is not\nvisualized.  There is no evidence of mesenteric lymphadenopathy.  3 mm and 6\nmm porta hepatis lymph nodes are unchanged.\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 adnexa are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPunctate bone island in the right proximal femur is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No significant interval change of a ill-defined pancreatic head mass\nmeasuring up to 3.0 x 2.2 cm with near complete encasement of the SMV with\nnear complete focal narrowing, extension to the portal confluence, encasement\nof the gastroduodenal artery and loss of fat plane between the adjacent\nduodenum.\n2. Unchanged main pancreatic ductal dilatation with atrophy of the remainder\nof the pancreas.\n3. Common bile duct stent is in place and appears patent.\n4. Independent origin of the hepatic artery directly off the aorta with\notherwise conventional hepatic arterial anatomy."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating and\nill-defined\nSize (maximal axial dimension in cm): 2.7 x 2.4 cm (05:109), not significantly\nchanged since prior\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: absent\nFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\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 (05:104)\nDegree of solid soft-tissue contact: >180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: present\n\nVariant anatomy: The common hepatic artery arises directly from the aorta,\njust inferior and medial to the celiac trunk, as on prior.\nVariant vessel contact:  absent\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: 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, nearly completely obliterated near the confluence with the splenic\nvein (5:111), as on prior.\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): Again seen is\nloss of fat planes between the pancreatic mass and adjacent first and second\nportions of the duodenum.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm. The celiac axis, SMA, ___, renal and\niliac arteries and their major branches are patent with no signs of occlusive\nor aneurysmal disease. The portal system including SMV, splenic and portal\nveins is patent, although there is significant narrowing at the splenic\nvein-SMV confluence as described above. The renal veins are patent and\ndemonstrate normal caliber. There is moderate calcium burden in the abdominal\naorta 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: Wedge-shaped area of geographic hyperdensity in the periphery\nof segment 7 (5:77) is similar to prior and may represent a hemangioma or a\nbenign perfusion anomaly.  The liver otherwise demonstrates homogenous\nattenuation throughout.  There is a vague hypodensity in the liver adjacent to\nthe superior aspect of the CBD stent which may represent focal fat or a\nperfusion anomaly.  There is no evidence of suspicious lesions.  CBD stent is\nin similar position compared to prior. There is refluxed oral contrast\nmaterial in the stent as well as in right lobe bile ducts.  Pneumobilia and\nmild prominence of the central intrahepatic bile ducts are similar to prior. \nMillimetric calcification in the gallbladder may represent a small stone.\nThere is no gallbladder distention, wall thickening or pericholecystic fluid.\n\nPANCREAS: The mass is described above.  The main pancreatic duct measures up\nto 5 mm in diameter, similar to 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 stones, suspicious renal lesions, or hydronephrosis. \nThere are multiple hypodensities in the kidneys bilaterally, the largest on\nthe right measuring up to 1.1 cm which is compatible with a simple cyst, and\nothers which are too small to characterize.  There are no urothelial lesions\nin the kidneys or ureters. 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 has normal caliber without evidence of fat stranding. There is no\nevidence of mesenteric 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\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nScattered millimetric sclerotic foci in the pelvic bones and right femur are\nsimilar to ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No significant interval change in the pancreatic head mass, including near\ncomplete encasement of the SMV and other findings as described above.  No\nevidence of progression or new foci of disease."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating and\nill-defined\nSize (maximal axial dimension in cm): 3.1 x 2.1 cm, relatively unchanged from\nprior study\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: absent\nSFocal vessel narrowing or contour irregularity: absent\nExtension to first SMA branch: Absent\n\nCeliac Axis involvement: absent\nFocal vessel narrowing or contour irregularity: Absent\n\nCommon hepatic artery involvement: absent\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\nDegree of solid soft-tissue contact: >180\u00b0\nDegree of increased hazy attenuation/stranding contact: >180\u00b0\nFocal vessel narrowing or contour irregularity: present\n\nVariant anatomy: The common hepatic artery arises directly from the aorta,\njust inferior and medial to the celiac trunk, as on prior.\nVariant vessel contact:  absent\nFocal vessel narrowing or contour irregularity:  Absent\n\nVenous evaluation\n\nMPV involvement: present\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): \nPresent, nearly completely obliterated near the confluence with the splenic\nvein, as on prior\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):\nThere remains loss of fat planes between the pancreatic mass and adjacent\nfirst and second portion the duodenum.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  The celiac axis, SMA, ___, renal and\niliac arteries and their major branches are patent with no signs of occlusive\nor aneurysmal disease.  Portal system including the SMV, splenic and portal\nveins are patent, although there is significant narrowing at this splenic\nvein- SMV confluence. The renal veins are patent and demonstrate normal\ncaliber.  There is moderate calcium burden in the abdominal aorta and great\nabdominal 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.  CBD stent is in similar position compared to\nprior.  Pneumobilia and mild prominence of the central intrahepatic bile ducts\nis similar to prior.  Millimetric calcifications in the gallbladder may\nrepresent small stone.  There is no gallbladder distention, wall thickening or\npericholecystic fluid.\n\nPANCREAS: The mass is described above.  The main pancreatic duct measures up\nto 5 mm in diameter, similar to 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 stones or hydronephrosis.  There are multiple\nhypodensities in the kidneys bilaterally, the largest on the right measuring\nup to 1.1 cm which is compatible with a simple cysts, and others which are too\nsmall characterize.  No urothelial lesions in the kidneys or ureters\nidentified. 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.\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. \nScattered millimetric sclerotic foci in the pelvic bones and right femur are\nsimilar to ___ and ___ films.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No significant interval change in the pancreatic head mass, including near\ncomplete encasement of the SMV and other findings as described above.  No\nevidence of progression or new foci of disease."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 3.2 x 2.3 cm, overall not significantly\nchanged from prior, however with portions at the periphery appearing less\nbulky than on prior, for example see image 4:108, compared with 4:110\npreviously (4:108-115).\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: Common bile\nduct is stented.\n\nArterial evaluation\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: The common hepatic artery arises directly from the aorta.\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\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\npresent, with near complete occlusion of the proximal SMA, similar to prior\n(8:53).\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): present.  The\nmass continues to invade the adjacent duodenal wall, however there is smooth\nenhancement of the duodenal mucosa over it (4:112).\n\n\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal 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.  A\nwedge-shaped area of peripheral hyper enhancement in the right hepatic lobe is\nconsistent with a perfusional abnormality (4:85).  There is no evidence of\nfocal lesions.  Mild prominence of the central intrahepatic biliary ducts is\nnot significantly changed from prior.  The common bile duct is stented, with\nno significant change in pneumobilia compared with prior.  The gallbladder is\ncontains a tiny stone, without evidence of gallbladder wall thickening or\npericholecystic fluid.\n\nPANCREAS: See above for pancreatic cancer staging.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 1.0 cm simple cyst arising from the upper pole of the right kidney is not\nsignificantly changed.  Multiple additional bilateral subcentimeter cortical\nhypodensities are too small to characterize, however are not significantly\nchanged from prior and likely represent cysts.  There is no evidence of stones\nor hydronephrosis. 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: 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 bilateral adnexae are within normal\nlimits.\n\nBONES:  Degenerative changes in lumbar spine are not significantly changed. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Overall no significant change in size of a 3.2 cm pancreatic head mass,\nhowever portions of the periphery appear slightly less bulky compared with\nprior.  There is persistent involvement of the main portal vein at the\nconfluence, with near complete occlusion of the superior SMV, and invasion\ninto the adjacent duodenal wall, however the duodenal mucosa overlying the\nmass appears intact."
        },
        {
            "input": "VASCULAR:\n\nThe abdominal aorta is normal in caliber with moderate atherosclerotic\ndisease.  The celiac axis, SMA, bilateral renal arteries, as well as the ___\nare patent.  There is no aneurysmal dilatation.  Bilateral common, internal,\nand external iliac arteries are patent, as are the bilateral common femoral\narteries.\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 homogeneous attenuation.  Again seen is\na wedge-shaped area of hyper enhancement in the right lobe of the liver\n(5:93), unchanged since the prior study and likely represents an area of\nperfusion anomaly.  There is pneumobilia secondary to a patent CBD stent. \nMild intrahepatic biliary ductal dilatation is unchanged.  The CBD stent is\npatent.  The gallbladder is unremarkable and contains some air.  There is no\nwall thickening or pericholecystic fluid.\n\nPANCREAS:  At the pancreatic head/ neck process, again seen is a hypodense,\nill-defined mass which measures approximately 4.4 x 1.9 cm at the level of the\nfiducial seeds (5:119), previously 4.5 x 2.0 cm, including an area which\nextends beyond the CBD stent.  This mass is not significantly changed since\nthe prior exam.  There is continued involvement of the main portal vein by\nthis mass by greater than 180 degrees but no vessel narrowing.  There is\nsignificant narrowing of the superior SMV and complete encasement of this\nvessel.  The distal SMV is patent.  The celiac axis, SMA, as well as the\nhepatic arteries are not involved.  Incidental note is made of the separate\norigin of the common hepatic artery which arises directly from the aorta. \nThis mass continues to invade into the second portion of the duodenum similar\nto prior exam.  The remaining pancreas is atrophic with minimal ductal\ndilatation, unchanged since the prior 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 symmetric in size.  Tiny cortically based\nhypodensities in both kidneys with the largest measuring 1.0 cm in the upper\npole of the right kidney are unchanged and likely represent cysts.  There is\nno urolithiasis.  There is no hydronephrosis or 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.\n\nRETROPERITONEUM: There is no mesenteric or retroperitoneal lymphadenopathy. \nThere is no pelvic sidewall or inguinal 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 bilateral adnexal regions are\nunremarkable.\n\nBONES: 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 significant interval change to the size of the pancreatic head mass with\ninvolvement of the main portal vein as well as the proximal SMV.  The latter\nof which is severely attenuated but distally the SMV is patent.  Invasion into\nthe adjacent duodenal wall is also unchanged."
        },
        {
            "input": "The please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nMild pneumobilia is again seen, with mild intrahepatic bile duct dilation.  A\nCBD stent is appropriately positioned (series 4, image 121).  A focus of\nwedge-like hyperenhancement along the periphery of hepatic segment VIII is\nunchanged from prior (series 4, image 92), likely representing a vascular\nshunt.  No concerning liver lesion is detected.  The liver density remains\nwithin normal limits.\n\nThe gallbladder is normal.  No radiopaque ductal stones are detected.\n\nFiducial markers are positioned along the medial and anterior aspect of an\nill-defined pancreatic head mass, which surrounds the CBD stent, measuring 3.0\nx 2.1 cm, decreased from 4.2 x 1.8 cm on the ___ examination\n(series 4, image 120).  There is tumor extension throughout the\npancreaticoduodenal groove.  Severe pancreatic body and tail atrophy is\nunchanged from prior.  There is continued encasement of the main portal vein\nat the SMV confluence, which is severely narrowed (series 4, image 120),\nthough the degree of soft tissue contact appears slightly decreased from prior\n(series 4, image 121).  No thrombus is detected.  The SMA and celiac trunk are\nseparate from the lesion.  The common hepatic artery arises directly from the\naorta, and is clear from the tumor (series 4, image 98).  The ___ centimeter\nof the GDA appear spared, however, the distal GDA is encased by the mass\n(series 4, image 120).\n\nThe spleen size is within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without concerning\nmass.  A well-circumscribed 11 mm cyst arises from the upper pole of the right\nkidney (series 4, image 112).  There is no hydronephrosis.\n\nThe bladder is under distended, and appears normal.  The uterus is anteverted,\nand normal in size.  There are no concerning adnexal lesions.\n\nThere are moderate atherosclerotic calcifications throughout the infrarenal\nabdominal aorta and iliac branches, without dissection or flow-limiting\nstenosis.  The SMA, renal arteries, and ___ are patent and normal in caliber.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  The appendix is normal (series 4, image 158).  There\nis no focal gastrointestinal lesion.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThere are no osseous lesions concerning for malignancy or infection. \nMultilevel disc space narrowing throughout the lumbar and lower thoracic\nspine, with associated mild endplate sclerosis, are unchanged since ___ (series 8, image 56).",
            "output": "1. Interval decrease in size of a pancreatic head mass surrounding the distal\nCBD since the ___ examination.  No abdominopelvic metastasis or\nlymphadenopathy.  Please refer to the separate chest CT dictation regarding\nintrathoracic findings.\n2. Continued tumor encasement and severe narrowing of the main portal vein at\nthe SMV confluence, without thrombosis.  The distal GDA is also encased.\n3. The common hepatic artery arises directly from the aorta."
        },
        {
            "input": "Again noted is an ill-defined hypoattenuated pancreatic head mass with\nsurrounds the CBD stent and measures 4.0 x 2.3 cm (series 6:98).  There is\ntumor extension throughout the pancreaticoduodenal groove.  There is\nsubsequent atrophy of the pancreatic body and tail.  Again noted is encasement\nof the main portal vein at the porto-splenic confluence which is severely\nnarrowed (series 6:98).  There is no thrombus.  There is more than 180 degrees\nof contact of the superior mesenteric vein, unchanged.  The superior\nmesenteric artery and  celiac trunk is separate from this mass.  The common\nhepatic artery has a separate origin off the aorta and is also separate from\nthe mass.  The distal gastroduodenal artery is encased by the mass, unchanged.\nAgain noted are fiduciary markers.\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. \nAgain noted is a ill-defined hyper attenuated focus in segment VII (Series\n6:72) unchanged from ___ and likely representing a vascular shunt. \nThere is no new lesion.  Again noted is pneumobilia.  The gallbladder is\nunremarkable.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 upper pole the right kidney measuring up to 1.1\ncm (series 6:90) there are multiple subcentimeter hypoattenuating foci in the\nbilateral kidneys which 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. \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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Pancreatic head mass surrounding the distal CBD is unchanged in size as\ncompared to CTA abdomen and pelvis ___.  There is continued tumor\nencasement and severe narrowing of the main portal vein, the portal splenic\nconfluence, and the gastroduodenal artery.  There is more than 180 degrees of\ncontact with the superior mesenteric vein, also unchanged.  Note is made of a\ncommon hepatic artery originating directly from the aorta, which is separate\nfrom the mass.\n2. Please refer to dedicated CT chest report on same day for 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:\nThere is a wedge-shaped peripheral area of hyper enhancement in segment ___\nsimilar to the prior study which is likely a perfusional defect.  There is no\nsuspicious focal liver lesion.\nThere is pneumobilia and moderate intrahepatic biliary duct dilatation.  CBD\nstent has been removed in the interval.  CBD is mildly dilated measuring up to\n9 mm proximally.  Distal CBD remains encased by residual tumor (see below) but\nremains patent.\nNote is made of gas within the gallbladder lumen.\n\nPANCREAS:\nThere has been improvement in the primary pancreatic mass.  Soft tissue mass\nin the pancreatic head is ill-defined and measures approximately 2 x 2.5 cm,\npreviously 3 x 4 cm.  There is persistent encasement of the distal CBD causing\nmoderate luminal narrowing and mild upstream dilatation.  Residual pancreatic\nparenchyma is significantly atrophic.  Mild upstream pancreatic duct\ndilatation is unchanged.  Fiducial markers are noted anterior to the\npancreatic head and uncinate.\nThere is persistent encasement of the proximal main portal vein by\napproximately 180 degrees causing greater than 50% focal luminal narrowing. \nThere is also persistent soft tissue encasement of the distal SMV.  There is\nno involvement of the first SMV branch.\nThe gastroduodenal artery is encased by tumor by greater than 180 degrees\nsimilar to the prior study.  There is no new tumoral mass extending to the\nliver hilum or 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. \n12 mm renal cyst in the upper pole of the right kidney is unchanged. \nAdditional subcentimeter cortical hypodensities bilaterally are too small to\ncharacterize.  There is no hydronephrosis.\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\n4 mm centrally necrotic upper mesenteric lymph node just posterior to the SMV\n(series 6, image 109) is unchanged, previously 4 mm.  No other enlarged or\nabnormal appearing mesenteric lymph node 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\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  Note is again made of\ncommon hepatic artery originating directly from the aorta.\nPlease see vascular involvement by tumor described above.  The portal vein,\nSMV and splenic vein are patent.\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. Interval decrease in size of the pancreatic head mass.  There is persistent\ninvolvement of the main portal vein, SMV and gastroduodenal artery as\ndescribed.\n2. 4 mm necrotic mesenteric lymph node is unchanged.  No new lymphadenopathy.\n3. No evidence of new solid organ metastasis in the abdomen and pelvis."
        },
        {
            "input": "LOWER CHEST: Please refer to the chest CT for thoracic findings done the same\nday.\n\nABDOMEN:\n\nHEPATOBILIARY: We again see a wedge-shaped peripheral area hyper enhancement\nin segment 7 8 similar to the prior study suggestive of perfusional defect. \nThere is no focal Liver lesion.  Again we see pneumobilia and moderate\nintrahepatic biliary duct dilatation in this patient with a previous retrieved\nstent in the common duct.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: We again see an ill-defined soft tissue mass around the head of the\npancreatitis measuring approximately 2.5 x 1.8 cm with encasement of the\ndistal common bile duct.  The residual pancreatic parenchyma is atrophic with\nmild upstream pancreatic ductal dilatation measuring 5 mm.  We again see\nfiducial markers in the anterior aspect of the head of the pancreas.  We again\nsee encasement of the proximal main portal vein of at least 180 degrees and\nencasement of the superior mesenteric vein with narrowing of respectively 50\nand 50-75%.  The gastroduodenal artery is encased by tumor by greater than 180\ndegree which is similar to the prior study.  No encasement of the common\nhepatic 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.\nThere is no evidence of stones, focal new renal lesions, or hydronephrosis. \nWe again see a 12 mm cyst at the upper aspect of the right kidney.  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. 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: We again see 4.5 mm necrotic lymph node just below the\nsuperior mesenteric vein which is unchanged.  No new adenopathy.\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\nVASCULAR: There is no abdominal aortic aneurysm.  There is mild to moderate\ncalcium burden in the abdominal aorta and great abdominal arteries.  Patient\nknown with a common hepatic artery originating directly from the aorta.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stability in size and morphology of a pancreatic head mass with unchanged\ninvolvement of the main portal vein, superior mesenteric vein and\ngastroduodenal artery as described.\n2. Unchanged 4 mm necrotic lymph node.\n3. No new adenopathy.  No other visceral metastasis in the abdomen and pelvis.\n4. For chest finding, please refer to the chest CT done the same day"
        },
        {
            "input": "LOWER CHEST: Bibasilar posterior lower lobe atelectasis, right greater than\nleft, is noted.  No pericardial effusion.  Trace bilateral pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic morphology of the liver.  Cholelithiasis without\nevidence of cholecystitis.  Low-attenuation small volume ascites in the upper\nabdomen.  No intra or extrahepatic ductal dilatation.\n\nPANCREAS: No pancreatic ductal dilatation.  No peripancreatic stranding.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY: No hydronephrosis or obstructing nephrolithiasis.\n\nGASTROINTESTINAL: Postsurgical changes of partial gastrectomy.  Stomach is\ndecompressed with partially visualized enteric tube terminating in the gastric\nlumen.  Mildly distended loops of small bowel in the mid abdomen, without\nfocal area of abrupt transition, and given limitations of nonenhanced study,\nlikely representing an ileus.  Oral contrast noted within the proximal small\nbowel.  Rectal tube in place.\n\nPELVIS: Partially distended urinary bladder.  Low attenuation ascites layering\nin the pelvis.\n\nREPRODUCTIVE ORGANS: Retroverted uterus.\n\nLYMPH NODES: Scattered prominent mesenteric lymph nodes, for example (image\n22, series 601) short axis measuring 1.2 cm.  Scattered retroperitoneal lymph\nnodes, not meeting size criteria for lymphadenopathy, giving limitations of an\nunenhanced technique.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: No destructive osseous lesions\n\nSOFT TISSUES: No retroperitoneal hematoma.  Superior anterior, midline\nabdominal wall hernia measuring approximately 3.3 cm in craniocaudal\ndimension, containing nondistended loop of transverse colon. Unchanged 2.1 cm\ncystic lesion in the right anterior abdominal wall which most likely\nrepresents a sebaceous cyst.  Mild to moderate anasarca.",
            "output": "1. No retroperitoneal hematoma, pneumoperitoneum or drainable fluid\ncollections.\n2. Loops of mildly distended small bowel in the mid abdomen without a\ntransition point which most likely represent ileus.\n3. Cirrhotic hepatic morphology with small volume, low-attenuation ascites in\nthe upper abdomen, and layering in the pelvis.\n4. Cholelithiasis without evidence of cholecystitis.\n5. Bilateral posterior lower lobe atelectasis.  Superimposed infection cannot\nbe excluded given the absence of intravenous contrast."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Large bilateral heterogeneous\nopacities are seen at the lung bases. Three left pleural catheters are in\nplace. Small right pleural effusion. Pericardial effusion is noted. \nThickening of the distal esophagus.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  Trace pericholecystic fluid is\nnonspecific in the setting of intra-abdominal ascites.\n\nSPLEEN: Splenic enhancement is mildly heterogeneous, likely of no clinical\nsignificance. Spleen is normal in size and there is no mass effect on the\nadjacent vessels or evidence of splenic infarction.\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 minimally thickened\nbilaterally. No adrenal nodule is identified.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. The appendix\nis visualized and is normal.\n\nMESENTERY AND RETROPERITONEUM: A 13 mm left crural lymph node (02:56) is\nstable, likely reactive. Other subcentimeter mesenteric and retroperitoneal\nlymph nodes are not enlarged by CT size criteria. There is no free\nintra-abdominal air. Small intra-abdominal ascites tracks to the pelvis.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Moderate free fluid in the\npelvis is noted. Prostate and seminal vesicles are unremarkable.  Scrotal\nfluid is noted.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. There is diffuse body wall edema.",
            "output": "1.  No evidence of intra-abdominal infection.\n2.  Anasarca with small-moderate ascites, pleural and pericardial effusions,\nand diffuse body wall edema.\n3.  CT chest reported separately."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  There is extensive\natherosclerotic disease involving the abdominal aorta and its major branches. \nThe abdominal aorta and its major branches are grossly patent.  There is heavy\natherosclerotic disease of the origin of the superior mesenteric artery, which\nis patent.\n\nLOWER CHEST: There are small bilateral, left greater than right nonhemorrhagic\npleural effusions with adjacent compressive atelectasis.  The visualized lung\nbases are otherwise grossly clear.  The heart is mildly enlarged, and mitral\nannular and coronary artery calcifications are noted. Hypoattenuation of the\nblood pool is suggestive of anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSmall subcentimeter hypodense lesions are nonspecific and too small to\ncharacterize but likely reflective of hepatic cysts or biliary hamartomas. \nThere is mild intrahepatic and extrahepatic biliary dilation likely reflective\nof the patient's post cholecystectomy state.  Within the segment V, there is\nan area of peripheral biliary dilation without CT evidence for cholangitis\n(series 3B:image 219).  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic, and there is mild dilatation of the\npancreatic duct most pronounced along the pancreatic body/tail where it\nmeasures up to 5 mm in diameter.  In addition, there are also multiple\nhypodense lesions scattered throughout the pancreas measuring up to 9 mm\n(series 3B:image 217, 221).  Also, there is prominence of the ampulla, not\nwell assessed on this exam.\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.  Thickening of\nleft adrenal may reflect hyperplasia.\n\nURINARY: The kidneys are symmetric in size with normal nephrograms. There is\nno evidence of stones or hydronephrosis.  Multiple bilateral small\nsubcentimeter renal hypodensities are too small to characterize but likely\nreflective of renal cysts.  There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia.  The stomach is\ncollapsed and otherwise within normal limits.  The visualized small bowel\nloops are within normal limits without bowel wall thickening or evidence of\nobstruction.  The appendix is not definitively seen, though there are no\nsecondary findings to suggest appendicitis.  There is no evidence of small\nbowel wall thickening, and there is extensive diverticulosis involving the\ndescending and sigmoid colon.\n\nAlong the rectum, there is a irregular enhancing area along the anterior\naspect of the right (series 3B:image 321).  In addition, there are prominent\nand engorged venous blood vessels arising from this area.  On arterial and\ndelayed phase imaging, there is no evidence to suggest active gastrointestinal\nbleeding.  There is no mesenteric free air or free fluid.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.1\n\nPELVIS: The bladder is mildly distended, and multiple small bladder\ndiverticulum are noted along the right lateral and posterior aspect (series\n3B:image 306, 299).  There is no focal bladder wall thickening.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is a mild amount of\npresacral edema.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  There is mild prominence\nof the vaginal cuff.  No adnexal abnormality is seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative disc disease is noted of the lumbar spine with grade 1\nanterolisthesis of L4 on L5.  There are hemangiomas noted within the L1 and L4\nvertebral bodies (series 604:image 79).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No CT evidence for active gastrointestinal bleeding.\n2. Focal irregular prominence and enhancement of the mucosa along the anterior\naspect of the rectum with adjacent prominent engorged vessels.  Findings may\nreflect hypertrophied mucosa versus possible neoplasm/mass.  Recommend\nclinical correlation with direct exam and/or endoscopy.\n3. Pancreatic atrophy with prominence of the ampulla, mild pancreatic ductal\ndilation and multiple scattered pancreatic hypodense lesions.  Findings are\nnonspecific, though neoplasm is a diagnostic possibility.  Further evaluation\ncan be obtained with endoscopy and EUS or MRCP.\n4. Extensive colonic diverticulosis.\n5. Mild intra and extrahepatic biliary dilation likely reflective of the\npatient's post cholecystectomy state.\n6. Moderate size 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 patient is status post left hepatic lobectomy.\nThere is been continued decrease in size of hypodense collection in the\ncentral right hepatic lobe consistent with resolving hematoma, difficult to\nmeasure, though with the largest component measuring 1.7 x 3.1 cm (602:56),\npreviously 2.4 x 4.2 cm.  Along the surgical margin, there is a 3.2 x 0.7 cm\nhypodensity, likely representing postsurgical changes.  Along the anterior\nperiphery of the the caudate lobe, there is a 2.7 x 0.9 cm hypodense lesion\n(303:100), as well as a similar 3.1 x 0.7 cm collection along the superior\naspect of the surgical margin (303:24), likely representing postsurgical\nhematomas.  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: Appearance of the GE junction is suggestive of prior\nfundoplication.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement 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 enhances heterogeneously.  Bilateral adnexae\nare within normal limits.  Previously seen heterogeneous, thickened\nendometrium is not appreciated on today's study.  There are congested vessels\nin the left adnexa associated with a dilated left gonadal vein that may be\nrelated to pelvic congestion syndrome in the appropriate clinical setting.\n\nLYMPH NODES: A pericardiophrenic lymph node is similar to slightly decreased\nin size, now measuring 7 mm (303:76), previously 8 mm.  There is no\nretroperitoneal or mesenteric lymphadenopathy.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate, primarily\nnoncalcified atherosclerotic disease is noted.  A replaced common hepatic\nartery to the SMA is again seen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are again noted at L2-3.\n\nSOFT TISSUES: Anterior abdominal wall surgical scar is noted extending from\nthe right lower quadrant to the upper abdomen at midline.  Diastasis recti is\nagain seen.  The partially visualized calcific density in the the subcutaneous\ntissues overlying the left lateral gluteal region is again seen.",
            "output": "1. Status post left hepatic lobectomy.\n2. A 3.2 x 0.7 cm hypodensity along the surgical margin likely represents\npost-surgical change, including a seroma or evolving hematoma.  Attention on\nfollow-up imaging is recommended.\n3. Continued decrease in size of pre-existing right hepatic lobe hematoma.  A\n3.2 x 0.7 cm hypodense collection along the caudate lobe and a 3.1 x 0.7 cm\nhypodense collection along the superior surgical margin likely represent post\nsurgical hematomas.\n4. Please see separate report of CT chest performed same day for description\nof 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 hepatic lobe lobectomy.  The noted\nhypodensity seen adjacent to the resection site on outside CT correlates with\na small residual hematoma which is slightly decreased in size compared with\n___, the largest portion measuring up to 2.5 x 1.5 cm today compared\nwith 3.1 x 1.7 cm in ___.  Additional linear hypodensities adjacent\nto the resection site are less prominent compared with ___,\ncompatible with resolving hematoma/postsurgical change.  A previously\ndescribed hypodense collection along the caudate lobe seen on CT in ___ has resolved, compatible with postsurgical change.  A 3.1 cm collection\nalong the superior aspect of the surgical margin described on CT chest ___ is felt to be due to a diaphragmatic fold (10:65; 13:25). There is no\nevidence of new focal hepatic 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 are tiny accessory spleens posterior to the\nspleen, stable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 unchanged appearance of the GE junction suggestive\nof prior fundoplication.  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 uterus contains a small enhancing fibroid, stable. \nNo adnexal abnormality is seen.\n\nLYMPH NODES: A 5 mm epicardial lymph node is slightly decreased in size\ncompared with ___, previously measuring up to 7 mm (10:60).  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.  The portal vein, splenic vein and SMV are patent.  Again noted is a\nreplaced right hepatic artery arising off the SMA.  Congested vessels in the\nleft adnexal are similar to prior.\n\nBONES: Degenerative changes at L2-L3 are not significantly changed.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes along the anterior abdominal wall\nwith unchanged diastasis of the rectus abdominus.  A subcutaneous soft tissue\nnodule along the lower left anterior abdominal wall is new from prior, likely\nrelated to a subcutaneous injection site (10:136).",
            "output": "1. Postsurgical changes status post left hepatectomy with continued decrease\nin size of a pre-existing right hepatic lobe hematoma compared to ___.  The 10 mm hypodense lesion described on outside CT in ___\ncorrelates with a portion of this hematoma which is decreasing in size.\n2. An additional collection adjacent to the caudate lobe seen in ___\nhas resolved, and a previously noted collection along the superior surgical\nmargin is felt to be due to a diaphragmatic fold.\n3. No focal hepatic lesions.\n4. New subcentimeter subcutaneous soft tissue nodule along the left anterior\nabdominal wall is nonspecific and may represent a subcutaneous injection site.\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 patient is status post left hepatic lobectomy, with\nexpected postsurgical changes re-demonstrated.  Hypoattenuating, nonenhancing\nlesion adjacent to the caudate lobe measuring 14 mm is not significantly\nchanged (5:96, 9:28).  Additional areas of linear hypodensity, which\nprogressively enhance on the delayed phase is probably related to scarring\nfollowing post operative hematoma.  Mild dilation and enhancement of a segment\n8 intrahepatic bile duct is likely postoperative, unchanged (5:98).  No new\nfocal lesions are seen.  The remaining main and right portal veins are patent.\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.  There are additional stable small nodules adjacent\nto the spleen which follows splenic enhancement, likely reflecting accessory\nspleens.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Changes following fundoplication are re-demonstrated.  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: There thickening of the endometrium with nodular\nenhancement (5:189, 605:91).  No adnexal mass is seen.\n\nLYMPH NODES: Re-demonstrated is thickening of the right diaphragmatic crus,\nwith an area of aortocaval soft tissue just inferior to the level of the renal\nveins (5:122).  This appears slightly more prominent compared with ___.\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. Status post left hepatic lobectomy with postoperative changes.  No new or\nincreasing biliary dilation.\n2. Aortocaval soft tissue is slightly more prominent compared to ___.  Continued attention on follow-up is warranted.\n3. Nodular endometrial enhancement is incompletely evaluated on CT.  However\nthis in combination with probable thickening of the endometrium is concerning\nfor malignancy.  Pelvic ultrasound is recommended.\n4. Please refer to the separately dictated CT chest report from the same date\nfor a description of thoracic findings.\n\nRECOMMENDATION(S):  Pelvic Ultrasound."
        },
        {
            "input": "LOWER CHEST: The tip of a venous catheter terminates in the superior\ncavoatrial junction.  Please refer to separate report of CT chest performed on\nthe same day for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post left hepatic lobectomy with stable\npostsurgical appearance.  The liver demonstrates homogenous attenuation\nthroughout.  A 1.3 x 0.9 cm nonenhancing hypodensity in segment VIII/I is\nunchanged and may represent postsurgical seroma or biloma.  Stable linear\nhypodensities with progressive enhancement, could represent scarring/fibrosis.\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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Findings suggest Nissen fundoplication.  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: Irregular enhancement of the uterus and ill-defined\nendometrium is seen through multiple priors.  No adnexal masses seen.\n\nLYMPH NODES: Subcentimeter aortocaval lymph nodes are unchanged (10:46). \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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are most pronounced at L2-L3 level.\n\nSOFT TISSUES: Richter's hernia at midline containing transverse colon. \nDystrophic calcification in the left gluteal region is unchanged could be\nsecondary to sequela from fat necrosis or hematoma.",
            "output": "1. Status post left hepatic lobectomy for intrahepatic cholangiocarcinoma with\nexpected postoperative changes and no evidence of local recurrence.\n2. Stable subcentimeter aortocaval lymph nodes.\n3. Irregular enhancement of the uterus and ill-defined endometrial stripe is\nstable through multiple priors, correlate with history of vaginal bleeding and\nconsider pelvic ultrasound for further evaluation.\n4.  Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  Irregular enhancement of the uterus and ill-defined\nendometrial stripe is stable through multiple priors, correlate with history\nof vaginal bleeding and consider pelvic ultrasound for further evaluation."
        },
        {
            "input": "LOWER CHEST:\n\nThe lung bases demonstrate innumerable tiny lucent cystic foci, consistent\nwith centrilobular emphysematous change.  There is no parenchymal opacity or\npleural effusion within the included field of view.\n\nABDOMEN:\n\nPANCREAS:  As it is noted in the clinical history, there is indeed a large,\nlocally infiltrative mass centered within the pancreatic head. This results an\nabrupt truncation of the dilated upstream pancreatic duct with diameter of up\nto 7 mm. The upstream pancreatic parenchyma is also markedly atrophied. The\nmass has indistinct, infiltrative borders but appears to span at least 3.7 x\n5.2 x 4.8 cm. The mass is hypoenhancing to pancreatic parenchyma, with foci of\nparticular low attenuation and apparent nonenhancement centrally, indicating\nnecrosis.\n\nThe mass infiltrates posteriorly along the celiac axis, which is surrounded\nalmost to its origin.  Resultant narrowing of the proximal common hepatic\nartery is present (5:117).  The tumor extends into the porta hepatis\nsurrounding the proper hepatic artery to just beyond the bifurcation.  The\nanterior aspect of the SMA is surrounded by tumor, and the gastroduodenal\nartery is attenuated as it courses through the mass.\n\nThe venous system is also extensively involved with tumor along the underside\nand posterior aspect of the distal splenic vein, abutting the right side of\nthe superior mesenteric vein, and encasing the entirety of the main portal\nvein, with mild resultant multifocal narrowing but no thrombosis.  There is\nalso posterior tumor extension to abut the anterior aspect of the IVC.\n\nThe mass abuts and likely invades the medial wall of the duodenal bulb\n(5:131).\n\nHEPATOBILIARY:  The mass appears to surround the distal most common bile duct.\nWhile kept patent with a recently placed metallic stent, the CBD remains\nnarrowed at the level of the mass (5:128).  Pneumobilia and residual contrast\nwithin the common hepatic duct are seen, expected post ERCP and stenting.\n\nThe liver demonstrates homogenous attenuation throughout prior to contrast\nadministration.  During the arterial phase of imaging, there is perivascular\nhypoenhancement which equilibrates on the subsequent portovenous phase of\nimaging.  The hepatic arterial inflow is markedly distended, of unclear cause\nand significance.\n\nThere is no hepatic lesion of concern to suggest hepatic metastases.\n\nThe gallbladder is unremarkable.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The right adrenal glands are normal in size and shape.  The left\nadrenal gland is minimally thickened, without discrete mass.\n\nURINARY: The kidneys are of normal in size with at least a partially\nduplicated collecting system on the left.  There is patchy high signal within\nthe posterolateral left renal parenchyma on the precontrast phase of imaging\nwithout apparent enhancement abnormality (2:25).  This may related to residual\ncontrast from prior imaging/ERCP.\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\nVASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcific burden in the\ninfrarenal abdominal aorta.  Upper abdominal vascular structures are describes\nseparately above as they relate to the pancreatic mass.\n\nPERITONEUM:  Innumerable soft tissue nodules are seen throughout the\nperitoneum, including bulky caking of the omentum.  This appearance is\ndiagnostic of peritoneal carcinomatosis.  A moderate amount of free fluid is\nseen throughout the peritoneal cavity.\n\nPELVIS:\n\nThe urinary bladder and distal ureters are unremarkable.  Peritoneal\ncarcinomatosis is also extensive within the pelvis (605b:98).\n\nREPRODUCTIVE ORGANS:  Coarse calcifications are noted within the prostate\ngland, which is normal in size.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  Cystic and sclerotic change is\npresent surrounding the sacroiliac joints bilaterally, left greater than\nright.\n\nAbdominal and pelvic wall is within normal limits.\n\nPANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 5.2 cm\nLocation: head/uncinate\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\npresent\nBiliary tree abrupt cutoff with or without upstream dilatation: present\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: 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: absent\nExtension to celiac axis: present\nExtension to bifurcation of right/left hepatic artery: present\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\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\nSplenic vein and IVC also contacted by tumor, <180\u00b0.\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: present\nAscites: present\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): present-\nDuodenum.",
            "output": "Extensive locally invasive pancreatic head mass with extensive arterial and\nvenous involvement, duodenal bulb invasion, obstruction of pancreatic and\nbiliary ductal systems and evidence of extensive peritoneal carcinomatosis."
        },
        {
            "input": "PELVIS:\n\nGASTROINTESTINAL:  A short segment of bowel, presumably the transverse colon,\nis seen entering a left paraumbilical hernia, consistent with a Richter's\nhernia (2:4). There is no evidence of strangulation or bowel ischemia.\nOtherwise, the remaining 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 prostate and seminal vesicles are 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. \nMild degenerative changes of the visualized lumbosacral spine are noted.\n\nSOFT TISSUES:  In the left inguinal region, there is a large fluid collection\nmeasuring 5.3 x 4.5 cm with an average ___ of 16 (601b:38) that, in the absence\nof intravenous contrast, appears to be well-defined, suggestive of a\npostoperative seroma or abscess.  Small locules of gas are consistent with\nexpected postoperative appearance.",
            "output": "1. 5.3 x 4.5 cm well-defined fluid collection in the left inguinal region\nsuggestive of a postoperative seroma or abscess.  Scattered small locules of\ngas reflect expected postoperative changes.\n2. Left paraumbilical hernia involving a short segment of bowel, presumably of\ntransverse colon, consistent with a a Richter's hernia.  No evidence of\nstrangulation, bowel ischemia or infarction."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nhepatic parenchyma, measures 83 ___ compared to 110 ___ in the spleen consistent\nwith fatty deposition 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 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. 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 patient is status post anterior abdominal wall hernia repair\nwith a mesh.  There is a recurrent hernia along the right lateral margin of\nthe mesh on series 5 ___ 59.  This contains a small bowel loop.  There is no\nevidence for obstruction.  The facial defect measures 2.2 by 3.7 cm.  There is\na recurrent hernia along the left lateral margin containing omentum.  The\nfascial defect is 1.9 by 2.2 cm.  The patient is status post inguinal hernia\nrepair on the left.  Postsurgical changes are noted including a plug.  The\nappearance is unchanged.  There is no evidence for a recurrent hernia.",
            "output": "1. Status post repair of an incisional hernia with 2 small recurrent hernias\nalong the edges of the mesh.  These findings are stable compared to prior\nstudy of ___.\n2. Status post left inguinal hernia repair.  No evidence for hernia\nrecurrence.\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. \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.  Surgical clips seen inferior to the spleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post partial left nephrectomy, with no mass in the\nsurgical bed.  The kidneys show 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. 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 left salpingo-oophorectomy with no\nadnexal masses bilaterally.  The uterus is unremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  The previously identified nodule\nalong the left pelvic lateral conal fascia is not seen on today's 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. \nRedemonstration of levoscoliosis, stable.  There are degenerative changes of\nthe thoracolumbar spine and right hip.  5 mm sclerotic lesion in the right\nfemoral neck is stable, representing a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of recurrent or metastatic disease within abdomen pelvis.\n2. Previously identified nodule along the left pelvic lateral coronal fascia\nis not seen.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "LOWER CHEST: For thoracic findings, please refer to the separate chest CT\nreport from same date. There is a concave appearance to the anterior\ncartilaginous aspect of rib 10 on the right, which is likely congenital.\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.  There is a\nmillimetric hypodensity within the posterior spleen (2: 60), which is stable\nfrom prior CT dated ___, which most likely represents a small\ncyst 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. \nIn the interpolar region on the left, there is a stable appearing focal area\nof cortical atrophy, consistent with likely prior injury from infection or\ninfarction.  There is no evidence of solid renal lesions or hydronephrosis. \nThere is no perinephric abnormality.  Unchanged appearance of the multiple\nhemostatic clips in the left retroperitoneum.\n\nGASTROINTESTINAL: The stomach is 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 small pelvic phleboliths.\n\nREPRODUCTIVE ORGANS: The uterus and right adnexa are unremarkable.  The\npatient is status post left salpingo oophorectomy.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  The previous described 2-3 cm focus\nat the left lateral conal fascia is not definitely visualized on today's exam,\nhowever there is a 5 mm soft tissue density superior to this along the left\nconal fascia, which is nonspecific (2:72).\n\nVASCULAR: 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 S-shaped curvature of the lumbar spine.  There are moderate to severe\ndegenerative changes of the right hip with subchondral cystic changes and\njoint space narrowing, as well as mild to moderate degenerative changes in the\nleft.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. The previously described focus at the left lateral conal fascia is not\ndefinitely visualized on today's exam, however, there is a 5 mm soft tissue\ndensity superior to this along the left conal fascia, which is nonspecific\n(2:72).  Attention on follow-up.\n2. Stable appearance status post left salpingo-oophorectomy and resection of\npelvic sarcoma without sign of local recurrence.  There is no lymphadenopathy."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  105 ___ on contrast scan (normal >100HU)There is no\nevidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is within normal limits, without stones or gallbladder wall\nthickening.\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.  The scar\nin the posterior left kidney again seen with no interval change There is no\nevidence 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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare no diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & 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 no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nThe uterus and and right adnexa appear normal.  Status post left oophorectomy.\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. Status post left oophorectomy with no signs of local recurrence or distal\nmetastasis in the abdomen pelvis and interval change since ___"
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: The patient is status post right trisegmentectomy, denoted by multiple\nsurgical clips. The remainder of the liver enhances homogeneously without\nfocal lesion or intrahepatic biliary duct dilation. The portal vein is\npatent.The gallbladder is not visualized.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized.  There is no evidence of abdominal ascites. There is a small\nfat-containing abdominal wall hernia in the left subcostal region, which\nappears unchanged from the prior study (5:32).\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwithout atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal without wall thickening.No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.Multiple surgical clips denote prior\nhysterectomy.  There is a 4.3 x 3.3 cm left ovarian cyst demonstrating an\ninternal attenuation of 17 ___.  This was not present on the ___ study. Given\nthat the patient has not had a pelvic ultrasound since ___, further\nevaluation with ultrasound is recommended.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. New 4.3 x 3.3 cm left ovarian cyst. Considering that the patient has not\nhad a pelvic ultrasound since ___, further evaluation with ultrasound is\nrecommended.\n\n2. No intra-abdominal or intrapelvic evidence of an inflammatory process or\nascites to correlate with the patient's abdominal tenderness and abnormal\nlabs."
        },
        {
            "input": "LOWER CHEST: There is minimal atelectasis in the imaged lung bases. No pleural\nor pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is post right hepatectomy.  No concerning abnormality\nis seen in the surgical bed.  There is diffuse steatosis in the remnant liver.\nA subcentimeter hypoattenuating lesion along the anterior margin (10:41) is\ntoo small to characterize, but likely represents a cyst or biliary hamartoma. \nThe liver demonstrates homogeneous attenuation.  No focal mass lesions are\nidentified.  The remaining hepatic and portal veins are patent. The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable. A small accessory spleen is noted in the\nleft upper quadrant (10:48).\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: Bilateral subcentimeter cysts are again noted.  The kidneys are\notherwise unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small and large bowel loops\nare normal in caliber.  No ascites. Normal appendix.\n\nPELVIS: The urinary bladder is unremarkable. There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm. Atherosclerotic disease is\nmild.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post right hepatectomy.\n2. Diffuse steatosis in the remnant liver, without suspicious lesions\nidentified.  No specific evidence of venous congestion.\n3. The remaining portal and hepatic veins are patent.\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": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is  moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: There are trace bilateral pleural effusions with subsegmental\natelectasis in both lower lobes.  Moderate coronary artery calcifications are\nnoted.\n\nABDOMEN:\n\nHEPATOBILIARY: There are scattered subcentimeter hypodense lesions throughout\nthe liver that are too small to characterize.  A CBD stent is noted in place\nwith expected pneumobilia.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.   There is marked enhancement of the\ngallbladder wall.\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 a 2.0 cm hypodense lesion in the superior pole of the right kidney\nsuggestive of cyst.  There are also subcentimeter hypodense lesions in both\nkidneys, that are too small to characterize.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:There is a large hiatal hernia.   Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.    There is no evidence of mesenteric\nlymphadenopathy.\n\nThere is small volume ascites\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 moderate amount of\npelvic free fluid.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions .There are\ncompression fractures involving T12, L2, L3, L4 and L5 with cement from prior\nvertebroplasty noted in L3.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. CBD stent in place with expected pneumobilia.\n2. Enhancement of the gallbladder wall and cystic duct could be reactive.\n3. No focal pancreatic lesion is noted.  The pancreatic duct is normal in\ncaliber.\n4. Small to moderate volume ascites of unclear etiology.\n5. Compression fractures involving T12 and L2-L5."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Pacemaker leads 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 contains gallstones without wall thickening or\nevidence of inflammation.\n\nPANCREAS: There is fatty atrophy of the pancreas 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.\n\nADRENALS: The right adrenal gland is normal in size and shape.  There is a\nleft adrenal nodule measuring 17 mm with a Hounsfield unit of 18,\nindeterminate (02:16).\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 (02:52.\n\nPELVIS: A Foley catheter is present in the bladder which is decompressed.  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: 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.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: There is extensive subcutaneous stranding and air centered along\nthe lower anterior abdominal wall and tracking superiorly along the left flank\nto approximately the level of the posterolateral left tenth rib and inferiorly\ninto the pannus and left groin with air extending adjacent to the left\ninguinal canal and into the proximal medial left thigh.  There is bilateral\nscrotal edema.  There are few small foci of air at the tip of the penis. \nThere is no air extending into the retroperitoneum.  No organized fluid\ncollection.  There is a small fat containing umbilical hernia.",
            "output": "1. Extensive subcutaneous stranding and air along the lower left abdominal\nwall extending superiorly along the left flank to approximately the level of\nthe left posterolateral tenth rib, and inferiorly into the left groin adjacent\nto the left inguinal canal and into the left medial thigh, with bilateral\nscrotal edema and small foci of air at the tip of the penis, raising concern\nfor necrotizing infection including fournier's gangrene. No organized fluid\ncollection.\n2. Cholelithiasis without evidence to acute cholecystitis.\n3. Diverticulosis with no evidence of acute diverticulitis.\n4. Indeterminate left adrenal nodule, for which outpatient CT or MRI adrenal\nis recommended when clinically appropriate.\n\nRECOMMENDATION(S):  Outpatient CT or MRI adrenal."
        },
        {
            "input": "LOWER 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.\n\nPANCREAS: The pancreas is fatty, 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.  An accessory spleen is re-demonstrated.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal 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 with gastric\npull-through. There is a duodenal diverticulum.  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 is mildly enlarged and 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.  No atherosclerotic disease\nis noted.\n\nBONES: Right thoracotomy changes are re-demonstrated. No acute fracture or\naggressive osseous lesion.\n\nSOFT TISSUES: Small fat containing umbilical and inguinal hernias.",
            "output": "1. No evidence of local disease recurrence or 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."
        },
        {
            "input": "LOWER 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.\n\nPANCREAS: The pancreas is fatty and 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.  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 patient is status post esophagectomy with gastric\npull-through.  There is duodenal diverticulum.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colonic\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: 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. \nChanges of prior right thoracotomy are seen.\n\nSOFT TISSUES: Minimal fat containing umbilical and inguinal hernias.",
            "output": "1. No evidence of local disease recurrence or metastatic disease in the\nabdomen 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: 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: Patient is status post esophagectomy and gastric\npull-through with the majority of the stomach visualized above the diaphragm. \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: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 local or distant recurrence 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 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.  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 no evidence of solid 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 visualized above the diaphragm.\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 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: Small, bilateral inguinal hernias containing fat are noted.",
            "output": "No evidence of local recurrence or metastatic disease within the abdomen or\npelvis."
        },
        {
            "input": "LOWER CHEST:  There is bibasilar dependent atelectasis without pleural\neffusions.  Heart size is normal, and there is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is diffusely hypoattenuating throughout, consistent with\nhepatic 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 is no evidence of focal renal lesions 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.  Status post appendectomy.  There is no free\nfluid or free air within the peritoneal cavity.\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 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.\n2.  Hepatic steatosis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  The major branches of the\nabdominal aorta are widely patent.  A duplicated left renal artery is\nincidentally noted.\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.  There is a hyperdense linear structure just\nabove the main portal vein (2:11) measuring 1.5 cm, not seen on the comparison\nstudies.  The patient is status post Whipple procedure.  The\nhepaticojejunostomy is unremarkable.  The gallbladder is is resected.\n\nPANCREAS: The patient is status post Whipple procedure.  The remnant pancreas\nis unremarkable, without worsening main pancreatic ductal dilatation (main\npancreatic duct measures up to 4 mm , unchanged) or new pancreatic mass.\n\nSPLEEN: The spleen shows normal size and attenuation 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 a normal nephrogram bilaterally. \nRe-demonstrated are bilateral renal cysts, measuring up to 5.2 x 4.0 cm in the\ninterpolar region of the right kidney (3:68), unchanged.  Several cysts\ndemonstrate high-density material (for example 02:32) compatible with\nhemorrhage, unchanged.  Multiple cysts are also seen in the left kidney,\nmeasuring up to 2.5 x 2.5 cm in the lower pole.  Other, bilateral\nsubcentimeter hypodensities are too small to characterize, but also likely\ncorrespond to small cysts.  No definite focal solid renal lesion is\nidentified.  There is no hydronephrosis.  There is no perinephric stranding.\n\nGASTROINTESTINAL: A small hiatal hernia is present.  The stomach is otherwise\nunremarkable.  The small bowel anastomosis status post Whipple procedure is\nunremarkable.  There is no bowel obstruction.  Sigmoid diverticulosis is\nmoderate.  There is no diverticulitis. Mild apparent rectal wall thickening\nwithout associated perirectal stranding or other abnormality is most likely\nrelated to rectal underdistention.  Scattered mesenteric lymph nodes measuring\nup to 5 mm are unchanged since the prior study.\n\nRETROPERITONEUM: There is no new retroperitoneal lymphadenopathy.  A left\nperiaortic node measures up to 6 mm, unchanged.  Several aortocaval lymph\nnodes are also unchanged, measuring up to 6 mm (3:60).  A nonenlarged right\nexternal iliac lymph node measures up to 6 mm.\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\nBONES: There 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 postoperative changes without evidence of local disease recurrence\nor abdominopelvic metastases.\n2. Linear, hyperdense structure, of unclear clinical significance, just above\nthe main portal vein was not definitively identified on prior examinations,\nand may represent a linear foreign body, such as a catheter or wire."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 segment IV a is too small to characterize but may represent\na biliary hamartoma or hepatic cyst.  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. \nSubcentimeter hypodensity in the left mid kidney is too small to characterize,\nbut statistically likely represents a simple cyst.  There is no evidence of\nsuspicious focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Postsurgical changes related to prior Roux-en-Y gastric\nbypass are noted.  No gross anastomotic complications.  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: There is an enlarged fibroid uterus with a dominant\nsubserosal fibroid measuring 3.3 x 2.9 cm (602:77).\n\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 traumatic injury in the abdomen or pelvis.  No acute\nfracture.\n2. Fibroid uterus."
        },
        {
            "input": "VASCULAR:\n\nNo abdominal aortic aneurysm.  There is no calcium burden in the abdominal\naorta and great abdominal arteries.\n\nThe deep inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 3 perforators on the right\nand 2 perforators on the left.\n\nThe perforators on the right measure: lateral 1 mm (series 3, image 87),\nintermediate 1 mm (series 3, image 79), medial 2 mm (series 3, image 91).\nThe perforators on the left measure: intermediate2 mm (series 3, image 98),\nmedial 1 mm.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The superior tip of the liver dome is not included in the\nimages.  Several scattered hypodensities in the liver too small to accurately\ncharacterize on CT (series 3, image 27, 32, 30, 34).  No evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits, without stones or gallbladder wall thickening.\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 stones, focal renal lesions, or hydronephrosis.  No perinephric\nabnormality.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout.  Colonic\ndiverticulosis in the sigmoid colon is mild.  The rectum is within normal\nlimits.  Appendix contains air, has normal caliber without evidence of fat\nstranding.  No evidence of mesenteric lymphadenopathy.\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 uterus appears to be surgically absent.  Structure in\nthe left adnexa is probably the ovary and hydrosalpinx (series 601, image 32).\nThe right ovary is not visualized.\n\nBONES: No evidence of worrisome osseous lesions or acute fracture.  Multilevel\ndegenerative changes in the spine are mild.  Bilateral sacroiliac joint\ndegenerative changes are severe.\n\nSOFT TISSUES: A fat containing midline ventral hernia is small with a 2.5 cm\nneck (series 3, image 58).  A fat containing umbilical hernia is small (series\n602, image 51).",
            "output": "1. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is medial and measures 2 mm. The largest perforator on the left is\nintermediate and measures 2 mm.\n2. Tiny liver hypodensities, too small to characterize on CT most likely\nrepresent cysts.\n3. Colonic diverticulosis."
        },
        {
            "input": "LOWER CHEST: For supradiaphragmatic findings, please see dedicated report from\nCT of the chest from same 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 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.  Again noted is\na duplex left collecting system.  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.  A\nventriculoperitoneal shunt is again seen. Small free fluid is noted in the\npelvis.\n\nREPRODUCTIVE ORGANS:  A hypoenhancing fibroid is seen within the uterus,\nunchanged since the prior examinations.  No adnexal masses are identified. \nPreviously seen left ovarian cyst is no longer visualized, and may have been\nfunctional.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  A\nnonenlarged periportal lymph node is identified.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.\n\nBONES: No suspicious bony lesions are identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No evidence of metastasis in the abdomen or pelvis.  Overall stable\nexamination since ___."
        },
        {
            "input": "LOWER CHEST: There is mild dependent atelectasis in the bilateral lower lobes.\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 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 duplicated left renal collecting system.  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 not definitively visualized,\nthere is a candidate for the appendix (02:51) which appears normal.  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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is conglomerate retroperitoneal lymphadenopathy measuring\n1.3 x 2.1 cm (2:40), new as compared to CT abdomen and pelvis ___. \nScattered mesenteric lymph nodes measuring up to 0.6 cm in short axis (02:47),\nnot pathologically enlarged by CT size criteria.  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: A right breast prosthesis is partially visualized.  A VP shunt\ncatheter courses through the subcutaneous tissues of the anterior abdominal\nwall in terminates in the right lower quadrant.  There is a tiny fat\ncontaining umbilical hernia.",
            "output": "1. Retroperitoneal lymphadenopathy is new as compared to CT abdomen pelvis ___, suspicious for new metastatic disease.  There are also scattered\nsubcentimeter mesenteric lymph nodes measuring up to 0.6 cm in short axis, not\npathologically enlarged by CT size criteria.\n2. The appendix is not definitely visualized.  There is a candidate for the\nappendix which appears normal.  There is no secondary sign of acute\nappendicitis."
        },
        {
            "input": "CHEST:  The imaged lung bases demonstrates moderate bibasilar atelectasis with\nno focal consolidation or pleural effusion. Heart size is normal with no\npericardial effusion.  Right breast prosthesis is partially imaged, intact.\n\nABDOMEN:\nEvaluation of the intraabdominal solid organs is limited by the lack of\nintravenous contrast. The liver, spleen, kidneys, adrenal glands, and pancreas\nare normal. The gallbladder is not seen, possibly surgically absent.\n\nThe distal esophagus, stomach, and small bowel are normal in caliber. The\nappendix is normal. Large bowel is unobstructed. Abutting the proximal\ntransverse colon is an area of fat stranding which extends to the skin\nsurface, the right mid-abdomen. There is slight enlargement of the overlying\nrectus muscle and subcutaneous fat stranding as well (2:38).\nVentriculoperitoneal shunt is seen entering the abdominal cavity in the left\nlower quadrant, terminating in the left lower quadrant. There is no free fluid\nor free air. No mesenteric or retroperitoneal lymphadenopathy is seen.\n\nPELVIS:  The uterus, adenexae, and urinary bladder are normal. No pelvic free\nfluid or lymphadenopathy.\n\nVESSELS: The aorta is normal in caliber. Infrarenal IVC filter is noted.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Focal area of stranding in the right mid-abdomen, extending from the skin\nsurface to the anterior aspect of the proximal transverse colon, with slight\nenlargement of the rectus muscle, compatible with a post surgical contusion,\ngiven the history of recent laparoscopy.\n2. No bowel obstruction.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 5:04 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "As was seen on the prior CT scan, the ventriculoperitoneal shunt enters the\nabdomen in the left lower quadrant, and terminates in the midline of the lower\nabdomen (02:35).  There is no fluid in the abdomen and only trace fluid in the\npelvis, but specifically no CSF collection at the termination of the catheter.\nThe catheter is in slightly different location compared to 2 days prior, which\nis expected.  Again noted is soft tissue stranding at the right rectus muscle\nadjacent to the proximal transverse colon, in keeping with recent laparoscopic\nport position and mild postsurgical stranding.  Visualized small and large\nbowel are normal in caliber.\n\nUrinary bladder, uterus, and adnexae are normal.  There is no retroperitoneal,\nmesenteric, or pelvic lymphadenopathy.\n\nPartially imaged inferior aspect of the kidneys are normal.  There is a duplex\nleft urinary collecting system, with two ureters joining as they enter the\npelvis.  IVC filter is noted with a relatively large filling defect at the\ncone of the filter, representing thrombus.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Slightly different position of the ventriculoperitoneal shunt termination,\nin the midline of the lower abdomen, with no associated fluid collection or\nCSFoma.\n2.  Unchanged appearance of soft tissue stranding abutting the right rectus\nmuscle, in keeping with recent laparoscopic port positioning and postsurgical\nchange.\n3.  Thrombus in the cone of the IVC filter, which has not been previously\nimaged with contrast and so a comparison is not possible."
        },
        {
            "input": "CHEST:\n\nThere is a small right pleural effusion and bibasilar atelectasis.  The lower\nchest is otherwise unremarkable.\n\nABDOMEN:\n\n The liver is nodular in contour, consistent with cirrhosis.  There is no\nconcerning focal lesion. There is no intrahepatic fluid collection. The portal\nveins and hepatic veins are patent.  Recanalization of the paraumbilical vein\nis noted. There is a large stone within the gallbladder, which is\nnondistended, with thin wall.  There is no biliary dilation. The pancreas is\nnormal, without focal lesion or duct dilation. The spleen is enlarged. The\nadrenal glands are normal. The kidneys enhance normally and excrete contrast\nbriskly. There are no solid renal lesions or hydronephrosis. The stomach and\nduodenum are normal. The small bowel and large bowel are normal in caliber,\nwithout wall thickening or mass. There is diverticulosis without evidence of\nactive inflammation. There is small volume ascites and diffuse mesenteric fat\nstranding,, which appears to be more significant around the duodenum.\n\nThere is periportal lymphadenopathy, with lymph nodes up to 3.5 x 2.4 cm in\nsize (5:29, 33). There is no fluid collection or pneumoperitoneum. The\nabdominal aorta is normal caliber, with patent main branches.  The portal vein\nand IVC are patent.  There is a fat and fluid containing umbilical hernia.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no pelvic or inguinal\nlymphadenopathy. The prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. No definitive acute abdominal or pelvic process.  Diffuse mesenteric fat\nstranding is likely secondary to third spacing, however increased\nconcentration of this process around the duodenum may suggest duodenitis.\n2. Cirrhosis and sequelae of chronic portal venous hypertension including\nsplenomegaly, small volume ascites.\n3. Cholelithiasis without evidence of cholecystitis.\n4. 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: Diffuse hypoattenuation of the liver is consistent with\nsteatosis.  A 1.1 cm hypoenhancing lesion in segment 4B is consistent with\nsimple cyst or biliary hamartoma.  Multiple additional subcentimeter\nhypodensities are too small to characterize, but also likely represent simple\ncysts or biliary hamartomas.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains a small amount of\nsludge or small layering stones.  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: Kidneys are of normal symmetric size.  There is delayed nephrogram on\nthe left side.  There is mild left hydroureteronephrosis which extends to the\nlevel of an obstructive stone at the UVJ measuring 6 mm.  There is mild\nhyperenhancement of the very distal left ureter.  Subcentimeter hypodensities\nin the right kidney are too small to characterize, but likely represent simple\ncysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Patient appears to\nbe status post right hemicolectomy.  Colon and rectum are unremarkable.  The\nappendix is not visualized.\n\nPELVIS: Bladder is unremarkable.  Left-sided UVJ stone is noted as described\nabove.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications are noted in 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.  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. Delayed left-sided nephrogram with mild left-sided hydroureteronephrosis\nwhich extends to the level of an obstructive 6 mm stone at the left UVJ.  Mild\nhyperenhancement of the very distal left ureter raises the possibility of\nascending infection.\n2. 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. \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.  There is subtle fat stranding\nin the right lower quadrant, inferior to the cecum (601:23, 2:60).  The small\nbowel, colon, and rectum are within normal limits.  The appendix is normal.\n\nPELVIS: The bladder is unremarkable.  There is no free fluid in the pelvis.\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.  No 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.  Otherwise, the\nabdominal and pelvic wall is within normal limits.",
            "output": "1. No acute intra-abdominal abnormality.\n2. Equivocal fat stranding in the right lower quadrant inferior to the cecum\nis of doubtful clinical significance.  The appendix and cecum appear normal.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:13 pm, 2 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: There are small bilateral nonhemorrhagic pleural effusions, right\ngreater than left, with adjacent compressive atelectasis.  Coronary artery\ncalcifications are present.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is mildly nodular in contour with homogeneous\nattenuation throughout.  There is no evidence of focal lesions.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains a percutaneous cholecystostomy tube and is collapsed with a small\namount of internal hyperdense material, in the setting of known recent\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 cyst in the lower pole the left kidney measures 2.1 cm. \nSubcentimeter hypodensity in the right kidney is too small to characterize by\nCT, but is also likely a cyst.  Previously described 1.5 cm mass in the lower\npole of the right kidney has not changed in size since ___, but is\nincompletely characterize currently (2:34).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout.  A large rectal stool ball measures 7.0\nx 6.3 cm, with mild rectal wall thickening and minimal adjacent presacral fat\nstranding.  There is colonic diverticulosis without wall thickening to suggest\ndiverticulitis.  Colonic stool burden is large.  The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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.  Unchanged small focal dissection of the left common iliac\nartery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDiffuse moderate degenerative changes of the lumbar spine, with disc space\nnarrowing and osteophyte formation again noted.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.",
            "output": "1.  Large stool burden and a rectal stool ball measuring 7.0 x 6.3 cm. \nAdjacent presacral fat stranding is similar to the decreased since ___,\nsuggesting chronic constipation and possibly stercoral colitis.\n\n2.  New small bilateral nonhemorrhagic pleural effusions, right greater than\nleft, with adjacent atelectasis.\n\n3.  1.5 cm mass in the lower pole the right kidney has not changed in size\nsince ___, but is incompletely characterized.  If clinically warranted,\nnonemergent renal ultrasound or MRI could be obtained.\n\n4.  Cholecystostomy tube is in place in the decompressed gallbladder."
        },
        {
            "input": "CHEST: The lungs demonstrate moderate emphysema and a 1 cm right lower lobe\nnodule (2:1). No pleural effusion or evidence of pneumonia. Heart is normal in\nsize with moderate coronary calcifications.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver, gallbladder, spleen, adrenal glands, and\nkidneys are normal. The pancreas is atrophic but otherwise normal. Stomach and\nsmall bowel are normal in caliber. The appendix is normal. The large bowel\ncontains a moderate fecal load, but no evidence of colitis. No mesenteric or\nretroperitoneal lymphadenopathy. No intra-abdominal free air or free fluid.\n\nPELVIS: There are bladder is unremarkable. The prostate is mildly enlarged.\nVascular calcifications are noted in the pelvis. No pelvic free fluid or\nlymphadenopathy.\n\nVESSELS: The aorta demonstrates considerable atherosclerotic disease with\naneurysmal dilatation of the infrarenal abdominal aorta to 3.2 cm.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  1 cm right lower lobe nodule warrants further followup with dedicated\nchest CT in ___ months.\n2.  Normal caliber small and large bowel.\n3.  Infrarenal abdominal aortic aneurysm measuring up to 3.2 cm, stable since\n___."
        },
        {
            "input": "Lower Thorax:  There is a nodular density in the right lower lobe - please see\nCT thorax from same day for further details.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\nThere are unchanged clips seen along the anterior abdominal wall.\n\nLiver:  There is a tiny subcentimeter lesion in segment IVb that is too small\nto characterize but is statistically likely to be a benign cyst or hemangioma.\nThe liver is otherwise normal with no focal lesion.\n\nGallbladder and Biliary System: The gallbladder is not distended and there are\nno calcified gallstones.There is no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is atrophic with no focal lesion, ductal dilatation or\ncalcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal lesion.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits,\nhowever, assessment is limited due to presence of intraluminal barium. There\nis no bowel obstruction.\n\nPelvis:  The urinary bladder is unremarkable.The prostate gland is enlarged.\n\nLymph Nodes: There is no size significant mesenteric, pelvic or\nretroperitoneal lymphadenopathy.\n\nVessels: There is diffuse atheromatous calcifications with minimal aneurysmal\ndilatation of the infrarenal abdominal aorta measuring up to 3.1 cm in\ndiameter (07:36) and near occlusion at the origin of the superior mesenteric\nartery.\n\nBones: There is degenerative change involving the lumbosacral spine and\nsacroiliac joints. There is no suspicious focal bone lesions.",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2.  Infrarenal abdominal aortic aneurysm measuring up to 3.1 cm.\n3.  Significant atheromatous vascular calcifications with significant\nnarrowing of the superior mesenteric artery."
        },
        {
            "input": "CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nThere is an 10 mm hypodensity within segment 4 of the liver which is\nincompletely characterized. The liver otherwise enhances homogeneously without\nfocal lesion or intrahepatic biliary dilatation. The gallbladder is\nunremarkable and the portal vein is patent. The pancreas, spleen and adrenal\nglands are unremarkable. The kidneys present symmetric nephrograms and\nexcretion of contrast with no focal lesions, stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  The appendix is visualized and there is no evidence of\nappendicitis.  There is no retroperitoneal or mesenteric lymphadenopathy by CT\nsize criteria. No ascites, free air or abdominal hernia.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There are numerous cysts in the\nbilateral ovaries. A intrauterine device is seen within the endometrial\ncavity. There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present.",
            "output": "Enlarged bilateral ovaries with multiple cysts. Can be further evaluated with\npelvic ultrasound."
        },
        {
            "input": "LUNG BASES: Please see dictation for separately reported CT Chest examination.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion.  There is\nno intrahepatic biliary ductal dilation. The portal vein is patent.  The\ngallbladder does not demonstrate evidence of stones or wall thickening.  The\npancreas enhances homogeneously.  There is no peripancreatic stranding or\nductal dilation. There is no splenomegaly or focal splenic lesion.  Adjacent\nto the outer capsule of the spleen is an 8 mm rounded soft tissue nodule,\nwhich was present but is larger in comparison to most recent CT from ___, and is new since CT from ___, concerning for metastasis.\n\nThe adrenal glands are normal. The right kidney demonstrates a normal\nenhancement pattern without evidence of hydronephrosis.  The patient is status\npost left nephrectomy. There is no evidence of concerning soft tissue focus in\nthe surgical left nephrectomy bed to suggest local recurrence. There is no\nretroperitoneal or mesenteric lymphadenopathy by CT size criteria.\n\nThe stomach and duodenum are unremarkable. Non-dilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening or\nobstruction.  The colon is unremarkable.  The appendix is not directly\nvisualized, however there are no secondary signs of appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation.  Major proximal tributaries appear patent.  There is no free\nintraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs including the bladder and terminal ureters are\nunremarkable. There is no pelvic sidewall or inguinal lymphadenopathy. There\nis no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is mild degenerative change of the imaged thoracolumbar spine. Alignment\nis normal.  A Schmorl's node is again identified in the superior endplate of\nL4.  There is no evidence of concerning focal lytic or sclerotic osseous\nlesion. A left spigelian hernia is noted.",
            "output": "1. 8 mm soft tissue nodule adjacent to the outer capsule of the spleen just\nunder the left hemidiaphragm, larger since ___ and new since ___.  Given interval change, this is concerning for metastasis.  Given size\nand location, this lesion would not be amenable to biopsy, and close follow-up\nis recommended.\n2. Please see separate report for intrathoracic findings from same-day CT\nchest.\n\nRECOMMENDATION(S):  Close follow-up of 8 mm soft tissue nodule adjacent to the\nouter capsule the spleen under the left hemidiaphragm."
        },
        {
            "input": "LOWER 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 several sub-5 mm hypodensities scattered throughout\nthe liver (2:  66, 67, 69) that are too small to characterize, but unchanged\nappearance since at least the ___ MRI.  The liver is otherwise\nhomogeneous in attenuation throughout.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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 calcified nodularity along the medial\naspect of spleen (2:63) that is unchanged since the reference CT performed in\n___, and is likely a benign etiology suggests a sequela of prior\nepiploic appendagitis.  More superiorly and posterior to the spleen is a 6 x 9\nmm soft tissue nodule (2:55) that newly developed since ___.  It\nhas subsequently progressively increased in size since ___, although\nhas remained stable since the most recent study on ___.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  The right kidney is normal in size and enhances homogeneously. \nThere are two small hypodensities in the lower pole of the right kidney that\nmeasure 4 mm and 12 mm respectively (601b:58) that are too small to\ncharacterize, but most likely represent cysts.  No concerning parenchymal\nmasses are identified.  No nephrolithiasis or hydronephrosis.  Patient is\nstatus post left nephrectomy.\n\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 definitely visualized, but\nthere are no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.  Again noted is a soft tissue nodule located along\nthe left anterior aspect of the bladder presumably in the space of Retzius\nthat measures 15 x 10 mm (2:116), slightly increased from ___ where it\nmeasured 13 x 10 mm.  In ___, this nodule measured 11 x 8 mm.  This\nmost likely represents a lymph node.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are unremarkable.\n\nLYMPH NODES:  There is a 10 x 12 mm left paracardial node (2:52) that has not\nsignificantly changed compared to ___.  No retroperitoneal,\nmesenteric, pelvic sidewall or 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.\n\nSOFT TISSUES:  There is a fat containing left anterior abdominal wall hernia. \nAbdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Slowly enlarging soft tissue nodule along the left anterior aspect of the\nbladder currently measuring 15 x 10 mm, most likely a metastatic focus.\n2. Additional 6 x 9 mm presumed metastatic focus along the posterior aspect of\nthe splenic capsule which has been progressively increasing in size from ___, but has remained stable since ___.\n3. No new sites of metastatic disease within the abdomen or pelvis.\n4. Fat containing left anterior abdominal wall hernia.\n5. CT chest dictated 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: The liver demonstrates homogenous attenuation throughout.  Tiny\n3 mm hypodensities in segment V (3:64, 67) are too small to characterize;\nhowever, these are stable from at least ___, and likely represent cysts\nor biliary hamartomas.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.  Portal venous\nsystem 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.  Calcification adjacent to the spleen may represent\nfat necrosis or calcified epiploic appendage (06:44) or calcified lymph node.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy.  Right kidney is normal in\nsize and enhances homogeneously.  No hydronephrosis.  There is a 1.1 cm simple\ncyst in the lower pole of the right kidney.  Additional 0.8 cm hypodensity in\nthe right lower pole is too small to characterize (3:74), but overall similar\nin size compared to ___ and statistically likely represents a 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.  The 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 gland 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: Evaluation of the soft tissues is notable for a fat containing\nspigelian hernia on the left.",
            "output": "1. Post left nephrectomy, without evidence of local recurrence or distant\nabdominopelvic metastases.\n2. CT chest dictated 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: 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 a subcentimeter hypodensity within\nthe right hepatic lobe measuring 7 mm, which is unchanged compared to multiple\nprior studies and consistent with a simple cyst or biliary hamartoma, however\ntoo small to completely characterize by CT.  Previously demonstrated similar\nhypodensities are not well visualized due to contrast phase.  The gallbladder\nis within normal limits.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Within the right adrenal gland, there is a heterogeneously enhancing\n4.1 x 3.1 cm lesion (series 4, image 122), with central hypoenhancement\nsuggestive of a necrotic metastasis, new compared to the prior study from ___.\n\nURINARY: Status post left nephrectomy.  There is a focal hypoenhancing and\nsomewhat indistinct area along the slightly superior right renal cortex\n(series 604, image 76), which is new compared to the prior study.  The right\nkidney demonstrates normal size and nephrogram without hydronephrosis. \nSeveral cortical hypodensities measuring up to 1.0 cm in the right renal\ncortex are unchanged from prior study and consistent with previously described\nsimple cysts on prior MRI.\n\nGASTROINTESTINAL: The stomach 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.\nAdjacent to the splenic flexure of the colon, there is a calcified nodule\nwithin the omentum as seen previously, suggestive of a remote torsed epiploic\nappendage (series 4, image 114).\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 no abdominal aortic aneurysm.  No substantial\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes along the anterior endplate of L3 are unchanged since\n___.\n\nSOFT TISSUES: Redemonstration of a left lateral ventral hernia containing fat\nas well as a small umbilical hernia also containing fat.  Numerous densities\nare demonstrated within the anterior subcutaneous tissues bilaterally, likely\nrepresenting injection granuloma.  There is a 4 mm nodule within the\nsubcutaneous tissue near the xiphoid process (series 4, image 123), which is\nnew from the prior study.",
            "output": "1. Solitary right kidney.  New (since ___ enhancing nodule within\nthe right renal interpolar cortex laterally measuring 1.1cm, concerning for\nmetastatic disease or a new renal neoplasm.\n2. New heterogeneous enlargement of the right adrenal gland with central\nhypoenhancement suggestive of a necrotic adrenal metastasis or intra adrenal\nhemorrhage.\n3. Tiny subcutaneous nodule in the skin near the xiphoid process, of\nindeterminate etiology.  Recommend attention on followup.\n4. Please see report from same day CT chest for description of thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  Trace pleural fluid.  Right heart\nenlargement.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Although the study was performed without the\nadministration of intravenous contrast, the IVC and hepatic veins appear\ndistended.  This is likely on a background of right heart dysfunction.  There\nis evidence of uncomplicated cholelithiasis.  There is no intrahepatic or\nextrahepatic bile duct dilatation.\n\nPANCREAS: Pancreas is atrophic.  There are no focal pancreatic parenchymal\nlesions.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (9 cm).  There are no focal splenic\nlesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: There is mild non-specific perinephric fat stranding, symmetric. \nRenal parenchyma is grossly unremarkable, allowing for non-contrast scan.  No\nhydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Stomach is otherwise\nunremarkable.  Small bowel loops demonstrate normal mural thickness are normal\nluminal caliber.  There is a small stool burden throughout the colon.  There\nare several scattered uncomplicated sigmoid diverticula.  Large bowel\notherwise unremarkable.  Note that there is some fecalization of the terminal\nileum.  The appendix in the right lower quadrant is normal.\n\nPERITONEUM: There is mild fat stranding in the small bowel mesentery. \nAdditional mild fat stranding is noted along the left paracolic gutter.  These\nfindings are non-specific.  No free fluid.  No free air.\n\nPELVIS: Urinary bladder is decompressed.  No gross abnormality identified.\n\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  No gross adnexal pathology.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Moderate vascular calcification.  No aneurysmal dilatation of the\nabdominal aorta or iliac vessels.\n\nBONES: Grade II anterolisthesis of L5 on S1 present on a background of\nbilateral pars defects.  Complete disc height loss L5-S1.  There are multiple\nold healed left lower rib fractures, better evaluated on the concurrently\nperformed chest CT.\n\nSOFT TISSUES: Within the subcutaneous soft tissues of the left anterior\nabdominal wall, there is an apparent peripheral soft tissue density with\noverlying skin thickening, spanning a distance of approximately 5.9 cm in\ntransverse dimension (series 2, image 83)..  Please correlate clinically. \nThis is located just above the level of the iliac crest.",
            "output": "1. Within the subcutaneous soft tissues of the left anterior abdominal wall,\nthere is an ovoid soft tissue density with overlying skin thickening,\nmeasuring approximately 5.9 by 1.5 cm in maximum transaxial ___,\napproximately at the height of the iliac crest.  Please correlate clinically\nfor presence of cellulitis or hematoma in this region.\n2. No acute abdominal or pelvic pathology is otherwise identified.\n3. Multiple left-sided rib fractures, better evaluated on the concurrently\nperformed chest CT from the same day.\n4. Grade II anterolisthesis of L5 on S1, present on a background of bilateral\npars defects, with superimposed severe degenerative disc disease at L5-S1."
        },
        {
            "input": "LOWER CHEST: There is mild paraseptal emphysema.  There is no evidence of\npleural or pericardial effusion.  Pacemaker leads are again visualized.\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.  There\nis a moderate size hematoma inferior to the gallbladder fossa measuring 7.9 x\n5.5 x 7.3 cm (4:34, 601:29), representing the sentinel clot.  No definite\nblush of contrast is seen to indicate active extravasation.  There are\nmultiple additional more focal collections of blood product scattered\nthroughout the abdomen, but primarily in the right upper quadrant.  There is a\nmoderate to large amount of complex free fluid, likely representing organizing\nblood products of various age.  There is also a small amount of extrahepatic\npneumobilia.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality. Nodular calcification medial to the right kidney may\nrepresent a calcified renal artery aneurysm.\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 unremarkable.  Re-demonstrated is a urethral\ndiverticulum.\n\nREPRODUCTIVE ORGANS: There is a right adnexal cystic structure measuring up to\n2.1 cm, decreased in size since ___.   The uterus is 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 aorta is ectatic\nmeasuring up to 2.1 cm just proximal to the aortic bifurcation, unchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a small amount of fat stranding extending along the\nprior trocar site.  There are numerous small foci of subcutaneous air and soft\ntissue stranding, likely representing subcutaneous injection sites.",
            "output": "1. Moderate to large volume of postoperative intra-abdominal and intrapelvic\nblood of varying age.  There is a 7.9 cm hematoma inferior to the gallbladder\nfossa.  No definite blush of contrast is seen to indicate active\nextravasation.\n2. Small extrahepatic pneumobilia.  Recommend correlation with history of\nrecent intervention.\n3. 2.1 cm right adnexal cyst is decreased in size since ___.  However, a\npelvic ultrasound may be obtained for further evaluation if clinically\nindicated.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:57 pm, 2 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar atelectasis, the lung bases are\nclear.  No pleural or pericardial effusion.  Severe coronary artery\ncalcifications are present, predominantly involving the right coronary artery.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\n1.8 cm hypodensity in the right hepatic lobe most likely reflects a cyst. \nAdditional subcentimeter hypodensities are too small to characterize.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.  There is vicarious excretion of contrast into the gallbladder,\nrelated to head and neck CTA performed 13 hours 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. \nBilateral renal cysts are present, measuring up to 3.5 cm on the right.  There\nalso left greater than right peripelvic cysts.  Excreted contrast is in the\nrenal pelvises. There is no evidence of suspicious renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL:  There is active arterial contrast extravasation arising\nfrom a diverticulum in the mid transverse colon, with pooling of contrast seen\non portal venous phase imaging (4:55, 5:55, 601:35).\n\nThere is a small hiatal hernia.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout.  Small bowel anastomosis is noted\nin the mid abdomen (02:57) there is extensive, pancolonic diverticulosis. \nThere is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is filled with contrast, and there is a posterior\ndiverticulum (2:72).  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nVASCULAR: There is a replaced right hepatic artery from the SMA.  There is\ncalcified and noncalcified atherosclerotic plaque at the origin of the\nsuperior mesenteric artery resulting in moderate luminal narrowing.  The ___\nis patent.  Severe calcified atherosclerotic plaque.  No abdominal aortic\naneurysm.\n\nREPRODUCTIVE ORGANS: TURP deformity is noted in the prostate.\n\nBONES: The patient is status post right medullary rod fixation for an\nintertrochanteric fracture.  There are severe bilateral hip degenerative\nchanges.  There is diffuse osseous demineralization.  No acute fracture or\nsuspicious osseous lesion is seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Actively bleeding diverticulum along the mid transverse colon.\n2. Calcified and noncalcified plaque at the origin of the superior mesenteric\nartery resulting in mild luminal narrowing.  Accessory right hepatic artery\nfrom the SMA.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:49 pm, 2 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: There is a calcified nodule in the left lung base, suggestive of\nprior granulomatous disease.  Otherwise, the visualized lung fields are clear.\nNo pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  Along the left\nlateral bladder wall, there is a 1.8 x 1.0 x 1.3 cm (series 3, image 139;\nseries 601, image 49) enhancing soft tissue mass.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding. The\nappendix is normal.\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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease.  Patient is status post\naorto bi-iliac stent placement for an abdominal aortic aneurysm, which now\nmeasures up to 4.1 x 3.3 cm (series 2, image 44) (previously approximately 4.3\nx 4.4 cm.  No contrast extravasation seen to suggest an endovascular leak.\n\nBONES: Degenerative changes are seen in the lumbar spine.  There are bilateral\nL5 pars interarticularis defects with grade 1 anterolisthesis of L5 on S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. New 1.8 x 1.0 x 1.3 cm enhancing soft tissue mass along the left lateral\nbladder wall, concerning for urothelial neoplasm.\n2. Post aorta bi-iliac stent placement with interval decrease in the size of\nthe abdominal aortic aneurysm, which now measures up to 4.1 x 3.3 cm.  No\ncontrast extravasation seen to suggest an endovascular leak.\n3. Diverticulosis without evidence of diverticulitis.\n\nRECOMMENDATION(S):  Recommend urology consultation for cystoscopy to further\nevaluate the new enhancing bladder wall mass.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 11:12 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "CHEST:\n\nThe bases of the lungs are clear with the exception of a 7 mm calcified\ngranuloma in the left lower lobe. The visualized heart and pericardium are\nunremarkable.  Note is made of coronary artery calcifications and\ncalcifications of the mitral annulus.\n\nABDOMEN:\n\nEvaluation of the solid organs and tissues is limited without intravenous\ncontrast. The liver is diffusely hypoattenuating consistent with fatty\ninfiltration with a focal area of sparing around the gallbladder fossa. There\nis no intrahepatic biliary dilatation. The gallbladder, pancreas, spleen and\nadrenal glands are unremarkable. The kidneys have a normal noncontrast\nappearance without stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction. There is sigmoid diverticulosis without evidence of\ndiverticulitis.  The appendix is  visualized and there is no evidence of\nappendicitis.  There is no retroperitoneal or mesenteric lymphadenopathy by CT\nsize criteria. No ascites, free air or abdominal hernia.\n\nAgain seen is a fusiform infrarenal abdominal aortic aneurysm measuring 4.3 x\n4.3 x 4.4 cm, not significantly changed from the ultrasound of ___. The iliac\narteries are of normal caliber. There is moderate atherosclerotic\ncalcifications of the abdominal aorta and the common iliac arteries\n\nPELVIS:\n\nThe urinary bladder is unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present. Mild\nmultilevel degenerative changes of the lumbar spine are again noted.",
            "output": "1. Stable infrarenal abdominal aortic aneurysm measuring up to 4.5 cm.\n2. Hepatic steatosis"
        },
        {
            "input": "Pre EVAR Angiogram of the Abdominal Aorta:\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal:  2.2 x 1.8 cm\n\n5 mm below lowest renal artery: 1.9 cm\n10 mm below lowest renal artery:  1.9 cm\n15 mm below lowest renal artery:  1.7 cm\n\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 4.4 x 4.4 cm\nLength: 4.9 cm\nVolume:\n\n-Aneurysm: 57.4 ml\n-Renal to Aortic bifurcation: 70.7 ml\n-Renal to Iliac bifurcation: 86.0 ml\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 0.9 cm cm; Left: normal 1.0 cm cm.\nExternal Iliacs: Right: normal 7.6 cm; Left: normal 6.9 cm.\nInternal Iliacs: Right: normal 0.7 cm; Left: normal 0.7 cm.\nFemoral: Right: normal 1.0 cm; Left: normal 0.9 cm.\n\nTortuosity Iliacs:  Right: none; Left:  None.\nFemoral Calcifications: Right: mild; Left: mild.\n\nLOWER CHEST:\n\nA calcified nodule seen on series 2, image 3 at the subpleural region of the\nleft lung base, unchanged since ___. The heart is normal size without\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous, but decreased attenuation\nthroughout consistent with 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, without stones or gallbladder wall\nthickening.\nPANCREAS:\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. There is no peripancreatic stranding.\nSPLEEN:  The spleen is prominent at 11.6 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: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Mild sigmoid diverticulosis is noted.\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 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. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1. Distal saccular aortic aneurysm measuring approximately 4.4 x 4.4 cm,\nplease see the above findings section for additional details.\n2. Mild fatty liver, prominent spleen, but no evidence for portal\nhypertension.\n3.  Mild sigmoid diverticulosis without diverticulitis."
        },
        {
            "input": "VASCULAR:\n Pre EVAR Angiogram of the Abdominal Aorta\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal:  2.5 cm\nAt lowest renal artery left: 2.3 cm\n5 mm below lowest renal artery: 2.1 cm\n10 mm below lowest renal artery:  2.1 cm\n15 mm below lowest renal artery:  2.0 cm\n\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 4.6 x 4.7 cm\nVolume:\n\n-Aneurysm: 71.0 ml\n-Renal to Aortic bifurcation: 89.0 ml\n-Renal to Iliac bifurcation: 113.1 ml\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 1.0 cm; Left: normal 1.2 cm.\nExternal Iliacs: Right: normal 0.8 cm; Left: normal 0.8 cm.\nInternal Iliacs: Right: normal 0.6 cm; Left: normal 0.6 cm.\nFemoral: Right: normal 0.8 cm; Left: normal 0.8 cm.\n\nTortuosity Iliacs:  Right: none; Left:  None.\nFemoral Calcifications: Right: Mild; Left: Mild.\n\n\nLOWER CHEST: Of note, there is an 8 x 7 mm ill-defined perifissural pulmonary\nnodule in the right lower lobe, which has enlarged in size since ___ comment was not identified on the CT from ___ (series 2, image\n3).  A calcified granuloma in the left lung base is unchanged.  Minimal\natelectasis is noted in the lung bases. There is no pleural or pericardial\neffusion.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is well distended and unremarkable.  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.  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: Prostatic calcifications are again identified.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  Bilateral pars defects at L5-S1\nare again seen.  Grade 1 anterolisthesis of L5 on S1, with underlying vacuum\nphenomena is unchanged.  Abdominal and pelvic wall is within normal limits.",
            "output": "1.  Suspicious, ill-defined 8 mm perifissural pulmonary nodule in the right\nlower lobe, which has enlarged since ___ and was not identified on\nthe CT from ___.\n\n2.  Since the CT on ___, the infrarenal abdominal aortic aneurysm\nhas slightly enlarged, now measuring 4.6 x 4.7 cm, previously 4.4 x 4.4 cm. \nPlease see the above vascular findings for additional details.\n\nNOTIFICATION:  The above findings were entered by Dr. ___ the\n___ Imaging Findings Dashboard for communication to the ordering\nclinician at 15:36 on ___."
        },
        {
            "input": "VASCULAR:\n Pre EVAR Angiogram of the Abdominal Aorta\n\nABDOMINAL AORTA DIAMETERS\nSuprarenal:  2.4 x 2.2 cm\nAt lowest renal artery left: 2.2 x 2.2 cm\n5 mm below lowest renal artery: 2.0 x 1.9 cm\n10 mm below lowest renal artery:  2.0 x 2.0 cm\n15 mm below lowest renal artery:  Right 2.0 x  2.0 cm\n\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 4.9 x 4.6 cm\nDiameter (Center-line): 5.0 x 4.8 cm\nLength: 5.5 cm\nVolume:\n\n1. Aneurysm: 74 ml\n2. Renal to Aortic bifurcation: 89 ml\n3. Renal to Iliac bifurcation: 109 ml\nILIACS AND FEMORALS:\nMeasured: Cross-sectional\nCommon Iliacs: Right: normal 1.1 cm; Left: normal 1.1 cm.\nExternal Iliacs: Right: normal 0.9 cm; Left: normal 0.9 cm.\nInternal Iliacs: Right: normal 0.8 cm; Left: normal 0.7 cm.\nFemoral: Right: normal 0.9 cm; Left: normal 0.9 cm.\n\nTortuosity Iliacs:  Right: mild; Left:  mild.\nFemoral Calcifications: Right: moderate; Left: moderate.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.  Mitral annulus calcification and coronary\nartery calcifications are again noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous decreased attenuation,\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, 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\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is mild sigmoid diverticulosis without\ndiverticulitis.  Appendix contains air, has normal caliber without evidence of\nfat stranding.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate contains calcifications and is mildly\nenlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild anterolisthesis of L5 on S1 with bilateral pars interarticularis\ndefects.  A small bone island is seen in the right acetabulum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable infrarenal abdominal aortic aneurysm measuring up to 5.0 cm with\nfull measurements as described above."
        },
        {
            "input": "ABDOMEN:\n\nSurgical sutures are identified at the visualized left lung base (5:5). \nPlease refer to the CT chest study from the same day for complete details on\nthoracic findings.\n\nThe liver demonstrates diffusely decreased enhancement, likely related to\nsteatosis or chemotherapy associated steatohepatitis. A subtle 1-2 mm\nhypodense lesion is identified in segment 7 of the liver in the subcapsular\nregion (02:54), unchanged. A 5 mm hypodense lesion along the falciform\nligament in segment 4A (02:58), also remains unchanged. No suspicious focal\nhepatic lesions are identified.  No intrahepatic or extrahepatic biliary\nductal dilatation.  The hepatic veins and portal veins are patent. Splenic\nvein and SMV are patent.  The gallbladder, pancreas, left adrenal gland and\nspleen are unremarkable. Patient is status post right nephrectomy and\nadrenalectomy. No evidence of disease recurrence or residual tumor in the\nsurgical bed.\n\nNo ascites. The stomach is unremarkable. Caliber of small and large bowel is\nwithin normal limits. No mesenteric lymphadenopathy. Small retroperitoneal\npara-aortic lymph nodes are again identified, none enlarged by size criteria.\n\nPELVIS:\n\nThe urinary bladder is unremarkable. A fibroid uterus is again noted. No\npelvic free fluid query rectum is unremarkable. No inguinal or pelvic\nlymphadenopathy.\n\nOSSEOUS STRUCTURES:\n\nNo suspicious osteolytic or osteoblastic lesions are identified.",
            "output": "*No evidence of disease recurrence or residual disease in the right\nnephrectomy and adrenalectomy surgical bed.  No evidence of metastatic\ndisease.\n*Stable hypodense lesions in the liver. Diffusely decreased enhancement of the\nliver likely related to steatosis or chemotherapy associated steatohepatitis."
        },
        {
            "input": "LOWER CHEST: Please see report from dedicated CT of the chest for\nsupradiaphragmatic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously hypodense, compatible with\nsteatosis.  No definite focal lesions are identified.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: Pancreas demonstrates normal attenuation throughout.  A previously\nidentified 5 mm enhancing focus in the uncinate process is not conspicuous on\nthe current 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 adrenal gland is surgically absent.  The left adrenal\ngland is normal.\n\nURINARY: The patient is status post right nephrectomy.  The nephrectomy bed is\nunchanged in appearance, without evidence of disease recurrence.  No focal\nlesions are identified in the left kidney.  There is no hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is mild\ncolonic 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: Multiple fibroids are seen in the enlarged uterus.  No\nadnexal 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. There is a replaced right\nhepatic artery arising from the SMA.  No significant atherosclerotic disease\nis noted.\n\nBONES: Mild multilevel degenerative changes are seen in the lower thoracic and\nlumbar spine.  There is no vertebral body height loss or suspicious bony\nlesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post right nephrectomy without local recurrence.  No abdominopelvic\nmetastasis.  Please refer to the separate chest CT dictation regarding\nintrathoracic findings.\n2. Previously-seen 5 mm enhancing focus in the uncinate process of the\npancreas is not visualized on the current study.  Attention on follow-up is\nrecommended."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\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. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 are few diverticula in the sigmoid colon. \nThere is no evidence of mesenteric lymphadenopathy.  There is no active\ncontrast extravasation or pooling contrast seen throughout the\ngastrointestinal tract to explain the patient's melena.\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: The prostate gland is unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia.",
            "output": "No active contrast extravasation or contrast pooling seen throughout the\ngastrointestinal system to explain the patient's melena."
        },
        {
            "input": "LOWER CHEST: Small amount of right lower lung base scarring, similar\nappearance to prior exam.  Trace bilateral pleural effusions and minimal\nbibasilar atelectasis.\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. \nRedemonstration of a 3.8 cm cyst located at the upper pole right kidney. \nOtherwise, there is no evidence of focal renal lesions or hydronephrosis. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The small bowel is fluid-filled and unremarkable. \nOtherwise, there is redemonstration of a large pelvic mass measuring 11.4 x\n9.7 cm (series 2, image 62) that appears to involve the sigmoid colon within\nan intraluminal component.  No evidence of large or small bowel obstruction. \nThe appendix is not definitively visualized.\n\nPELVIS: Redemonstration of a 11.4 x 9.7 cm confluent lobulated soft tissue\nmass centrally located within the pelvis, as also evaluated on prior PET-CT\nand previously thought to be likely recurrent disease.  The urinary bladder is\nunder distended, but grossly unremarkable.\n\nREPRODUCTIVE ORGANS: Patient is status post radical 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.  Mild atherosclerotic disease\nis noted.  Of note, there is a circumaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Lack of intra-abdominal and subcutaneous fat limits exam. \nHowever, within limits of exam, the retroperitoneal and mesenteric fat appears\nto be subtly more radiodense than expected for fat, which may represent a\nsmall amount of mesenteric ascites.",
            "output": "1. Redemonstration of a large confluent lobulated pelvic mass measuring 11.4 x\n9.7 cm involving the sigmoid colon with an intraluminal component.  No\nevidence of obstruction.\n2. Lack of intra-abdominal and subcutaneous fat limits exam, however,\nretroperitoneal and mesenteric fat appears a more radiodense than expected,\nwhich may represent a small amount of mesenteric ascites."
        },
        {
            "input": "LOWER CHEST: Moderate pleural effusions bilaterally.  Bibasilar atelectasis,\nworse on the left, without focal consolidation.  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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 3.2 cm right upper pole cyst is again noted.  Otherwise, the kidneys\nare of normal and symmetric size with normal nephrogram.  Double-J left\nureteral stent appears appropriately positioned.  There is no evidence of\nfocal renal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Nasogastric tube is present in the stomach.  Diffuse mildly\ndilated loops of bowel without clear transition point to suggest obstruction. \nCatheter is present in the left lower quadrant ostomy.\n\nExtraluminal contrast likely arising from the rectal stump superior to staple\nline (5:75/07:30) without associated fluid collection.  This is adjacent to a\nsurgically placed drain.\n\nThere is small diffuse abdominopelvic free fluid and third-spacing, with\nseveral anti-dependent peritoneal air locules, likely within expected limits\nfor postoperative status, without organized fluid collections.\n\nPELVIS: Foley catheter is in place and the bladder collapsed.  Right approach\npelvic drain with tip positioned in the left pelvis.\n\nREPRODUCTIVE ORGANS: Prostate 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.  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 amount of extraluminal contrast likely arising from the rectal stump\nsuperior to staple line, without associated fluid collection.  This is\nadjacent to a surgical drain.\n2.  Small diffuse abdominopelvic free fluid with several peritoneal air\nlocules, likely iatrogenic, without organized fluid collections.\n3.  Mildly diffusely dilated bowel loops without transition point, compatible\nwith ileus.\n4.  Moderate bilateral pleural effusions.\n\nNOTIFICATION:  Findings discussed with ___ surgery immediately after\nthe study."
        },
        {
            "input": "LOWER CHEST: Moderate bilateral pleural effusions again noted.  There is small\nto moderate bibasilar atelectasis.  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 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 3.2 cm cyst\nin the right upper pole, again noted.  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.  Foci of air seen within the upper and midpole of the left renal\ncollecting system likely introduced through the double-J left ureteral stent\nin the setting of a Foley catheter.\n\nGASTROINTESTINAL: Re-demonstrated are diffusely dilated loops of small bowel\nwithout a clear transition point.  Patient is status post sigmoid colectomy. \nPreviously administered contrast is seen within the large bowel extending to\nthe level of the left lower quadrant ostomy.  Previously administered contrast\nis seen extraluminally arising from the rectal stump superior to the staple\nline, less conspicuous than on the prior study.  An adjacent surgically placed\ndrain is unchanged in position.  Re-demonstrated is third-spacing of fluid and\nmild pneumoperitoneum, likely postsurgical.\n\nPELVIS: The urinary bladder contains a Foley catheter and air, likely\nsecondary to catheterization.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Left lower quadrant ostomy as noted above.  A midline surgical\nscar is seen.  Along the lower aspect of the incision is a diastasis measuring\napproximately 13 mm (4:4, 2:63) and contains fluid and/or fat.  No evidence of\nherniated bowel.",
            "output": "1. No evidence of an umbilical hernia.  Small diastasis of the lower abdomen\nalong a midline incision measuring up to 13 mm in diameter and containing\nfat/fluid.\n2. Extraluminal contrast in the region of the rectal stump, less conspicuous\nthan seen previously\n3. Diffusely dilated loops of small bowel without a discrete transition point\ncompatible with persistent ileus.\n4. Locules of gas are seen within the left renal collecting system likely\nintroduced through the left ureteral stent in the setting of a Foley catheter.\n5. Mild pneumoperitoneum and abdominopelvic free fluid, unchanged.\n6. Moderate bilateral pleural effusions partially imaged."
        },
        {
            "input": "CT OF THE ABDOMEN\n\nThere is a small hiatal hernia. Evaluation for visceral organs is limited due\nto lack of intravenous contrast. Within this limitation, the liver\ndemonstrates a homogeneous attenuation. There is no evidence of intrahepatic\nor extrahepatic biliary ductal dilatation. The gallbladder is decompressed.\nThere is no gallbladder wall edema or pericholecystic fluid collection to\nsuggest acute inflammation. A punctate density within the gallbladder lumen,\nmay represent a tiny gallbladder stone. The spleen is normal in size. The\npancreas demonstrates homogeneous attenuation without ductal dilatation or\nperipancreatic fluid collection.\n\nThe right adrenal gland is normal. The left adrenal gland appears slightly\nthickened without discrete nodularity. The kidneys demonstrate homogeneous\nattenuation without hydronephrosis.  Small and large bowel loops are normal in\ncaliber without evidence of bowel wall thickening or obstruction.  Evaluation\nfor bowel ischemia is limited due to lack of intravenous contrast. However, no\nportal venous gas or pneumatosis is evident.  The appendix is visualized and\nappears normal.  There is no free air or free fluid within the abdomen. There\nare scattered retroperitoneal and mesenteric lymph nodes, which do not appear\npathologically enlarged by CT criteria. No discrete intra-abdominal fluid\ncollections seen to suggest abscess formation.\n\nCT OF THE PELVIS:\n\nA Foley catheter is in place. The bladder is collapsed around a Foley\ncatheter. Small amount of air within the bladder, likely relates to\ninstrumentation. The rectum, sigmoid colon and prostate gland are\nunremarkable.  There is no free air or free fluid within the pelvis. No pelvic\nwall or inguinal lymphadenopathy.\n\nOsseous structures:  No suspicious lytic or sclerotic bony lesion is seen.)",
            "output": "1. Limited assessment due to lack of intravenous contrast. Within this\nlimitation, no acute CT findings to account for patient's clinical\npresentation.\n\n2. Small hiatal hernia.\n\n3. Chest findings are 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 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: New moderate right-sided hydronephrosis with delayed nephrogram.  The\nureter is dilated proximally within normal distal ureter.  The left kidney is\nnormal.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Redemonstrated\nshort-segment moderate right transverse colon wall thickening has not\nsignificantly changed compared to prior.  The appendix 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. Redemonstrated short-segment right transverse colon wall thickening could\nrepresent unresolved persistent colitis however neoplasm should be considered.\n2. New moderate right-sided hydronephrosis with delayed nephrogram, likely\nrelated to adjacent inflammation from the colon at the level of the proximal\nureter."
        },
        {
            "input": "LOWER CHEST: There are trace bilateral pleural effusions, as well as mild\nbibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.5 cm hypodensity in segment VIII/IV a of the liver consistent\nwith 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 adrenal gland is normal in size and shape.  The left\nadrenal gland is thickened.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 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.\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": "Minor atelectasis is found at each lung base.  Heart is borderline in size.\n\nThere is no biliary dilatation.  Gallbladder is almost empty.  No focal liver\nlesions are identified.  Pancreas appears normal.  Spleen is normal in size\nand appearance.  Adrenals are unremarkable.  There is no evidence for stones,\nsolid masses or hydronephrosis involving either kidney.\n\nThe stomach and small bowel are unremarkable.  Appendix is identified and\nappears within normal limits.  Large bowel is also unremarkable.\n\nProstate is mild to moderately enlarged with central hypertrophy.  Central the\ndistal ureters, bladder and seminal vesicles are unremarkable.  Major vascular\nstructures appear within normal limits.  There is no lymphadenopathy or\nascites. Mesenteric nodes measure at most 7 mm in short dimension.  Small\nportal venous varix along the falciform ligament is doubtful in significance. \nMajor vascular structures appear within normal limits.\n\nThe neck of midline epigastric hernia which is located 8 cm above the\numbilicus measures 6 mm in diameter and the sac measures up to 20 mm (8:41 and\n5:34).\n\nMajor vascular structures appear widely patent.  There is no lymphadenopathy\nor free air free fluid.\n\nThere are no suspicious bone lesions.  Vertebral body heights and interspaces\nare preserved in height.",
            "output": "Fat-containing epigastric hernia with slight surrounding fat stranding. \nBorderline cardiomegaly."
        },
        {
            "input": "CT ABDOMEN:  : The visualized lung bases are clear. There is no pleural or\npericardial effusion.  Hypodensity of the blood pool relative to the cardiac\nmusculature is compatible with provided history of anemia.\n\nEvaluation of the intra-abdominal organs is limited without intravenous\ncontrast. The unenhanced liver, gallbladder and bilateral adrenal glands are\nnormal. The spleen is not enlarged. A 1.5 cm hypodensity within the pancreatic\nbody corresponds to the cystic lesion seen on MRCP ___, most\nlikely a side branch IPMN. There is no hydronephrosis, renal stone or contour\naltering renal mass identified.\n\nThe small and large bowel are normal in course and caliber without\nobstruction.  The appendix is visualized and is normal.  There is no free\nfluid and no free air. Specifically, no retroperitoneal hematoma is\nidentified.  Mild diffuse mesenteric haziness and mild diffuse body wall edema\nmay be related to volume status as the IVC is distended. No enlarged\nmesenteric or retroperitoneal lymph nodes are identified.\n\nCT PELVIS: The rectum, sigmoid colon, and bladder are unremarkable. A popcorn\ncalcification within the uterus likely a fibroid. No adnexal abnormality is\nidentified.  There is trace nonhemorrhagic free fluid in the pelvis. No pelvic\nor inguinal lymphadenopathy.\n\nBONE WINDOWS: No bone finding suspicious for infection or malignancy is seen.\nA rounded lucent lesion with stippled calcifications in the T11 vertebral body\nis likely a hemangioma.",
            "output": "1.  No evidence of retroperitoneal or pelvic hematoma.\n2.  No splenomegaly.\n3.  Pancreatic body cystic lesion most likely represents a side branch IPMN. \nFollow up MRI in six months is recommended as per MRCP report ___."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm within the visualized aorta.  There is\nmoderate calcified and noncalcified atherosclerotic plaque visualized in the\naortoiliac vessels.  Distal aorta, iliacs, CFA, SFA, and profundus are widely\npatent.\n\nThe prostate arteries demonstrate expected anatomy, originating off the\nanterior branch of the internal iliac artery bilaterally (605:27, 29).\n\nABDOMEN:\n\nGASTROINTESTINAL: The stomach is not visualized.  Partially seen small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nFecal material is seen in the small bowel which may represent delayed transit.\nPartially seen colon demonstrates diverticulosis.  The appendix is normal. \nThe rectum is within normal limits.\n\nLYMPH NODES: 9 mm peripherally calcified lesion in the left pelvis may\nrepresent a torsed diverticula or calcified lymph node.  There is no inguinal\nlymphadenopathy.\n\nPELVIS: Foley is noted within the urinary bladder.  Otherwise, the urinary\nbladder and distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is markedly enlarged and heterogeneous\nmeasuring 7.8 x 5.5 x 7.7 cm (TV x CC x AP) for an approximate prostatic\nvolume of 171.8 cm 3.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative disease is seen in the lower lumbar spine, noting loss\nof disc height and osteophyte formation.\n\nSOFT TISSUES: There is a fat containing inguinal hernia on the right.  There\nis a small fat containing umbilical hernia.",
            "output": "1. Prostatomegaly with an approximate prostatic volume of 171.8 cm 3. \nExpected anatomic course of the prostatic arteries originating off the\ninternal iliac arteries bilaterally.\n2. Diverticulosis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\nCeliac artery and SMA are patent.  ___ is diminutive with heavy calcification\nwhich limits evaluation of patency.\n\nLOWER CHEST: Mild ___ opacities in bilateral lung bases are suggestive\nof micro aspiration.  7 mm subpleural nodule is identified in the right lower\nlobe (03:11).  Small right and trace left pleural effusions are noted. \nEsophagus is dilated with fluid.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.1\ncm cyst is identified in segment 7.  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. \nMultiple renal cysts are identified bilaterally.  The largest cyst measures\n7.2 cm in the upper pole of right kidney.  There is no hydronephrosis.  There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Stomach and esophagus is dilated with fluid, suspicious for\ngastric outlet obstruction.  Focal thickening of gastric mucosa is identified\nat the pylorus, measuring 2.5 x 1.2 cm.  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: Bladder wall appears diffusely thickened.  There is no evidence of\npelvic or inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  Ovarian cysts measuring 1 cm or\nless are noted bilaterally.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture\nfixation hardware is noted in the left proximal femur.\n\nSOFT TISSUES: Diffuse subcutaneous tissue edema is noted.",
            "output": "1. Stomach and esophagus is dilated with fluid, suspicious for gastric outlet\nobstruction. There is focal thickening of gastric mucosa at the pylorus.  If\nthe obstructive symptoms persist, consider EGD for better evaluation.\n2. Transverse, descending, and sigmoid colon demonstrates thickened wall\nconsistent with colitis, infectious or inflammatory in eitiology.  Ischemic\ncolitis is less likely.\n3. Diffusely thickened bladder wall.\n4. Small right pleural effusion.\n5. 7 mm pulmonary nodule is identified in the right lower lobe. Please see\nbelow for follow-up recommendation.\n\nRECOMMENDATION(S):\n For incidentally detected single solid pulmonary nodule measuring 6 to 8 mm,\na CT 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 ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___"
        },
        {
            "input": "LOWER CHEST: There are small bilateral nonhemorrhagic pleural effusions with\nadjacent atelectasis. No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Mild intrahepatic bile duct dilation\nwith mild dilation of the extrahepatic bile duct to 11 mm is unchanged from ___. Gallstones are seen within the gallbladder, similar to ___ allowing for differences in technique, without evidence of acute\ncholecystitis. Per discussion with the referring team, there is no clinical\nconcern for acute cholecystitis.\n\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nPANCREAS: The pancreas has normal attenuation throughout. The pancreatic duct\nin the head and uncinate processes is upper limits of normal diameter,\nunchanged from ___.\n\nADRENALS:  The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis.\n\nGASTROINTESTINAL:  Fluid is seen in non-dilated proximal small bowel loops\nwith more decompressed distal loops but no clear transition point to suggest\nbowel obstruction.  The findings may represent enteritis in the appropriate\nclinical setting. There has been interval decompression of the distal\nesophagus and stomach compared to ___ with resolution of distal\nesophageal fluid. A small hiatal hernia is noted. Nonspecific soft tissue\ndensity at the gastric fundus (02:16, 602b:60) may correspond to the possible\nGIST described in the history. A right inguinal hernia contains small bowel\nloops without evidence of obstruction. Colon and rectum are within normal\nlimits.  There is large amount of stool in the rectum.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is heavy calcium\nburden in the abdominal aorta and great abdominal arteries. Incidentally noted\nis a common origin of the celiac axis and SMA, normal variant.  The main\nportal vein, splenic vein and SMV are patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is small free fluid in\nthe pelvis. The uterus is not seen. A pessary device is in place.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Moderately severe degenerate change in the thoracolumbar spine is\nnoted with levoscoliosis centered at L1.",
            "output": "1. No evidence of bowel perforation or obstruction.  Findings above may\nrepresent enteritis in the appropriate clinical setting.  Interval \ndecompression of the distal esophagus and stomach compared to CT ___.\n2.  Nonspecific soft tissue density at the gastric fundus may represent normal\ngastric folds or correspond to the possible GIST described in the history.\n3. Cholelithiasis without evidence of acute cholecystitis. Mild intrahepatic\nand extrahepatic bile duct dilation with pancreatic duct upper limits of\nnormal.  These findings are unchanged from MRCP ___.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 1:30 ___."
        },
        {
            "input": "VASCULAR:\n\nThere is focal fusiform dilatation of the infrarenal abdominal aorta (Series\n3, image 250 a and series 601, image 56) measuring up to 2.7 cm, unchanged\ncompared to ___.   There is extensive calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: There is trace left pleural effusion, improved compared to ___.  Left lower lobe airspace opacity has also improved.  No new\nconsolidation to suggest pneumonia.  There is bilateral dependent atelectasis.\nMild cardiomegaly is unchanged.  No 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 contains multiple gallstones\nin the neck of the gallbladder without wall thickening or distension.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 or stones in either kidney.  Multiple\nsubcentimeter hypoattenuating lesions throughout the bilateral kidneys are too\nsmall to characterize.  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.  There is no evidence of active extravasation of\ncontrast into the bowel lumen to suggest active GI bleeding.  There is small\nto moderate amount of stool burden throughout the colon.  There is a 0.7 cm\nfecalith in a cecal diverticulum (series 601, image 61).  The rectum and colon\nare otherwise unremarkable..  The appendix is normal.  there is no evidence of\nmesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There is diffuse bladder wall thickening, improved compared to ___. there is no evidence of pelvic or inguinal lymphadenopathy. \nThere 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. \nAgain seen are multilevel degenerative changes of the thoracolumbar spine. \nPatient is status post T1-L3 posterior fusion.  Fracture of the L1 is\nunchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of active GI bleeding.\n2. Interval improvement of the diffuse bladder wall thickening.\n3. Interval improvement of left trace pleural effusion and left lower lobe\nairspace opacity.\n4. Unchanged focal fusiform dilatation of the infrarenal abdominal aorta up to\n2.7 cm.\n5. Cholelithiasis without cholecystitis."
        },
        {
            "input": "Lung Bases:  Trace pleural effusions are noted bilaterally with mild dependent\natelectasis.  The imaged portion of the heart is unremarkable.\n\nAbdomen: The liver, gallbladder, spleen appear normal.  Main portal vein is\npatent.  Pancreas is unremarkable.  Adrenals are normal.  Kidneys enhance\nsymmetrically and excretion of contrast is prompt and equal.  No worrisome\nrenal lesion.  No hydronephrosis or signs of pyelonephritis.  The abdominal\naorta is normal in course and caliber with widely patent major branches.  No\nsignificant atherosclerosis involving the abdominal aorta.  No retroperitoneal\nor mesenteric adenopathy.  Stomach is decompressed.  Duodenum is unremarkable.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus obstruction.  A\nsmall supraumbilical ventral hernia is again noted containing a small amount\nof fluid and fat.  The appendix is normal.  The colon is thin walled\ncontaining a mild fecal load.  No colonic wall thickening or signs of acute\ninflammation or obstruction.  Redundant sigmoid colon noted.  Fibroid uterus\nnoted with increased number and size of uterine fibroids compared with prior\nexam.  Fibroids measure up 2.9 x 3.2 cm, several demonstrating central\ndegeneration.  No adnexal mass.  Corpus luteum in the left ovary noted.  No\nfree pelvic fluid.  Urinary bladder is late partially distended appearing\nunremarkable.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "1. Uterine fibroids, slightly increased in size in number, with several\ndemonstrating central degeneration.\n2. Normal appendix.\n3. Small supraumbilical fat and fluid containing hernia, similar to prior.\n4. Trace pleural effusions."
        },
        {
            "input": "The bases of the lungs are clear. There is no pleural or pericardial effusion.\n\nLIVER: There is a 7 mm rounded hypodensity within segment 8 of the liver,\nwhich is not completely characterized on this exam but is statistically likely\nto be a cyst (5:13). The liver otherwise enhances homogeneously without focal\nlesion or intrahepatic biliary duct dilation. The portal vein is patent.The\nnon-distended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.A normal, air-filled appendix is\nvisualized.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwithout atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS:  The patient is status post hysterectomy and BSO. There is a 5.7 x\n2.2 cm fluid collection, with an enhancing rim (5:63), seen in the left deep\npelvis posterior to the bladder (8:36) and extending superiorly to terminate\nat the medial border of the left iliopsoas. On coronal images, this\nrim-enhancing fluid collection appears to extend inferiorly to the level of\nthe superior vaginal cuff (5:68 and ___. A small foci of air is seen\nwithin the fluid collection (5:67 and 7:29).  This represents an early\nabscess. There is also a right adnexal soft tissue collection with mass effect\non the adjacent bowel, likely a phlegmon (5:66). There is no evidence of free\nabdominal air.\n\nThe urinary bladder appears normal without wall thickening.No pelvic wall or\ninguinal lymph node enlargement by CT size criteria is seen.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1.  Hypodense, irregular intrapelvic fluid collection with an\nincompletely-enhancing rim extending posterosuperiorly from the vaginal cuff\nto the medial border of the left iliopsoas muscle. This represents an early\nabscess / phlegmon.\n\n2. Right adnexal phlegmon."
        },
        {
            "input": "LOWER CHEST: Right lung base ground-glass opacifications are new, concerning\nfor pneumonia.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nHypodense 7 mm focus in hepatic segment ___ is too small to characterize but\nunchanged from ___.  Mild intrahepatic biliary dilation is unchanged.  The\ngallbladder is difficult to visualize, likely decompressed.\n\nPANCREAS: An 8 mm hypodense lesion within the pancreatic body is unchanged. \nThe pancreatic tail hypodense lesion is unchanged but difficult to fully\ncharacterize.  The pancreatic duct is mildly dilated, similar to 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: Status post right nephrectomy.  The left Kidney is unremarkable. \nThere is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Status post left hemicolectomy\nthere is a moderate amount of fecal loading in the left lower quadrant; the\ncolon is otherwise within normal limits.\n\nPELVIS: Status post cystectomy.  Right lower quadrant ileal conduit is seen.\n\nREPRODUCTIVE ORGANS: 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.  Moderate atherosclerotic\ndisease is noted.  Status post IVC filter.  Hyperdense linear structures\nre-demonstrated within the left common femoral vein, possibly representing a\nforeign body from the IVC filter, unchanged from the prior 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. Right lung base ground-glass opacities are consistent with\naspiration/pneumonia.\n2. No acute intra-abdominal process identified, within the limitations of a\nnoncontrast study.\n3. Additional chronic and stable findings as described above."
        },
        {
            "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 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.  A 7 mm hypodensity is seen within the interpolar\nregion of the right kidney, too small to characterize but likely a cyst.\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\nnot definitively identified, but there are no secondary signs of appendicitis.\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum. The aorta and iliac branches are\nnormal in course and caliber. The celiac trunk and SMA are grossly patent.\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.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "No evidence of acute intra-abdominal process."
        },
        {
            "input": "LOWER CHEST: No suspicious pulmonary nodules or masses.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: Slightly bulky appearance of the uterus which was better\ncharacterized on previous pelvic ultrasound which may represent small fibroids\nor adenomyosis.  Mild thickening the endometrium is 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.  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. No CT findings to suggest pancreatitis or inflammatory bowel disease.\n3. Pelvic findings were better characterized on prior pelvic ultrasound done ___ and reference is made to the ultrasound report."
        },
        {
            "input": "VASCULAR:\n\nThe SMA and celiac axis are patent.  Mild narrowing of the ___ due to\natherosclerotic disease.  ___ varices are noted. There is no\nabdominal aortic aneurysm. There is mild-to-moderate calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Small bilateral pleural effusions, with associated compressive\natelectasis.  Moderate coronary artery calcifications.  Aortic valvular\ncalcifications.  The tip of a central venous catheter terminates within the\ndistal SVC.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\nsubcentimeter hypodensity within segment IVb (07:42) appears unchanged.  No\nsuspicious hepatic lesions are identified.  The gallbladder is within normal\nlimits, 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. \nNo hydronephrosis of either the left or right kidney.  A subcentimeter right\nrenal hypodensity (7:66) is too small to characterize.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Scattered colonic\ndiverticulosis, without evidence of acute diverticulitis.  The previously seen\nwall thickening within the small bowel and splenic flexure of the colon appear\nresolved.  No evidence of bowel wall hypoenhancement or pneumatosis to suggest\nischemia.  The colon is fluid filled and distended with air, which may reflect\ndiarrhea.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is decompressed around a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Moderate volume ascites\nappears similar.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles appear unremarkable for\nage.\n\nBONES: The bones are diffusely demineralized.  There is no evidence of\nworrisome osseous lesions or acute fracture.  Sclerosis of S1 appears\nunchanged.  Multilevel degenerative changes of the thoracolumbar spine. \nDegenerative changes of the bilateral hips and sacroiliac joints.  A sclerotic\nfocus within the left acetabulum (9:78) is likely a bone island.\n\nSOFT TISSUES: Bilateral, fat containing inguinal hernias.  Diffuse anasarca.",
            "output": "1. No evidence of bowel wall hypoenhancement or pneumatosis to suggest\nischemia.  Mild narrowing of the ___ due to atherosclerotic disease, but\notherwise patent celiac axis, SMA, and ___.\n2. Interval resolution of bowel wall thickening of the small and large bowel.\n3. Fluid filled and air distended colon, which may reflect diarrhea.\n4. Moderate ascites.\n5. Small, bilateral 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: The liver demonstrates homogenous attenuation throughout.  A\ntoo small to characterize hypodensity in the left hepatic lobe is unchanged. \nNo suspicious focal hepatic lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThere is moderate volume ascites in the abdomen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 in either kidney.  A hypodensity in the right kidney is too\nsmall to characterize.  No suspicious renal lesion.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No small bowel obstruction. \nNo marked bowel wall thickening. The colon is fluid-filled which could be seen\nin the setting diarrhea..  The appendix is unremarkable.  There is no fluid\ncollection in the abdomen.\n\nPELVIS: The urinary bladder is collapsed with a Foley catheter in place. \nThere is trace free fluid in the pelvis.  There is no fluid collection in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged.\n\nLYMPH NODES: The abdominal, pelvic, and inguinal lymph nodes are not enlarged.\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 right fat and fluid containing inguinal hernia. \nThere is a fat containing left inguinal hernia.  There is anasarca.",
            "output": "1. No acute process within the abdomen and pelvis.  Specifically, no\nabdominopelvic fluid collection.\n2. Interval improvement of known small-bowel GVHD.\n3. Moderate volume ascites.\n4. Please see separate report performed on the same day for detailed\nevaluation of the chest."
        },
        {
            "input": "LOWER CHEST: There small bilateral pleural effusions, the left improved\ncompared to prior.  Trace pericardial effusion is noted.  There is moderate\nbibasilar atelectasis.  Heterogeneous enhancement of left lower lobe opacities\nare concerning for superimposed infection (6; 6).\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. \nThere is increased perihepatic ascites but decreased left paracolic gutter\nfluid.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Subcentimeter\nhypodense lesion in the right lower pole is too small to characterize (6; 47),\nsimilar to prior.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is distended with food and contrast.  There is\nredemonstration of multiple loops of small bowel wall thickening and mucosal\nhyperenhancement in the ileum extending to the ileocecal valve starting from\nthe right upper quadrant (8; 10) and there is interval increased wall\nthickening and edema of the ascending and transverse colon with less prominent\nwall thickening and surrounding fat stranding of the descending and sigmoid\ncolon.  There is sigmoid diverticulosis without evidence of diverticulitis.\n\nPELVIS: The bladder wall is thickened greater than expected for\nunderdistention which may represent component of chronic outlet obstruction. \nThere is a Foley catheter in place.  Air within the bladder is consistent with\nrecent instrumentation.  There is trace 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is diffuse osteopenia.  Mild superior endplate compression deformity of\nthe L1 vertebral body (9; 50) is new compared to prior, without loss of more\nthan 50% of vertebral body height.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.",
            "output": "1. Diffuse wall thickening of the ileal loops in the right abdomen extending\nto the ileocecal valve and interval wall thickening and edema involving the\nascending through at least the splenic flexure, worsened compared to prior.\n2. New superior endplate compression deformity of L1 vertebral body is noted.\n3. Small bilateral pleural effusions, improved compared to prior.\n4. Heterogeneous enhancement of left lower lobe opacities for which\nsuperimposed infection cannot be excluded."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is a\nsmall pericardial effusion.  No pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nevidence of focal lesions.  A previously described 4 mm hypodensity in hepatic\nsegment 4 is not well visualized on the current study.  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: Scattered hypodensities throughout the spleen likely reflect\nhemangiomas.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 wall thickening and pericolonic inflammation.  Scattered\ndiverticular present without focal inflammation to suggest diverticulitis.\n\nPELVIS: The urinary bladder is decompressed.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged measuring 5.5 cm in transverse\ndiameter.\n\nLYMPH NODES: There is no size significant retroperitoneal or mesenteric\nlymphadenopathy.  Multiple small scattered mesenteric lymph nodes are\nvisualized.  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 within the lumbar spine.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias.",
            "output": "1. Pancolonic wall thickening and pericolonic inflammation likely reflects\nnonspecific colitis for which infectious and inflammatory causes should be\nconsidered.\n2. Diverticulosis without focal inflammation to suggest diverticulitis.\n3. Small pericardial effusion."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  No pleural\neffusion.  A small pericardial effusion is partially visualized and appears\nstable from ___.\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 top-normal in size measuring up to 13 cm with multiple\nsubcentimeter indistinct hypodense lesions within it as seen on previous\nexams.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Pancolitis seen\non CT performed ___ has dramatically improved, essentially resolved. \nProminent diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding. The appendix is normal.\n\nPELVIS: The urinary bladder is incompletely distended and demonstrates\ncircumferential wall thickening.  There is no free 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. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes in the spine are redemonstrated.  Sclerosis in the S1\nvertebral body is unchanged.\n\nSOFT TISSUES: Bilateral inguinal hernias and a tiny periumbilical hernia\ncontaining fat are noted.",
            "output": "1. No abnormality to explain the patient's worsening epigastric pain.\n2. Circumferential bladder wall thickening reflect underdistention and can be\ncorrelated with clinical presentation and urinalysis to exclude cystitis.\n3. Previously seen pancolitis on CT in ___ has resolved.\n4. Diverticulosis without evidence of acute diverticulitis.\n5. Small pericardial effusion appears stable, partially visualized.\n6. Stable hypodensities within the spleen.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 3:08 pm, at the time of\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: Multiple stable subcentimeter low-density lesions are again\nseen and too small to characterize, may represent cysts or biliary hamartomas.\nThere is new lesion.  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 is enlarged measuring 13.3 cm, without evidence of focal\nlesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Punctate bilateral cortical low-density lesions are unchanged and\nremain too small to characterize.  There is no hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Multiple loops of ileum\ndemonstrate mucosal hyperenhancement and wall thickening as well as mild\nengorgement Vasa recta adjacent to the affected bowel segments.  The colon and\nrectum are within normal limits.\n\nPELVIS: There is mild bladder wall thickening likely due to underdistention\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The bilateral fat containing inguinal hernias greater on the\nright.",
            "output": "1. Multiple loops of ileum demonstrate mucosal hyperenhancement and wall edema\nas well as mild engorgement Vasa recta adjacent to the affected bowel segments\nfor which enteritis or GVHD is considered."
        },
        {
            "input": "There is trace fluid within the visualized fissures (series 5, image 1). \nThere is a trace pericardial effusion (series 5, image 1).\n\nThe liver density is within normal limits.  Punctate hypodense lesions within\nsegments IV (series 5, image 24) and V (series 5, image 35) are unchanged,\nremaining too small to completely characterize, but statistically likely\nrepresenting tiny cysts or hamartomas.  No new or concerning hepatic lesion is\ndetected.  There is no intra or extrahepatic bile duct dilation.  The\ngallbladder is normal.  No radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nremain normal in caliber.  In comparison to the ___ examination,\nthere has been interval improvement of diffuse distal small bowel wall\nthickening, now all mild to trace (series 5, image 52), with decreased\nstranding, and unchanged vascular engorgement (series 5, image 53).  There is\nno new segment of inflamed or edematous bowel.\n\nNo focal gastrointestinal lesion is detected.  There is no bowel obstruction.\n\nTrace fluid within the pericolic gutters has minimally increased since the\nprior examination (series 5, image 49, 52).  There are no organized or\ndrainable fluid collections within the abdomen or pelvis.\n\nThe bladder is decompressed, demonstrating a diffusely mildly thickened wall\n(series 5, image 80, series 8, image 37).\n\nThe prostate is moderately enlarged (series 5, image 85).\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy.\n\nThere are no osseous lesions concerning for malignancy or infection. \nSubcentimeter left femoral neck and iliac bone islands are incidentally noted\n(series 7, image 41, 37).",
            "output": "1. Mild diffuse small-bowel wall thickening persists but has improved in\ncomparison to the ___ examination.\n2. No abdominopelvic abscess.\n3. Diffuse mildly thickened bladder wall.  Correlate with any urinary symptoms\nand urinalysis to exclude the possibility of cystitis.\n4. New trace ascites along the pericolic gutters.\n5. Trace pericardial effusion and trace fluid within the pulmonary fissures.\n6. Moderate prostatomegaly."
        },
        {
            "input": "LOWER CHEST: There is a new small left-sided pleural effusion with associated\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: Small cyst or biliary hamartoma is seen hepatic segment 4B,\nunchanged.  There is no focal fatty next to the ligament of Treitz.  Otherwise\nthe liver demonstrates homogenous attenuation throughout.  There is no new\nfocal lesion. There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder demonstrates marked 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 spine is normal in size.  Subcentimeter low-density lesions in the\nliver appear less conspicuous from prior exam on ___ largest\nmeasuring 6 mm in lateral aspect of spleen (series 5, image 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is interval increase in diffuse wall thickening\ninvolving near entire small bowel with new wall thickening seen involving the\nstomach suggestive of worsening underlying GVHD.  The colon is relatively\nnormal in caliber containing multiple diverticula.  There is no obstruction.\n\nThere is new small volume of ascites in the abdomen pelvis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There are\nbilateral small inguinal hernias containing fluid.\n\nREPRODUCTIVE ORGANS: The prostate is heterogeneously enlarged measuring 5.5\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.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic foci in the in the left intertrochanteric region and left are\nunchanged\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval increase in diffuse small bowel wall thickening with new stomach\nwall thickening suggestive of worsening underlying GVHD/inflammation.\n2. New small volume of ascites in the abdomen and pelvis.\n3. New small left pleural effusion with associated atelectasis."
        },
        {
            "input": "LOWER CHEST: Please refer to the dedicated same day CT chest exam for full\ndescription of intrathoracic findings.\n\nABDOMEN:\nHEPATOBILIARY: There is a tiny millimetric hypodensity in the right hepatic\nlobe segment 4A, likely hepatic cyst or biliary hamartoma (04:53).  The liver\notherwise demonstrates homogenous attenuation throughout.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis distended with sludge without wall thickening or pericholecystic fluid to\nsuggest acute cholecystitis.  There is moderate amount of intra-abdominal\nascites which tracks into the lower quadrants and pelvis, which appears\nincreased since the prior study in ___.\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. There are multifocal areas of\nsmall bowel mucosal hyper-enhancement compatible with known graft vs host\ndisease, may be slightly improved since the prior exam in ___. \nScattered diverticulosis is seen in the descending and sigmoid colon without\nevidence of acute diverticulitis.  Small amount of fluid is seen within the\ncolon without wall thickening or other abnormality.  There is no rectal\nabnormality.  The appendix is not seen.\n\nPELVIS: The urinary bladder is mildly distended.  There is no distal\nhydroureter.\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-to-moderate\natherosclerotic disease is noted.\n\nBONES: Sclerotic foci seen in the left acetabulum and left intertrochanteric\nfemur likely represent bone islands.  There is similar appearance of sclerotic\nregions in the right iliac and midline sacrum since exams dating to ___.\n\nSOFT TISSUES: There is diffuse anasarca. There is a right small fat and\nascites containing inguinal hernia.  Small left fat containing inguinal hernia\nis unchanged.",
            "output": "1. Slight interval improvement of multifocal areas of small bowel mucosal\nhyperenhancement compatible with known GVHD since the CT study in ___.\n2. Moderate amount of intra-abdominal ascites is increased since the prior\nexam, tracking into the lower quadrants and pelvis.\n3. Please refer to the dedicated same day CT chest exam for full description\nof intrathoracic findings."
        },
        {
            "input": "There are small bilateral pleural effusions which have enlarged since the\nprior examination (series 4, image 2).  There is severe left lower lobe\natelectasis (series 4, image 4).  The heart size is normal.  There is a trace\npericardial effusion which has improved since the ___ examination\n(series 4, image 2).\n\nThe liver density is within normal limits.  Unchanged punctate hypodensities\nin segments 4 (series 4, image 22) and 5 (series 4, image 28) are unchanged,\nlikely tiny biliary hamartomas or cysts.  No new or concerning hepatic lesion\nis detected.  The gallbladder is normal.  No ductal stones are detected. \nThere is no intra or extrahepatic bile duct dilation.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is within normal limits.  A subcentimeter hypodensity within\nthe mid spleen is unchanged from prior, likely a small hemangioma (series 4,\nimage 27).\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  Again seen are multiple loops of small bowel\ndemonstrating mildly thickened and hyperemic walls (series 4 image 59, 4 image\n50), unchanged from the prior examinations, without obstruction, pneumatosis,\nor free air.  There is a rectal tube in situ.  There is mild colonic\ndiverticulosis.\n\nThe bladder is decompressed, containing a Foley catheter (series 7, image 24).\nThe prostate is mildly enlarged.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, ___, and iliac branches are patent and\nnormal in caliber.  There are mild atherosclerotic calcifications along the\ninfrarenal abdominal aorta and iliac branches, without dissection or\nflow-limiting stenosis.\n\nThere are no osseous lesions concerning for malignancy or infection.  Moderate\nthoracolumbar spondylosis is unchanged.\n\nMild abdominopelvic ascites is unchanged.",
            "output": "1. Multifocal areas of small-bowel mucosal hyperenhancement, compatible with\nknown history of GVHD, appears stable in comparison to the ___\nexamination.\n2. Small bilateral pleural effusions have enlarged since ___.  Severe\nleft lower lobe atelectasis has worsened.\n3. Trace pericardial effusion has improved.\n4. Mild prostatomegaly."
        },
        {
            "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: Stable small bilateral pleural effusions with associated\nsubsegmental atelectasis and stable trace pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  No\nsuspicious masses.  Stable tiny low attenuating lesions within the liver too\nsmall to adequately characterize but statistically represent benign cysts. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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 significant lesions.\n\nADRENALS: The right and left adrenal glands 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: Again seen are multiple loops of small bowel demonstrating\nmild mucosal thickening and hyperemia unchanged from prior examinations.  No\npneumatosis.  There are few scattered colonic diverticula.  Rectal tube in\nplace.  The large bowel and rectum are within normal limits.  A normal\nappendix is visualized.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.  No\nretroperitoneal hematoma identified.\n\nPELVIS: The bladder is decompressed compressed with the Foley catheter.  There\nis no evidence of pelvic or inguinal lymphadenopathy.  Stable degree of free\nfluid within the lower abdomen and pelvis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Stable degree of body wall edema compatible with anasarca.  Tiny\nfat containing periumbilical hernia and moderate bilateral fat containing\ninguinal hernias again noted.",
            "output": "1. Stable appearance of the small bowel with areas of mucosal thickening and\nhyperenhancement compatible with patient's known history of graft versus host\ndisease.  No obstruction, pneumatosis, or evidence of gastrointestinal\nhemorrhage.\n2. Stable pleural effusions, ascites, and degree of anasarca.\n3. Additional chronic changes as above."
        },
        {
            "input": "LOWER CHEST: Slight interval increase in bilateral small pleural effusions,\nleft greater than right with overlying compressive atelectasis.  Trace\npericardial effusion is unchanged.  Heart size is normal.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered hepatic hypodensities are too small to fully characterize.  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.  Punctate\nhypoattenuating focus in the mid spleen is unchanged from prior exam, possibly\nreflecting a small hemangioma (5:24, 7:42).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size 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 loops of small bowel\ndemonstrate mild bowel wall thickening and hyperemia, similar to prior\nexaminations without evidence of abnormal dilatation or pneumatosis.  As\ncompared to most recent prior exam, the colon appears progressively\nfluid-filled and dilated measuring up to 10.0 cm in the ascending colon.  No\ntransition point is identified.  There is no evidence of pneumatosis or\nabnormal mucosal hyperenhancement.  Small volume ascites appears slightly\nincreased compared to prior exam.  No evidence of pneumoperitoneum.\n\nPELVIS: The urinary bladder is decompressed with Foley catheter in place. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild prostatomegaly, 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Multilevel vertebral body height loss in the thoracolumbar spine\nappears largely unchanged compared to multiple prior exams.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diffuse body wall anasarca appears similar to slightly\nprogressed compared to prior exam.  Small fat and fluid containing right\ninguinal hernia and fat containing left inguinal hernia appears unchanged. \nTiny fat containing periumbilical hernia is again noted.",
            "output": "1. Interval progression of diffuse colonic dilatation with multiple air-fluid\nlevels.  No evidence of abnormal mucosal hyperenhancement or pneumatosis.  No\nobstructing lesion or transition point is identified.  Findings may represent\nacute colonic ___ syndrome.\n2. Similar degree of small-bowel mucosal hyperenhancement and thickening\ncompatible with known history of graft versus host disease.  No evidence of\nsmall-bowel obstruction or pneumatosis.\n3. Small bilateral pleural effusions with overlying compressive atelectasis\nhas progressed compared to ___.\n4. Stable trace pericardial effusion.\n5. Diffuse body wall anasarca, similar to slightly progressed compared to\nprior exam."
        },
        {
            "input": "Evaluation is limited with beam hardening artifact.\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: No focal hepatic lesions.  No intra or extrahepatic ductal\ndilatation.  Slight interval progression of perihepatic ascites. No\ncholelithiasis.  Minimally distended gallbladder without wall thickening to\nsuggest 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 focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No abnormally dilated loops of\nbowel.  Rectal tube in place The appendix is not visualized.\n\nPELVIS: Urinary bladder is decompressed with Foley catheter in place. The\nbladder wall appears thickened.  Trace ascitic fluid layering in the bilateral\nparacolic gutters and dependent portion of 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.a\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Subcentimeter enostosis in the left iliac bone, unchanged. \nDegenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: Bilateral inguinal hernias containing fat are noted.  Diffuse\nanasarca, similar to prior.",
            "output": "1. No evidence of intraabdominal or pelvic abscess.\n2. Bladder wall thickening, which may be secondary to underdistention, however\ncystitis cannot be excluded.  Correlation with urinalysis is recommended.\n3. Slight interval progression of trace perihepatic fluid, and small amount\nascites layering in the dependent portion of the pelvis. Diffuse anasarca is\noverall unchanged."
        },
        {
            "input": "LOWER CHEST: There is interval mild increase examination, particularly on the\nleft.  There is associated bibasilar compressive atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nfocus of low density are identified ( 05:34) which has been present on\nprevious examinations and is likely a small cyst based on recent MR. ___ new\nfocal lesion is identified.  There is ___ intrahepatic or extrahepatic biliary\ndilatation.  The gall bladder is moderately distended, similar to previous\nexaminations without wall thickening.  There is pericholecystic fluid likely\nextending from the perihepatic ascites.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\ndefinite focal lesions or pancreatic ductal dilatation.  There is ___\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is moderate 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. \nThere is ___ evidence of solid renal lesions or hydronephrosis.  There is ___\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is under distended.  Multiple loops of small\nbowel particularly in the mid abdomen demonstrate mucosal thickening and\nhyperenhancement and surrounding fat stranding and scattered fluid (5:\n96-120).  There is also mild thickening of the terminal ileum, likely\naccentuated due to collapsed status.  Engorgement of the Vasa recta is noted. \nThere is mild pericolic fat stranding surrounding the cecum.\n\nFluid layers within the rectal vault and loops of colon.  ___ evidence of\nobstruction.\n\nPELVIS: The urinary bladder demonstrates a Foley catheter, and is collapsed. \nModerate amount of free fluid is present in the pelvis and paracolic gutters,\ndemonstrating simple density.\n\nREPRODUCTIVE ORGANS: Prostate gland is unremarkable.\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.\n\nBONES: There is ___ evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are again noted in the visualized spine.\n\nSOFT TISSUES: A tiny fat containing umbilical hernia is present.  Fluid is\nnoted to be layering within a right inguinal hernia.  There is asymmetric\nthickening and edema in the left lateral abdominal wall, however this is\nsimilar to prior examination and may relate to prolonged positioning.",
            "output": "1. Multiple loops of small bowel demonstrate mucosal hyperenhancement and wall\nthickening, with associated mesenteric congestion and fat stranding.  Findings\nare consistent with enteritis that may relate to graft-versus-host disease. \nMild involvement of the cecum is suggested.  ___ evidence of obstruction.\n2.   Moderate simple ascites, increased since previous examination.\n3.   Diffuse anasarca. Mild increase in bilateral pleural effusions, with\nassociated compressive atelectasis."
        },
        {
            "input": "LOWER CHEST: Again demonstrated, are small bilateral pleural effusions,\npartially imaged.  There is a least partial left lower lobe collapse,\npartially imaged.  There are extensive aortic valve and coronary artery\ncalcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a stable left hepatic lobe millimetric hypodensity which is too small\nto characterize but likely represents a cyst or biliary hamartoma (05:21). \nOtherwise, there is no evidence of concern focal 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is new interval marked\nsubmucosal edema of a long segment of duodenum extending into the jejunum\n(05:41).  There is persistent mucosal enhancement and thickening of multiple\npelvic ileal small bowel loops extending to the terminal ileum.  Colon is\nwithin normal limits.  The rectum contains a rectal tube but otherwise\nunremarkable.\n\nPELVIS: The urinary bladder containing a Foley catheter is decompressed and\ntherefore suboptimally assessed.  However, there appears to be circumferential\nthickening of the urinary bladder walls.  Otherwise, the distal ureters are\ngrossly unremarkable.  There is no free 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 extensive diffuse calcification of the splenic artery.\nThere is no abdominal aortic aneurysm.  Otherwise, the remaining vasculature\ndemonstrates moderate atherosclerotic disease.  Atherosclerotic disease is\nnoted.\n\nBONES: Again demonstrated, is a stable bone island in the left acetabulum. \nAgain demonstrated, is stable focal sclerosis of the right iliac bone (5:77). \nThe there are post biopsy changes in the right iliac bone.  No evidence of\nacute fracture.  Again demonstrated, is a stable trabeculated appearance of\nthe S1 vertebral body likely representing a hemangioma (08:24).\n\nSOFT TISSUES: Again demonstrated, is diffuse anasarca with greatest extent\nalong the left flank soft tissues.",
            "output": "1. Interval development of new duodenal-jejunal submucosal edema in the\nsetting of persistent ileal mucosal enhancement and thickening, is concerning\nfor interval worsening of graft-versus-host disease.  No small bowel\nobstruction.\n2.   Overall decrease in abdominopelvic ascites.\n3. Partially imaged, at least partial left lower lobe collapse and small\nbilateral pleural effusions.  CT chest is recommended for further evaluation.\n4. Extensive coronary artery and aortic valve calcifications.\n5. Apparent circumferential thickening of the urinary bladder wall. \nCorrelation with urinalysis is recommended.\n6. Redemonstration of diffuse anasarca.\n\nRECOMMENDATION(S):   CT chest.\n\nUrinalysis."
        },
        {
            "input": "LOWER CHEST: Unchanged bilateral pleural effusions with adjacent atelectasis,\nvery similar to the recent prior CT.  Valvular and coronary artery\ncalcification.  The tip of the central venous catheter is seen within the\ndistal superior vena cava.\n\nABDOMEN:\n\nHEPATOBILIARY: Tiny hypodensity in segment 4B is similar to prior, probably\nnot significant.  No suspicious 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.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The distal duodenum and\nproximal jejunum are collapsed but likely have some wall thickening which\nappears slightly improved when compared to the prior study.  There is\npersistent mild surrounding fat stranding.  The remainder of the small bowel\nappears normal.  There is a possible developing colonic abnormality, however. \nThis is characterized by mild wall thickening from the cecum through\nascending: With some involvement of the transverse:.\n\nPELVIS: Foley catheter in situ.  Moderate ascites collecting mostly along the\nleft flank and in the pelvic cul de sac appears very similar in quantity.\n\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 arterial\ncalcification noted.\n\nBONES: Multilevel spinal, bilateral hip and sacroiliac joint degenerative\nchange.  No suspicious osseous lesions.  Sclerotic S1 vertebral body is\nunchanged.\n\nSOFT TISSUES: Diffuse anasarca, similar to prior.  Bilateral inguinal hernias,\nthe right contains fat and ascitic fluid and the left contains fat.",
            "output": "-Improved proximal small bowel abnormality.\n-However, finding suggest new colonic abnormality which may be infectious or\ninflammatory including possibility of involvement with graft-versus-host\ndisease.\n-Unchanged volume of ascites.\n-Unchanged bilateral pleural effusions with adjacent atelectasis."
        },
        {
            "input": "VASCULAR:\n\nOn correlation with CTA examination of ___, there is\nredemonstration of a large left retroperitoneal hematoma, measuring up to 5.0\nx 5.7 cm in its largest dimension at the level of the left iliac crest,\ncompared to prior measurements of 5.1 x 4.7 cm at the same level.  In maximum\nAP extent, the hematoma measures up to 9.1 cm at the level of the sacral iliac\njoints, compared to prior measurements of 8.4 cm.  Area that was thought to\nrepresent possible arterial active extravasation in the posterior aspect of\nthe hematoma (303:107) most likely represents small vessels traversing the\nhematoma.  No definite active arterial extravasation is seen.\n\nThe left femoral pseudoaneurysm previously identified is not significantly\nchanged in size, measuring up to 2.2 x 2.7 cm without evidence of contrast\nwithin the lumen, suggestive of successful thrombosis on the ultrasound-guided\nprocedure of ___.\n\nAs previously described, there is mild to moderate atherosclerotic disease\nthroughout the abdominal aorta, particularly in the infrarenal segment,\nresulting in approximately 50% stenosis at the level of L2 (602: 94, 301:57). \nMild stenosis is identified at the celiac axis and superior mesenteric artery\norigins.  The patient is status post left renal artery stent placement.  The\nright renal artery slightly better visualized on this examination is, (301:45)\nand appears very diminutive leading to an atrophic right kidney.  The inferior\nmesenteric artery is not well visualized.\nThe aortobifemoral stents/graft are patent.  No evidence of aneurysmal\ndilatation.  Native distal aorta and iliac vessels remain occluded.  A simple\nfluid collection in the right groin region surrounding probable site of\nvascular anastomosis likely relates to seroma versus lymphocele, and is\nunchanged since recent CTA of ___.\n\nThe right psoas muscle is normal in size.\n\nLOWER CHEST: Within normal 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 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 right kidney is markedly atrophic, however does demonstrate\nnephrogram without evidence of hydronephrosis or definite mass.  The left\nkidney shows patchy areas of relative cortical ___, fairly similar\nto the prior examination.  No significant adjacent fat stranding is\nidentified.  Left hydronephrosis has mildly increased compared to the previous\nexaminations.  A slightly prominent ureter is identified to the level at which\nthe left psoas muscle starts enlarging.\n\nGASTROINTESTINAL: The stomach is within normal limits.  An enteric tube is\npresent terminating in the gastric body.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nRETROPERITONEUM: No retroperitoneal lymphadenopathy is identified.  Extensive\nleft retroperitoneal hematoma as above.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is moderate free fluid\nin the pelvis demonstrating simple density.\n\nREPRODUCTIVE ORGANS: The uterus is present and unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is moderate fat stranding throughout the subcutaneous\ntissues of the abdominopelvic walls, particularly on the left extending into\nthe left thigh soft tissues.  Surgical clips are noted in the anterior\nmidline, and in the bilateral anterior lower pelvic wall corresponding to the\nfemoral regions.",
            "output": "1. Mild interval increase in size of the large left retroperitoneal hematoma,\nnow measuring up to 5.0 x 5.7 x 9.1 cm in maximum ___ compared to prior\nmeasurements of 5.7 x 4.7 x 8.4 cm in similar planes.  However no definite\narterial active extravasation is identified.  No new separate site of hematoma\nis identified.\n2. Interval complete thrombosis of the left femoral pseudoaneurysm that\nremains unchanged in size.\n3. Stable atherosclerotic disease of the abdominal aorta, resulting in focal\nstenosis of the infrarenal aorta of approximately 50%.  Patent aortobifemoral\ngrafts.\n4. Slight increase in mild left-sided hydronephrosis, likely related to\nproximal ureter obstruction from the left retroperitoneal hematoma."
        },
        {
            "input": "LOWER CHEST:\n\nSmall right-sided and trace left-sided pleural effusions. \nAtelectasis/scarring at the lung basis.  Small pericardial effusion measuring\nup to 10 mm in thickness.  No consolidation.  No discrete nodules or masses at\nthe lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Portal and hepatic veins patent.  Patient is\nstatus-post cholecystectomy.  There is no intrahepatic or extrahepatic bile\nduct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.  No peripancreatic\nfat stranding.\n\nSPLEEN: The spleen is normal in size.  There is a tiny hypoattenuating focus\nin the anterior spleen (series 11, image 17).\n\nADRENALS: The right adrenal gland is unremarkable.  The left adrenal gland is\nnot definitely visualized, and may have been resected.\n\nURINARY: Patient is status-post left nephrectomy.  Multiple surgical clips are\nnoted in the nephrectomy bed.  Multiple surgical clips additionally track\ninferiorly along the posterior pararenal fascia.  The right kidney\ndemonstrates compensatory hypertrophy.  There are multiple right-sided renal\ncortical cysts.  At the upper pole of the right kidney, there is an exophytic\ncortical lesion which measures approximately 11 mm in diameter (series 13,\nimage 75).  This lesion is essentially unchanged in size from the study\nperformed in ___.  On the non-contrast scan, the lesion demonstrates an\ninternal attenuation of -30 Hounsfield units.  It enhances on the arterial\nphase to 27 Hounsfield units, and continues to enhance in the portal venous\nphase to 50 Hounsfield units.  There is an additional lesion at the upper pole\nof the right kidney, which measures up to 32 Hounsfield units on the\nnon-contrast scan, and demonstrates no enhancement on the arterial portal\nvenous phase.  This is likely consistent with hemorrhagic or proteinaceous\ncyst.  There is no evidence of hydronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia.  Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal mural thickness and luminal caliber. \nSince the CT performed ___, patient has undergone sigmoid resection. \nA sigmoid stump demonstrates uncomplicated diverticula.  There is a diversion\ncolostomy in the left hemiabdomen.  Residual bowel demonstrates diffuse\nmoderately severe but uncomplicated diverticulosis, to the level of the stoma.\nThere is no evidence of active contrast extravasation to suggest focal bleed. \nThere is a parastomal hernia containing omental fat (series 11, image 57).\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nPELVIS: There is stable diffuse trabeculation of the bladder wall, likely\nreflecting sequela of chronic outlet obstruction.\n\nREPRODUCTIVE ORGANS: Patient is status-post TURP. The residual prostate gland\ndoes not appear enlarged, and again contains two large coarse calcifications.\nSeminal vesicles are unremarkable.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is heavy aortoiliac calcification.  No AAA.  An IVC filter is\nin situ.  On the portal venous phase, there is a geographic hypoattenuating\nfilling defect, likely reflecting nonocclusive thrombus.  This thrombus does\nnot extend beyond the IVC filter.  Portal vein, portal confluence, SMV, and\nsplenic vein patent.\n\nBONES: No acute or focal destructive osseous lesions.  Degenerative facet\narthropathy lumbar spine.  Degenerative disc disease lumbar spine, most\npronounced at L5-S1 and L1-L2.  Compression fracture involving the T11\nvertebral body, appears chronic, but is new from the study performed in ___,\nwith approximately 50% height loss anteriorly.  No evidence of retropulsion\ninto the spinal canal.\n\nSOFT TISSUES: Rim enhancing midline fluid collection within the subcutaneous\nsoft tissues of the supraumbilical anterior abdominal wall, measuring\napproximately 2.2 x 10.1 x 10.5 cm in AP, transverse, and craniocaudal\n___, without internal locules of air.  This is new from ___.  There is\nno evidence of surrounding fat stranding or regional skin thickening.  On\ncorrelation with the CT performed in ___, patient appears to have undergone\nrepair of an upper abdominal wall hernia.  No notes pertaining to hernia\nrepair are found on review of patient's electronic record.  Clinical\ncorrelation is recommend.",
            "output": "1. Since the study performed in ___, patient has undergone sigmoid resection.\nThe sigmoid stump demonstrates uncomplicated diverticulosis.  There is a\ndiversion colostomy in the left hemiabdomen.  Residual large bowel\ndemonstrates diffuse diverticulosis, without evidence of diverticulitis.  No\nevidence of contrast extravasation to suggest presence of active\ngastrointestinal bleed on today's study.\n2. Fat containing peristomal hernia, as above.  Stoma otherwise unremarkable.\n3. A 12 mm enhancing lesion at the upper pole of the right kidney.  Given\npresence of enhancement, renal MRI is recommended for further evaluation on an\noutpatient basis.  An additional hyperdense focus at the upper pole of the\nright kidney is likely reflective of a proteinaceous or hemorrhagic cyst.\n4. An IVC filter is in situ, with nonocclusive thrombus inferior to the\nfilter.  The thrombus does not extend beyond the IVC filter.\n5. Rim enhancing fluid collection within subcutaneous soft tissues of the\nanterior abdominal wall.  No internal locules of air are identified.  No\nsurrounding fat stranding or skin thickening.  Collection measures up to 10.5\ncm in craniocaudal extent.  There appears to have been repair of an upper\nabdominal wall hernia since the study performed in ___.  No details\npertaining to this repair are found on review of patient's electronic record. \nFinding may reflect a post-operative seroma, but superimposed infection is not\nexcluded, despite the absence of regional inflammatory fat stranding and skin\nthickening.  Clarification regarding temporal relation to abdominal wall\nhernia repair is recommended.\n6. Chronic appearing compression fracture involving the T11 vertebral body,\nwith approximately 50% height loss anteriorly.  No evidence of retropulsion\ninto the spinal canal.\n\nRECOMMENDATION(S):  MRI abdomen with contrast on an outpatient basis to\nfurther evaluate the lesion in the superior pole of the right kidney with\napparent enhancement."
        },
        {
            "input": "LUNG BASES: Please see dictation for separately reported CT Chest examination.\n\nCT ABDOMEN:\nAgain seen is diffuse intrahepatic and extrahepatic biliary ductal dilatation,\nwith a common bile duct diameter of 1.2 cm (series 3, image 52). Additionally,\nthere is unchanged pancreatic ductal dilatation to 4 mm, stable since ___. There is no evidence of obstructing stone or mass. The liver enhances\nhomogeneously without evidence of focal lesion. The gallbladder does not show\nwall thickening or other evidence of inflammation.\n\nThere is no splenomegaly or focal splenic lesion.\n\nThe previously identified pancreatic body/tail cystic lesion is unchanged,\ncurrently measuring 0.9 x 0.9 cm (series 3, image 46). Otherwise, the pancreas\nenhances homogeneously without evidence of peripancreatic inflammation. There\nis pancreas divisum.\n\nThe adrenal glands are within normal limits.\n\nThe 3.3 cm superior right renal cyst is unchanged. Multiple scattered\nbilateral renal cortical hypodensities are too small to characterize.\nOtherwise, the kidneys display normal symmetric nephrograms.  There is no\nevidence of hydronephrosis.\n\nNon-dilated loops of small bowel are normal in course and caliber. There is no\nwall thickening or evidence of obstruction.  The colon is unremarkable.\n\nThere is no evidence of mesenteric or retroperitoneal lymphadenopathy by CT\nsize criteria. The abdominal aorta is of normal caliber throughout, and major\nbranches appear patent. There is no intra-abdominal free air or fluid.\n\nCT PELVIS:\nAgain seen are unchanged calcified uterine fibroids, the largest of which is\nexophytic and measures 1.6 x 1.7 cm (series 3, image 90). Otherwise, the\nimaged pelvic organs are unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy by CT size criteria.\n\nBONE WINDOW: There is moderate degenerative joint disease of the imaged\nthoracolumbar spine, with intervertebral vacuum disc phenomenon at multiple\nlevels. Alignment is normal.  There are no concerning osteolytic or\nosteosclerotic lesions identified.",
            "output": "1. No evidence of intra-abdominal or intrapelvic metastasis.\n2. Unchanged diffuse biliary ductal and pancreatic duct dilatation.  No\nevidence of obstructing stone or mass.\n3. Stable subcentimeter pancreatic cystic lesion.\n4. Please refer to separate report for intrathoracic findings from same day CT\nchest."
        },
        {
            "input": "CHEST:  Limited assessment of the lung bases are clear.  No pleural effusion.\nThe visualized heart is normal in size without pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.No\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is normal\nwithout calcified gallstones. The portal vein, SMV, and splenic vein are\npatent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.  No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. Moderate sigmoid diverticulitis is noted within an approximately 8\ncm segment involved. Associated bowel wall thickening, fat stranding, and\nadjacent mesenteric fluid with inflammation is seen surrounding a diverticula\n(2: 68). No loss of mucosal enhancement. No extraluminal air. No\npneumoperitoneum.  No additional inflamed diverticulum identified. Fat\nstranding extends to the rectum and is the most likely etiology of pain. No\npneumatosis. No focal fluid collection. No thrombophlebitis. The large bowel\nis otherwise normal in caliber without wall thickening, fat stranding, or\nfocal mass lesion.  The appendix is not visualized however no evidence of\nacute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  Small amount of atherosclerotic\ncalcification noted. The iliac arteries are normal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. Normal uterus and ovaries.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine. No focal lytic or sclerotic lesion\nconcerning for malignancy.",
            "output": "1.  Moderate sigmoid diverticulitis.  No extraluminal air. No\npneumoperitoneum. No focal fluid collection. No thrombophlebitis.\n2.  Fat stranding extends to the rectum,  likely etiology of pain.\n3.  No small bowel obstruction.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with ___ QA\nnurse via email  on ___ at 10:04 AM, 20 minutes after discovery of the\nfindings."
        },
        {
            "input": "CTA ABDOMEN/PELVIS: The abdominal aorta is normal in caliber without evidence\nof aneurysm or dilation.  There is no evidence of abdominal aortic dissection.\nMajor proximal tributaries are patent.  Specifically, the celiac axis is\npatent.  Hepatic artery anatomy is conventional.  The SMA, bilateral renal\narteries, and ___ are patent.  The bilateral common, external common iliac\narteries are patent and normal in caliber without evidence of dissection.  The\nproximal imaged femoral arterial vasculature is patent and unremarkable.\n\nCT ABDOMEN/PELVIS: Minimal streaky opacities at the lung bases are compatible\nwith subsegmental atelectasis.  Otherwise, the imaged lung bases are clear. \nThere is no pleural or pericardial effusion.  There is no hiatus hernia.\n\nThere is a normal arterial phase enhancement pattern of the liver.  There is\nno intrahepatic biliary ductal dilation.  The portal vein appears patent.  The\ngallbladder is unremarkable.  The pancreas enhances homogeneously.  There is\nno peripancreatic stranding or ductal dilation.  The adrenal glands are\nunremarkable.\n\nAgain seen is an unchanged appearance of a duplicated left renal collecting\nsystem with associated dilation of the lower pole moiety and lower pole left\nrenal cortical thinning, similar in appearance prior CT from ___,\nlikely sequela of chronic long-term reflux.  Tiny bilateral renal cortical\nhypodensities are too small to characterize by CT measure up to 8 mm,\nunchanged from prior exam, likely simply renal cysts.  Otherwise, the kidneys\nenhance normally and symmetrically.  There is no hydronephrosis.\n\n There is no mesenteric or retroperitoneal lymphadenopathy by CT size\ncriteria.  There is no free intraperitoneal air or fluid.  The stomach and\nduodenum are unremarkable.  Non-dilated small bowel loops are normal in course\nand caliber without evidence of wall thickening or obstruction.  The colon is\nunremarkable.  The appendix is not directly visualized, however, there are no\nsecondary signs of appendicitis.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nThe prostate is mildly enlarged.  Otherwise, the imaged pelvic organs,\nincluding the bladder and terminal ureters, are unremarkable.  There is no\npelvic sidewall, iliac chain, or inguinal lymphadenopathy.  There is no free\npelvic fluid.\n\nMUSCULOSKELETAL: There is mild degenerative change of the imaged thoracolumbar\nspine, worst at L5-S1.  Alignment is normal.  No concerning focal lytic or\nsclerotic osseous lesions are identified.",
            "output": "1. No evidence of dissection or other abdominal aortic abnormality.  Normal\nCTA abdomen and pelvis.\n2. No acute intra-abdominal or intrapelvic process.\n3. Stable appearance of a duplicated left renal collecting system with chronic\ndilation of the lower pole moiety and left lower renal pole cortical thinning,\nlikely sequela of longstanding/chronic reflux.\n4. Mildly enlarged prostate."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 tiny scattered hypodensities are seen in the liver, the largest in the\nleft hepatic lobe at the dome measures 5 mm, all too small to characterize,\npotentially tiny biliary hamartomas or cysts.  No evidence of suspicious 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 unremarkable.  A long continuous segment of\nthe distal and terminal ileum spanning approximately 25 cm demonstrates\ncircumferential wall thickening and mural stratification with mucosal\nhyperenhancement, adjacent fat stranding, and Vasa recta prominence.  Findings\nare compatible with acute on chronic Crohn disease, in a distribution similar\nto that noted on the prior MRI.  There is resultant luminal narrowing with\nmild upstream small-bowel dilation.  No fluid collections or fistulous.  Small\namount of interloop fluid.  The colon and rectum are within normal limits. The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: Multiple enlarged right lower quadrant ileocolic lymph nodes\nmeasuring up to 1.5 cm are likely reactive.  There is no pelvic 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Approximately 25 cmlong continuous diseased segment of distal and terminal\nileum demonstrating acute on chronic inflammation compatible with Crohn\ndisease, in a similar distribution to that seen on the prior MR enterography. \nThere is upstream bowel dilatation without frank obstruction.  No fluid\ncollections or fistulas.\n2. Reactive mesenteric lymphadenopathy in the right lower quadrant.\n3. Normal appendix."
        },
        {
            "input": "LOWER CHEST:\n\nSmall left-sided and trace right-sided pleural effusions.  Dense atelectasis\nleft lung base.\n\nABDOMEN:\n\nDirect comparison is made to the non-contrast MRCP performed ___\nat an outside hospital.  Note that this MR is significantly degraded by motion\nartifact.\n\nAllowing for the differences in modality and technique, there has been\ninterval deterioration in the appearance of the pancreas since the study\nperformed ___.  There is now a 6 cm segment of the pancreatic\nneck and proximal body which demonstrates no enhancement on this portal venous\nCT, in keeping with necrosis (series 601, image 52 and series 2, image 56). \nThere was no perceptible defect in this location on the non-contrast MRCP\nperformed ___. The enhancing portions of the gland are edematous,\nin keeping with changes of interstitial pancreatitis.\n\nThe splenic vein is attenuated for a short segment over a length of\napproximately 4 cm from the confluence, but remains patent.  There is similar\nattenuation of the SMV and IMV, without occlusion or over thrombus.  The\nsplenic artery is intact.  No splenic artery aneurysm.\n\nThere is extensive peripancreatic fat stranding and fluid.  There is a rim\nenhancing fluid collection along the greater curvature of the stomach\nmeasuring approximately 5.7 x 4.9 cm in AP and transverse dimension (series 2,\nimage 52).  There is a second peripancreatic fluid collection, draping over\nthe distal duodenum, measuring approximately 4.3 x 9.4 cm in AP and transverse\ndimension (series 2, image 69).  These collections were not definitely present\non the prior MRI.\n\nThe main pancreatic duct is not dilated.\n\nGallbladder lumen is mildly distended.  There is mild thickening and hyperemia\nof the gallbladder wall, likely reactive in nature.  Fundal gallbladder\nadenomyomatosis is suspected.  There is mild prominence of the CBD, with mild\nwall enhancement, again likely reactive in nature.  Finally, there is mild\ndilatation of the intrahepatic biliary tree, symmetric in the right and left\nliver lobes, reactive in nature.\n\nThere are no focal liver lesions to suggest presence of liver abscess.  There\nis mild fat deposition along the falciform ligament.  Liver is normal in\ncontour.  Portal and hepatic veins appear patent.\n\nThe spleen is not enlarged (13 cm).\n\nKidneys are normal.  No hydronephrosis.\n\nThere is mild thickening of a jejunal loop in the left upper quadrant, this is\nlikely reactive in nature, as this is located adjacent to the severely\ninflamed pancreas.  Small bowel otherwise unremarkable.  No evidence of\nmechanical small bowel obstruction.  Large bowel normal.\n\nThere are several bulky peripancreatic and gastrohepatic lymph nodes,\nmeasuring up to 13 mm in short axis (series 2, image 54).  These are likely\nreactive in nature.\n\nAbdominal aorta is non-aneurysmal.  Major branch vessels are patent.\n\nThere is mild thickening and enhancement of the peritoneal reflections\nthroughout the abdomen and pelvis, reactive in nature.  There is small volume\npelvic free fluid.\n\nThere are coarse calcifications within the prostate gland. No gross prostatic\nenlargement. Unremarkable seminal vesicles.  Urinary bladder is normal.\n\nNo acute or focal destructive osseous lesions.  Advanced degenerative changes\nare noted in the right hip joint.  Additional degenerative changes are seen in\nthe lower lumbar facets.  Unilateral left L5 pars defect.\n\nAbdominal and pelvic wall unremarkable.",
            "output": "Direct comparison is made to the MRCP performed ___ at an outside\ninstitution.  This is a limited motion degraded non-contrast MRI.  Allowing\nfor this limitation, there appears to be deterioration in the appearance of\nthe pancreas since this MRI.\n\nThere is a 6 cm segment of the pancreatic neck and proximal body which\ndemonstrates no enhancement on today's study, in keeping with necrosis.  This\nappears new.  There is partial attenuation of the splenic vein, SMV, and IMV,\nwithout complete occlusion or overt thrombosis.  No vascular complications\notherwise.\n\nThere are two small rim enhancing fluid collections adjacent to the pancreas\nmeasuring 4.3 x 9.4 cm and 5.7 x 4.9 cm, as above.  These collections were not\ndefinitely present on the prior MRI.  There is additional large volume not\norganized fluid and fat stranding around the pancreas.\n\nThere are reactive changes within the gallbladder wall.  Similarly, there are\nreactive changes within the CBD, with mild dilatation and wall hyperemia. \nMild intrahepatic bile duct dilatation is noted, again likely in relation to\nthe acute process involving the pancreas.\n\nSmall left-sided and trace right-sided pleural effusions, with dense\natelectasis at the left lung base."
        },
        {
            "input": "Study is limited by patient's arms overlying the abdomen, due to discomfort.\n\nPlease refer to separate chest CT report for thoracic details.\n\n Significant atrophy of the lateral segment left hepatic lobe. No suspicious\nfocal hepatic lesions allowing for technical limitations. Patent portal veins.\nPneumobilia is demonstrated. The patient is post pancreaticoduodenectomy for\nprior ampullary neuroendocrine tumor. Remaining pancreatic parenchyma appears\nunremarkable.\n\nNormal spleen and adrenals.\n\nNo hydronephrosis. Multiple peripelvic cysts are seen bilaterally. A tiny\nbilateral subcentimeter renal hypodensities, too small to characterize,\npossibly cysts. 8 2.3 cm exophytic lower pole left renal soft tissue density\nlesion most likely represents a hemorrhagic cyst, enlarged from prior study.\n\nIngested material and contrast within the stomach. Post gastrojejunostomy\nwithout obstruction. There is significant circumference wall thickening of the\nhepatic flexure, suspicious for adenocarcinoma (2, 65). Additionally, a\nsegment of mildly thickened transverse colon is noted (2, 74). No focal small\nbowel thickening.\n\nModerate atherosclerosis of normal caliber abdominal aorta. No prominent\nretroperitoneal or mesenteric adenopathy.\n\nPostoperative changes of the right lower quadrant abdominal wall. Decompressed\nbladder. No free pelvic fluid. Mildly enlarged right external iliac node, 1.2\ncm, nonspecific finding.\n\nGeneralized stranding of the subcutaneous soft tissues. Bony demineralization\nis present. Post left hip arthroplasty with malleable plate and screws within\nthe left acetabulum. Marked degenerative changes of the spine.",
            "output": "-Marked concentric thickening of the colonic hepatic flexure, suspicious for\ncolon carcinoma. Recommend endoscopic correlation.\n-No significant mesenteric or retroperitoneal lymphadenopathy. Evaluation of\nthe liver is limited by the patient's overlying arms, however no suspicious\nhepatic lesions are noted. Of note, the prior abdominal CT demonstrated\nhypervascular foci suspicious for neuroendocrine tumor metastases, which are\nincompletely evaluated on this single phase study. A multiphasic MRI or CT\ncould provide better assessment, if clinically warranted.\n-Post pancreaticoduodenectomy with postoperative changes.\n-Probable hemorrhagic/ proteinaceous lower pole left renal cyst, enlarged from\nprior studies.\n-Multiple other 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: Wedge-shaped area of hypoenhancement in segment 4 B likely\nperfusion all.  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 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. 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: Small lymph nodes in the gastrohepatic ligament measuring up to\n10 mm.  (Series 5, image 86).  Additional very small lymph nodes are noted in\nthe porta hepatis.  Aortocaval retroperitoneal lymph node measuring 6 mm\n(series 5, image 107).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Replaced left accessory hepatic of the left gastric and replaced\nright hepatic of the SMA 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. \nUmbilical hernia containing fat.",
            "output": "1. Lymph nodes in the gastrohepatic ligament, porta hepatis and\nretroperitoneum measuring up to 10 mm.  Attention on follow-up is recommended."
        },
        {
            "input": "LOWER CHEST: 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 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 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. Mild\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or 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: Prostate gland is at the upper limit of normal. \nProstatic 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 is mild anterolisthesis L5 over S1, unchanged from prior.  A L4\nvertebral body Schmorl's node is noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No finding 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 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.  There is severe reactive bladder wall thickening at\nthe dome.  Findings highly suspicious for colovesicular fistula described\nbelow.\n\nGASTROINTESTINAL: In the area of sigmoid diverticulitis on CT scan performed\nin ___, there is persistent sigmoid colonic wall thickening with moderate\nsurrounding inflammatory changes (2:69; 601:21).  A tract extends from the\nsigmoid colon to the bladder dome which contains locules gas with several\nlocules of gas also noted within the bladder and within the phlegmon more\nanteriorly (602:38; 601:26 through 23).  There is no drainable abscess.  The\nstomach is unremarkable.  Small bowel loops demonstrate normal caliber, wall\nthickness, and enhancement throughout. The rectum is within normal limits. The\nappendix is normal.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy by CT size criteria.  Scattered\nsmall lymph nodes noted in the pelvis and retroperitoneum 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. Colovesicular fistula from the sigmoid colon to the bladder dome with\nsignificant inflammatory changes in the bladder wall.  No drainable abscess.\n2. Moderate pelvic inflammatory changes surround the region of sigmoid\ndiverticulitis seen previously with persistent colonic wall thickening. Severe\nreactive bladder wall thickening at the dome.\n\nNOTIFICATION:  The findings were discussed with Dr. ___. by ___\n___, M.D. on the telephone on ___ at 3:59 pm, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate minimal bibasilar atelectasis.\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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits. \nThere is free air along the anterior aspect of the liver (4; 26), which may be\nexpected given recent surgery.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size 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 diffuse dilatation of\nsmall bowel loops in the upper abdomen measuring up to 3.5 cm (6; 18). \nMultiple loops of small bowel in the lower mid abdomen demonstrate wall\nthickening with adjacent stranding as well as possible decrease in caliber (6;\n18) in the region of the surgical bed.  Patient is status post laparoscopic\nsigmoid colectomy and colovesicular fistula takedown as well as an omental\nflap which was placed between the bladder and the area of the colovesicular\nfistula and the colonic anastomosis.  Contrast is seen within the rectum,\nthrough the anastomosis, and into the descending colon.  The colonic wall at\nthe anastomosis appears thickened with mild narrowing of the lumen (4; 75). \nInferior to the anastomosis in the peritoneal reflection, there are 2 rim\nenhancing fluid collections, 1 measuring 2.9 x 3.6 cm (4; 83) and another more\nmedially measuring 1.3 cm (4; 87).  A right lower abdominal approach drain\nterminates in the left upper pelvis outside of any fluid collection.  Multiple\nfoci of soft tissue gas within the lower pelvis, and right anterior abdominal\nwall including the right inguinal canal and right scrotal sac are consistent\nwith recent surgery.  The appendix is normal.\n\nPELVIS: The bladder wall is thickened.  The bladder contains a Foley catheter.\nFoci of air along the bladder dome is again demonstrated, similar to prior, in\narea of prior colovesicular fistula.  There is small amount of 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: Soft tissue gas in the right lower abdominal wall and soft\ntissue stranding in the umbilicus consistent with recent surgery.",
            "output": "1. Status post laparoscopic sigmoid colectomy and colovesicular fistula\ntakedown within omental flap with postsurgical changes including free air\nanterior to the liver and in the pelvis as well as in the abdominal wall and\ndiffuse stranding.  Right lower abdominal wall approach drain terminates in\nthe left upper pelvis/left lower abdomen.\n2. There is no contrast extravasation from the colonic anastomosis.  The\ncolonic wall appears thickened with mild narrowing at the anastomosis.\n3. 2 rim enhancing fluid collections, the larger measuring 3.6 cm are seen in\nthe peritoneal reflection just inferior to the colonic anastomosis concerning\nfor development of abscesses.\n4. Extensive fluid filled dilatation of the small bowel loops with small bowel\nwall thickening, concerning for post operative ileus versus partial\nobstruction."
        },
        {
            "input": "Calcified pleural plaques are noted bilaterally, compatible with a history of\nasbestos exposure. There is no pleural or pericardial effusion.\n\nLIVER: The liver enhances homogeneously without intrahepatic biliary duct\ndilation. There is a subcentimeter hypodensity in segment ___ of the liver,\nwhich is too small to fully characterize but likely represents a hamartoma.\nThe portal and hepatic veins are patent. The nondistended gallbladder is\nwithin normal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The left adrenal gland appears mildly enlarged and nodular (5:15).\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI: The stomach is mildly distended without obvious intraluminal mass or wall\nthickening. A suture line from a small bowel anastomosis is noted in the left\nlower quadrant (05:40).  There is no evidence of obstruction or perforation.\nThe appendix is not definitively visualized, but there is no fat stranding or\nfree fluid in the right lower quadrant to suggest acute appendicitis. There is\nextensive colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The infrarenal aorta is mildly aneurysmal measuring up to 3.3\ncm (05:30), with extensive atherosclerotic calcifications. There is no\nretroperitoneal or mesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS:  In the right lower quadrant there is a 3.5 x 6.4 cm\nwell-circumscribed hypodensity, compatible with a seroma (5:65). There is\nadjacent fat stranding with a small pocket of nondependent air (5:61) and an\noverlying 1.9 cm wide, 2 cm deep skin defect. This is concerning for a\nsuperinfected seroma. A similar-appearing well-circumscribed lesion was seen\nin the right lower quadrant on the prior study of ___, at which\ntime it measured 2.3 x 2.8 cm but had no secondary findings of infection.\nAdditionally, there is a large, multilobulated soft tissue mass in the\ncul-de-sac (05:58), which appears to be distinct from the uterus, and likely\nrepresents lymphoma, but it is possible this arises from the right ovary,\nwhich is not definitively visualized. Overall, it is unchanged in short-term\nfollowup from the prior study of ___. There is a simple cyst\narising from the left ovary. The left piriformis muscle appears asymmetrically\nthickened, with a hypodense nodule with mild peripheral enhancement seen of\nthe posterior aspect (5:73), concerning for lymphomatous involvement. The\nurinary bladder appears normal. No pelvic wall or inguinal lymph node\nenlargement by CT size criteria is seen. There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:  There are mild degenerative changes of the lumbar spine.\nNo focal lesion suspicious for malignancy present.",
            "output": "1. 3.5 x 6.4 cm seroma with secondary signs of infection.\n2. 3.3 cm infrarenal abdominal aortic aneurysm.\n3. Large soft tissue mass in the cul-de-sac, and enlargement of the left\npiriformis, concerning for lymphomatous involvement.\n4. Extensive atherosclerotic calcifications and diverticulosis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 4:11 ___, 25 minutes after discovery\nof the findings."
        },
        {
            "input": "CHEST: Again seen at the right lung base is a large calcified pleural plaque.\n2 calcified granulomas are noted of the left lung base. The lungs are\notherwise clear. The heart is enlarged and there is no pericardial effusion. \nThe descending thoracic aorta demonstrates considerable atherosclerosis.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver is normal in attenuation with no intrahepatic\nbiliary dilatation. The gallbladder is nondistended. Spleen is normal in size.\nThe adrenal glands are normal bilaterally. The pancreas is mildly atrophic, no\nsurrounding stranding. The unenhanced kidneys are normal in size with no\nevidence of nephrolithiasis. There is no hydronephrosis.\nThe distal esophagus and stomach are normal in caliber. Small bowel is\ndecompressed. The large bowel is normal in caliber with no evidence of\ncolitis.\nThere is no mesenteric or retroperitoneal lymphadenopathy, however there is\nnonspecific increased soft tissue at the left para-aortic region and just\nbeyond the diaphragmatic hiatus, which has been seen on prior studies. There\nis no free air or free fluid within the abdomen. Thickening of the anterior\nlateral abdominal wall fascia on the right is likely related to prior\nincarcerated hernia and resultant seroma.\n\nPELVIS: Large soft tissue masses in the pelvis are unchanged since the prior\nCTs from ___, possibly related to the patient's history of lymphoma.\nThe uterus is normal and there is no right adnexal mass. There is a cyst in\nthe left adnexa measuring up to 3.1 cm, measuring simple fluid density,\nunchanged since ___.\n\nVESSELS:  Infrarenal abdominal aortic aneurysm measures up to 3.2 cm,\npreviously 3.3 cm and ___.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. Unchanged soft tissue masses in the dependent portion of the pelvis,\npossibly related to patient's known history of lymphoma.\n2. Stable 3.2 cm infrarenal abdominal aortic aneurysm.\n3. Unchanged right lung base calcified pleural plaque, possibly sequela of\nprior asbestos exposure.\n4. Stable 3.1 cm left adnexal cyst."
        },
        {
            "input": "LOWER CHEST: The heart is significantly enlarged.  There is no evidence of\npericardial effusion or wall thickening.  There is stable dense calcification\ninvolving the right pleura.  There are multiple calcified granuloma in the\nleft lung base.  There are 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 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 redemonstration of bilateral renal multiple subcentimeter\nlow attenuation lesions, too small to characterized.  There is no evidence of\nsolid 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 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 uterus is anteverted.  There is a large\nmultilobulated fibroid arising from the posterior uterine body measuring 8.2 x\n7.2 x 6.7 cm (series 2, image 60; previously measuring 8.0 x 7.8 x 6.4 cm)\ngrossly unchanged from previous study. There is redemonstration of a left\nadnexal 3 cm low-attenuation lesion grossly unchanged from previous study.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is redemonstration of a infrarenal abdominal aorta aneurysm\nmeasuring up to 3.6 cm unchanged from previous study.  Moderate\natherosclerotic disease is noted.\n\nBONES: There is mild multilevel degenerative changes of the thoracolumbar\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No finding to explain the patient's symptoms.\n2. Stable infrarenal abdominal aortic aneurysm.\n3. Fibroid uterus and left ovarian cyst, stable compared to the exam from ___\nyear and only slightly increased in size over the last ___ years."
        },
        {
            "input": "LOWER CHEST: Small hiatal hernia.  Bibasilar atelectasis.  Lung bases,\nvisualized pleural spaces, and lower mediastinal structures otherwise\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a small hypoattenuating lesion in segment III of the\nliver, measuring approximately 13 mm in diameter (series 3, image 12).  This\nlesion has low attenuation, likely reflecting a cyst.  There is a small\ngranuloma within the right lobe of the liver, adjacent to the gallbladder\nfossa.  No focal parenchymal lesions otherwise.  Normal gallbladder.  No\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: Spleen is normal (8 cm).  No focal parenchymal lesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: The right kidney slightly edematous.  There is mild right perinephric\nfat stranding.  A 5 mm calculus is identified at the right UPJ, resulting in\nminimal prominence of the right renal collecting system, without high-grade\nhydronephrosis.  There is no ureteric calculus within the right ureter more\ndistally.  There is a non-obstructive 8 mm calculus at the lower pole of the\nright kidney.  No left nephrolithiasis or ureteric calculus.  Left-sided renal\ncortical cysts, with the dominant interpolar cyst measuring up to 6 cm in\ndiameter.  No left hydronephrosis.\n\nGASTROINTESTINAL: Extensive sigmoid and descending diverticulosis.  Scattered\nadditional diverticula in the transverse colon.  No findings of acute\ndiverticulitis.  Appendix in the right lower quadrant normal.  Normal small\nbowel.\n\nPELVIS: Largely collapsed but otherwise unremarkable urinary bladder.\n\nREPRODUCTIVE ORGANS: Mildly bulky prostate gland.  Normal seminal vesicles.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Mild atheromatous calcification of the aortoiliac vasculature. \nSlightly tortuous iliac arteries.  No aneurysmal dilatation of the abdominal\naorta.\n\nBONES: No acute or focal destructive osseous lesions.  Mild multilevel\ndegenerative disc disease throughout the visualized spine.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.",
            "output": "1. 5 mm calculus at the right UPJ causing mild hydronephrosis.\n2. 8 mm nonobstructive stone in the right lower pole.  No left nephrolithiasis\n\nRECOMMENDATION(S):  Discussed with ___ at 15:13 on ___."
        },
        {
            "input": "LOWER CHEST: There is mild scarring at the bilateral lung bases.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is redemonstration of a subcentimeter hypodense lesion in the left lobe\nof the liver, too small to further characterize but likely a cyst. \nAdditionally, there is a punctate calcification in the right lobe of the\nliver, likely representing a granuloma.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Pancreas is normal in attenuation.  However, in the body of the\npancreas there are subtle hypodense lesions measuring 0.9 x 0.8 cm (series\n601, image 64), 0.7 x 0.5 cm (series 601, image 63), and 0.3 x 0.2 cm (series\n601, image 63).  These lesions are not fully characterized full.  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/PELVIS: The kidneys are of normal and symmetric size.  At the\ninterpolar region of the left kidney, there is a 5.9 x 5.8 cm cyst.  There is\npersistent mild hydroureteronephrosis with mild asymmetric right-sided\nperinephric stranding.  There is a 4 mm stone seen in the distal right ureter.\nThere is also redemonstration of additional 4 mm stone seen in the lower pole\nof the right kidney.  The urinary bladder is unremarkable.  There is no\nfree-fluid in the pelvis.\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 or fat stranding. The\nappendix is normal.\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. 4 mm obstructing stone in the distal right ureter causing mild\nhydroureteronephrosis.\n2. Redemonstration of a 6 mm nonobstructing stone in the lower pole of the\nright kidney.\n3. Subtle hypodense pancreatic lesions poorly visualized on this exam. \nRecommend comparison with more remote priors; however, if not available,\nrecommend further evaluation with nonemergent 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 a small calcification in segment 4 B, likely a granuloma.  There is\nno evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.  There are\nmultiple stable hypoattenuating lesions in bilateral kidneys which likely\nrepresent renal cysts, the largest of these in the left kidney upper pole and\nmeasures 6.6 x 6.0 cm.  There is no perinephric abnormality.  There is a 4 mm\nnonobstructing stone in the lower pole of the right kidney. There has been\ninterval resolution of right-sided hydronephrosis and hydroureter, as well as\npassing of a right-sided ureteral stone.  There is no obstructing stone in\neither ureter.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness. Diverticulosis of the sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding. The appendix is\nnormal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate may be mildly enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is mild to moderate atherosclerosis of the abdominal vessels. \nThere 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. There is been interval passing right-sided ureteral calculus and resolution\nof right-sided hydronephrosis and hydroureter.\n2. Nonobstructing right lower pole renal calculus.\n3. Notable colonic diverticular 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 9 x 7 mm nonobstructing left renal calculus.  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\ntrace 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.\n\nBONES: Pubic symphysis appears wide measuring 1.5 cm.  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. Nonobstructing 9 mm left renal calculus.\n2. Trace free fluid in the pelvis.  This is non physiologic in a male patient\nthough there is no identified underlying cause.\n3. Widening of the pubic symphysis up to 1.5 cm suggesting diastasis."
        },
        {
            "input": "LOWER CHEST: The imaged lung bases are clear aside from mild dependent\natelectasis.  The imaged portion of the heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of suspicious focal lesions.  A hypodensity in segment 6\nwas previously characterized as a hemangioma on MRI from ___.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas appears unremarkable.  Please note, reported pancreatic\ncysts described on prior MRI are poorly visualized.\n\nSPLEEN: The spleen is normal in size.\n\nADRENALS: Adrenals are normal bilaterally.\n\nURINARY: Kidneys enhance symmetrically.  No worrisome renal lesion.  No\nhydronephrosis.\n\nGASTROINTESTINAL: The stomach and duodenum appear normal.  Small bowel loops\ndemonstrate no signs of ileus or obstruction.  The appendix is normal.  There\nis mild fat stranding along the anterior aspect of the cecum/ascending colon\nwithout underlying bowel wall thickening.  No definite signs of diverticulitis\nor epiploic appendagitis.  Findings are nonspecific.  The remainder of the\ncolon is unremarkable and mostly decompressed.  No free air or free fluid.  No\nsignificant fecal load.\n\nPELVIS: Urinary bladder is partially distended appearing normal.  The prostate\nis slightly enlarged with median lobe hyperplasia causing some bladder base\nindentation.  Distal ureters appear normal.  No pelvic free fluid.\n\nLYMPH NODES: There is no 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. \nL5-S1 degenerative disease is moderate to severe.\n\nSOFT TISSUES: Patient is undergone prior inguinal hernia repair.",
            "output": "1. Nonspecific fat stranding in the right lower quadrant anterior to the cecum\nand ascending colon without underlying bowel wall thickening or\ndiverticulitis.  No free air or free fluid.  Appendix is normal.\n2. Additional nonemergent findings as above."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis.  The partially imaged 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 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. \nSmall right renal cysts.  No concerning lesions.  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 appendix is\nnot clearly visualized though there are no secondary signs of appendicitis. \nThere is notable colonic fluid distension.  The level of the sigmoid colon\nthere is some distortion of the lumen with mild thickening concerning for\ncolitis.  Mild adjacent fat stranding is also noted.  There is mild\ndiverticulosis without diverticulitis.  No free fluid.  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 endometrium measures approximately 7 mm in thickness.\nThe 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 significant\natherosclerotic disease is noted.\n\nBONES: Partially imaged superior endplate T7 compression deformity, with a\nchronic overall appearance.  No other evidence of fractures.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.",
            "output": "1. Mild thickening of the sigmoid colon likely reflecting a segmental colitis.\nAssociated large bowel obstruction with marked fluid distention of the entire\ncolon.  Please note, given relative distortion of the sigmoid colon, a\nsigmoidoscopy/colonoscopy is advised following resolution of the acute\nsymptoms to better assess for underlying lesion.\n2. Abnormal endometrial thickening measuring approximately 7 mm.  Recommend\nnonemergent pelvic ultrasound for further evaluation.\n3. Partially imaged T7 compression deformity, likely chronic.\n\nRECOMMENDATION(S):\n1. Sigmoidoscopy/colonoscopy to evaluate for possible colonic mural lesion.\n2. Nonemergent pelvic ultrasound to assess endometrial thickening.\n\nNOTIFICATION:  The updated impression and recommendation regarding impression\n1 were discussed with ___, M.D. by ___, M.D. on the\ntelephone on ___ at 11:20 pm, less than 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "VASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  Note is made of\nseparate origins of the splenic and common hepatic arteries arising from the\naorta at the same level (3:62).  The superior mesenteric inferior mesenteric\narteries are widely patent, as are the bilateral renal arteries.  There is no\nevidence of aortoiliac dissection.  The portal vasculature is patent.\n\nLOWER CHEST: There is mild bronchial wall thickening in the lung bases\nbilaterally, with mucoid impaction in the left base (03:13).  Bilateral\npleural effusions are small, slightly greater on the right.  Additionally, a 4\nmm and 6 mm pulmonary nodule are identified in the left base, new since the\nprior exam (03:16).  The heart is mildly enlarged.  There is a small hiatal\nhernia.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple hepatic cysts are again noted.  No concerning hepatic\nlesion is identified.  The gallbladder is within normal limits, without stones\nwith mild pericholecystic fluid, likely due to third spacing.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The bilateral adrenal glands are minimally thickened, unchanged\ncompared to the prior exams, with no evidence of focal nodule or mass.\n\nURINARY: The bilateral kidneys enhance symmetrically.  Subcentimeter renal\nhypodensities are again noted, compatible with small cysts, but too small\naccurately characterize.  There is no hydronephrosis or perinephric\nabnormality bilaterally.\n\nGASTROINTESTINAL: The small hiatal hernia is again noted.  The stomach is\notherwise unremarkable.  Loops of small bowel are normal in course and caliber\nwith no evidence of wall thickening, obstruction, or mucosal changes to\nsuggest ischemia.  Extensive colonic diverticulosis is noted, with no evidence\nof diverticulitis  Appendix is not visualized.  Mild mesenteric stranding,\nwith scattered small mesenteric and retroperitoneal lymph nodes are perhaps\nslightly more prominent compared to prior studies, but none of which are\npathologically enlarged by CT size criteria.  Prominent peripancreatic and\nporta hepatic lymph nodes are also unchanged.\n\nRETROPERITONEUM: Scattered retroperitoneal lymph nodes measure up to 8 mm in\nshort axis diameter (03:108), previously 7 mm.\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: Multilevel degenerative changes are again noted in the lumbar spine. \nNo osseous lesion worrisome for malignancy or infection is identified.  There\nis a a right total hip arthroplasty.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No signs of mesenteric ischemia or abdominopelvic arterial injury.\n2. Mild cardiomegaly with bilateral pleural effusions and third spacing of\nfluid in the upper abdomen, compatible with heart failure.\n3. Extensive colonic diverticulosis, with no evidence of diverticulitis.\n4. Misty mesentery with scattered prominent porta hepatic, mesenteric and\nretroperitoneal lymph nodes is nonspecific, and similar if not minimally more\nprominent compared to prior examinations.\n5. Bibasilar consolidations with bronchial wall thickening and mucoid\nimpaction on the left.\n6. New left lung base nodules measure 4 and 6 mm, possibly related to\ninfectious or inflammatory origin, but for which follow-up CT is recommended\nin ___ year according to ___ society guidelines.\n7. Small hiatal hernia and hepatic cysts are unchanged.\n\nRECOMMENDATION(S):  Follow up CT in one year for re-evaluation of the\npulmonary nodules described above."
        },
        {
            "input": "Streak artifact from right hip prosthesis limits evaluation.\n\nPELVIS:  The partially visualized small and large bowel are unremarkable. \nSubtle Ms. ___ appearance to the imaged mesentery (3:1) is similar to prior. \nThe urinary bladder and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged and the seminal vesicles\nare unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right total hip arthroplasty and fixation screws\nthrough the left femoral head and neck.  There is no evidence of hardware\nloosening or malalignment.  Some areas of dystrophic calcification are noted\nsuperior to the right greater trochanter.  Mild degenerative changes are noted\nin the lower lumbar spine and left femoroacetabular joint.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute fracture or dislocation.\n2. Status post right total hip arthroplasty and fixation screws to the left\nfemoral head and neck, without evidence of hardware related complication."
        },
        {
            "input": "LOWER CHEST: Incidental note is made of a 4 mm nodule abutting the pleural\nsurface of the right lower lobe (2:3).  Mild dependent atelectasis is also\npresent.  No pleural effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: There are areas of higher attenuation at the right hepatic lobe\nperiphery (601b:25), which may represent fatty sparing in this otherwise is\ndetect liver.  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.  Patient is post\npartial colectomy/sigmoidectomy, with an unremarkable anastomosis in the\nmidline pelvis (2:83, 601b:45).  The remainder of the colon demonstrates\ndiverticulosis, however without is no evidence of fat stranding or wall\nthickening.  The appendix is not visualize, however there are no secondary\nfindings of appendicitis.\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. \nMild degenerative changes of the lumbar spine are identified.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia (2:69). \nInferior to this, there is a ventral wall hernia containing multiple loops of\nnondilated small bowel 602b:38).  Small amount of fat stranding is identified\nin the soft tissues adjacent to this hernia (602b:  40).",
            "output": "1.  No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain.  Specifically, no dilated loops of bowel.\n\n2.  Post partial colectomy/sigmoidectomy, with unremarkable anastomosis in the\nmidline pelvis.  Remaining colon demonstrates multiple diverticula, without\nwall thickening or adjacent fat stranding.\n\n3.  Ventral wall hernia containing multiple loops of nondilated small bowel,\nwhich contain oral contrast.  No evidence of obstruction at this site.\n\n4.  Incidental note is made of a 4 mm right lower lobe pulmonary nodule.  Per\n___ Society guidelines, if the patient is high risk for malignancy\n(history of smoking), then follow-up CT chest to demonstrate stability may be\nobtained in ___ year.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 04:30 on ___, immediately after\ndiscovery."
        },
        {
            "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 non-distended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\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: The adrenal glands are visualized and unremarkable.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach contains contrast, and there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.  Large amount of stool is noted in\nthe colon. A normal, air-filled appendix is visualized.There is colonic\ndiverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM: The aorta and common iliac vessels are normal in caliber,\nwith moderate atherosclerotic calcifications. There is no retroperitoneal or\nmesenteric lymph node enlargement by CT size criteria.\n\nCT PELVIS: There is an area of hyperdensity in the right bladder, which most\nlikely represents mixing of excreted IV contrast on this single phase study\n(601b:36). However, this can be confirmed with bladder ultrasound. The uterus\ncontains a calcified fibroid, unchanged in appearance from the ___ CT scan\n(2:53). The ovaries are not visualized. There is a small, fat-containing left\ninguinal hernia. The left levator ani is atrophic with bulging of the rectum\nto the left side, which may be contributing to the patient's constipation. No\npelvic wall or inguinal lymph node enlargement by CT size criteria is\nseen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.  There\nis levoscoliosis of the mid-lumbar spine.  There is grade 3 L5 on S1\nanterolisthesis with bilateral spondylolisthesis. There is a chronic\ncompression fracture of the L4 vertebral body.",
            "output": "1.  No definitive evidence of an intra-abdominal or intrapelvic mass.\n\n2.  Small area of hyperdensity in the right part of the bladder, which most\nlikely is mixing of excreted IV contrast on this single phase study. However\nif there is a clinical suspicion, this could be confirmed with bladder\nultrasound.\n\n3.  Leftward bulging of the rectum due to an atrophic left levator ani,\npossibly contributing to constipation.\n\n4.  Grade 3 L5 on S1 anterolisthesis and chronic compression fracture of the\nL4 vertebral body."
        },
        {
            "input": "There is diffuse osteopenia.\n\nMild cortical regularity along the right sacral ala (series 3, image 49), is\nnot seen on prior study from ___, although given apparent marrow edema on\nsagittal inversion recovery images on ___, may reflect an acute or\nsubacute fracture.  There is no displaced fracture identified within the\nproximal femurs.  No lytic or sclerotic lesions are seen within the visualized\nfemurs or pelvis.\n\nThere is unchanged mild L4 compression deformity.  Moderate spondylosis at\nL4-5 is identified, with vacuum disc phenomenon and subchondral sclerosis.\nSevere L5-S1 spondylosis with grade 2 anterolisthesis and bilateral pars\ndefects are noted.  Questionable minimally displaced fracture of the right L5\ntransverse process is noted.  (Series 3, image 29).  This may be partially due\nto osteopenia.\n\nMultiple calcified uterine fibroids are seen.\n\nA large amount of stool is noted throughout the colon and rectum. There is a\nsmall hiatal hernia containing loops of the transverse colon.\n\nModerate aortoiliac calcific atherosclerosis is noted.",
            "output": "1. Nondisplaced right sacral ala fracture, new since the ___.\n2. Questionable nondisplaced fracture of the right L5 transverse process.\n3. Myelomatous involvement of the pelvic bones identified on MRI is not well\nvisualized on CT.  No large lytic or sclerotic lesions seen."
        },
        {
            "input": "LOWER CHEST: Severe emphysematous changes as well as linear atelectasis are\nseen in lung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  The\nattenuation of the liver is increased relative to the spleen.  There is no\nevidence of focal lesions.\n\nThere is mild intrahepatic biliary ductal dilatation, unchanged.  The CBD\nmeasures 6 mm normal in caliber.  The gallbladder 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, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 large hiatal hernia containing portion of\nstomach.  Small bowel is normal in caliber.  The transverse colon noted to be\nprotruding anterior to the liver with large area of fecal loading seen\nthroughout the colon.  There is no evidence of obstruction.  There is evidence\nof rectal prolapse\n\nPELVIS: The urinary bladder is unremarkable.  Pelvic assisted device is seen. \nMultiple calcified fibroids are 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: Severe levoscoliosis of thoracolumbar spine is again seen with multiple\ncompression deformities of the spine similar to prior exam.  Grade 2\nanterolisthesis of L5 on S1.  Chronic insufficiency fracture of the sacrum is\nagain seen.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of retroperitoneal bleeding.\n2. Large degree of fecal loading compatible with constipation.\n3. Large hiatal hernia containing portion of stomach.\n4. Increased hepatic attenuation relative to the spleen may reflect\nhemosiderosis secondary to blood transfusions."
        },
        {
            "input": "LOWER CHEST: There is minimal dependent bibasilar atelectasis without focal\nconsolidation.  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:Previously seen left lobe, presumed hemangioma, on ultrasound is\nnot visualized on this CT, and likely represents an artifact on ultrasound. \nNo focal liver masses identified.  There is no evidence of intrahepatic or\nextrahepatic biliary dilation.  There is a punctate hyperdensity in the neck\nof the gallbladder, compatible with the known cholelithiasis, seen better on\nultrasound.  No pericholecystic inflammation or gallbladder wall thickening\nnoted.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: No splenomegaly.  There is a 9 mm rounded hypodensity in the superior\naspect of the spleen (06:33) that 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. \nTiny, subcentimeter rounded hypodensities in the left renal cortex, superior\npole, although incompletely characterized, statistically are likely cysts.  No\nhydronephrosis on either side.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post gastric band, which appears within\nnormal limits.  The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. The colon and\nrectum are within normal limits. The appendix appears within normal limits. \nThere is some suggestion of minimal fat stranding (series 4; image 53, series\n6; image 33) in the right lower quadrant, which is likely inconsequential.\n\nPELVIS: Urinary bladder is underdistended, limiting evaluation.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Hypodensity in the anterior uterus likely represents a\nnoncalcified fibroid, that was noted on the pelvic ultrasound dated ___ no history of pregnancy.  Uterus otherwise unremarkable. \nAge-appropriate appearance of both ovaries.  No large 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is an anterior abdominal wall diastasis.  Otherwise, the\nabdominal and pelvic wall is within normal limits.  The gastric band chamber\nis present within the subcutaneous tissues of the left upper quadrant\nabdominal wall.",
            "output": "1.  No acute process noted in the abdomen or pelvis.\n2.  There is minimal stranding of fat surrounding the appendix.  The appendix\nitself however is not dilated, does not demonstrate mucosal hyperenhancement\nor any imaging evidence for acute inflammation.  The patient was re-examined\nclinically with no clinical exam findings to suggest acute appendicitis\ncorroborating with lack of inflammation noted on CT\n3.  Previously suggested left hepatic lobe lesion is not visualized on CT."
        },
        {
            "input": "LOWER CHEST: The imaged lung bases are clear with the exception of bibasilar\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 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. \nBilat subcentimeter inferior pole cortical hypodensities are too small to\ncharacterize, but most likely reflect simple cysts.  There is no evidence of\nsuspicious renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis a very short segment of distal descending/proximal sigmoid colon that\ndemonstrates wall thickening and adjacent fat stranding.  There are several\ndiverticuli in this region, and this could be due to acute uncomplicated\ndiverticulitis versus short segment colitis.  There is no evidence of\nperforation.  No fluid collection.  The remainder of the sigmoid colon and\nrectum is unremarkable.  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 is unremarkable.  No adnexal mass 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.  Trace 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 uncomplicated diverticulitis versus sort segment colitis of the distal\ndescending/proximal sigmoid colon.  No fluid collection.  No evidence of\nperforation."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 several tiny hypodense structures within the liver, too\nsmall to characterize but statistically most likely to be benign cysts.  There\nis no evidence of intrahepatic biliary dilatation.  The extrahepatic common\nbile duct the level of the duodenum measures up to 9 mm, previously 8 mm, most\nlikely status post cholecystectomy changes.  The gallbladder is surgically\nabsent.\n\nPANCREAS: At the tail the pancreas, there is a 4 mm calcific density (series\n2, image 24), not previously seen on prior CT.  Otherwise, the pancreas has\nnormal attenuation throughout. There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout. \nRedemonstration of a calcific density within the spleen, likely sequela of\nprior 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. \nRedemonstration of 2 simple bilateral hypodense rounded structures, measuring\nup to 1.6 cm in the lower pole of the left kidney and 1.3 cm at the upper pole\nof the right kidney, which are slightly enlarged since ___.  The left renal\nstructure most likely represents a renal cyst and the right renal structure is\nincompletely characterized.  There is no evidence of additional focal renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Centered within the a sigmoid diverticulum, there is subtle\nstranding without adjacent focal fluid collection (series 2, image 67), which\nis may represent mild uncomplicated sigmoid diverticulitis.\n\nThe stomach is unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout. Diverticulosis of the descending\nand sigmoid colon 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: Again seen are 2 left hypodense rounded adnexal\nstructures likely representing cysts, which measure up to 2.5 cm and 1.5 cm in\ndiameter, previously measuring up to 3.1 cm and 2.6 cm previously.  The uterus\nand right 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is been interval progression of degenerative changes are seen within the\nlumbar spine, with endplate sclerosis at ___ and increased vertebral body\nheight loss at L4 and L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Subtle stranding adjacent to a sigmoid diverticulum, suggestive of mild\nuncomplicated sigmoid diverticulitis.\n2. Interval decrease in size of 2 left adnexal cysts, measuring up to 2.5 cm\non current exam, previously measuring up to 3.1 cm.  Long term\nstability/decrease in size is definitely reassuring.  Difficult to optimally\nassess the walls of the cyst.  Could consider outpatient pelvic ultrasound.\n\nRECOMMENDATION(S):  If the adnexal cysts have not been recently characterized\non pelvic ultrasound, recommend further evaluation with nonemergent pelvic\nultrasound."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.  Gastric varices are noted.  A\nreplaced left hepatic artery arises from the left gastric (series 4, image\n21).  The portal and hepatic veins are patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneous in attenuation, without ductal\ndilation or concerning focal lesion.  Pneumobilia in the left lobe is\ncompatible with recent ERCP and stent placement.  There is a trace\nintra-abdominal free fluid.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.  Layering hyperdensity within the\ngallbladder is suggestive of vicarious excretion of contrast.\n\nPANCREAS: There are diffuse coarse calcifications throughout the pancreas,\ncompatible with chronic pancreatitis.  In the head and uncinate process is a\nlarge cystic structure measuring 9.1 x 9.4 x 9.1 cm.  This demonstrates a thin\nwall (series 4, image 50).  Is not clear if there is direct communication with\nthe main pancreatic duct.  There is no solid enhancing component.  There is no\nperipancreatic stranding.\n\nThere is severe compression of the upper SMV, portal-SMV confluence, and\nsplenic confluent from the main lesion, resulting in extensive mesenteric\ncollaterals (series 4, image 34).\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nADRENALS: The bilateral adrenal glands are normal in caliber and\nconfiguration.\n\nURINARY: The kidneys are symmetric and normal in size, demonstrating normal\nnephrograms and excreting contrast promptly.  There is no stone, concerning\nmass, or hydronephrosis.\n\nGASTROINTESTINAL: Small and large bowel is normal in caliber, without wall\nthickening or evidence of obstruction.  A normal air-filled appendix is\nvisualized.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is a small amount of\nsimple free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.\n\nBONES: There is no focal lytic or sclerotic lesion to suggest neoplasm or\ninfection.  A compression fracture of the L1 vertebral body is of unclear\nchronicity.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 9.1 x 9.4 unilocular cystic structure in the pancreatic head/uncinate\nprocess with a thin wall, most compatible with pseudocyst given background of\nsevere chronic pancreatitis.  Underlying duct disruption cannot be excluded.\nMass effect from this lesion is the likely cause of recent CBD narrowing and\nobstruction.  Other cystic lesions such as IPMN are possible but atypical\ngiven the large size of the lesion.  Recommend comparison with prior imaging\nstudies to see the time course of development of this lesion and any\ncorrelation with recent episodes of acute pancreatitis.\n2. Severe compression of the upper SMV, portal-SMV confluence, and splenic\nconfluence, with extensive mesenteric collaterals.\n3. Compression fracture of the L1 vertebral body, of unclear chronicity.\n4. Trace ascites.\n5. Gastric varices.\n\nRECOMMENDATION(S):  Upload any recent OSH reference studies; and addendum can\nbe added for any comparisons made."
        },
        {
            "input": "There is a trace dependent atelectasis the lung bases. The remainder of the\nlungs are clear.  A pericardial cyst within the anterior costophrenic angle of\nthe right hemi thorax is stable in size and character from the prior MRI done\non ___.  The heart is normal appearing.\n\nOn this non contrast exam, the liver, spleen, pancreas, adrenal glands and\nkidneys appear within normal limits.  The gallbladder is filled with contrast,\nlikely due to vicarious excretion.  The small and large bowel are normal in\ncaliber and there is no evidence of obstruction.  There is no free fluid or\nfree air in the abdomen or pelvis.\n\nThe abdominal aorta is normal in caliber. There is moderate atherosclerosis of\nthe abdominal aorta and bilateral iliac arteries.\n\nPelvis: The bladder is distended and appears within normal limits. The\nreproductive organs are normal appearing. There is diverticulosis with no\nevidence of diverticulitis involving the sigmoid colon.\n\nThere are no suspicious osseous lesions identified. Note is made of posterior\nfusion hardware involving the lumbosacral spine. Soft tissue stranding along\nthe right pelvis at the level of the right femoral head is most consistent\nwith recent cardiac catheterization.",
            "output": "No evidence of intra-abdominal or intrapelvic fluid collection. Soft tissue\nstranding along the right pelvis at the level of the right femoral head is\nmost consistent with recent catheterization procedure. No acute\nintra-abdominal process."
        },
        {
            "input": "LOWER CHEST: There is a small left pleural effusion with adjacent compressive\natelectasis.  There is trace pericardial fluid.  The lung bases are otherwise\nclear.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver 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: Multiple punctate calcifications are seen within the spleen suggestive\nof prior granulomatous disease.\nADRENALS: The right and left adrenal glands are normal in size and shape.\nURINARY: The kidneys are of normal and symmetric size.  There is mild\nnonspecific perinephric stranding.  There is no evidence of focal renal\nlesions or hydronephrosis.  There is no nephrolithiasis.\nGASTROINTESTINAL: 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. Appendix contains air, has\nnormal caliber without evidence of fat stranding. There is no evidence of\nmesenteric lymphadenopathy.  Misty mesentery in the mid abdomen is a\nnonspecific finding.\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 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.\nIncreased density in the subcutaneous tissues of the left lower quadrant is\nlikely due to injection site changes (2:77)",
            "output": "1. No CT explanation for patient's acute abdominal pain.\n2. Nonspecific perinephric stranding and misty mesentery."
        },
        {
            "input": "The bases of the lungs are clear.\n\nThere is incarceration of small bowel loops within the ventral hernia sac,\nwith adjacent stranding, and free fluid.  There is mild distention of the\nsmall bowel, measuring up to 3.1 cm.  Free fluid is seen extending\nintraperitoneally anterior to the liver and surrounding the spleen.  There is\nno evidence of pneumatosis, or intraperitoneal free air.\n\nThe liver is normal without evidence of focal lesions or intrahepatic biliary\nductal dilatation.  The gallbladder is normal.  The spleen is homogeneous, and\nnormal in size.  The adrenal glands bilaterally are normal.  The kidneys\nbilaterally are normal without evidence of focal lesions, or hydronephrosis. \nThe pancreas is normal without evidence of focal lesions, or pancreatic ductal\ndilatation.\n\nThe stomach, duodenum, and colon are overall otherwise unremarkable.\n\nCT pelvis:  The urinary bladder is normal.  There is no pelvic wall, or\ninguinal lymphadenopathy.\n\nOsseous structures:  No lytic or blastic lesions concerning for malignancy are\nidentified.",
            "output": "Incarceration of small bowel loops within the ventral hernia sac, with\nadjacent stranding and free fluid extending to the liver and spleen.  There is\nmild prominence of the small bowel, measuring up to 3.1 cm.  No evidence of\npneumatosis, or intraperitoneal free air.\n\nSurgical consult is recommended.\n\nRECOMMENDATION(S):  Surgical consult is recommended.\n\nNOTIFICATION:  Findings were discussed with Dr. ___\n5-minutes after the discovery of the findings in person by Dr. ___."
        },
        {
            "input": "LOWER CHEST: There is a small left pleural effusion with overlying compressive\natelectasis.  There is trace right basilar atelectasis.  The previously seen\nlarge pericardial effusion is largerly resolved.\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 1.4 cm cyst in the lower pole of the left 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 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 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 evidence of mass or lymphadenopathy in the abdomen and pelvis.\n2. Small left pleural effusion and bibasilar atelectasis."
        },
        {
            "input": "ABDOMEN:\n\nA loculated small right pleural effusion and a small left pleural effusion is\nidentified. Calcified pleural plaques are identified bilaterally, in keeping\nwith asbestos related pleural disease. There is evidence of round atelectasis\nat the right lung base. Cardiac size is mildly enlarged, with enlarged right\natrium.\n\nThe liver demonstrates symmetric enhancement, with no focal lesions\nidentified. Mild intrahepatic biliary ductal dilatation is noted. Patient is\nstatus post open cholecystectomy since prior CT chest from ___,\ncomplicated by an open wound (05:33). Tiny locules of gas are identified at\nthe right anterior abdominal wall (05:26, 29). A biliary stent is now\nidentified. The CBD measures approximately 1.2 cm. Diffuse fatty infiltration\nof the pancreas is noted. The adrenal glands and spleen are unremarkable. Both\nkidneys demonstrate symmetric enhancement and excretion of contrast. A tiny 6\nmm hypodensity is identified in the lower pole of the left kidney is too small\nto characterize, however likely related to simple cyst. No hydronephrosis.\nSmall amount of perihepatic fluid is identified. Trace fluid is identified in\nthe gastrohepatic ligament (05:36) abutting the second portion of the duodenum\nresulting in mild luminal narrowing. No evidence of free air. A small hiatal\nhernia is identified. Stomach is unremarkable. Caliber of small large bowel is\nwithin normal limits.  Few duodenal diverticuli are identified.  A left lower\nquadrant colostomy is identified. There is evidence of focal fat necrosis\nadjacent to the hernia site (05:50). Diffuse colonic diverticulosis is\nevident. The appendix is unremarkable.  No retroperitoneal or mesenteric\nlymphadenopathy.  The portal veins, SMV and splenic vein are patent. Minor\nbilateral flank soft tissue stranding is identified.\n\nPELVIS:\n\nModerately distended urinary bladder is unremarkable. Prostate gland is\nunremarkable. Small amount of presacral dependent fluid is identified (5:70).\nBilateral fat containing inguinal hernias are identified. No inguinal or\npelvic lymphadenopathy.\n\nOSSEOUS STRUCTURES:\n\nModerate multilevel degenerative changes of the spine are evident. No\nsuspicious focal osteolytic or osteoblastic lesions are seen.",
            "output": "1. Bilateral calcified pleural plaques, in keeping with asbestos related\npleural disease. Loculated small right pleural effusion and small left pleural\neffusion, with round atelectasis at the right lung base.\n2. Cardiomegaly, with enlarged right atrium which may suggest increased right\nheart volume. Clinical correlation is recommended.\n3. Status post open cholecystectomy complicated by open wound, with tiny\nlocules of gas at the right anterior abdominal wall. Biliary stent now\nidentified. Prominent CBD measuring up to 1.2 cm, likely related to post\ncholecystectomy state.\n4. Small perihepatic fluid identified. Trace fluid identified in the\ngastrohepatic ligament abutting the second portion of the duodenum. This\nlikely relates to postoperative seroma, however underlying infection is not\nincluded.\n5. Other incidental findings include diffuse fatty infiltration of the\npancreas, small hiatal hernia, left lower quadrant colostomy, colonic\ndiverticulosis and bilateral fat containing inguinal hernias."
        },
        {
            "input": "LOWER CHEST: For intrathoracic findings, please refer to the dedicated CT\nthorax report\n\nABDOMEN:\n\nHEPATOBILIARY: There is redemonstration of innumerable hypoattenuating lesions\nthroughout the liver, similar to the prior examination .  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 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.  There is a 2 cm fluid attenuating left interpolar renal cyst.\n\nGASTROINTESTINAL: There is a moderate hiatal hernia with worsening wall\nthickening in the mid/distal esophagus filled with debris..  Small bowel loops\ndemonstrate normal caliber and wall thickness throughout. There is colonic\ndiverticulosis without evidence of diverticulitis.  The appendix is fluid\nfilled without any significant periappendiceal fat stranding and has a normal\nfocus of intraluminal gas distally.\nThere is diffuse haziness of the mesentery.  There is no large intra-abdominal\nfree fluid or free air.\n\nPELVIS: Evaluation of the pelvis is suboptimal secondary to marked beam\nartifact from bilateral hip arthroplasties.  No obvious intrapelvic free fluid\nor intrapelvic mass is seen.\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 are multilevel degenerative changes of the spine with multilevel\nvacuum disc phenomenon.\n\nSOFT TISSUES: There is worsening diffuse subcutaneous edema..  There is stable\nskin thickening of the bilateral central abdominal walls.",
            "output": "1. No CT evidence of an acute intra-abdominal process in this unenhanced\nexamination.\n2. Worsening body wall subcutaneous and mesenteric edema.\n3. Innumerable hypoattenuation lesions throughout the liver similar to prior\nexamination, suspicious for underlying metastatic disease.  Correlation with\nCT or MRI liver mass protocol is recommended if clinically indicated.\n4. Moderate hiatal hernia with worsening thickening of the mid/distal\nesophagus filled with debris.  Findings may be related to the reported history\nof gastric cancer.  Correlate clinically with direct visualization as\nclinically indicated."
        },
        {
            "input": "Again seen are multiple hypoattenuating hepatic lesions some of which\ndemonstrate a rim of enhancement and are concerning for metastatic disease. \nFor instance in the left hepatic lobe measuring 0.9 cm.\n\nThe pancreatic mass measuring 3.8 cm in longest dimension is again seen in the\nsuperior aspect of the pancreatic head.  The mass causes distal pancreatic\natrophy and ductal dilatation measuring up to 4 mm, unchanged from the day\nprior.  It also causes severe attenuation of the portal splenic and main\nportal vein.  There is also involvement of the common hepatic artery.  No SMA\ninvolvement is demonstrated.  The splenic vein remains patent.\n\nThere is a new CBD stent and contrast within the CBD with marked improvement\nof previous biliary dilatation.  Cholecystectomy changes are again noted. The\nspleen, adrenal glands and kidneys are unremarkable.\n\nThere is stable retroperitoneal adenopathy, for example a portacaval lymph\nnode measuring 1.6 cm and a 1.6 cm lymph node adjacent to the uncinate\nprocess.  No enlarged pelvic lymph nodes are seen.\n\nPost hysterectomy changes are again seen.  No ascites or intestinal\nobstruction.  There is mild surrounding edema in a collapsed proximal colon\nand pneumatosis in the splenic flexure, as seen on the day prior.  No free\nair.\n\nNo aggressive osseous lesions are seen. Lung bases are clear.",
            "output": "Improved biliary obstruction post CBD stent.  Redemonstration of pancreatic\nmalignancy with vascular involvement, retroperitoneal adenopathy and findings\nconcerning for hepatic metastatic disease.\n\nMild proximal colitis and pneumatosis in the splenic flexure."
        },
        {
            "input": "LOWER CHEST: For full description of the lung please refer to chest CT report\nfrom same day\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 subcentimeter hypodense lesions in the right kidney in the\ninterpolar region on image 73 and 74.  There is a 2.1 cm cyst in the lower\npole of the right kidney.  There is 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. 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 a lytic lesion in the transverse process of L5 on series 5 ___\n81 measuring 2.2 x 1.4 cm, previously 1.6 x 1.0 cm.  A lytic lesion in the\nright iliac wing on series 5 ___ 86 is increased in size currently measuring\n1.9 x 1.2 cm, previously 1.2 x 0.6 cm.  A lytic lesion in the left acetabulum\non series 5 ___ 109 measures 3.2 x 1.8 cm, previously 2.1 by 1.3 cm.\n\nSOFT TISSUES: There is a 3.6 x 2.8 cm mass with rim calcification in the\nrectal or spine in muscles on the right on series 5 ___ 82.  This is stable in\nsize.  There is a 1.9 x 1.2 cm enhancing lesion in the gluteus muscles on the\nright on series 5 ___ 95.  This is difficult to visualize on PET-CT without\nthe use of intravenous contrast however contour deformity is similar and this\nlesion is likely stable.",
            "output": "1. Increase in lytic bone metastases in the transverse process of L5, the\nright iliac wing and left acetabulum.\n2. Stable soft tissue lesions in the gluteus muscle and erector spinous muscle\non the right, please note that these were mildly FDG avid\n3. No new lesions seen"
        },
        {
            "input": "CHEST: There is minimal dependent atelectasis. The lung bases are otherwise\nclear.  The heart is normal in size and there is no evidence of pericardial\neffusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously and is without focal lesions. The portal\nvenous system is patent. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation. There is cholelithiasis without evidence of cholecystitis.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions. There is possible pancreas divisum.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. A\nsubcentimeter hypodensity in the lower pole of the left kidney is too small to\ncharacterize (300b:32). There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThere is a small hiatal hernia. The stomach is decompressed.  The small and\nlarge bowel are normal in caliber and without evidence of wall thickening. The\nappendix is well-visualized and normal.\n\nThere is dense calcification of the abdominal aorta and its major branches..\nThere is no abdominal aortic aneurysm. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nViews of the pelvis are slightly limited by streak artifact.  The bladder is\nwell distended and normal. There is no pelvic free fluid. There is no pelvic\nsidewall or inguinal lymphadenopathy. Uterus and adnexae are are grossly\nunremarkable.\n\nOSSEOUS STRUCTURES: An old left anterior eighth rib fractures noted. Left\nperiprosthetic femoral fracture is partially visualized. There is asymmetric\nenlargement of the muscles about the left femur.  There is no evidence of\nactive extravasation. A 7.1 cm lipoma is noted in the left gluteal region. No\nfocal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1. No evidence of intra-abdominal organ injury.\n2. Partially visualized left periprosthetic femoral fracture.\n3. Cholelithiasis without evidence of cholecystitis."
        },
        {
            "input": "LOWER CHEST: There are left basilar consolidative opacities, likely related to\naspiration and/or developing pneumonia.  Small heterogeneous consolidated\nopacity in the right lower lobe may also be related to aspiration and/or\npneumonia.  No pericardial effusion.  Moderate cardiac enlargement and\ncoronary artery calcifications are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nSmall hypoattenuating foci in the right hepatic lobe are too small to fully\ncharacterize but may reflect simple hepatic cysts versus biliary hamartomas\n(02:28).  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 or pancreatic 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 normal in size and shape.  There is an\nintermediate density 1.2 x 1.1 cm right adrenal nodule (02:27).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nBilateral renal cysts, measure up to 5.0 x 3.7 cm in the left upper pole\nkidney (02:40), and 2.5 x 2.2 cm in the right lower pole kidney (02:46).  No\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is fluid-filled and distended.  The entirety of\nthe small bowel is dilated with fluid and air, measuring up to 4.7 cm in the\nduodenum (601:48).  There is gradual tapering of caliber at the terminal\nileum.  No evidence of pneumoperitoneum.  Bowel wall enhances homogeneously\nthroughout.  A few segments of the transverse colon appears slightly\ndistended.  The distal sigmoid colon and rectum is fluid-filled.  The appendix\nis normal.  There is trace ascites.  No pneumoperitoneum.\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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Moderate bilateral hip joint degenerative changes are noted. \nMild-to-moderate degenerative changes of the thoracolumbar spine are noted. \nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Diastasis recti is noted.  There is asymmetric fatty\ninfiltration of the left iliopsoas muscle as compared to the right.",
            "output": "1. The entirety of the small bowel is fluid-filled and dilated up to 4.7 cm\nwith gradual tapering at the terminal ileum.  This is associated with a few\nsomewhat dilated segments of the transverse colon.  Findings may be related to\nileus.\n2. Trace ascites.  No pneumoperitoneum.\n3. 1.2 cm indeterminate density right adrenal nodule.  Further\ncharacterization with CT/MR adrenal protocol may be considered on a\nnonemergent basis.\n4. Bibasilar airspace opacities may reflect pneumonia and/or aspiration."
        },
        {
            "input": "LOWER CHEST: There is a trace left pleural effusion and left greater than\nright basilar opacities.  Overall, the appearance of the lung bases is similar\nto ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.\nThere is no evidence of suspicious lesions within the limitations of an\nunenhanced scan.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation. The gallbladder is opacified with hyperdense mature cereal, most\nlikely reflecting vicarious excretion of previously administered intravenous\ncontrast.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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: Mild nodular thickening of both adrenal glands is unchanged.\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 coiled in the stomach, with the tip . \nOverall, small-bowel dilation has decreased.  However, there remains a\nfluid-filled, dilated loop in the right lower quadrant without a discrete\ntransition point.  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 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. Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere degenerative changes of both hip joints are noted, as well as\nmultilevel moderate degenerative changes of the imaged thoracolumbar spine.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Improving ileus, with a persistent loop of mildly dilated, fluid-filled\nsmall bowel in the right lower abdomen.\n2. Similar appearance of both lung bases, with a trace left pleural effusion\nand bibasilar airspace opacities which could reflect atelectasis or\naspiration."
        },
        {
            "input": "LOWER CHEST: Mild left greater than right basilar atelectasis.  Trace left\npleural 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 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: A 1.2 cm right adrenal nodule measures-3 Hounsfield units,\ncompatible with an adenoma.  A subcentimeter left adrenal nodule measures 7\nHounsfield units also compatible with an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size.  Bilateral simple renal\ncysts are present.  There is no hydronephrosis.  There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is mildly distended containing a large amount\noral contrast with air-fluid level.  Loops of small bowel in the central and\nanterior abdomen are dilated with air-fluid levels containing oral contrast\nand measuring up to 3.8 cm, slightly more distended than prior.  All there is\nan area of focal narrowing in the right abdomen near the ileum (2:61), air and\nstool are demonstrated in the colon and distal bowel loops are essentially\nnormal caliber.  There is no evidence of inflammation, pneumoperitoneum, or\nabscess.  The colon appears slightly more gas-filled and distended although\nnot abnormal.  Normal appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Prostatomegaly.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy 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. \nDegenerative changes are again noted in spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Slightly increased distension of dilated small bowel loops measuring up to 3.8\ncm.  Focal area of narrowing in the right abdomen noted although distal loops\nof bowel and colon are not decompressed.  This appearance could represent\nileus with peristalsis in this region or partial obstruction.  Loops of colon\nare air-filled and mildly more distended than on prior exam although not\nabnormal.  No evidence of perforation, inflammatory process, or abscess."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.  The\nappendix is fluid-filled though does not appear to be acutely inflamed.  The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There is a left corpus luteum.  The uterus and right\nadnexae are within normal limits.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is mild retrolisthesis of L5 on S1.  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 focal abnormalities identified within 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:\nSmall volume ascites throughout the abdomen and pelvis.\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.  Pneumobilia is expected.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure.  Remaining pancreas is\nnormal in size and bulk.  No focal pancreatic lesions within the limitation of\na noncontrast examination.  No 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.  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: Postsurgical anatomy after Whipple procedure.  Distal small\nbowel loops demonstrate normal caliber and wall thickness throughout.  There\nis mild thickening and surrounding stranding affecting the ascending colon,\nsuspicious for colitis.  The distal colon and rectum are within normal limits.\n\nPELVIS: The bladder is decompressed by a Foley.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no gross retroperitoneal or mesenteric lymphadenopathy. \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.\n\nSOFT TISSUES: Diffuse subcutaneous edema.",
            "output": "1. Limited examination due to noncontrast technique.  Within these\nlimitations, status post Whipple procedure without definite evidence of\nrecurrence or metastatic disease in the abdomen or pelvis.\n2. Mild wall thickening and fat stranding surrounding the ascending colon,\nwhich should be correlated clinically for evidence of colitis.\n3. 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 14:11 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "LOWER CHEST: There is a 5 mm pulmonary nodule in the right middle lobe\n(03:44).  Two pleural nodular lesions are seen abutting the right lower lobe\n(3:49, 57).  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.  Stable mild pneumobilia.  The gallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure.  The remaining pancreas\nhas normal attenuation throughout, 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: There is new moderate to severe hydronephrosis of the right renal\npelvis of unclear etiology.  There is no definite nephrolithiasis.  The left\nkidney appears grossly unremarkable.  There are several focal hypodensities in\nthe renal cortices bilaterally, too small to characterize.  There is no\nsuspicious solid renal lesions within the limitations of an unenhanced scan. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient status post gastrojejunostomy from ___'s\nprocedure.  The distal small bowel demonstrate normal caliber and wall\nthickness throughout.  Previously seen mild thickening and surrounding\nstranding of the ascending colon is no longer visualized.  The appendix is not\nvisualized.  Scattered diverticulosis without evidence of diverticulitis.\n\nPELVIS: The urinary bladder is unremarkable.  The distal ureters are partially\nvisualized.  Interval removal of the Foley catheter since ___.  There is\nno free 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 no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of the visualized spine.\n\nSOFT TISSUES: Mild diffuse subcutaneous edema, similar compared to prior.",
            "output": "1. Interval development of moderate to severe right hydronephrosis.  The\nunderlying cause is not identified, although the examination is severely\nlimited by noncontrast technique and lack of visceral fat.\n2. No definite abdominopelvic metastasis, although the development of new\nright hydronephrosis and absence of a stone raises concern for a potential\nobstructing lesion.\n3. Please refer to same day chest CT report for description of intrathoracic\nfindings.\n\nRECOMMENDATION(S):  Further evaluation with MRI or PET could be considered if\nrenal function precludes contrast-enhanced CT.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 14:10 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: There is increased the linear opacifications at the right lung\nbase in the right middle lobe and right lower lobe which could represent\natelectasis or fibrosis.  There is a tiny calcified granuloma right lower\nlobe.  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 suspicious\nrenal 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. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or 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 and bilateral adnexae are grossly 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 no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No abdominal or pelvic mass.  No CT findings to explain the patient's\nabdominal 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 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 visualized.\n\nPELVIS: The urinary bladder appears slightly thickened though this may be due\nto underdistention.  And distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, globular uterus with heterogeneous\nenhancement.  Within the uterus there is a dominant, heterogeneous 5.7 x 5.1\ncm fibroid.  Of note, there is fluid along the fundus of the endometrium\n(series 2, image 57).  There is small volume pelvic fluid measuring\nlow-density.  No enhancing fluid collection to indicate abscess.  Ovaries are\nbetter assessed 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.  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. Redemonstration of a prominent, fibroid uterus.  A dominant fibroid\ndemonstrates substantial mass effect on the endometrium and measures\napproximately 5.7 x 5.1 cm.  The fibroid demonstrates heterogeneous\nenhancement, potentially due to degeneration. Small volume low-density pelvic\nfluid.\n2. Apparent bladder wall thickening, potentially due to underdistention though\ncorrelation with UA is suggested regarding the possibility of cystitis.\n3. No bowel obstruction nor evidence of colitis.  Appendix not definitively\nidentified.  Paucity of intra-abdominal fat, specifically in the right lower\nquadrant subsequently limits evaluation for assessment of adjacent\ninflammatory changes."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: Mild malrotation of the right kidney.\n\nGASTROINTESTINAL: Paucity of intra-abdominal fat limits assessment, and\nappendix as best appreciated on coronal sequences.  The appendix is retrocecal\nand extends into the right pelvis (series 601, image 27), it is fluid-filled\nand demonstrates mucosal enhancement, borderline measuring between 7-8 mm in\ndiameter.  There is a small amount of adjacent fluid and extending into the\ncul de sac, with probable reactive right iliac chain lymph node.\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 grossly within\nnormal limits.  The right adnexa abuts the cecum near the origin of the\nappendix (series 2, image 62), with a probable corpus luteum cyst.\n\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 raise concern for early tip appendicitis, without complication."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  There\nare numerous punctate bilateral nonobstructing renal calculi.  Excreted\ncontrast is present within the bladder, which is otherwise unremarkable.\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.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There are metallic tubal\nligation devices noted.  No adnexal mass.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute\nfracture.There are laminectomy changes at T11 and T12.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.  Soft tissues\nare otherwise unremarkable.",
            "output": "1. No acute findings in the abdomen or pelvis.\n2. Bilateral punctate nonobstructing renal calculi, more numerous on the left.\nNo 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 a 1 there are\nseveral stones in the left kidney that are nonobstructing.  The largest in the\ninterpolar region measures 4 mm on series 2, ___ 71.  There is a mild 1 mm\nstone on series 2 ___ 68 as well as 2 1 mm stones in the lower pole of the\nleft kidney on series 2 ___ 76.  In addition there is a there may be\nadditional minute stones best seen on series 602 ___ 69.  Mm non-obstructing\nstone in the upper pole of the right kidney.  (Se 2, ___ 64).   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.\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 consistent with the patient's\npostpartum state..\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 nonobstructing renal stones measuring up to 4 mm in the left\nkidney."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder is largely distended.  The distal ureters are unremarkable.\nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is post hysterectomy.  No large adnexal masses\nseen.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes of bilateral hips are noted with subchondral cyst\nformation and osteophyte formation, right greater than left.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute fracture."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  No pseudoaneurysm is\nidentified.\n\nLOWER CHEST: Small opacities in bilateral lung bases are less than before and\nlikely reflect resolving atelectasis.  There is no pleural or pericardial\neffusion.\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: Area of hypoenhancement at the head of the pancreas is similar to\nbefore and compatible with known necrotizing pancreatitis.  There is\npersistent large fluid collection surrounding the pancreas and tracking along\nbilateral Gerota's fascia and along the right pelvic wall.  The largest axial\ndimension measures 14.1 x 3.4 cm (3:113), smaller than before (previously 16.4\nx 4.0 cm), but possibly more organized.  Heterogeneous appearance of the fluid\ncollection near the pancreatic head is similar to before.\n\nSPLEEN: Enlarged spleen measures 15.5 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. \nNo hydronephrosis is seen bilaterally.\n\nGASTROINTESTINAL:  A transesophageal tube terminates in the jejunum.  Small\nbowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are within normal limits.  Appendix is\nunremarkable.\n\nRETROPERITONEUM: Multiple prominent retroperitoneal lymph nodes are not\npathologically enlarged.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.\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. Area of hypoenhancement in the pancreatic head is similar to ___ and\ncompatible with necrotizing pancreatitis.\n2. Peripancreatic fluid collection is overall smaller compared to ___ and\npossibly slightly more organized.\n3. Splenomegaly"
        },
        {
            "input": "A CT of the chest has been performed as part of this examination and will be\nreported separately.\n\nThere is a large left chest wall hematoma again noted measuring 31.2 cm in\nlength for which the reader is referred to the separate CT chest report.  In\naddition there are bilateral pleural effusions noted.\n\nThere is a small volume of perihepatic ascites unchanged from the prior exam. \nAssessment of the solid organs is limited by the non-contrast technique. The\nliver attenuation is heterogeneous, in keeping with the patient's known\nextensive HCC.  There is a 4.5 x 3.1 cm subcapsular fluid collection along the\nanterior aspect of the left lobe of the liver anteriorly.  The portal vein is\nmassively expanded by tumor thrombus.\n\nCholelithiasis is noted.  The spleen is normal size.  There are perisplenic\nvarices noted.  The pancreas and adrenal glands are unremarkable.\n\nThe kidneys are increased in attenuation on this non-contrast study in keeping\nwith renal dysfunction.  There is a 4.5 cm cortical cyst arising from the\nlower pole of the right kidney.\n\nThere is a Foley catheter in the bladder, and temperature probe in the rectum.\n\nMinor atheromatous calcification is seen involving the abdominal aorta and the\niliac arteries. There are surgical clips along the iliac vessels in keeping\nwith prior lymph node dissection, and the patient has had a prostatectomy.\n\nDiffuse body wall edema is noted. Multilevel degenerative disc and facet joint\nchanges are present. There is no osseous lesion.",
            "output": "1. Large left chest wall hematoma, and bilateral pleural effusions. The reader\nis referred to the CT chest report for more detailed description of thoracic\nfindings.\n2. The patient's known extensive HCC, and portal vein tumor thrombus is not\nwell evaluated on this non-contrast study, but appears grossly unchanged from\nthe prior exams. There is a small volume of ascites.\n3. Persistent contrast opacification of the kidneys on this non-contrast\nexamination after CT from one day prior is in keeping with renal dysfunction.\n4. Cholelithiasis."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  Emphysema is noted at the lung\nbases.\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\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nPANCREAS: A 15.0 x 12.9 x 15.7 cm mass in the pancreatic head with\nheterogenous enhancement and central necrosis has increased in size from the\nprior study when it was previously 14 x 10 x 11 cm.  The mass displaces the\nadjacent bowel and mesenteric vessels, but does not encase them. The remainder\nof the pancreatic body and tail enhance homogenously. There is no main\npancreatic duct dilation.\n\nADRENALS: The right and left adrenal glands are normal.\n\nURINARY: The kidneys enhance symmetrically and excrete contrast promptly\nwithout hydronephrosis. Hypodensities are seen in the left kidney, some of\nwhich are too small to characterize and others of which are simple cysts\nmeasuring up to 5.2 cm in the left renal upper pole and 5.9 cm in the left\nrenal lower pole.\n\nGASTROINTESTINAL: The small and large bowel are normal in caliber without\nobstruction. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening and fat stranding.. Appendix contains air, has normal caliber\nwithout evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy.  Small retroperitoneal lymph nodes are not\nenlarged by CT size criteria and are unchanged from ___. There is\nno free fluid and no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in\nthe abdominal aorta and great abdominal arteries.  Incidentally noted is a\nreplaced left hepatic artery from the left gastric artery and a replaced right\nhepatic artery from the SMA.  The IVC is compressed but patent. The main\nportal vein and splenic vein are patent. The SMV is not opacified on today's\nstudy, unchanged.  The left renal vein is compromised by the mass with\npara-spinal collateral flow. Para-esophageal varices are also noted, likely\ncollaterals.\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. Prostate is unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Subcutaneous lesions in the left chest wall measuring 4.0 cm (04:49)\nand 2.4 cm (4:62) are unchanged since ___. Multiple additional\nsubcutaneous nodules are also similar to prior.",
            "output": "1.  Interval increase in size of pancreatic mass since ___. The\nmass causes venous compression as detailed above with collateral vessels.\n2.  No new disease in the abdomen and pelvis.\n3.  CT chest reported separately."
        },
        {
            "input": "LOWER CHEST: Large right lower lobe known non-small cell lung carcinoma is\nincompletely imaged and reference is made to prior CTA study report of ___.  This mass is inseparable from the diaphragm.  Small right-sided pleural\neffusion with adjacent atelectasis.  Trace left-sided pleural effusion\n\nABDOMEN:\n\nHEPATOBILIARY: Nutmeg appearance of the liver most likely secondary to\ncongestion from IVC infiltration by the lung mass.  Subcentimeter hypodense\nlesion in segment 6 of the liver is too small to accurately characterize. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder contains a 2.4 cm gallstone, but no features of 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 left adrenal appears bulky, but no focal discrete lesion.  The\nright adrenal appears normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSimple appearing left renal cortical 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 normal.\n\nPELVIS: Multiple bladder diverticula.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Left adnexal cystic lesion measuring 2 cm diameter.\n\nLYMPH NODES: There is a large necrotic lymph node measuring 16 mm in diameter\nadjacent to the IVC at the level of the caudate lobe (series 2, image 19)\nmeasuring 16 mm in diameter.  Indeterminate retrocrural lymph node (series 2,\nimage 22).\n\nVASCULAR: The pulmonary mass invades the suprahepatic IVC.  No clear extension\ninto the right atrium.  The right gonadal vessels are distended and\nunopacified with contrast suggesting ovarian vein thrombophlebitis.\n\nBONES: There 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 right lower lobe known non-small cell lung carcinoma is incompletely\nimaged and reference is made to prior CTA study report of ___.\n2. This mass is inseparable from the diaphragm and diaphragmatic involvement\ncannot be excluded.\n3. This mass invades the suprahepatic IVC.\n4.   Metastatic para caval lymph node in the upper abdomen adjacent to the\ncaudate lobe of the liver.\n5.   The left adrenal appears bulky, but no focal discrete lesion.\n6.   Right ovarian vein thrombophlebitis.\n7.   Cholelithiasis, no features of cholecystitis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with\nDr. ___ on the ___ ___ at 5:55 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. 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 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. Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes have progressed slightly, now with new\nsuperior endplate compression and sclerosis at L2.  Inferior endplate\nsclerosis at L4 is unchanged.  Lumbarization of the S1 vertebral body is again\nseen.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No abdominopelvic lymphadenopathy.\n2. New ( since the last scan) mild compression deformity and sclerosis of the\nsuperior endplate of L2 is concerning for an age indeterminate fracture ,\nlikely post traumatic and unchanged sclerosis of the inferior endplate of L4\n(using similar convention to prior study, with lumbarization of S1).\n3. Please refer to separate report of CT chest performed same day 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: The liver is shrunken and nodular in contour, compatible with\ncirrhotic morphology.  There is no evidence of focal lesions. The common bile\nduct is dilated up to 1.0 cm (601:28).  This appears similar to prior MRCP\nperformed ___.  There is no evidence of an obstructing stone or\nmass.  The gallbladder is within normal limits.  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 enlarged up to 14.4 cm in AP dimension (02:22).  No\nfocal splenic lesions 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: 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 is underdistended with Foley catheter in place. \nThere is trace free 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 no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Gastric, esophageal, and splenic varices are noted.  Again\ndemonstrated is a recannulized umbilical vein.\n\nBONES: Moderate to severe degenerative changes of the bilateral hip joints,\nright greater than left.  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. Cirrhotic liver morphology with sequelae of portal hypertension including\nsplenomegaly, moderate volume ascites, and abdominal varices.\n2. Mildly dilated common bile duct up to 1.0 cm, similar to prior MRCP\nperformed ___.  No evidence of an obstructing stone.\n3. Moderate to severe degenerative changes of the bilateral hip joints.\n4. Otherwise, no acute findings in the abdomen or pelvis to account for\npatient'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 displays diffuse hypoattenuation suggestive of\nsteatosis.  The liver contour appears slightly nodular.  There are more focal\nareas of subtle hypodensity within the liver which are incompletely\ncharacterized on this single-phase study.  For example a 3.7 cm hypodensity in\nsegment IV (02:55).  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is distended with mild wall thickening\nbut without surrounding inflammatory change.  No 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 is mildly enlarged up to 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube is coiled in the stomach, however with the tip\npointing towards the pylorus.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  There is wall thickening and\nedema of the cecum which is likely due to portal colopathy.  There are sigmoid\ndiverticula without evidence of acute diverticulitis.  The appendix is not\nidentified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace ascites 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 no 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 inguinal hernias, the one on the left\ncontaining fat, and the one on the right containing fat and a small amount of\nfluid. There is diffuse anasarca. There is a 8 mm nonspecific soft tissue\nnodule at the umbilicus, may be a sebaceous cyst.",
            "output": "1. Suggestive of diffuse hepatic steatosis with possible cirrhosis.  There are\nmore focal ill-defined areas of hypodensity within the liver which may be due\nto patchy fat deposition, however are incompletely characterized this\nsingle-phase study.  Non urgent liver MRI could be obtained for further\ncharacterization.\n2. Splenomegaly and trace ascites.\n3. Wall thickening and edema of the cecum is likely due to portal colopathy,\nhowever colitis cannot be excluded.  The appendix is not identified.\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: Hepatic contour appears subtly nodular and there is widening of\nthe hilar periportal space, consistent with cirrhosis.  Heterogeneous hepatic\nenhancement is presumably related to cirrhosis.  Hypoattenuating lesions are\ntoo small to completely characterize, but most consistent with cysts or\nbiliary hamartomas.  No arterially enhancing lesions identified.  The portal\nveins and hepatic veins are patent.  Hepatic arterial anatomy is conventional.\nNo intrahepatic or extrahepatic biliary ductal dilation.  There is mild\ndiffuse gallbladder wall edema.  There is a 3 mm gallbladder polyp (series\n301, image 62).  The gallbladder is not significantly distended.  There is\ntrace 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 measures up to 16.0 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 renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Difficult to distinguish\nbetween known sigmoid colon strictures and luminal underdistention.  Cecal\nwall edema has resolved.  Hyperattenuating dependent material in the cecum\ndoes not change on postcontrast imaging.  No evidence of active extravasation.\nThe appendix is normal.\n\nPELVIS:  There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  No significant major visceral artery stenosis, dissection,\nor aneurysm.  There is a recanalized umbilical vein.  The mesenteric veins and\nportal veins 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 evidence of significant arterial stenosis or other significant arterial\npathology.  Aortic atherosclerosis is very mild.\n2. No evidence of intraluminal contrast extravasation.\n3. Cirrhosis with evidence of portal hypertension including a recanalized\numbilical vein, trace perihepatic ascites, and splenomegaly."
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion with associated\natelectasis.  Slightly more dense appearance of intraventricular septum could\nrepresent anemia.  There is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There are a few subcentimeter hypodense lesions within the\nliver which are too small to characterize but likely represent cysts of\nhamartomas.  The liver has a slightly nodular and shrunken contour in keeping\nwith cirrhosis.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is not distended.  Gallbladder wall thickening,\nlikely secondary to third spacing or cirrhosis.  A couple of punctate\nhyperdense dependent calculi in the neck 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: There is splenomegaly with the spleen measuring 16.0 cm in the\ncraniocaudal dimension, previously 14 cm.  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.  There is no suspicious\nrenal 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.\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 few prominent celiac axis lymph nodes, likely related\nto cirrhosis.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are old right sided rib fractures. 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. Cirrhotic morphology of the liver with sequela of portal hypertension.\n2. Splenomegaly appear slightly increased: Currently 16 cm, previously 14 cm\n3. Small right pleural effusion with associated atelectasis.\n4. Cholelithiasis without definite evidence cholecystitis.  The gallbladder is\nnot distended.  Mild gallbladder wall thickening likely secondary to third\nspacing or cirrhosis.  If there is clinical concern consider dedicated\ngallbladder ultrasound."
        },
        {
            "input": "LOWER CHEST: Trace nonhemorrhagic right pleural effusion.  Minimal bibasilar\natelectasis.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are again several subcentimeter hypodensities in the hepatic dome which\nare too small to characterize but likely represent 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. \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.  The distal\ntransverse, descending, and sigmoid colon are mildly decompressed however\nthere does appear to be wall thickening out of proportion to the expected\nrange which could represent mild colitis in an area that demonstrates\ndiverticuli and mild surrounding stranding (2:83, 47, 40; ___.  Mild\nprominence of the Vasa recta at the junction of the descending and sigmoid\ncolons (2:70; 601:25) and trace free fluid along the pericolic gutter.  No\nevidence of perforation or abscess.\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 appear 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: Tiny umbilical hernia containing fat is noted.",
            "output": "Mild colitis involving the sigmoid, and potentially distal transverse and\ndescending colons.  Infectious and inflammatory etiologies are favored or\npossibly diverticular disease.  No perforation or abscess.  No bowel\nobstruction.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___,\nM.D. on the telephone on ___ at 4:51 pm, 2 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST: There is no evidence of pleural or pericardial effusion.  Diffuse\nperilymphatic nodularity is seen in the partially visualized lungs, better\nassessed on dedicated CT chest from ___.  There is partial\nvisualization of a 1.2 cm right pericardial lymph node (2:1), slightly less\nconspicuous compared to the prior CT chest from ___.\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 mildly enlarged, measuring up to 13.5 cm.  The spleen\nshows 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. Diverticulosis of the sigmoid colon is noted, without evidence of\nwall thickening or 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: Probable subserosal fibroid along the right side of the\nuterine body measures 2.5 cm (2:77), unchanged from prior study.  The uterus\nis otherwise unremarkable.  No adnexal abnormality identified.\n\nLYMPH NODES: There is stable appearance of a mildly prominent pericaval lymph\nnode measuring 1.1 cm (2:32), likely reactive.  There is no mesenteric\nlymphadenopathy.  There 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: Small fat containing umbilical hernia.  Small fat containing\nbilateral inguinal hernias, left slightly greater than right.  The abdominal\nand pelvic wall is otherwise within normal limits.",
            "output": "1. No evidence of acute abnormality identified within the abdomen or pelvis\nwhich would explain patient's current symptoms.\n2. Scattered sigmoid diverticulosis without evidence of diverticulitis.\n3. Redemonstration of diffuse perilymphatic nodularity in the partially\nvisualized lungs and mildly enlarged right pericardial lymph node, slightly\nless conspicuous compared to the prior CT chest from ___. \nDifferential considerations again include pulmonary sarcoidosis versus\npossible respiratory bronchiolitis.\n4. Stable appearance of a mildly prominent pericaval lymph node measuring 1.1\ncm, likely reactive.\n5. Small fibroid uterus."
        },
        {
            "input": "LOWER CHEST: Smooth interstitial thickening within the bilateral lung bases is\nsuggestive of mild interstitial edema.  Status post aortic and mitral valve\nreplacements.  Moderate cardiomegaly is stable.  Extensive coronary artery\ncalcifications are again seen.  No pericardial or pleural effusion.\n\nABDOMEN:\n\nEvaluation is slightly limited due to suboptimal contrast timing, but the\nstudy remains diagnostic for the given indication.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild central intrahepatic biliary duct\ndilatation is stable.  No extrahepatic biliary dilatation.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: There is moderate fatty atrophy of the pancreatic head, increased\nfrom prior.  The pancreas has otherwise 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. \nApparent nodular cortical contour is likely congenital or secondary to prior\ninfection, and appears similar to prior.  Bilateral parapelvic cysts have\nessentially resolved.  Few subcentimeter hypodensities throughout the\nbilateral kidneys are too small to characterize but statistically likely\nrepresent cysts.  There is no hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia is again seen.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  A large amount of gas is seen within the rectum\nwhich is otherwise unremarkable.  There is mild sigmoid 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 uterus is unremarkable.  No adnexal abnormality.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: The portal vein, SMV, and splenic veins are patent.  There is no\nabdominal aortic aneurysm.  Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPartially visualized median sternotomy wires appear intact.\n\nSOFT TISSUES: Midline postsurgical changes are seen about the midline\nepigastrium.  A tiny fat containing umbilical hernia is again seen.  There is\nnonspecific induration of the skin at the umbilicus, similar to prior.",
            "output": "1. No acute findings within the abdomen or pelvis to explain the patient's\nreported symptoms.  Specifically, no evidence of obstruction or localizing\nsource of infection.\n2. Mild interstitial pulmonary edema.\n3. Diverticulosis without acute 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 homogenous attenuation 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:  There is bilateral mild adrenal thickening, possibly hyperplasia.\n\nURINARY:  The kidneys, bilaterally, have a nodular appearance likely\ncongenital or secondary to previous infection. The kidneys enhance\nsymmetrically and excrete contrast promptly without hydronephrosis.  There are\ninnumerable bilateral parapelvic and parenchymal hypodensities which\nconsistent with renal cyst and unchanged from the previous examination.\n\nGASTROINTESTINAL:  There is a small hiatal hernia. The small and large bowel\nare normal in course and caliber without obstruction. Colon and rectum are\nwithin normal limits. Appendix  has normal caliber without evidence of fat\nstranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The main portal\nvein, splenic vein and SMV are patent.\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. There is a small lobulation of the left side of the uterus which is\npossibly a fibroid.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.",
            "output": "1. No evidence of pathology in the abdomen or pelvis to explain the patient's\nweight loss, nausea, or epigastric pain.\n\n2.  Possible left-sided uterine fibroid.\n\n3.  Possible mild bilateral adrenal hyperplasia"
        },
        {
            "input": "LOWER CHEST:\n\nThere is minimal dependent atelectasis. The visualized lung bases are\notherwise clear, without 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.\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 symmetric and normal in size. A nodular appearance is\nagain likely congenital or secondary to previous infection, unchanged from\nprior exam. Bilateral parapelvic cysts are noted.  Hypodensities bilaterally\nare too small to characterize, but likely represent cysts. These are unchanged\ncompared to ___ .\nGASTROINTESTINAL:  A small hiatal hernia is again noted. Small and large bowel\nloops are within normal limits, normal in caliber without wall thickening or\nevidence of obstruction. A normal, air-filled appendix is visualized.\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.  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. The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. No findings to explain the patient's symptoms.\n2. Unchanged bilateral renal hypodensities, too small to characterize, likely\nrepresent cysts.\n3. Small hiatal hernia."
        },
        {
            "input": "There is no pleural or pericardial effusion.  ___ node in the left\nlung is stable back to ___.  Lung bases otherwise clear.\n\nWithin the limitations of a noncontrast enhanced CT, the liver, spleen,\npancreas, and adrenal glands are normal appearing.  There is possibly a small\nstone in the gallbladder neck (image 2:26) which was also seen on prior\nimaging.  There is no pericholecystic fluid or gallbladder wall thickening.\n\nThe kidneys are normal-appearing. There is no hydronephrosis in either kidney.\nThere are no focal densities to suggest stones in the kidneys, ureters, or\nbladder.  The previously seen 1.2 mm density in the left lower renal pole is\nno longer present. Asymmetric thickening of the posterior and left lateral\nwall bladder is again noted, similar to prior MR study. Seminal vesicles and\nprostate are normal.\n\nThe stomach is normal appearing without evidence of intraluminal mass. There\nis no bowel dilatation to suggest obstruction.  The appendix is\nnormal-appearing. There is no free fluid or free air.  The abdominal aorta is\nof normal caliber.\n\nThere are multilevel degenerative changes of the spine without focal lesions.",
            "output": "1. No radio-opaque stones in bilateral kidneys, ureters, or bladder. No\nhydronephrosis.  No findings to explain patient's symptoms.\n2. Stable asymmetric thickening of the posterior and left lateral bladder\nwall, also described on prior MR study from ___."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases.  There is no\npneumothorax.  No 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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 partial right upper pole nephrectomy. \nPostsurgical hyperdense material is present on the precontrast imaging. \nPostsurgical perinephric hematoma is noted.  Air locules are present in the\nperinephric, anterior pararenal space as well as in the peritoneal cavity an\nexpected postoperative finding.  There is no active arterial extravasation of\ncontrast. There is no evidence of pseudo aneurysm (although isolated arterial\nimaging was not performed to assess for early venous filling).   There is\npersistent hypodense perfusional changes in the superior and posterior aspect\nof the right kidney suggesting hypoperfusion/renal infarction (series 8, image\n26).  There is no extravasation of contrast from the right renal collecting\nsystem.\nSubcentimeter simple appearing cyst in the kidneys bilateral.\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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Minimal soft tissue density in the distal right ureter most likely\nrepresents hematoma.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is minimal free fluid in the pelvis.\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: No suspicious bone lesions.  Bilateral L5 spondylolysis with minimal\ngrade 1 anterior spondylolisthesis.\n\nSOFT TISSUES: Postsurgical air is seen in relation to the right anterior\nabdominal wall.",
            "output": "1. The patient is status post partial right upper pole nephrectomy with\nexpected postsurgical changes.  There is no active arterial extravasation of\ncontrast.  There is no evidence of pseudoaneurysm formation (although isolated\narterial imaging was not performed to assess for early venous filling).\n2. There is persistent hypodense perfusional changes in the superior and\nposterior aspect of the right kidney suggesting hypoperfusion/renal\ninfarction.\n3. There is no extravasation of contrast from the right renal collecting\nsystem.  No hydronephrosis."
        },
        {
            "input": "PELVIS: Foley within the bladder which is decompressed with a small amount of\nlikely iatrogenic air.  Normal prostate and seminal vesicles.\n\nPERITONEUM/RETROPERITONEUM: No ascites or pneumoperitoneum.\n\nLYMPH NODES: No adenopathy\n\nVASCULAR: The common femoral, internal, external, and common iliac veins are\npatent..  No venous thrombosis is visualized.  The common, external, internal,\nand common femoral arteries are patent.\n\nBONES: Partially sacralized of the left L5-S1 vertebral bodies.\n\nSOFT TISSUES: Unremarkable",
            "output": "No evidence of pelvic venous thrombosis."
        },
        {
            "input": "LOWER CHEST:\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.  New small pericardial and left pleural\neffusions.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The hepatic parenchyma enhances homogeneously.  The previously\nvisualized segment VII subcentimeter hypodensity is not seen on today's exam. \nNo focal liver lesions noted.  The portal vein and its branches are patent.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: The pancreatic parenchyma enhances homogeneously without main duct\ndilation..\nSPLEEN:  No splenomegaly.  A 1.5 cm subcapsular pocket of fluid along the\nspleen (series 4, image 55) is unchanged from before..\nADRENALS:  No adrenal nodules.\nURINARY: No hydronephrosis seen on either side.  No solid enhancing renal\nmasses identified.\nGASTROINTESTINAL: The patient is post distal esophagectomy and gastric\npull-through.  There is soft tissue thickening along the distal gastric wall\n(series 4, image 55) that was also present on the prior scan and is unchanged\nin thickness, likely representing postsurgical change, continued attention on\nfollow-up recommended.\n\nLYMPH NODES: There are no enlarged lymph nodes in the retroperitoneum or\nmesentery..\nVASCULAR: Abdominal aorta is normal in caliber.  No atherosclerotic changes\nidentified.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  No prostatomegaly. \nNormal seminal vesicles.  No free fluid in the pelvis or pelvic\nlymphadenopathy.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  There is a levoconvex curvature of\nthe upper lumbar spine.",
            "output": "1. New small pericardial and left pleural effusions.Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n2. Post distal esophagectomy with a gastric pull-through.  Linear soft tissue\nthickening along the stomach is stable compared to the prior exam and likely\nrepresents postsurgical changes, close attention on follow-up recommended.\n3. No liver lesions, suspicious osseous lesions or abdominal/pelvic\nlymphadenopathy noted."
        },
        {
            "input": "LOWER CHEST: Patient is status post esophagectomy and gastric pull up. \nMinimal atelectasis is identified adjacent to the intrathoracic stomach.  The\nno suspicious pulmonary nodule pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY:   The liver is normal in size.  No focal hepatic lesions are\nidentified.  This interval decompression of the dilated intrahepatic bile\nducts to the presence of 3 metallic stents.  Pneumobilia is identified left\nlobe of liver.  The gallbladder is also decompressed.  The intrahepatic\nvasculature is patent.  There is unchanged changed appearance of the small\nnodules adjacent to the left lobe of 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 and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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. \nOsteopenia is identified in the left proximal femur, similar to on the prior\nstudy.\n\nSOFT TISSUES: There is a stable 1.6 cm enhancing nodule in the right rectus\nabdominus muscle consistent with a metastatic lesion.",
            "output": "1. Status post interval placement of 3 metallic stents in the biliary tree\nwith subsequent decompression of the intrahepatic bile duct dilation.  2. \nStable soft tissue nodules along the liver and stomach enhancing right rectus\nabdominus lesion consistent with metastatic lesions."
        },
        {
            "input": "LOWER CHEST: The patient is status post esophagectomy with gastric\npull-through.  Please refer to 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. \nThere is redemonstration of a subcentimeter nodule inferior to the left\nhepatic lobe, unchanged from prior study (05:28).  There are 3 metallic\nbiliary stents in unchanged position with interval development of mild\nintrahepatic biliary ductal dilatation, right greater than left, which appears\nnew compared to prior study dated ___.  There is unchanged\npneumobilia in the left hepatic lobe.  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 patient is status post resection of the gastroesophageal\njunction cancer and gastric pull-through with expected postsurgical anatomy. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged scoliosis of the thoracic spine with convexity to the right.\n\nSOFT TISSUES: There is redemonstration of a enhancing nodule in the right\nrectus abdominus muscle measuring 1.6 cm, unchanged from prior study.",
            "output": "1. Unchanged soft tissue nodules inferior to the liver and within the right\nrectus abdominus muscle, compatible with metastatic lesions.  No evidence new\nmetastatic lesions in the abdomen and pelvis.\n2. Interval development of mild right intrahepatic biliary ductal dilatation,\nnew from prior study dated ___.  Metallic biliary stents are in\nstable position with no definite 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: Patient is status post esophagectomy with gastric pull-through. \nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver demonstrates homogeneous attenuation throughout.  There\nare no suspicious hepatic lesions.  There are three biliary stents in\nunchanged position with interval stability of left hepatic lobe pneumobilia\nand right greater than left mild intrahepatic biliary ductal dilatation. \nGallbladder is decompressed and unremarkable.  No perihepatic ascites.  The\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: Patient is status post esophagectomy and gastric\npull-through.  There is no small-bowel obstruction.  Colon and rectum\nunremarkable.  The appendix is normal.  No free fluid in the abdomen.\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 within normal limits.\n\nLYMPH NODES: An 8 mm nodule inferior to the left hepatic lobe is unchanged\nfrom prior (2:72).  No lymphadenopathy within the abdomen or pelvis by CT size\ncriteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: There is S-shaped scoliosis of the thoracolumbar spine.  No suspicious\nosseous lesions.\n\nSOFT TISSUES: There is a 1.6 x 1.1 mm enhancing lesion in the right internal\noblique muscle, stable from prior (2:83).  A hyperenhancing lesion in the\nright rectus abdominus muscle measures 2.5 x 1.7 cm, previously 2.1 x 1.8 cm\n(2:98)",
            "output": "1. Interval increase in size of a enhancing lesion in the right rectus\nabdominus muscle.  Enhancing lesion in the right internal oblique muscle is\nstable in size from prior.  No new sites of metastatic disease within the\nabdomen 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: Will be reported separately\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  3 CBD stents in situ with mild\ndilatation of the intrahepatic bile ducts appearing similar compared to prior.\nLeft intrahepatic bile ducts are filled with air indicating patency.  Air is\nnoted in all 3 the biliary stents suggesting patency.  The gallbladder is\ncollapsed\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal 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 gastro esophagectomy with\ngastric pull-up.  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: Subcentimeter periportal lymph nodes appear similar compared to\nprior.  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. \nSpinal asymmetry/curvature is unchanged.\n\nSOFT TISSUES: The partially calcified lesion in the right rectus abdominus\nmuscle demonstrating hyperenhancement is increased in size compared to prior\ncurrently measuring 29 x 21 mm (previously 25 x 17 mm).  The hyperenhancing\nlesion in the right internal oblique measuring 19 x 16 mm in diameter is\nincreased in size compared to prior, previously measuring 16 x 11 mm. \nPeriumbilical hyperenhancing soft tissue nodule (series 11, image 51)\nmeasuring 19 x 14 mm is increased in size compared to prior currently\nmeasuring 17 x 10 mm.",
            "output": "1. 3 hyperenhancing soft tissue nodules in the anterior abdominal\nwall/musculature as described above is slightly increased in size compared to\nprior imaging.\n2. No new intra-abdominal or pelvic lesions identified\n3. For chest findings reference is made to CT chest report of the same date.\n4. For CNS findings reference is made to brain MR done ___"
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour.  There is mild focal fat deposition\nalong the falciform ligament.  In the subcapsular segment VII of the liver,\nthere is a small hypoattenuating lesion which measures approximately 7 mm in\ndiameter, and has the attenuation of a cyst.  This lesion was likely present\non the remote CT performed in ___, although less conspicuous.  Several\nadditional tiny foci of Hypoattenuating are too small to characterize by CT. \nPortal and hepatic veins patent.  Normal gallbladder.  No intrahepatic or\nextrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  There is a\ntiny 4 mm cystic lesion in the tail of the pancreas, not definitely seen on\nthe prior examinations.  The main pancreatic duct is not dilated.\n\nSPLEEN: The spleen is not enlarged (9 cm.  Again noted are several tiny\naccessory spleens in the left upper quadrant.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Bilateral renal cortical cysts.  The largest is localized to the\nlower pole of the left kidney.  It demonstrates no significant growth from the\nremote CT performed in ___.  No focal parenchymal lesions otherwise.  No\nhydronephrosis.  No nephrolithiasis.\n\nGASTROINTESTINAL: Stomach is unremarkable.  No abnormality of the small bowel.\nUncomplicated sigmoid and descending diverticulosis.  Appendix in the right\nlower quadrant normal.\n\nPELVIS: Urinary bladder largely collapsed.\n\nREPRODUCTIVE ORGANS: Patient is status post prostatectomy. Seminal vesicles\nunremarkable.  Of note is a penile implant.  A fluid filled balloon reservoir\nis noted along the anterior left pelvis, but high in the left rectus abdominus\nmuscle.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Mild aortoiliac atherosclerosis.  No abdominal aortic aneurysm. \nMajor branch vessels of the abdominal aorta patent.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.",
            "output": "1. No evidence of acute abdominal or pelvic pathology to explain patient's\nsymptoms.\n2. No evidence of metastatic disease to the abdomen and pelvis.  No evidence\nof bone metastases.\n3. Uncomplicated colonic diverticulosis.  No findings of acute diverticulitis.\n4. Incidental 4 mm cystic lesion in the tail of the pancreas.  The main\npancreatic duct is not dilated.\n\nRECOMMENDATION(S):  For management of pancreatic cyst(s) up to 5 mm in\npatients in less than ___ years of age, a non-contrast MRCP follow-up is\nrecommended in ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from: ___"
        },
        {
            "input": "LOWER CHEST:\n\nThe visualized 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\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits,\nwithout stones or gallbladder wall thickening.  Periportal edema and\npericholecystic fluid are consistent with third spacing secondary to IV fluid\nadministration.\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 symmetric and normal in size, demonstrating normal\nnephrograms and excrete contrast promptly. There is no focal mass or\nhydronephrosis.\nGASTROINTESTINAL:  Small bowel loops are normal in caliber, without wall\nthickening or evidence of obstruction. The colon and rectum appear normal.\nAlthough the appendix is not visualized, there are no secondary signs of acute\nappendicitis.\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.\nREPRODUCTIVE ORGANS: The uterus and left adnexa appear normal.  The right\novary appears enlarged compared to the left, with multiple hypodense foci.\nThis could be due to inability to separate the ovaries from adjacent small\nbowel, leading to overestimation of right ovarian size, versus physiologic\ncyst. However, ovarian torsion cannot be excluded on this exam. There is trace\nfree fluid adjacent to the right adnexa.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. Enlarged appearance of the right ovary compared to the left, which is\nincompletely evaluated. This could be due to inability to separate the ovary\nfrom adjacent small bowel or due to physiologic cysts, but ovarian torsion\ncannot be excluded on CT. Further evaluation with a pelvic ultrasound was\nrecommended and demonstrated normal ovaries without evidence of torsion.\n2. Periportal edema and pericholecystic fluid, likely due to third spacing in\nthe setting of IV fluid administration. No evidence of acute cholecystitis."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.  There is atelectasis at the\nlung bases.\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\nSPLEEN: The spleen shows normal size and attenuation throughout. Two splenic\nhypodensities are unchanged from ___, likely representing\nhemangiomas.\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. Simple cysts in both kidneys measure up to 4.3 cm in\nthe left renal lower pole and 3.7 cm in the right renal lower pole. These are\nunchanged.\n\nGASTROINTESTINAL: The small and large bowel are normal in course and caliber\nwithout obstruction. Diverticulosis of the sigmoid colon is noted, without\nevidence of wall thickening and fat stranding..\n\nMESENTERY AND RETROPERITONEUM: Subcentimeter retroperitoneal lymph nodes with\nnormal fatty hila are unchanged from ___. Mesenteric and\nretroperitoneal lymph nodes are not enlarged by CT size criteria. There is no\nfree fluid and no free air.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries. The main portal\nvein, splenic vein and SMV are patent.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable. Subcentimeter\npelvic and inguinal lymph nodes are unchanged from ___ not\nenlarged by CT size criteria. There is no free fluid in the pelvis. The\nprostate is enlarged with suggestion of prior TURP.\n\nBONES AND SOFT TISSUES: Heterogeneous attenuation and multiple ill-defined\nlucencies in the vertebral bodies of the thoracic and lumbar spines is\nunchanged from ___. Degenerative change in the lower thoracic and\nlumbar spine is also similar to the prior study. The patient is status post\nmedian sternotomy. Cervical spinal hardware is incompletely evaluated. The\npatient is status post ventral hernia repair. A ventral hernia within the\nepigastrium and another ventral hernia inferior to the mesh both contain fat\nwithout evidence of strangulation.",
            "output": "1. No change from ___. No enlarged lymph nodes in the abdomen or\npelvis.  CT chest reported separately.\n2. Heterogeneous appearance of the vertebral bodies with multiple ill-defined\nlucencies, unchanged from ___.  Lymphomatous involvement cannot be\nexcluded.\n3. Chronic findings of sigmoid diverticulosis, splenic hypodensities most\nlikely hemangiomas, and fat containing ventral abdominal wall hernias."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. There is no pleural or pericardial\neffusion..\n\nABDOMEN:\n\nThe liver the enhances homogeneously and with is without focal lesions. The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. There is no evidence of radiopaque\ngallstones. The gallbladder is unremarkable.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening.  The proximal appendix is mildly\ndilated with some associated fat stranding measuring up to 9 mm (601b: 24). A\ndensity at its base likely represents a fecalith (series 601b:27). There is no\nevidence of diverticulitis.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified.  The uterus is unremarkable. Follicles are noted within the right\novary.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  There is bilateral spondylolysis and spondylolisthesis of L5\nvertebral body, likely an incidental finding.",
            "output": "1. Mild dilation of the proximal appendix and surrounding fat stranding with a\nminimally dilated appendiceal tip, findings are concerning for appendicitis.\n2. Bilateral spondylolysis of the L5 vertebral body, likely an incidental\nfinding.\n\nNOTIFICATION:  Findings discussed with Dr. ___ by Dr. ___ the\ntelephone on ___ at 22:20, 5 min after they were made."
        },
        {
            "input": "CHEST: The visualized lung bases demonstrate moderate bibasilar atelectasis,\nwith no pleural effusion. Calcified granuloma is noted at the right lung base\n(06:10). The heart is top-normal in size with no pericardial effusion.\n\nABDOMEN:\nThe liver is normal in attenuation with minimal intrahepatic biliary\nprominence, which can be seen status post cholecystectomy. The spleen is\nnormal in attenuation. The gallbladder surgically absent. The pancreas is\nmildly atrophic, with no surrounding inflammatory change. The kidneys are\natrophic bilaterally, with cortical hypodensities indicative of cysts, the\nlargest off the interpolar region of the left kidney measuring up to 5.6 cm\n(06:37). No hydronephrosis. The adrenal glands are normal bilaterally. Stomach\nis decompressed, and the small bowel is normal in caliber. The region of the\nileocolic anastomosis demonstrates passage of contrast into the large bowel,\nwith no evidence of extraluminal extravasation. Immediately proximal to the\nanastomosis is a circumferentially thickened loop of ileum with surrounding\nmesenteric stranding, but no drainable fluid collection. The remainder of the\nlarge bowel is normal with no inflammation. No free air or free fluid.\nReactive mesenteric lymphadenopathy is noted.\n\nPELVIS:\nUrinary bladder, uterus, and adnexal structures are unremarkable. The rectum\nand sigmoid are normal in caliber. There is no pelvic free fluid or\nlymphadenopathy.\n\nVESSELS: The aorta demonstrates mild atherosclerotic calcification without\naneurysmal dilatation and its major branches are patent.\n\nOSSEOUS STRUCTURES: No concerning osseous lesion is seen.",
            "output": "1.  Patent ileocolic anastomosis With no extravasation of oral contrast.\n2. Just proximal to the anastomosis, focal concentrically thickened loop of\nileum with surrounding stranding. No drainable fluid collection. Etiologies\ninclude infectious, inflammatory, and less likely ischemic, as the vasculature\ndemonstrates a paucity of atherosclerosis."
        },
        {
            "input": "LOWER CHEST: Trace right pleural effusion is new from ___. \nPlatelike atelectasis is noted at the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Normal appendix.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace free\nfluid in the pelvis is likely physiologic.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is noted.  The ovaries are unremarkable in\nappearance.\n\nLYMPH NODES: There is no retroperitoneal lymphadenopathy by size criteria. \nThere is a cluster of subcentimeter mesenteric lymph nodes with mild haziness\nof the surrounding mesenteric fat, suggestive of mesenteric panniculitis\n(03:34).  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. \nSubchondral cystic changes are noted along the left femoral head.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. No evidence of metastatic disease within the abdomen or pelvis.\n2. Fibroid uterus.  Trace pelvic free fluid is likely physiologic.\n3. New trace right pleural effusion."
        },
        {
            "input": "POST EVAR EVALUATION\nPatient is status post EVAR with a stent extending from infrarenal abdominal\naorta to the aortic bifurcation.  And occluder is visualized at the origin of\nthe inferior mesenteric artery.  Stent is patent.  There is no evidence of an\nendoleak.  The excluded aneurysm sac remains stable in size and demonstrates\ninternal thrombus.  The major branches of the abdominal aorta remain patent.\n\nANEURYSM Infrarenal\nDiameter (Cross-sectional): 2.7 x 2.6 cm\nDiameter (Center-line): 2.6 x 2.6 cm\nVolume:\n\n1. Aneurysm: 11.4 ml\n2. Renal to Aortic bifurcation: 20.7 ml\n3. Renal to Iliac bifurcation: 37.6 ml\nENDOLEAK: no\n\nVASCULAR:\nThere is moderate calcium burden in the bilateral common iliac arteries\nextending to the internal iliac arteries.  The left hepatic artery is replaced\nfrom the left gastric artery. Incidental note is made of 2 renal arteries\nsupplying the right kidney and the left kidney.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen within the segment 2 is a 1.7 cm hypodense lesion\nwith peripheral nodular discontinuous enhancement consistent with a liver\nhemangioma.  The liver otherwise demonstrates homogenous attenuation\nthroughout. There is no evidence of suspicious focal lesions. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis is resected.\n\nPANCREAS: The pancreas is atrophic and has normal attenuation throughout,\nwithout 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. \nExtending from the mid to lower pole of the right kidney is a 10.3 centimeter\nexophytic simple renal cyst; unchanged from ___.  There is no evidence\nof stones or hydronephrosis. 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.  Colonic\ndiverticulosis.  The rectum is within normal limits.  Appendix is resected. \nThere is minimal misty appearance of the mid abdominal mesentery (4: 27) with\nminimal prominence of the adjacent mesenteric lymph nodes, unchanged from\nprior.  There is no mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There is a new small pocket of air within the urinary bladder which\ncould be secondary to prior bladder instrumentation in the appropriate\nclinical setting.  The urinary bladder and distal ureters are otherwise\nunremarkable.  Multiple surgical clips are again noted within the pelvis\nconsistent with prior lymphadenectomy.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Penile prosthesis are again noted.  The prostate and\nseminal vesicles 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. Status post infrarenal EVAR without evidence of endoleak or dissection.\n2. Stable liver hemangioma.\n3. Stable right renal cyst.\n4. Diverticulosis.\n5. Small pocket of air within the urinary bladder could be secondary to prior\nbladder instrumentation in the appropriate clinical setting.  Otherwise normal\nappearing bladder wall."
        },
        {
            "input": "Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n\nThe liver density is within normal limits.  A 10 mm hypodensity along the\nposterior aspect of segment II is unchanged since ___, most compatible with a\ncyst (series 4, image 101).  There is an equivocal 2 mm hypodensity along the\nperiphery of segment VIII, which is not definitely seen on prior examinations,\nstatistically likely a tiny biliary hamartoma (series 4, image 110).\n\nThe patient is post cholecystectomy.  There is no intra or extrahepatic bile\nduct dilation.  No radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is within normal limits.  There are no focal splenic lesions. \nThere are 2 accessory spleens abutting the pancreatic tail (series 4, image\n111), unchanged since ___.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  A 10.0 x 7.0 cm right interpolar renal cyst has gradually\nenlarged since ___, without concerning features.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.  The\npatient is post appendectomy.  There is mild colonic diverticulosis.  No focal\nfluid collections are seen.\n\nThe bladder is decompressed, limiting evaluation, although without focal\nlesion identified.  The patient is post prostatectomy.  A penile prosthesis is\npartially visualized.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.  An infrarenal abdominal aortic endovascular\nstent is unchanged in configuration, without intraluminal filling defect.  A\n2.4 cm aneurysm sac is unchanged, without evidence of endoleak (series 4,\nimage 140).  The patient is post embolization of the ___ (series 4, image\n147).  The celiac trunk, SMA, renal arteries, including bilateral excess only\narteries, and iliac branches remain patent and normal in caliber.\n\nThere is severe L5/S1 disc height loss with endplate sclerosis and moderate\nosteophytosis (series 605, image 73).  There are no osseous lesions concerning\nfor malignancy or infection.",
            "output": "1. The bladder is decompressed, limiting evaluation, however, no focal lesions\nare identified.  No abdominopelvic metastasis or lymphadenopathy.\n2. Post EVAR of an infrarenal abdominal aortic aneurysm.  The aneurysm sac is\nunchanged.  No endoleak detected.\n3. 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\nday for description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  A\nstable circumscribed 1 cm lesion in segment 2 is consistent with a benign\ncyst.  Mild dilation of the extrahepatic duct at 9 mm is stable and likely\nrelated to prior cholecystectomy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There are few scattered\npunctate pancreatic calcifications, which could be associated with 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: The kidneys are of normal and symmetric size with normal nephrogram. \nA 10.5 x 7.1 cm cortical cyst in the lower aspect of the right kidney is not\nsignificantly changed.  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.  There is mild hazy attenuation in the small\nbowel mesentery, compatible with mesenteric panniculitis.  The appearance is\nunchanged from ___.\n\nPELVIS: The patient is status post prostatectomy and TURBT.  Penile implant is\nnoted.  Visualization of pelvic structures is limited by metal artifact from\nsurgical clips.  The bladder wall appears mildly thickened in the dome but\notherwise grossly unremarkable.  The there is no evidence of free-fluid in the\npelvis.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic lymphadenopathy allowing for limited visualization due to metal\nartifact.  Bilateral inguinal nodes measuring up to 1 cm are stable.\n\nVASCULAR: The patient is status post EVAR.  Small posterior infrarenal\nsaccular aneurysm sac is not significantly changed and there is no evidence of\nendoleak.  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. Postsurgical changes in the pelvis.  No evidence of metastatic disease in\nthe abdomen or pelvis.\n2. Stable appearance of saccular abdominal aortic aneurysm sac post EVAR.\n3. Please refer to the separate report for the CT chest."
        },
        {
            "input": "Lung Bases:  Imaged lung bases notable for hypoventilatory changes and mild\natelectasis.  The imaged portion of the heart is mildly enlarged with dense\nCoronary artery calcification and aortic valvular calcification.  No pleural\nor pericardial effusion is seen.\n\nAbdomen: The liver enhances normally.  No focal liver lesions.  Main portal\nvein is patent.  No intrahepatic biliary ductal dilation.  The gallbladder\ncontains several calcified gallstones.  The gallbladder wall is minimally\nthickened which and there is mild fat stranding adjacent to the gallbladder\nneck.  The common bile duct is nondilated.  The spleen is normal.  Adrenal\nglands are normal bilaterally.  The pancreas is somewhat atrophic in\nappearance.  Kidneys enhance symmetrically.  There are small renal cortical\nhypodensities, larger on the right arising from the interpolar region\nmeasuring 1.6 x 1.7 cm likely a cyst.  No hydronephrosis or signs of\npyelonephritis. No retroperitoneal adenopathy or hematoma.  The stomach is\nrelatively decompressed.  There is a large periampullary duodenum\ndiverticulum.  Duodenum otherwise unremarkable.\n\nThe abdominal aorta is mildly ectatic and markedly calcified.  On series 2,\nimage 51, along root of small bowel mesentery, there is a 2.7 x 1.6 x 1.4 cm\npartially calcified hyperdense lesion, indeterminate, may represent a\npartially calcified aneurysm of the SMA vs. mesenteric mass.  No adjacent\nhematoma is seen.  No additional mesenteric abnormality is seen.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  The\nappendix is air-filled and normal.  Colon contains a mild fecal load.  Urinary\nbladder is full mostly decompressed.  The prostate gland appears somewhat\nenlarged measuring approximately 5.1 cm in transverse dimension.  Small fat\ncontaining left inguinal hernia noted.  No pelvic sidewall or inguinal\nadenopathy.\n\nBones: Serpiginous subchondral sclerosis at the femoral heads with mild\nflattening along the superior aspect of the femoral heads suggesting stage ___\ndisease.",
            "output": "1. Cholelithiasis with mild thickening of the gallbladder wall and mild\npericholecystic fat stranding.  Please correlate clinically, ultrasound if\nneeded to further assess.\n2. Partially calcified lesion measuring 2.7 x 1.6 x 1.4 cm along the small\nbowel mesenteric root is indeterminate, differential considerations include\ncalcified aneurysm versus mesenteric mass.  Clinical correlation advised.  A\nCTA may be performed to further assess on a nonemergent basis.\n3. Bilateral femoral head avascular necrosis.\n4. Severe atherosclerosis."
        },
        {
            "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: Bilateral basal subsegmental atelectasis.  Bilateral small\npleural effusions.  No pericardial fluid.  Moderate cardiomegaly.  Mild\ngynecomastia bilaterally.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nGeographic hypodensity within segment 4 a, which may represent focal fat or\nperfusional anomaly.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is distended, and contains multiple\ncalcified gallstones.  The gallbladder wall is thickened and there is\nassociated surrounding stranding.  The CBD is not dilated.  There is hyperemia\nwithin the gallbladder fossa on arterial phase imaging.\n\nPANCREAS: The pancreas has normal attenuation throughout, with multiple\nparenchymal calcifications, likely from chronic pancreatitis.  The main\npancreatic duct is not dilated.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Mild bilateral nodular thickening of the adrenal glands,\nrepresenting macronodular hyperplasia.\n\nURINARY: Bilateral kidneys are atrophic.  There are bilateral hypodense\nlesions within the kidneys, statistically representing cysts.  The largest\ncyst is located in the right mid kidney measuring 1.6 cm.\n\nGASTROINTESTINAL: Multiple duodenal diverticulum.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. Colon\nand rectum are within normal limits.  Appendix contains air, has normal\ncaliber without evidence of fat stranding.  There is a calcified mesenteric\nmass measuring 1.5 x 1.3 cm which appears separate from the adjacent arteries.\nThere is ill-defined soft tissue surrounding the calcified portion of the\nmass.  No collaterals are appreciated surrounding the mesenteric mass. \nBilateral fat containing inguinal hernia.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nBONES: Bilateral avascular necrosis of the femoral heads.  Normal femoral head\nconvexity is appreciated at this time.\n\nSOFT TISSUES: Collateral vessels are appreciated in the left upper chest wall.",
            "output": "1. Partially calcified mesenteric mass once again appreciated.  A benign\netiology is favored and differential considerations include prior mesenteric\ninjury or very small sclerosing mesenteritis.  Carcinoid is less favored given\nthe absence of small bowel abnormality and jejunal location.  This lesion is\nnot amenable for biopsy.\n2. Gallstones within the gallbladder neck with associated gallbladder wall\nthickening, distention, pericholecystic fluid and stranding, as well as\nhyperemia within the gallbladder fossa, compatible with acute cholecystitis.\n3. Similar appearance of bilateral avascular necrosis of the femoral heads.\n4. Small bilateral pleural effusions with associated subsegmental atelectasis,\nnew compared to prior.\n5. Calcifications within the pancreatic parenchyma, likely sequelae of chronic\npancreatitis.\n6. Bilateral macronodular adrenal hyperplasia."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries but moderate at the iliofemoral\narteries.  No arterial occlusion.\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. 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 kidney's are unremarkable besides bilateral cortical scars\npreviously described.  No hydronephrosis.  Bilateral extrarenal pelves.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Circumferential wall thickening of the ascending\ncolon likely representing colitis.  A substantial stool burden is seen from\nthe transverse colon distally.  No pneumatosis.  No fat stranding.  There is\nno evidence of mesenteric 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: The prostate measures 5.7 x 4.4 cm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPartial left sacralization of L5.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia.",
            "output": "1. Circumferential wall thickening of the ascending colon suggestive of\ncolitis.  In the setting of a neutropenic patient, a typhlitis is to be\nconsidered.  Other causes such as inflammatory or ischemic cannot be excluded.\n\nNOTIFICATION:  The findings were discussed with Dr ___. by ___,\nM.D. on the telephone on ___ at 7:48 pm, 10 minutes after discovery of\nthe 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\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY: Multiple heterogeneously hypoenhancing masses near completely\noccupy the left hepatic lobe, which is nodular in contour, with lesions again\nseen throughout the right hepatic lobe was well. Representative lesions\ninclude a hepatic segment V subcapsular mass, which measures 1.7 x 2.8 cm,\nprevious approximately 1.6 x 2.6 cm (05:24), and a 2.8 x 2.4 cm hepatic\nsegment VIII lesion (05:26), previously 2.7 x 2.1 cm. 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 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.\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.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits\n\nBONES AND SOFT TISSUES:\n\nNo osseous lesions worrisome for malignancy are identified. Postsurgical\nchanges in the left anterior abdominal wall from prior flap reconstruction of\nthe left breast. There is slight anterolisthesis of L4 on L5 (08:32), and\nsacralization of the L5 vertebral body.",
            "output": "1. Widespread hepatic masses, highly concerning for metastatic disease, many\nof appear centrally necrotic. Overall, minimally changed compared to the prior\noutside CT from ___.\n2. Postsurgical changes in the left anterior abdominal wall related to prior\nflap reconstruction."
        },
        {
            "input": "LOWER CHEST: Please see report from dedicated CT of the chest for\nsupradiaphragmatic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Again noted is a markedly abnormal liver with diffuse\nheterogeneity of the hepatic parenchyma, atrophy of the left lobe of the\nliver, and nodularity of the liver contours, comparable to the recent\nexamination, and consistent with pseudo cirrhosis related to treated breast\ncancer metastases.  Hepatic metastatic lesions have remained largely similar\nto the prior examination. For example they measure 1.3 x 1.8 cm (02:49), 1.2 x\n1.5 cm (02:50), 0.9 x 1.5 cm (02:51), 1.1 x 2.1 cm (02:56), and 1.6 x 1.2 cm\n(2:60).  The gallbladder is within normal limits.\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 focal hypodense lesion adjacent to the splenic hilum measuring\napproximately 6 by 7 mm is noted.  This was seen on the most recent prior\nexamination as well as more distant priors.  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: 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.  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 surgically absent. No adnexal masses 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. No significant\natherosclerotic disease is noted.\n\nBONES: No suspicious osseous lesions are identified.\n\nSOFT TISSUES: There is  atrophy of the left rectus abdominis muscle.\nPostsurgical changes are noted along the left anterior abdominal wall.",
            "output": "1. Unchanged appearance of the liver with numerous known hepatic metastases\nand left hepatic lobe atrophy with parenchymal heterogeneity and nodular\ncontours related to metastatic disease from the known breast primary.\n2. No new abdomino-pelvic lymphadenopathy ; ascites or peritoneal nodules."
        },
        {
            "input": "The tendon, linear atelectasis is noted at the right lung base. The visualized\nlung bases are otherwise clear. The heart is normal in size and there is no\nevidence of pericardial effusion.  Coronary artery calcifications are present.\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 demonstrates cholelithiasis. The pancreas\ndemonstrates fatty atrophy. The spleen and bilateral adrenal glands are\nnormal. The kidneys enhance symmetrically and are without suspicious solid\nmass.\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\nair-filled and normal. Colonic diverticulosis is present without evidence of\ndiverticulitis.\n\nThere is no retroperitoneal lymphadenopathy by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum. The aorta and iliac branches contain\ncalcifications and are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.\n\nPELVIS:\n\nThe bladder appears normal.  Bilateral small fat containing inguinal hernias\nare noted. There is no pelvic side-wall or inguinal lymphadenopathy by CT size\ncriteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:  Nondisplaced rib fractures are seen through the posterior\nright seventh and eighth ribs, and probably also the ninth. Multilevel,\nmultifactorial degenerative changes are seen within the visualized\nthoracolumbar spine. No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  No evidence of acute intra-abdominal process.\n2.  Nondisplaced fractures of the posterior right seventh and eighth ribs.\n3.  Cholelithiasis.\n4.  Diverticulosis without acute diverticulitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is a mild calcified plaque of the\ninfrarenal abdominal aorta, which is associated with noncalcified atheroma\nresulting in significant stenosis of the infrarenal abdominal aorta, and\nextends into the origin of the left common iliac artery (4A:122-130).  Hepatic\narterial anatomy is conventional.  The celiac axis, SMA, and ___ are widely\npatent.  The renal arteries are widely patent bilaterally.  Aside from the\naforementioned atheroma, the iliac arteries are patent.  There is a large\nfilling defect in the right profunda femoral artery (04:201) which extends\ninto its branches, likely represents noncalcified atheroma.\n\nLOWER CHEST: There is heterogeneous, micronodular opacification at the right\nlung base which could be sequela of aspiration or developing pneumonia. \nAdditionally, there are small bilateral nonhemorrhagic pleural effusions. \nHeart size is normal and there is no 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 contains gallstones, without\nevidence of gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas is normal in attenuation with no duct dilation or\nstranding.  Extending off the inferior aspect of the uncinate process is a\nill-defined focus (602b:80) which measures fat density likely represents\nmesenteric fat abutting the pancreatic parenchyma.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Sigmoid and descending colonic diverticula are\nnoted, without evidence of diverticulitis.  Appendix is not visualized.  There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is decompressed and contains a Foley catheter. \nThere is no evidence of pelvic or inguinal lymphadenopathy.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHealed right-sided rib fractures are noted.",
            "output": "1. No intraluminal IV contrast extravasation into the large or small bowel. \nNo abdominopelvic hematoma.\n2. Sigmoid and descending colonic diverticulosis.\n3. Heterogeneous micronodular consolidation at the right lung base may\nrepresent sequela of aspiration or pneumonia.\n4. Intraluminal filling defect at the aortic bifurcation associated with\ncalcified atherosclerotic plaque, extending into the origin of the left common\niliac artery, has the appearance of noncalcified atheroma.  This results in\nmoderate to severe narrowing of the luminal diameter of the infrarenal\nabdominal aorta as well as the origin of the left common iliac artery.\n5. Intraluminal filling defect of the right profunda femoral artery extending\ninto its branches, associated with calcified plaque, also likely representing\narterial atheroma.  This results in moderate to severe narrowing of the\narterial lumen.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 9:19 ___, 4 minutes after discovery of\nthe findings."
        },
        {
            "input": "No destructive bone lesion is seen.  There is mild left hip degenerative\nchange with mild joint space narrowing and marginal spurring.  Minimal right\nhip marginal spurring.  Small focus of intra medullary calcification in the\nright subtrochanteric proximal femur may reflect a tiny incidental\nenchondroma.\n\nThere is transitional lumbosacral anatomy, with anomalous articulation of the\nright L5 transverse process with the right sacral ala.\n\nNo pelvic sidewall lymphadenopathy is identified.  Hypodense lesion in the\nleft flank likely reflects a incompletely evaluated renal cyst.",
            "output": "No aggressive focal bone lesion is identified, within limits of CT (note that\ndedicated pelvic MRI would be a more sensitive technique for detection of a\nbone 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 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: Spleen is enlarged measuring up to 16.2 cm in craniocaudal dimension,\nunchanged to slightly decreased from prior when it measured 16.7 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.  Punctate\nnonobstructing stone is noted in the upper pole 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  There is a large multiloculated\ncystic and solid mass in the cul-de-sac measuring 9.4 x 4.7 cm.  Previously\nseen large bilateral adnexal cysts have been removed in the interim (the\npatient underwent bilateral ovarian cystectomies on ___, with\npathology revealing endometriosis and lymphoma).  Given that the ovaries are\nnot clearly identified separate from this mass, this likely represents both\novaries with lymphomatous involvement.\n\nLYMPH NODES: Retroperitoneal lymphadenopathy has significantly improved\ncompared to prior CT from ___.  For example, a 10 mm aortocaval node\npreviously measured up to 17 mm (4:71).  Mesenteric lymphadenopathy has also\nsignificantly improved compared to prior.  For example, a mesenteric node in\nthe left upper quadrant measures up to 13 mm, previously up to 30 mm (4:72). \nPeripancreatic and porta hepatis lymph nodes have decreased in size.  Pelvic\nlymph nodes have decreased in size.  For example a right external iliac node\nmeasures 10 mm, previously up to 17 mm (4:114).\n\nVASCULAR: There is no abdominal aortic aneurysm.  No significant\natherosclerotic disease is noted.\n\nBONES: Mottled appearance of the posterior right iliac bone at the level of\nthe SI joint appears slightly more sclerotic compared to the prior CT from ___ (4:101), and new compared to prior CT from ___.\n\nSOFT TISSUES: Postsurgical changes along the low anterior abdominal wall and a\nsmall fat containing umbilical hernia are noted.",
            "output": "1. Significant interval decrease in size of retroperitoneal, mesenteric, and\npelvic lymphadenopathy.  Persistent splenomegaly.\n2. Large multiloculated cystic and solid mass in the cul-de-sac measuring 9.4\nx 4.7 cm.  Previously seen large bilateral adnexal cysts have been removed in\nthe interim (the patient underwent bilateral ovarian cystectomies on ___, with pathology revealing endometriosis and lymphoma).  Given that the\novaries are not clearly identified separate from this mass, this likely\nrepresents both ovaries with lymphomatous involvement.\n3. Mottled appearance of the posterior right iliac bone at the level of the SI\njoint with slightly increased sclerosis.  This could represent a bone marrow\nbiopsy site if there is such a history.  Otherwise lymphomatous involvement is\na consideration.\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 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 solid renal lesions or hydronephrosis.  There is a 4\nmm nonobstructing renal calculus in the right midpole region and there is a 3 \nmm nonobstructing calculus in the left lower pole region.  There is a duplex\nkidney on the left with 2 pelvicaliceal systems that unite at the\npelviureteric junction forming a single ureter (series 5, image 72)\n\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 known multiloculated cystic masses in the pelvis do\nnot demonstrate any significant change in size when comparison is made with\nthe MRI study from the ___ and the PET-CT dated ___ but have\nincreased in size when comparison is made with the CT scan from the ___.  Measured together, the cystic masses within the pelvis measure\napproximately 11 x 12.5 cm in axial ___.  I note that pathology from\nbilateral ovarian cystectomy is on ___ showed a pathological\ndiagnosis of endometriosis and lymphoma.\n\nLYMPH NODES: Mesenteric lymph nodes demonstrate slight regression in size when\ncompared with the CT scan from the ___ but are stable when\ncompared with the more recent PET scan.  For reference, a lymph node posterior\nto a prominent mesenteric vein in the left-side of the abdomen (series 5,\nimage 64) measures 2.1 x 0.9 cm on the current scan compared with 2.8 x 1.4 cm\nin ___.  There are a few subcentimeter retroperitoneal lymph nodes\naround the level of the renal vessels that also demonstrated slight decrease\nin size .\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease\nis noted.\n\nBONES: L-spine L3 vertebroplasty is noted.  The bones and sacrum demonstrate a\nheterogenic mixed lytic and sclerotic pattern that is stable when comparison\nis made with the previous CT study from ___ and PET-CT.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Persistent innumerable mesenteric nodes and a few small retroperitoneal\nnodes demonstrate slight interval regression in size  when compared with the\nCT scan dated ___ but are more similar in size when compared with\nthe more recent PET-CT from ___.\n2. Multiloculated pelvic mass, stable in size when compared with the MRI scan\nfrom ___ but have increased significantly in size since the CT scan from\n___. I note that is cystectomy in ___ revealed a\nhistological diagnosis of endometriosis and lymphoma.\n3. Heterogeneity of the bilateral ilium and possibly the sacrum similar in\nappearance when compared with the CT scan from ___.\n4. Possible duplicated left kidney. There are small bilateral nonobstructing\nGU calculi.\n5. Please see report of CT scan from same day for details of intrathoracic\nfindings."
        },
        {
            "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 appears\nnormal.  No radiopaque ductal stones are seen.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal mass.\n\nThe spleen size is normal.  There are no focal splenic lesions.\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  2 mm left interpolar and right upper pole renal stones are\nagain demonstrated, without obstruction (series 4, image 67, 63).\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  No focal gastrointestinal lesion is detected.\n\nThe bladder is decompressed, and appears grossly normal.\n\nThe uterus is anteverted, and normal in size.  Complex cystic bilateral\nadnexal lesions are again demonstrated, spanning up to 12.7 x 11.0 cm axially\n(series 4, image 104), appearing similar in configuration in comparison to the\nCT examination from ___, and more completely characterized on the\npelvic MRI from ___.\n\nMesenteric lymphadenopathy appears similar in comparison to the ___ examination.  For example, a dominant 1.9 x 0.8 cm jejunal mesenteric\nnode previously measured 2.1 x 9.2 cm (series 4, image 66).  Retroperitoneal\nlymphadenopathy is also stable, for example a 1.2 x 0.8 cm aortocaval node\npreviously measured 1.2 x 0.9 cm (series 4, image 74).  No newly enlarged\nmesenteric, retroperitoneal, inguinal, or intrapelvic lymph nodes are seen.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.  The portal and hepatic veins, SMV,\nand splenic vein are patent.\n\nThere are no osseous lesions concerning for infection.  Diffuse mottled\nappearance of the bone marrow is unchanged in comparison to the prior CT from\n___.  The patient is post L2 and L3 kyphoplasty.  Multilevel mild\nto moderate compression deformities are again seen throughout the\nthoracolumbar spine, and are stable since the prior CT.\n\nThere is a small fat containing umbilical hernia (series 4, image 83).",
            "output": "1. Mesenteric and retroperitoneal adenopathy appears stable in comparison to\nthe ___ examination.  No evidence of lymphadenopathy progression\nwithin the abdomen or pelvis.\n2. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n3. Bilateral complex adnexal cystic lesions relate to hydrosalpinx and\nendometriosis as detailed on the dedicated pelvic MRI from ___. \nThe overall configuration and size is unchanged since the ___ CT and\nMRI.\n4. Bilateral nonobstructing nephrolithiasis.\n5. Small fat containing umbilical hernia."
        },
        {
            "input": "Lungs: The lung bases are unremarkable.\n\nLiver: The liver is homogeneous with a smooth contour.  No suspicious liver\nlesion.\n\nThe portal vein and hepatic veins are patent.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. There is\nminimal focal wall thickening at the gallbladder fundus, consistent with\nadenomyomatosis.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nAdrenal glands: Unremarkable.\n\nUrinary: Cortical hypodensities are seen within the right kidney, too small to\ncharacterize, but likely cortical cysts. There is mild left hydronephrosis.\n\nPelvis:\n\nAccording to the pathology report from the prostate biopsy performed ___,\nthe patient has prostatic adenocarcinoma, ___ score 9.\n\nThe prostate measures 3.9 cm x 4.8 cm and is mildly enlarged. There is nodular\nextension of the prostate to the bladder base with indentation, as well as\nmass effect on the left ureterovesicular junction, causing mild left\nhydronephrosis (series 2, image 76).\n\nThere is no free fluid in the pelvis.\n\nGastrointestinal: There is a moderate-sized hiatal hernia. The bowel is within\nnormal limits, except for a few diverticula. No evidence of bowel dilatation\nor obstruction.\n\nVascular: No significant atherosclerotic calcifications of the abdominal\naorta.\n\nLymph nodes: A round 1.2 cm right internal iliac lymph node is seen. Small\nsubcentimeter ileocolic,  para-aortic and retrocrural lymph nodes are seen,\nnot meeting size criteria for pathologic enlargement.\n\nBone and soft tissues: No suspicious bone lesion. Mild degenerative disc\ndisease at L5-S1. There is a fat-containing right inguinal hernia.",
            "output": "1. Nodular extension of the prostate to the bladder base with mass effect on\nthe left ureterovesicular junction, causing mild left hydronephrosis,\nconcerning for extraprostatic extension.\n\n2. Suspicious round enlarged 1.2 cm right internal iliac lymph node."
        },
        {
            "input": "LOWER CHEST: Bilateral trace of pleural effusion with the atelectasis. \nUnchanged 6 mm nodule in the left lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged important atrophy of the left hepatic lobe/post left\nhepatectomy.  The gallbladder is unremarkable.  No biliary duct dilatation. \nNo focal suspicious hepatic lesion.  The right portal vein and hepatic veins\nare patent.\n\nPANCREAS: Unremarkable\n\nSPLEEN: Unremarkable\n\nADRENALS: Unremarkable\n\nURINARY: Unchanged mildly bilateral UPJ obstruction with mild to moderate\nbilateral hydronephrosis worse on the left and bilateral hydroureter\nthroughout their entire intra-abdominal course.  The ureters are again seen\nentering into the left inguinal hernia that contains the urinary bladder.\n\nGASTROINTESTINAL: In the interim, the patient was operated for resection of\nadhesions.  We again see air-fluid levels in the proximal middle small-bowel\nthat is distended up to 5.5 cm with tapering of the of bowel diameter\ndiscrepancy in the right flank.  No pneumatosis.  There is the small amount of\nfluid in the mesentery as well as in the abdomen.  No bowel wall thickening. \nNo pneumatosis.\n\nPELVIS: The urinary bladder is located within the left inguinal hernia with\nsmall amount of free fluid.\n\nREPRODUCTIVE ORGANS: Unremarkable\n\nLYMPH NODES: There is no intra-abdominal adenopathy.\n\nVASCULAR: Unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: S/p abdominal wall laparotomy changes with secondary small\namount of pneumoperitoneum.",
            "output": "1. Persistent dilatation of small bowel loops with air-fluid level with\nmultiple areas of narrowing and tapering in the right flank, could be\nsuggestive of persistent obstruction.\n2. Recent postoperative changes with small amount of ascites and mild\npneumoperitoneum.\n3. 6 mm nodule in the left lower lobe.\n\nRECOMMENDATION(S):  Chest CT follow-up in ___ months\n\nNOTIFICATION:  The findings were discussed with medical team, M.D. by ___\n___, M.D. on the telephone on ___ at 12:45 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "Lung Bases:  Bilateral pleural effusions are partially visualized which\nappears small to moderate in size with associated compressive atelectasis in\nthe lower lungs, difficult to exclude a component of aspiration.  Intracardiac\nblood pool appears slightly hypodense relative to the myocardium suggesting\nunderlying anemia.  There is faint aortic valvular calcification noted.  The\nheart appears within normal limits of size, though only partially imaged.\n\nAbdomen: A punctate calcific density seen within the right renal lower pole\nwhich may represent a nonobstructing stone.  No hydronephrosis or ureteral\nstone is seen.  An incompletely characterized hypodensity is seen arising from\nthe midpole right kidney measuring approximately 3.3 x 3.6 x 4.4 cm.  The\nunenhanced appearance of the liver is unremarkable.  The gallbladder appears\nnormal.  The spleen appears normal.  Adrenals are unremarkable.  The pancreas\nappears slightly atrophic.  The abdominal aorta is tortuous and extensively\ncalcified though there is no aneurysm seen.  No retroperitoneal adenopathy or\nhematoma.  The stomach is decompressed.  The duodenum appears 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 in the right lower quadrant.  The colon contains a mild fecal\nload.  There is no colonic wall thickening or signs of acute inflammation. \nThe uterus is surgically absent.  No adnexal mass is seen.  There is evidence\nof pelvic floor descent.  The urinary bladder is mostly decompressed.  There\nis no pelvic free fluid.  No pelvic sidewall or inguinal adenopathy is seen.\n\nBones: An acute appearing superior endplate mild compression deformity is\nnoted at L1.  Minimal perivertebral soft tissue thickening suggesting minimal\nhematoma formation.  A chronic compression deformity at L3 is associated with\nsignificant loss of vertebral body height and minimal bony retropulsion.",
            "output": "1. Mild superior endplate compression deformity of L1, appears acute, likely\naccounts for patient's reported pain.\n2. Chronic L3 compression deformity with further loss of vertebral body\nheight.\n3. Nonobstructing right renal stone is punctate.\n4. Right renal hypodensity may represent a cyst though not fully\ncharacterized.\n5. Partially imaged pleural effusions appearing small to moderate in size with\ncompressive lower lobe atelectasis, difficult to exclude a component of\naspiration."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis in the right lung base.  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 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 solid renal lesions or hydronephrosis.  2.5 cm simple\ncyst in the right kidney.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.\n\nThere is focal inflammatory stranding along the anti mesenteric side of the\ndistal descending colon with 1.6 cm oval fatty structure, most consistent with\nepiploic appendagitis (4:64, 6:16, 7:64).  No evidence diverticulosis in this\nregion to raise suspicion for diverticulitis.  The adjacent colon is normal\nwithout wall thickening.  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 uterus contains several small nodules suggestive\nsmall fibroids as seen prior ultrasound.  The uterus is retroflexed.  The\nbilateral adnexae are within normal limits.  Both ovaries are visualized, in\nsize, and contains small cysts compatible with 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. Left lower quadrant epiploic appendagitis.\n2. Normal appendix.  No free fluid or abscess.\n3. Both ovaries are visualized, normal in size, and demonstrate physiologic\nfollicular activity."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Tiny\nhypoattenuating lesion in the right lobe of the liver too small to\ncharacterize though likely a cyst or hemangioma.  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. \nSubcentimeter hypodense lesion in the spleen is incompletely characterized\nthough of doubtful clinical significance and is likely present on 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 are bilateral renal cysts measuring up to 2.8 cm at the upper pole the\nleft kidney and 2.5 cm at the upper pole the left kidney.  These have enlarged\nsince prior.  Additional smaller hypodensities bilaterally are too small to\ncharacterize though statistically cysts.  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.  Large stool ball seen distending the rectum.\nA temperature probe is noted in the rectum.  The appendix 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 calcified.  The bilateral adnexae are\ngrossly within normal limits.  A pessary is noted in the 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nchronic depression deformity is noted at the L1 vertebral body. \nMild-to-moderate multilevel degenerative changes of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute intra-abdominal or pelvic abnormality.  No\nobstruction.\n2. Large stool burden in the rectum."
        },
        {
            "input": "LOWER CHEST: There are bilateral trace pleural effusions with subjacent\npassive atelectasis.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple lesions compatible with hemangiomas are re-demonstrated, as\npreviously characterized on MRI of the abdomen.  The largest these in segment\nIV a measures 1.8 x 2 0 cm.  No new lesions are 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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, largest at the left inferior pole\nmeasures 4.6 cm.  There are no suspicious 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: There is a Foley catheter in the urinary bladder, which is\ndecompressed.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality seen.\n\nLYMPH NODES: There are stable retroperitoneal / left paraaortic lymph nodes\nmeasuring up to 1 cm in short axis (02:38).  No new or increasing\nabdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: The bones are diffusely demineralized.  There is a new compression\nfracture of the T11 vertebral body with prevertebral soft tissue swelling,\ntherefore likely acute (602:37, 2:18).  There is no endplate irregularity or\nCT evidence of discitis/osteomyelitis.  There is no significant retropulsion. \nNo additional acute fractures are seen.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. Acute appearing compression fracture of the T11 vertebral body with\nprevertebral soft tissue swelling.  No retropulsion.\n2. No acute findings in the abdomen or pelvis.\n3. Trace 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 liver demonstrates homogenous attenuation throughout. \nMultiple hepatic lesions compatible with hemangioma are redemonstrated as\npreviously characterized on prior MRI.  The largest measures 2 cm in segment\nIV A.  No new 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 unremarkable besides bilateral renal cysts, the\nlargest at the inferior pole of the left kidney measures 4.8 cm and the\nlargest in the inferior pole of the right kidney measures 1.7 cm.  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 and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal mass.\n\nLYMPH NODES: Previously described retroperitoneal soft tissues left lymph\nnodes appears slightly less prominent.  Maximum diameter measures\napproximately 8.5 mm (series 2, image 65), previously measuring 9.5 mm.  No\nnew lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: In the interim, a kyphoplasty of T11 was performed.  No new acute\nfracture.  No focal concerning bone lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Minimal improvement of few retroperitoneal lymph nodes.\n2. No new abdominopelvic lymphadenopathy.\n3. Multiple hepatic hemangiomas.\n4. Please refer to separate chest CT done the same day 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:\nSmall ascites is increased compared to ___.  Thickening of the\nlateral conal an anterior renal fascia bilaterally along with bilateral flank,\nabdominal wall and back subcutaneous edema are likely from third-spacing.\n\nHEPATOBILIARY: Liver demonstrates homogeneous attenuation throughout.  No\nfocal lesion is identified.  Intra and extrahepatic bile ducts are not\ndilated.  Enhancement of extrahepatic and central intrahepatic bile duct walls\nis similar to before.  Gallbladder is absent.\n\nPANCREAS: Patient is post Whipple procedure.  Remaining pancreas appears as\nexpected after Whipple procedure with mild atrophy within the body and tail\nwake but homogeneous enhancement.  No ductal dilation is identified. \nPancreaticojejunostomy and hepaticojejunostomy appear similar to before.  Fat\nstranding with small amount of surrounding fluid at the porta hepatis is also\nsimilar to before.  Multiple fiducial markers in the pancreatic bed and at the\nconfluence of the left renal vein but the IVC are again noted.\n\nSPLEEN: Previously noted perisplenic fluid collection has resolved.  Spleen\ndemonstrates homogeneous attenuation throughout.\n\nADRENALS: Bilateral adrenal glands are unremarkable.\n\nURINARY: A non-enhancing exophytic lesion in mid left kidney is unchanged and\nis likely a hemorrhagic or proteinaceous cyst.  Bilateral nephrograms are\nsymmetric.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Patient is post Whipple procedure. The distal gastric body\nand antrum are circumferentially thickened and edematous with a slightly\nstriated appearance in portions, which appears increased compared to ___.  There is indistinctness of the gastric serosa and some locations.  There\nis extensive sigmoid diverticulosis.  There is diffuse mild thickening of left\nlateral transverse colon, descending colon, sigmoid, and rectum, probably from\ncollapsed state.\n\nLYMPH NODES: No pathologically enlarged lymph node is identified.\n\nVASCULAR: Splenorenal and gastric varices are similar to before.  There is no\nabdominal aortic aneurysm.  Mild Atherosclerotic disease is noted.\n\nPELVIS:\nBladder is unremarkable. Mild free fluid in the pelvis is new and appears\nsimple.  .Lobulated enlarged prostate measures 5.5 x 4.4 x 5.6 cm, similar to\nbefore.\n\nBONES: No suspicious bone lesion is identified.",
            "output": "1. Distal gastric body and antral edematous thickening is increased compared\nto ___, suspicious for gastritis.\n2. Small amount of fluid and stranding at the pancreatic head surgical bed are\nsimilar to before with the pancreaticojejunostomy and hepaticojejunostomy\nhaving the expected appearance and the residual pancreas normal in appearance.\n.\n3. Small ascites is increased. New anasarca.\n4. Unchanged enlarged lobulated prostate.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12PM, 5 minutes after discovery of\nthe findings."
        },
        {
            "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.  A 7\nmm nonenhancing hypodensity in hepatic segment VI is unchanged and probably\nrepresents a cyst (series 4, image 104)..  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is is\nresected.  The portal venous system is patent.  There has been interval\ndecrease in the perihepatic ascites.\n\nPANCREAS: The patient is status post Whipple procedure.  The remaining\npancreatic parenchyma is normally enhancing.  There is no pancreatic ductal\ndilatation.  There is no stranding surrounding the remaining pancreas. \nStranding and free fluid about the hepaticojejunostomy and\npancreaticojejunostomy is grossly unchanged compared to ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 1.2 cm exophytic cyst in the left interpolar cortex is unchanged compared to\nprior, and remains slightly hyperdense, compatible with a proteinaceous or\nhemorrhagic cyst (series 4, image 116).  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: The patient is status post Whipple procedure.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nThere is sigmoid diverticulosis without colonic wall thickening or pericolonic\nfat stranding.  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 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 an lobulated, similar to prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\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. Trace fluid and stranding about the surgical bed adjacent to the\npancreaticojejunostomy and hepaticojejunostomy is unchanged compared to ___.  The remaining pancreas is unremarkable.\n3. Previously described edematous thickening of the gastric body and antrum is\ngrossly unchanged compared to ___.\n4. Interval decrease in ascites.\n5. Diverticulosis.\n6. Please see the separately dictated chest CT report from the same date for\nthoracic findings."
        },
        {
            "input": "LOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion. Please refer to separate report for same-day\nCT chest for complete description of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: A hypoattenuating lesion in the inferior/posterior aspect of\nhepatic segment VI is unchanged and too small to completely characterize,\nlikely a cyst or biliary hamartoma (series 4, image 102)..  No new or\nsuspicious hepatic lesion.  The remainder of the hepatic parenchyma enhances\nhomogeneously.  No intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is is resected.\n\nPANCREAS: The patient is status-post Whipple.  The residual pancreatic\nparenchyma enhances homogeneously without focal lesions.  The main pancreatic\nduct is not dilated.  Stranding/soft tissue density adjacent to the left\ngastric and celiac arteries, pancreaticojejunostomy, hepaticojejunostomy, and\nwithin the proximal mesentery appears unchanged since ___.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: An exophytic interpolar left renal cyst is unchanged in size and\nmeasures 1.3 x 1.2 cm with persistent hyper attenuation most consistent with a\nhemorrhagic or proteinaceous cyst (series 4, image 111).\n\nGASTROINTESTINAL: The patient is status-post Whipple.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis diverticulosis without focal wall thickening or adjacent fat stranding. \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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate remains severely enlarged.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.  Incidental note\nis made of replaced left hepatic artery arising from the left gastric artery. \nIncidental note is made of an accessory left renal artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Linear stranding in the anterior abdominal wall reflects\nfibrosis related to surgery.",
            "output": "1. No evidence of metastasis within the abdomen or pelvis.\n2. Stable soft tissue density adjacent to the left gastric and celiac\narteries, pancreaticojejunostomy, hepaticojejunostomy, and within the proximal\nmesentery appears unchanged, probably postsurgical, but warrants continued\nattention on follow-up.\n3. Diverticulosis."
        },
        {
            "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 separately reported chest CT from the same day\nfor thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged hypoattenuating lesion in the inferior/posterior\naspect of the hepatic segment 6, unchanged since prior studies and likely\nrepresents a cyst or biliary hamartoma (3:103).  The liver demonstrates\nhomogenous attenuation throughout. There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nCholecystectomy.\n\nPANCREAS: Patient is status post Whipple.  The remaining pancreatic parenchyma\nis atrophic and has mild pancreatic duct dilation, unchanged since prior\nstudy.  There is no evidence of focal lesions or peripancreatic stranding.\n\nUnchanged stranding surrounding the CBD.  Stable fluid density adjacent to the\nleft gastric artery.\nPancreaticojejunostomy and hepaticojejunostomy anastomosis within normal\nlimits.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 1.2 x 1.2 left cortical density in the interpolar region of the left\nkidney. There is no stones or hydronephrosis.  There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Whipple.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nSigmoid diverticulosis.  Rectum is within normal limits.  Appendix contains\nair, has normal caliber without evidence of fat stranding.  There is no\nevidence of mesenteric lymphadenopathy.  Stable mesenteric lymph nodes\n(3:127).\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: Enlarged prostate causing mass effect in the posterior\nwall of the bladder.\n\nBONES: There 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.  Please\nrefer to separately reported chest CT for thoracic findings.\n2.  Stable stranding adjacent to the CBD, unchanged from prior study and\nlikely postsurgical.  Stable fluid density adjacent to the left gastric\nartery."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Please refer to the separately dictated report of same date chest\nCT.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a mildly hypoattenuating lesion in the subcapsular aspect of segment\n7 (series 4, image 87), this is new compared to the prior CT.  Stable\nappearance of the subcentimeter low-attenuation lesion inferiorly in segment 6\n(series 1, image 102).  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure.  The pancreatic\nremnant shows atrophy changes in mild ductal dilatation, stable compared to\nthe prior CT.  No recurrent mass seen in the surgical bed.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 cortical cyst in the interpolar region of the left\nkidney measuring 1.1 cm.  There is no evidence of hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Status post Whipple's procedure.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout. \nAppendix is unremarkable stable appearance of colonic diverticulosis.  Stable\nappearance of mild mesenteric stranding and tiny mesenteric lymph nodes.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is minimally filled.  There is no evidence of\npelvic or inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Stable prostatomegaly.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "New mildly hypoattenuating lesion in the subcapsular aspect of segment 7,\ngiven that this is new compared to the prior CT from ___, this is\nhighly suspicious for a metastasis.  No other interval change."
        },
        {
            "input": "LOWER CHEST: Please see separate report performed on the same day for detailed\nevaluation of the chest.\n\nABDOMEN:\n\n\nHEPATOBILIARY: The liver demonstrate normal morphology.  The 1.5 cm metastasis\nin segment VII (series 3, image 96) has increased in size compared to ___.  There is also diffuse hypoattenuation along the ___\npouch compatible with implants (series 3, image 98) which appear contiguous\nwith the enlarging segment VII metastasis.  A 0.7 cm cyst in segment VI\n(series 3, image 114) is unchanged.  No additional hepatic lesions.  The\ngallbladder is surgically absent.  No biliary ductal dilatation.\n\nPANCREAS: Patient is status post Whipple procedure.  The pancreatic remnant is\natrophic without focal lesion or pancreatic ductal dilatation.\n\nSPLEEN: Unremarkable.\n\nADRENALS: Unremarkable.\n\nURINARY: Unremarkable except for an unchanged 1.0 cm hyperattenuating lesion\nin the interpolar region of the left kidney (series 3, image 129), consistent\nwith a hemorrhagic cyst as characterized MR from ___.  Subcentimeter\nhypoattenuating lesion in the upper pole of the left kidney is too small to\ncharacterize (series 3, image 119).\n\nGASTROINTESTINAL: Status post Whipple procedure with intact gastrojejunostomy.\nNo bowel obstruction.  Sigmoid diverticulosis without diverticulitis.  No\nascites.\n\nPELVIS: No pelvic free fluid.  Prostatomegaly again noted.\n\nLYMPH NODES: Prominent mesenteric lymph nodes measuring up to 0.8 cm with\nsurrounding stranding (series 3, image 148) are unchanged.  No enlarged\nretroperitoneal lymph nodes are seen.\n\nVASCULAR: No abdominal aortic aneurysm.  The celiac artery, SMA, and ___ are\npatent.  The portal and hepatic venous vasculature is patent.\n\nBONES: No suspicious osseous lesions.\n\nSOFT TISSUES: Small fat containing umbilical hernia.",
            "output": "1. Interval increased in size the hepatic segment VII metastasis with new\nimplants the posterior surface of the liver likely representing worsening of\ndisease.\n2. Please see separate report performed on the same day for detailed\nevaluation of 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.  A\n3.7 x 2.5 cm lesion in hepatic segment VII demonstrates progressive, nodular\nenhancement and is most consistent with a hemangioma.  No additional liver\nlesions are identified.  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:\n\nPreviously seen ascites has resolved.  Peritoneal soft tissue nodularity is\nmost prominent in the left abdomen (6:73, 79).\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 urinary bladder is decompressed.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is a small\ncalcification in the left ovary.  No adnexal mass 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.  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. Omental soft tissue consistent with peritoneal carcinomatosis.  Ascites has\nresolved.\n2. 3.7 x 2.5 cm liver lesion is most consistent with a hemangioma.\n3. Please refer to the separately dictated CT chest report from the same date\nfor description 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: The liver demonstrates homogenous attenuation throughout. \nAgain noted is a 4.3 x 3.2 cm hemangioma at the junction of segment VII and\nVIII.  4 mm hypodensity in segment III is also unchanged.  No new hepatic\nlesion.  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 adrenal gland is normal in size and shape. Unchanged mild\nthickening of the left adrenal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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\nPreviously described peritoneal nodules are not seen on today's exam.  No\nascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of recurrent disease in the abdomen or pelvis.  Stable hepatic\nhemangioma in the right lobe.\n2. Please refer to separate chest CT done the same day for thoracic findings."
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar atelectasis.  Otherwise, 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. \nThere is redemonstration of a 3.6 x 2.1 cm hemangioma centered in hepatic\nsegment 7, unchanged (05:53).  A 3 mm hypodense lesion in hepatic segment 3 is\nunchanged and is too small to characterize(05:52).\n\nThere is interval development of mild perihepatic ascites measuring simple\nfluid.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is distended and contains a peripherally dense\ngallstone.  There is no evidence of gallbladder-wall thickening or 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 adrenal gland is normal in size and shape.  There is\nredemonstration of thickening of the lateral limb of the left adrenal gland\nwithout evidence of a discrete nodule (05:56).\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere are subcentimeter hypodense lesions bilaterally, too small to\ncharacterize but likely representing simple cysts.  There is no evidence of\nhydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There are multiple dilated, fluid-filled loops of small\nbowel measuring up to 3.1 cm in the right lower quadrant.  There are several\nareas of decompression though without discrete transition point or distal\ndecompression.  There relative increased soft tissue density in the right\nlower quadrant in association with decompressed small bowel loop, which most\nlikely secondary to underdistention though underlying mass is difficult to\nentirely exclude (for example 5:94 and 9:28).\n\nMultiple segments of small bowel demonstrate bowel wall edema and hyperemia,\nsuggestive of enteritis (5:84 and 09:11).\n\nThe colon and rectum contain a moderate amount of stool and air with partial\ndecompression of the descending and sigmoid colon.\n\nPELVIS: The urinary bladder is largely decompressed.  There is a moderate\namount of ascites within the pelvis measuring simple fluid.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and\nsalpingo-oophorectomy.\n\nLYMPH NODES: There are scattered subcentimeter mesenteric and retroperitoneal\nlymph nodes measuring up to 5 mm, not pathologically enlarged based on CT size\ncriteria (5:62).  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.  There\nare subcentimeter hyperdense nodules along the peritoneum anteriorly,\nsuggestive of possible peritoneal tumor deposits (5:75, 5:69, 5:70).  This is\nnew since prior.  There is no definite omental thickening.",
            "output": "1. Short segment of small bowel in the right mid abdomen demonstrates bowel\nwall edema and hyperemia, suggestive of enteritis, potentially infectious or\ninflammatory.\n2. Dilated, fluid-filled loops of small bowel throughout the abdomen without\nevidence discrete transition point or distal decompression.  This could be due\nto a secondary ileus.  Possibility of developing or early small bowel\nobstruction would be possible.\n3. Region of small-bowel caliber narrowing with apparent wall thickening\npotentially due to underdistention however given patient's history of\nmalignancy, component of underlying mass is difficult to exclude.  Close\nattention on follow-up is recommended.\n4. Interval development of moderate volume ascites and multiple subcentimeter\nhyperdense peritoneal nodules, suspicious for peritoneal carcinomatosis.\n5. Cholelithiasis and marked gallbladder distension without evidence of\ngallbladder-wall thickening or edema.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:30 pm, 10\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 is no evidence of concerning focal lesions.  Unchanged 2.2 x 3.5 cm\nhemangioma in segment 7.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  Large volume ascites.  The gallbladder is notable for\nintraluminal 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 no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Stomach is essentially unremarkable.  Duodenal diverticulum\nis noted.  There are dilated loops of small bowel measuring up to 4.1 cm, more\ndistended than compared to prior examination.  A transition point is suspected\nto be in the right lower quadrant with decompressed large bowel.  There is no\nevidence of bowel ischemia or pneumatosis.\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. Dilated loops of small bowel measuring up to 4.1 cm with decompressed large\nbowel distally consistent with small bowel obstruction.  Acute transition\npoint is suspected in the right lower quadrant.  No evidence of pneumatosis or\nbowel ischemia.\n2. Large volume ascites.  Omental soft tissue nodularity seen on prior exam is\nnot as clearly delineated on today's exam, potentially obscured by\nintra-abdominal ascites which has increased in the interim."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is mild\nbibasilar atelectasis.  Catheter terminates in the right atrium. There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN: There is large volume ascites.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nHypodense lesion in hepatic segment VII measuring 3.5 x 1.7 cm is unchanged. \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. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Duodenal diverticulum is\nnoted.  Dilated loops of small bowel with air-fluid levels measure up to 4.1\ncm, similar to the prior study.  No definite transition point was not\nidentified.  There is some tethering of the bowel in the pelvis as seen\npreviously.  No discrete mass lesion the identified in this region however\nunderlying disease related to patient's known ovarian cancer would certainly\nbe possible.  There is no evidence of bowel ischemia or pneumatosis.  The\ncolon and rectum are decompressed, with portions containing air and fecal\ncontents.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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.  Mild atherosclerotic disease\nis noted.  Filling defect worrisome for thrombosis noted in the right common\niliac 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. Dilated loops of small bowel measuring up to 4.1 cm.  The large bowel\ncontains air and fecal contents but appears somewhat decompressed.  This is\nconsistent with small-bowel obstruction, not significantly changed from the\nprior study.  There is no evidence of pneumatosis to suggest bowel ischemia.\n2. Large volume ascites.\n3. Filling defect in the right common iliac vein worrisome for venous\nthrombosis.\n\nNOTIFICATION:  Update of the venous finding discussed by Dr. ___ with Dr.\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 37 x 21 x 28 mm slightly irregular hypoenhancing lesion in hepatic\nsegment 7 (series 2 image 113) that was previously 35 x 17 mm measured on ___, likely representing a hemangioma.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder contains a\ngallstone measuring 18 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 left adrenal gland is mildly thickened without other\nirregularities (series 2, image 108).  The right adrenal gland is normal in\nsize 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 are tiny\npunctate nonobstructing kidney stones unchanged from previous CT imaging. \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: 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There are costocartilage calcifications.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a lumbar hernia in right posterolateral abdominal wall\n(series 2 image 132 post.  The abdominal and pelvic wall is within normal\nlimits.",
            "output": "1. No new metastatic disease in the abdomen or pelvis.\n2. Previously noted small-bowel obstruction and ascites have completely\nresolved.\n3. Incidental findings including a right lobe hepatic hemangioma, gallstones,\npunctate bilateral nonobstructing renal calculi noted.\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: Redemonstration heterogeneously hypodense lesion within the\nperiphery of segment 7 of the liver measuring 3.7 x 2.3 cm (2:110), previously\n3.7 x 2.1 cm.  The lesion has been grossly stable over multiple prior exams\ndating back to ___ and likely represents a hemangioma.  There is\nno evidence of focal concerning 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 adrenal gland is unremarkable.  The left adrenal gland is\nmildly thickened without discrete nodules.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nSmall subcentimeter right renal cortical hypodensity, statistically likely a\nsmall cyst.  No evidence of solid renal lesions.  Bilateral tiny\nnonobstructive renal calculi are redemonstrated.  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 a\nsmall amount of nonspecific pelvic free fluid with mild smooth peritoneal\nthickening and enhancement in the lower abdomen/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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Diffuse decreased bone mineralization.  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. Mild amount of nonspecific free fluid and minimal peritoneal enhancement. \nNo specific evidence of metastatic disease in the abdomen.\n2. Stable appearance of right hepatic lobe liver hemangioma, gallstone, and\nnonobstructive small renal calculi.\n3. Please refer to separate report of CT scan of the chest for detailed\ndescription of the intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis. Otherwise the lungs, heart and\nmediastinum appear normal.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  A single enlarged periportal lymph\nnode is noted (series 601, image 25) measuring up to 15 mm in greatest short\naxis dimension. The common bile duct is mildly enlarged measuring 7 mm,\nhowever the distal CBD appears to taper to the level of the ampulla.  There is\nmild central intrahepatic biliary duct prominence.  The gallbladder is within\nnormal limits, without 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.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. There is a large fecal load within the colon. The\nappendix is not clearly visualized, however there are no secondary signs of\nappendicitis.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free fluid and no free air.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\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: No bone finding suspicious for infection or malignancy\nis seen.  No fracture is identified. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1.  There is no evidence of fracture or acute intra-abdominal or intrapelvic\ninjury.\n\n2. Enlarged periportal lymph node is a nonspecific finding, however it may be\nreactive due to underlying liver disease.  Correlate clinically with liver\nfunction tests.\n\n3. Mildly enlarged common bile duct and prominence of the central intrahepatic\nbile ducts, with tapering of the distal CBD to the level of the ampulla. If\nthere is concern for biliary pathology, an MRCP would be recommended for\nfurther assessment."
        },
        {
            "input": "PELVIS: The partially visualized small and large bowel loops are unremarkable\nin appearance.  The appendix is unremarkable in appearance.  The bladder is\ndistended with contrast, but otherwise unremarkable in appearance.  The\nprostate is not enlarged.  There is no pelvic or inguinal lymphadenopathy. No\npelvic free fluid.  The distal abdominal aorta and iliac vessels are\nunremarkable in appearance without atherosclerosis.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: There is a moderate right hip joint\neffusion.  In addition, there appears to be synovial thickening and\nenhancement on the right (series 2, image 39).  This is concerning for\nsynovitis, likely infectious in nature.  In addition, there are multiple small\nrim enhancing fluid collections extending from the right hip joint into the\nright pectineus, adductor magnus, and obturator internus muscles (series 2,\nimage 47).  Although each of these small fluid collections are difficult to\nmeasured, the total area of muscular involvement measures approximately 4.5 x\n7.1 cm in maximum axial ___.  There is a small amount of subcutaneous\nsoft tissue stranding.  There is no obvious evidence of osseous erosion. \nOtherwise, the soft tissues and bones are within normal limits without\nsuspicious osseous lesions or evidence of acute fracture.",
            "output": "1. Moderate-sized right hip joint effusion with synovial thickening and\nenhancement, concerning for septic arthritis.\n2. Multiple small rim enhancing fluid collections extending from the right hip\njoint into the right adductor and obturator musculature measuring up to 7.1\ncm, compatible with intramuscular abscesses.\n3. No obvious osseous erosion, although MRI is more sensitive for the\ndetection of acute osteomyelitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 intrahepatic or extrahepatic biliary dilatation. \nThere is a millimetric right hepatic hypodensity which is too small to\ncharacterize (series 2, image 22).  The gallbladder is within normal limits.\n\nPANCREAS: There is a 12.5 x 9.3 x 14.4 cm multiloculated cystic mass arising\nfrom the pancreatic tail, most likely representing a cystic mucinous neoplasm.\nThe pancreatic head and neck are normal in attenuation, without main ductal\ndilatation.\n\nSPLEEN: The spleen is enlarged, measuring 14.3 cm.\n\nADRENALS: There is a 1.8 cm hypoattenuating left adrenal lesion,\nindeterminate; metastasis is a consideration.  The right adrenal gland within\nnormal limits.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a 2.4 cm cyst in the posterior upper pole of the left kidney.  There\nis no hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is displaced anteriorly by the cystic pancreatic\nmass.  Small bowel loops are normal in caliber.  The colon and rectum are\nwithin normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is collapsed and not well evaluated.  There is\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There a few mildly hyperenhancing 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.  Minimal atherosclerotic\ndisease is noted.  There is occlusion of the splenic vein by the cystic\npancreatic mass, with extensive mesenteric collaterals.  (Series 2, image 27).\n\nBONES: A 5 mm sclerotic lesion in the L4 vertebral body may represent a bone\nisland.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 12.2 x 9.3 x 14.4 cm multiloculated cystic mass arising from the pancreatic\ntail, most likely representing a cystic mucinous neoplasm.  Associated\nocclusion of the splenic vein, resulting in splenomegaly and extensive\nmesenteric varices.\n2. 1.8 cm hypoattenuating left adrenal lesion, indeterminate.  Metastasis is a\nconsideration.\n3. No bowel obstruction."
        },
        {
            "input": "VASCULAR:\n\nS/p fenestrated aortic aneurysm repair with expected post treatment changes\nwith few air bubbles in the aneurysm sac. Globally, the visceral stents (AMS,\nceliac trunk and both right and left renal arteries) arising from the aortic\nprosthesis are patent.  No evidence of endoleak.\n\nLOWER CHEST: Bilateral small pleural effusion with bilateral linear\natelectasis.\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. There is no peripancreatic\nstranding.\n\nSPLEEN: Splenectomy with a 2 cm splenule in the surgical bed.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Wedge shaped renal infarct measuring 3.4 x 4.0 cm in the interpolar\nregion of the right kidney.  The left kidney is homogeneous with normal\nnephrogram. There is no evidence of stones, focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters. \nBoth renal arteries and veins are patent.\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 bladder is collapsed on a Foley tube.  There is no evidence of\npelvic 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute right renal infarct in the interpolar region.\n2. S/p fenestrated aortic aneurysm repair with no signs of endoleak."
        },
        {
            "input": "LOWER 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\nare 3 subcentimeter ovoid hypodensities the largest of which is 8 mm (601b:24,\n601b:25) consistent with cysts.  A hypodensity with partial enhancement in the\n___ segment of the liver measures 1.3 x 1.9 x 1.4 cm (601b:40, 3:55), and a\nhypodensity with enhancing components measures 1.6 x 1.2 x 1.0 cm in the ___\nsegment of the liver (601b:42, 3:46).  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 hydronephrosis.  There are bilateral parapelvic cysts.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is post gastric band surgery with radiopaque\nband and reservoir in place. Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement throughout.  There is an area of wall\nthickening and ill-defined mass in the ascending colon (3:66, 601b:29) which\nlikely corresponds to the previously reported abnormality.  There is\nsignificant omental caking and nodularity (3:77, 3:74, 6:40).  The rectum is\nwithin 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.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent. Bilateral adnexae are\nwithin normal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy by CT\nsize 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 are seen in the lumbar spine.  There is no\nevidence of acute fracture. Incidentally noted is a sclerotic oval lesion in\nthe sacrum (3:97) with speckled chondroid matrix and intact cortex without\nassociated soft tissue mass most consistent with an enchondroma or enostosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Wall thickening and ill-defined mass in the ascending colon and associated\nomental caking and nodularity indicative of a  neoplastic process with\nmetastasis.\n2. Two hepatic hypodensities with enhancing components measuring 1.3 x 1.9 x\n1.4 cm and 1.6 x 1.2 x 1.0 cm. Enhancement pattern favors hemangioma although\nmetastasis remains in the differential.\n3. Three hepatic subcentimeter hypodensities most consistent with cysts."
        },
        {
            "input": "VASCULAR:  There is no abdominal aortic aneurysm.  The abdominal aorta and its\nmajor branches are widely patent.  The portal vein is patent.\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 homogeneous background attenuation. \nAgain seen are multiple scattered liver hypodensities, not significantly\nchanged from prior, the largest is in segment ___ and measures 9 mm.  Also\nunchanged is a hepatic hemangioma at the right dome (series 3A, image 23).  No\nnew lesions are identified.  Gallbladder is unremarkable.  There is no intra\nor extrahepatic biliary duct dilation.  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 is top-normal in size measuring 13.0 cm in AP dimension.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:  There are bilateral renal stones measuring up to 6 mm in the left\nand right lower pole.  There is a 3 mm stone in the proximal left ureter with\nsurrounding stranding.  There are bilateral peripelvic cysts limiting\nevaluation for hydronephrosis however, compared to ___ the left renal\npelvis appears more dilated.  There is fluid tracking around the left ureter\nand into the pelvis, new from prior, measuring low-density.\n\nGASTROINTESTINAL:  There is a moderate hiatal hernia.  The patient is status\npost gastric banding with unchanged postoperative appearance.  Small and large\nbowel are normal in caliber without focal wall thickening.  Large bowel is\nalso normal in caliber without focal wall thickening.  The degree of omental\ncaking, most pronounced in the left upper quadrant has not significantly\nchanged compared to ___.  There is no intra-abdominal free air.  There is\nno mesenteric adenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS:  The bladder is well distended and normal.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are severe degenerative changes of the lumbar spine with mild\nanterolisthesis of L4-5 and complete loss of disc space between L1-L2.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 3 mm obstructing stone in the left proximal ureter causing upstream mild\nhydroureteronephrosis.  There is fluid tracking along the course of the left\nureter and into the pelvis, probably reactive.  Of note, IV contrast has not\nyet been excreted into the ureter limiting evaluation of ureteral disruption.\n2. No evidence of mesenteric ischemia.\n3. Bilateral non-obstructing renal stones.\n4. Multiple hepatic hypodense lesions have not significantly changed.\n5. Stable omental caking, as compared to prior.\n6. Moderate 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: Multiple subcentimeter hepatic hypodensities are too small to\ncharacterize by CT, but are unchanged since the prior study.  Previously\ndescribed hypoattenuating 1.7 x 1.3 cm hemangioma in segment VI is unchanged\nin size. No new focal hepatic lesion.  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: Foci of cortical scarring in both kidneys are unchanged.  There has\nbeen interval placement of a left nephroureteral stent, with distal portion in\nthe urinary bladder. Hyperdense stones again seen in both kidneys, measuring\nup to 6 mm on the right (4:66) and 5 mm on the left (4:67).  There is no\nperinephric abnormality or hydronephrosis.\n\nGASTROINTESTINAL: Gastric banding and a small hiatal hernia again noted. Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  As before, the known ascending colon malignancy is not well seen.\nOmental caking is similar to the prior study.\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. Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nAnterolisthesis of L4 and L5 and retrolisthesis of L1 on L2 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  Unchanged liver lesions and omental caking, compatible with known\nmetastatic colon cancer.\n\n2. Interval placement of the left-sided nephroureteral stent, with persistent\nstones identified in both kidneys. No evidence of hydronephrosis."
        },
        {
            "input": "LOWER CHEST: There is a 3 mm lung nodule in the right lower lobe (series 3:\nImage 1), grossly unchanged from CT chest dating ___.  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 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 a 5.3 mm x 4.4 mm nonobstructing stone in the\ninterpolar region of the left kidney, grossly unchanged from prior exam. \nThere are no stones seen within the right kidney.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout.  Rectal contrast demonstrates\ndiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening and fat stranding. The appendix is not visualized.  Midline\nsurgical clips are seen in the anterior abdomen (series 5: Image 9).\n\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. Diverticulosis without diverticulitis of the sigmoid colon.  No evidence of\nobstruction or adhesions.\n2. 3 mm lung nodule in the right lower lobe, unchanged from previous CT chest\ndating ___.  Further examination of the lungs is limited on this\nexam.\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": "URINARY: The partially visualized kidneys are grossly unremarkable.\n\nGASTROINTESTINAL: The visualized 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 reproductive organs are unremarkable.\n\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 diastases of left sacroiliac joint with associated erosive changes\nis worrisome for sacroiliitis.  No periosteal new bone formation.  No focal\nblastic lesions worrisome for malignancy.  No acute fracture.\n\nSOFT TISSUES: The psoas, piriformis and iliacus muscles are unremarkable\nbilaterally.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild diastases with erosive changes of left sacroiliac joint is worrisome\nfor left sacroiliitis.\n2. No fluid collection or evidence of myositis."
        },
        {
            "input": "URINARY:  The partially visualized kidneys are grossly unremarkable.\n\nGASTROINTESTINAL: The visualized 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 is decompressed with a Foley catheter.  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.  Few\nprominent inguinal lymph nodes do not meet CT size criteria for enlargement. \nThere is no pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES:  Mild persistent diastases of the left sacroiliac joint with associated\nerosive changes is stable since prior examination, worrisome for sacroiliitis.\nNo periosteal new bone formation.  No focal blastic lesions worrisome for\nmalignancy.  No acute fracture.\n\nSOFT TISSUES: There is interval increase in size and fat stranding around the\nleft piriformis muscle in comparison to ___.  No focal fluid\ncollection.",
            "output": "1. Left piriformis muscle myositis with increased fat stranding and\nenlargement since ___.  No fluid collection.\n2. Persistent left 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 diffuse hypoattenuation, compatible with\nhepatic steatosis.  Slightly increased focal fat is seen adjacent to the\nfalciform ligament (2:9).  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is otherwise unremarkable.\nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  Mild colonic diverticulosis without evidence of diverticulitis. \nThe colon and rectum are 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: 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFixation hardware is again noted at the right acetabulum.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Hepatic steatosis.  Please see the below recommendations if further\nevaluation is clinically indicated.\n2. Small hiatal hernia.\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 MR ___, in conjunction with a GI/Hepatology\nconsultation.  *\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: Please refer to separate report of CT chest performed on the same\n___ for description of the thoracic findings.\n\nABDOMEN:\n\nThe visualization of some portions of the abdomen is limited by streak\nartifact from posterior fusion hardware.\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.4\ncm hypodense lesion with nodular peripheral enhancement is seen in the right\nhepatic lobe (2:65) and is incompletely characterized in single phase.  No\nother lesions are identified within the limitations the study.  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 left adrenal gland appears slightly thickened, comparison with\nthe prior MRI cannot be established given respiratory motion.  The right\nadrenal glands 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.  Oral contrast is seen in small\nbowel loops and colon.  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: Urinary bladder appears unremarkable.  Distal ureters are not seen. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is grossly unremarkable.\n\nLYMPH NODES: Multiple calcified lymph nodes and adenopathy are seen in the\nmesentery and retroperitoneum, for instance a 1.7 cm periportal calcified\nadenopathy (2:66), multiple calcifications in the retroperitoneum (2: 74) also\nnoted.  No definitive pelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Discitis-osteomyelitis changes with fracture involving T10 and T11\ncausing marked kyphosis of the thoracic spine are redemonstrated.  Patient is\nnow status post posterior spine fixation with laminectomy from T10 through T11\nand posterior fusion via bilateral pedicle screws and fusion rods spanning T8\nthrough L1.  No other abnormal findings in the bones.\n\nSOFT TISSUES: Multiple peripherally enhancing collections are noted in the\nparaspinal musculature for instance in the right paraspinal muscle at the\nlevel of the right upper pole a 2.5 x 2.3 cm rim enhancing collection is again\nseen (2:61), a 2.7 x 1.6 cm right subpleural (02:47) rim enhancing collection\nis also noted at the level of T11, other collections in the thorax will be\nseparately reported.",
            "output": "1. Discitis osteomyelitis and fractures involving the T10 and T11 vertebral\nbodies with new posterior fixation.\n2. Multiple rim enhancing collections are seen in the paraspinal musculature\nlikely represent abscesses.\n3. 1.4 cm hypodense lesion in the right hepatic lobe is incompletely\ncharacterized in a single phase CT and visualization is partially limited by\nposterior spinal fusion hardware artifact.  While in the context of this\npatient this could represent an abscess, hemangioma is also possible.\n4. Multiple calcified lymph nodes and lymphadenopathy in the mesentery and\nretroperitoneum is likely related to granulomatous disease.\n5. Please refer to separately reported chest CT for intrathoracic findings.\n6. Possible thickening of the left adrenal gland."
        },
        {
            "input": "LOWER 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.  In\nsegment VI is a hyperenhancing lesion that measures 1.2 x 1.0 cm most\nconsistent with a flash filling hemangioma, (series 2, image 63).  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  The 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: Multiple calcified lymph nodes and adenopathy in the mesentery\nand retroperitoneum are grossly unchanged in size when compared to prior.  A\nrepresentative lymph node is located in the porta hepatis  and measures 17 mm\nin short axis, (series 2, image 56), unchanged from prior.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Discitis/osteomyelitis changes resulted in destruction of the T10 and\nT11 vertebral bodies with resultant severe kyphosis are again demonstrated. \nThe patient is status post posterior fusion via screws and fusion rods\nspanning T8 through L1.  No evidence of hardware complication.  There is no\nevidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There has been interval resolution of multiple fluid collections\nin the paraspinal musculature.  For example in the right para spinal muscles\nat the level of T11 there has been interval resolution of a rim enhancing\ncollection.  No new rim enhancing collections.",
            "output": "1. No interval change in appearance of osseous destruction involving the T10\nand T11 vertebral bodies secondary to discitis-osteomyelitis with posterior\nfixation devices in place.\n2. Interval resolution of multiple fluid collections in the paraspinal\nmusculature.\n3. No interval change in appearance of multiple calcified lymph nodes and\nadenopathy in the mesentery and the retroperitoneum.\n4. Please refer to same-day CT chest for a detailed report 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 attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The nondistended 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: Patient is post total left nephrectomy, with adjacent surgical clip. \nNo evidence of recurrence in the surgical bed.  Multiple subcentimeter\nhypodensities in the right kidney are too small to characterize, but likely\ncysts, as described on MR from ___ (10:32 36, 37).\n\nGASTROINTESTINAL: Stomach is moderately well distended with oral contrast and\nunremarkable.  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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is trace calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:  Streak artifact from the left hip prosthesis limits evaluation of the\npelvic structures.  Visualized portions of the urinary bladder and\nreproductive organs appear grossly unremarkable.  There is no free fluid in\nthe pelvis.\n\nBONES AND SOFT TISSUES: Mild to moderate degenerative changes of the\nthoracolumbar spine are present.  A small sclerotic focus in the L2 vertebral\nbody is likely a bone island.  Note is made of the left hip arthroplasty, as\nwell as bilateral SI joint degenerative changes. Focal soft tissue changes in\nthe anterior right abdominal wall may reflect prior injection site.",
            "output": "1. Post total left nephrectomy with no evidence of recurrence in the surgical\nbed.  No recurrent malignancy or metastatic disease identified in the abdomen\nor pelvis.\n\n2. Please see dedicated CT chest report from the current date for the thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: A 16 x 10 mm left lower lobe nodule is noted. For further\ndetails, please see separate report for intrathoracic findings from same-day\nCT chest.\n\nCT ABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously without evidence of concerning\nfocal lesion. There is no intrahepatic biliary ductal dilation. The portal\nvein is patent. The gallbladder is unremarkable without evidence of wall\nthickening or inflammation.\n\nPANCREAS: The pancreas enhances homogeneously. There is no peripancreatic\nstranding or ductal dilation.\n\nSPLEEN: There is no splenomegaly or focal splenic lesion.\n\nADRENALS: The adrenal glands are normal.\n\nURINARY: The patient is status post left nephrectomy. There is no evidence of\nrecurrence within the surgical left nephrectomy bed.  The right kidney\ndemonstrates normal enhancement. There is no right hydronephrosis.\n\nGASTROINTESTINAL: There is a small hiatus hernia. The stomach and duodenum are\nunremarkable. Non-dilated small bowel loops are normal in course and caliber\nwithout evidence of wall thickening or obstruction. The colon is unremarkable.\nThe appendix is not directly visualized, however, there are no secondary signs\nof appendicitis.\n\nVASCULAR AND LYMPH NODES: Mild atherosclerotic disease is most prominent in\nthe infrarenal abdominal aorta. The abdominal aorta is normal in caliber\nwithout evidence of aneurysm or dilation. Major proximal tributaries are\npatent.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nArtifact from left total hip arthroplasty components somewhat obscures\nevaluation of intrapelvic structures. Within this limitation, the imaged\npelvic organs, including the bladder and terminal ureters, are unremarkable. \nThere is no visible pelvic or inguinal lymphadenopathy. There is no free\npelvic fluid seen.\n\nMUSCULOSKELETAL: The patient is status post total hip arthroplasty.  The\nimaged thoracolumbar spine demonstrates normal alignment. No concerning focal\nlytic or sclerotic osseous lesions are seen.",
            "output": "1. Status post left nephrectomy. No evidence of local or distant recurrence\nwithin the abdomen or pelvis.\n2. Limited evaluation of the pelvis due to hardware artifact from left hip\narthroplasty components.\n3. Small hiatus hernia.\n4. Please see separate report for intrathoracic findings from same-day CT\nchest."
        },
        {
            "input": "LOWER CHEST:\nThere is a 11 x 9 mm nodule in the left lower lobe (series 5, image 45). \nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The hepatic parenchyma enhances homogeneously.  No focal liver\nlesions.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous attenuation without main duct dilation.\nSPLEEN:  No splenomegaly.\nADRENALS:  No adrenal nodules.  8 mm fluid density lesion adjacent to the\nmedial limb of the left adrenal gland (05:58) previously measured 11 mm.\nURINARY:  Post left nephrectomy status.  Minimal soft tissue stranding\nadjacent to surgical clips in the left nephrectomy bed remains unchanged,\nlikely postsurgical changes.  No nodular soft tissue suspicious for\nrecurrence.\nExtrarenal pelvis noted on the right side.  5 mm right renal superior pole\nhypodensities too small to be optimally characterized.\nGASTROINTESTINAL:  Small hiatus hernia.  No bowel obstruction.  Scattered\ncolonic diverticulosis.\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen.  The left\nlateral pelvic wall is somewhat limited by beam hardening artifact.  No\nenlarged right lateral pelvic wall lymphadenopathy.\nVASCULAR: There is a moderate amount of calcified atherosclerotic plaque\nthroughout the abdominal aorta and its branches without aneurysmal dilation.\n\nPELVIS:\nThe bladder minimally distended, hence limited in evaluation.  The uterus is\nnot visualized, likely surgically absent.  The right ovary is noted and\nappears unchanged compared to the prior exam.  The left ovary is not clearly\nvisualized.\n\nBONES AND SOFT TISSUES:\nLeft hip prosthesis is partially imaged.  No worrisome osseous lesions. \nMultilevel degenerative changes of the thoracolumbar spine noted.\nSubcutaneous soft tissue nodules in the lower anterior abdominal wall are\nlikely related to subcutaneous injections.",
            "output": "1. No metastatic disease in the abdomen or pelvis.\n2. Post left nephrectomy status with minimal soft tissue stranding in the\nnephrectomy bed which is unchanged compared to the prior exam.\n3. No solid enhancing right renal masses.\n4. Small hiatus hernia with 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.  A\n2.3 cm linear hypodensity in the hepatic dome is unchanged from ___\nand may represent a rent or fold in the capsule.  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.  Note is made of 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. \nMultiple bilateral renal cortical cysts measure up to 2.3 cm.  There is no\nevidence of solid 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.  A rectal tube is in place.  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 a fibroid uterus.  Thickened low-density\nendometrial stripe measures up to 12 mm.  No concerning adnexal mass lesions.\n\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 3.1 cm partially sclerotic focus in the intertrochanteric left\nfemur.  Demonstrates rings and arcs calcification, and most likely represents\nan enchondroma.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  A rim calcified\nsoft tissue density in the subcutaneous fat of the right gluteal region is\nmost consistent with an injection granuloma.",
            "output": "1. No acute process within the abdomen or pelvis.\n2. Thickened endometrium may represent fluid within the endometrial canal in\nthe setting of mild cervical stenosis.  Recommend nonurgent pelvic ultrasound\nfor further evaluation.\n\n3. Fibroid uterus.\n4. Please see separate chest CT report for details of intrathoracic findings.\n\nRECOMMENDATION(S):\n\n1. Thickened endometrium may represent fluid within the endometrial canal in\nthe setting of mild cervical stenosis. Recommend nonurgent pelvic ultrasound\nfor further evaluation."
        },
        {
            "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 nondistended gallbladder\nis within normal limits, without wall thickening or pericholecystic fluid.\n\nSPLEEN: Splenomegaly is stable, measuring 14 cm in maximum dimension. There is\na small accessory spleen just posterolateral to the tail of the pancreas.\n\nPANCREAS: The pancreas is without focal lesion or peripancreatic stranding or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS:  The left kidney is atrophic but demonstrates normal nephrogram. The\nright kidney is with normal excretion of contrast. There are 2 subcentimeter\nhypodense lesions within the right lower kidney pole, stable since prior\nstudy. There are no radio-opaque stones.\n\nGI: The stomach is normal appearing. The small and large bowels are within\nnormal caliber, without wall thickening or evidence of obstruction.\n\nVASCULATURE: The aorta is normal in caliber, without evidence of aneurysmal\ndilatation or significant calcified atherosclerotic plaques.\n\nLYMPHATICS:  There is a small retroperitoneal lymph node, just posterior to\nthe left psoas muscle (image 2:89), that is slightly more dense in appearance\nbut is overall stable in size since ___ (measuring 6.2 mm versus 6.1 mm\nin prior study).  There is also mildly enhancing left inguinal lymph known\nthat (image 2:113, measuring 8.1 mm, again stable since prior study in ___. Nonpathologic nodes are again seen along bilateral iliac chain.\n\nCT PELVIS: The urinary bladder is unremarkable.  The prostate and seminal\nvesicles are normal appearing. There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES:  Sclerotic lesion is again seen in the L5 vertebral body,\nunchanged since at least ___. There are otherwise no pathologic osseous\nlesions. At L5/S1, there are right facet osteophytes resulting in moderate\nright neural foraminal narrowing. There is no evidence of high-grade spinal\nstenosis throughout the spine.",
            "output": "Since prior study in ___, there are no significant changes.\n1. One retroperitoneal lymph node posterior to the left psoas muscle appears\nmore dense however is stable in size. Attention on followup is warranted.\nOtherwise, nonpathologic stable lymph nodes are again seen in the left\ninguinal and in bilateral iliac chain.\n2. Stable splenomegaly."
        },
        {
            "input": "LOWER CHEST: The partially assessed lung bases are clear. There is no pleural\nor pericardial effusion. Please see separately submitted report of Chest CT\nfor full description of the lungs.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation.  The portal and hepatic veins are patent. The\nnondistended gallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and moderately enlarged measuring up to 14.9\ncm (08:31), little changed from the prior study. A small accessory spleen is\nnoted (5:81).\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\n\nADRENALS: The adrenal glands are unremarkable.\n\nKIDNEYS:  A small hypodensity in the lower pole right kidney too small to\nfully characterize, but likely represents a simple cyst (5:94). The kidneys\ndemonstrate symmetric nephrograms and excrete contrast promptly.  The left\nkidney is atrophic with a normal nephrogram, unchanged from the prior study.\nThere is no hydronephrosis.\n\nGI: The stomach is moderately distended without obvious intraluminal mass or\nwall thickening. The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction. A normal appendix is visualized.\nThere is colonic diverticulosis without evidence of diverticulitis.\n\nRETROPERITONEUM:  The aorta is normal in caliber, with rare atherosclerotic\ncalcifications.  A small retroperitoneal lymph node adjacent to the left psoas\nmuscle (5:96) measures up to 0.8 cm, unchanged in size dating back to ___ when measured in a similar plane, and smaller than ___. This area\ncontinues to increase in density, likely a calcifying site of treated disease.\nA small enhancing left inguinal lymph node is also unchanged dating back to ___, measuring 3.6 cm in short axis. Small lymph nodes along bilateral\niliac chains are not pathologically enlarged, and unchanged from recent prior\nstudies. There is no retroperitoneal or mesenteric lymph node enlargement by\nCT size criteria.\n\nCT PELVIS:   The urinary bladder appears normal. No pelvic wall or inguinal\nlymph node enlargement by CT size criteria is seen. There is no pelvic free\nfluid.\n\nSOFT TISSUES:  The soft tissues are unremarkable.\n\nOSSEOUS STRUCTURES:  A small sclerotic focus in the L1 spinous process is\nunchanged from multiple prior studies, likely representing a benign bone\nisland (5:74). A sclerotic focus in the left L5 pedicle has increased only\nslightly in size from ___, now measuring 1.1 cm, unchanged from the immediate\nprior study when measured in similar planes and compatible with a benign bone\nisland (5:97). Scattered additional subcentimeter sclerotic foci within the\nlumbar spine and pelvic bones are little changed from prior studies and most\nlikely represent additional small benign bone islands. No focal lesion\nsuspicious for malignancy present.",
            "output": "1. Overall little change from the prior study.\n2. Small left retroperitoneal lymph node is unchanged in size, and mildly\nincreased in density, likely a site of calcifying treated disease.\n3. Scattered small sclerotic foci in the lumbar spine and pelvic bones most\nlikely representing benign bone islands. .\n4. Stable 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 is mildly enlarged measuring 13.5 cm, stable.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY:   The left kidney is atrophic with compensatory hypertrophy of the\nright kidney.  The left renal artery is small in caliber (4:71).  There is no\nhydronephrosis.\n\n\nGASTROINTESTINAL: The stomach is 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 by CT\nsize criteria.  Left common iliac (4:91) and external iliac lymph nodes (04:10\n8) are unchanged since prior, maximally measuring 5 mm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Rounded dense sclerotic 10 mm focus at the left L5 pedicle is stable\nsince at least ___, consistent with a bone island.  Lucency at the\nright femoral neck, right greater than left, is stable since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No new lymphadenopathy in the abdomen or pelvis.\n2. Chronic atrophy of the left kidney may be related to renal artery stenosis\nwith compensatory hypertrophy of the right kidney.  No hydronephrosis on\neither side.\n3. Stable mild splenomegaly.\n4. See same-day chest CT for thoracic details."
        },
        {
            "input": "LOWER CHEST: 2 mm pulmonary nodule in the right lower lobe is unchanged and\nnot suspicious.  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 decompressed and not well 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 atrophic, consistent with chronic kidney disease. \nMultiple bilateral hypoattenuating renal lesions seen, the largest in the\nupper pole of the right kidney measuring to 23 mm in diameter (similar\ncompared to prior) consistent with a renal cyst.  Bilateral lower pole solid\nisodense lesions measure approximately 5.9 x 2.8 cm on the left and 3.4 x 2.9\ncm on right (in coronal plane), better appreciated on the MRI from ___ and renal ultrasound done ___, but grossly unchanged.  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 is enlarged and bulky in contour, likely\nreflective of fibroids. Right cystic adnexal lesion 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. There is mild stenosis at the\norigin of the celiac axis with mild poststenotic dilation. 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.\nEvaluation of breast is reserved exclusively for mammography.",
            "output": "1. Left mid to lower pole and right lower pole solid renal lesions appear\ngrossly unchanged within the limitations of an unenhanced scan, measuring\napproximately 5.9 x 2.8 cm on the left and 3.4 x 2.9 cm on the right, better\nappreciated on the MRI from ___.  Please note that these lesions\nare suboptimally characterized without IV contrast.  If IV contrast cannot be\nadministered, ultrasound could be considered as a reasonable alternative.\n2. No new or enlarging lymph nodes in the abdomen or pelvis.\n\nRECOMMENDATION(S):  Please note that these lesions are suboptimally\ncharacterized without IV contrast. If IV contrast cannot be administered,\nultrasound could be"
        },
        {
            "input": "LOWER CHEST: Imaged lung bases are clear.  The imaged portion of the heart is\nunremarkable.\n\nABDOMEN: Tiny foci of free air seen along the anterior margin of the liver.\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.  No portal venous gas.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  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.  The left adrenal gland is not\nwell visualized.\n\nURINARY: The kidneys are of normal and 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.  Small bowel loops\ndemonstrate no signs of ileus or obstruction.  Suture material is seen along\nthe right mid abdomen at the site of prior resection in this patient with\nreported prior cecal volvulus.  There is a large volume of stool within the\ncolon.  Gas is noted within the wall of the right colon to the level of the\nmid transverse colon consistent with new pneumatosis intestinalis.  The\ndescending and sigmoid colon appears within normal limits.  No small bowel\nobstruction.  There is a small amount of fluid in the pelvis.\n\nPELVIS: The urinary bladder is distended.  The distal ureters are not well\nvisualized.  No significant free fluid.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Pneumatosis intestinalis involving the right colon extending from the level of\nthe enterocolonic anastomosis in the right mid abdomen through the mid\ntransverse colon, with associated tiny volume pneumoperitoneum.  The\ndifferential for pneumatosis intestinalis includes bowel ischemia though given\npatient age, consider alternative etiologies such as inflammatory bowel\ndisease, medication induced pneumatosis or connective tissue disorders.\n\nNOTIFICATION:  The findings and the recommendation for further evaluation in\nthe ED were discussed with ___, N.P. by ___, M.D. on\nthe telephone on ___ at 6:23 pm, 10 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST:\nMinimal bibasilar dependent atelectasis noted.  There is mild soft tissue in\nthe right perihilar region associated with punctate calcifications, partially\nimaged.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously.  No focal liver\nlesions or intrahepatic biliary ductal dilation noted.  The portal vein and\nits branches; and the hepatic veins are patent.\nThe gallbladder is distended with no radiopaque calculi within it or\npericholecystic inflammation.\nPANCREAS: There is homogeneous enhancement of the pancreatic parenchyma\nwithout main duct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions..\nADRENALS:  There are no adrenal nodules..\nURINARY: No hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is a small hiatus hernia.  No bowel obstruction. \nThere is concentric wall thickening of the terminal ileum and adjacent cecum\n(series 3, image 48/series 5, image 24) without bowel obstruction.  This\nappearance was also present on the CT dated ___ but incompletely\nevaluated on ___ given lack of oral contrast on this exam. \nScattered sigmoid diverticuli noted.\na the appendix is visualized and has a normal appearance.\nLYMPH NODES: There is interval decrease in size of the distal periesophageal\nlymph node noted on the CT dated ___.  Similarly the lymph nodal\nmass in the right lower quadrant that was previously biopsied is much smaller\nin size now measuring 3.5 x 2.5 cm compared to a prior of 4.5 x 2.8 cm\n(03:49).\nAdditional subcentimeter short axis rounded distal periesophageal,\nperipancreatic, retroperitoneal (aortocaval and para-aortic), mesenteric,\nbilateral external iliac and inguinal lymph nodes are present and smaller in\nsize compared to the prior exam.\nVASCULAR: There is a small amount of calcified atherosclerotic plaque within\nthe abdominal aorta and its branches without aneurysmal dilation.\n\nPELVIS:\nThe bladder the urinary bladder is moderately distended and appears normal.  A\nmetal devices present on the skin in the left inguinal region causing dense\nartifacts.  Left hip prosthesis also causes dense artifacts over the pelvis..\n\nBONES AND SOFT TISSUES:\nIntact left hip prosthesis noted.  Degenerative changes of the right hip joint\nseen.  Chronic compression deformity of the L1 vertebral body with mild loss\nof height (less than 50%) is unchanged since the prior exam.",
            "output": "1. Persistent innumerable distal periesophageal, retroperitoneal, mesenteric,\npelvic and right lower quadrant lymph nodes with interval decrease in size\ncompared to ___.\n2. Concentric wall thickening of the terminal ileum and adjacent cecum has\nprogressed compared to the CT dated ___ but cannot be compared to\nthe CT dated ___ due to lack of oral contrast on this latter exam.\nEtiology likely remains involvement of the ileocecal junction by lymphoma,\nwith interval decrease in size of conglomerated lymphadenopathy (previously\nbiopsied) in the drainage area of the ileocecal junction.  No other areas of\nbowel wall thickening seen on this exam."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\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 layering debris in the gallbladder\nlumen, potentially reflecting sludge.  The gallbladder is within normal limits\notherwise.\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 has been interval enlargement of the spleen from the study\nperformed ___.  Spleen now measures 13 cm in craniocaudal extent,\npreviously 10 cm.  Furthermore, the AP diameter of the spleen has increased\nfrom 5.3 cm to 8.3 cm.  There are no focal parenchymal lesions within the\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 with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  The stomach is unremarkable\notherwise.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  The concentric thickening of the terminal ileum and\ncecum demonstrated on the prior studies shows near-complete resolution.  There\nis regional small volume fluid and fat stranding/streakiness, but no\nmeasurable residual soft tissue mass or measurable wall thickening.\n\nPERITONEUM: Previously seen mild anterior omental stranding is now slightly\nmore conspicuous and seen predominantly along the right omentum.  No large\nvolume free abdominal or pelvic fluid.  No organized abdominopelvic fluid\ncollections.\n\nPELVIS: Urinary bladder is only partially distended.  No abnormality noted.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Retrocrural lymphadenopathy demonstrating interval worsening. \nIndex conglomerate in the left retrocrural space measures 1.9 x 2.2 cm,\npreviously 1.4 x 2.0 (series 4, image 51).  A right retrocrural lymph node\nmeasures 16 mm in short axis, previously 11 mm (series 4, image 48).  A second\nindex retrocrural lymph node on the right measures 14 mm in diameter,\npreviously 7 mm (series 4, image 43).  There is a new periportal lymph node\nmeasuring 15 mm in short axis (series 4, image 51).  There is new upper\naortocaval lymphadenopathy.  Although the individual lymph nodes are only\nmildly bulky by size criteria, these are too numerous in number.  The largest\nsingle node measures 11 mm in short axis (series 4, image 60).  Scattered\nlower retroperitoneal lymph nodes a stable, with an index aortocaval lymph\nnode measuring 11 mm in short axis, previously 11 mm (series 4, image 70).  A\ncluster of small nodes are seen at the root of the mesentery, largely\nunchanged.  These remain excessive by number.  There is no inguinal or pelvic\nlymphadenopathy.  Previously described paraesophageal lymph nodes are smaller,\nwith index lymph node, right paraesophageal, measuring 7 mm in short axis,\npreviously 13 mm (series 4, image 36).  A second paresophageal lymph node\nmeasures 5 mm in short axis, previously 9 mm (series 4, image 38).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Patient is status-post left total hip arthroplasty.  There is\ndegenerative facet arthropathy in the lower lumbar spine.  Dense sclerotic\nlesions in the left ilium and left pubis symphysis are stable, likely\nreflecting benign bone islands.  No acute or focal destructive osseous lesion.\n\nSOFT TISSUES: There is mild dependent subcutaneous soft tissue edema.  The\nabdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Mixed response to treatment.\n2. Near complete resolution of concentric thickening of the terminal ileum and\ncecum, with no measurable soft tissue mass or measurable bowel wall\nthickening.  Regional small volume fluid and fat stranding/streakiness remain.\n3. While previously described paraesophageal lymph nodes are smaller, there\nhas been progression of retrocrural lymphadenopathy.  There is new upper\nretroperitoneal and new periportal lymphadenopathy.  Mesenteric lymph nodes\nand lower retroperitoneal lymph nodes are stable.\n4. There is new splenic enlargement, without focal splenic lesions.\n5. Previously seen slight omental fat stranding and haziness are now slightly\nmore conspicuous and seen predominantly in the right omentum.  The\nsignificance of this finding is indeterminate."
        },
        {
            "input": "LOWER 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 attenuation throughout without evidence of\nfocal lesions.  Mild splenomegaly, measuring approximately 13 cm in the\ncraniocaudal dimension, similar to the study dated ___.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is a small hiatal\nhernia.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout. There is mesenteric haziness suggestive of\ninfiltrative lymphomatous disease surrounding the cecum and terminal ileum,\nwhich appears to progressed compared to the most recent prior (series 2, image\n79). There is soft tissue stranding surrounding the falciform and round\nligament as well as central mesentery (series 2, image 87) slightly increased\ncompared to prior.  There is progression in the anterior omental stranding,\npredominantly along the right omentum.\n\nPELVIS: The distal ureters are unremarkable.  There is circumferential\nthickening of the bladder wall, likely secondary to partial lower urinary\ntract obstruction.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatemegaly.  Seminal vesicles are normal.\n\nLYMPH NODES: There has been slight interval worsening of the retrocrural\nlymphadenopathy.  There is a conglomerate in the left retrocrural space\nmeasures 2.3 x 1.9 cm, previously 2.2 x 1.9 cm (series 2, image 50).  Right\nretrocrural lymph node conglomerate measures 1.8 x 1.5 cm, previously 1.4 x\n1.6 cm (series 2, image 48).  Periportal lymph node measures 1.2 cm in short\naxis (series 2, image 50), is unchanged compared to the most recent study. \nThere is interval progression of the aortocaval lymphadenopathy, now measuring\n1.5 cm in short axis, previously 1.1 cm (series 2, image 66).  There are\nmultiple retroperitoneal lymph nodes, the largest of which measures 1.2 cm in\nshort axis, previously measuring 1.1 cm on most recent study (series 2, image\n69).  There are innumerable lymph nodes in the mesenteric root.  Inguinal\nlymph nodes are also mildly enlarged for example on right (series 2, image\n109) measuring 9 mm in diameter, previously 7 mm.\n\nAgain seen is paraesophageal lymphadenopathy.  There is a right paraesophageal\nlymph node measuring 8 mm in short axis, previously 7 mm (series 2, image 34).\nA second right paraesophageal lymph node now measures 7 mm in short axis,\npreviously measuring 5 mm (series 2, image 36).  A left paraesophageal lymph\nnode measures 1.2 cm in short axis, previously measuring 7 mm (series 2, image\n28).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: The patient is status post left total hip arthroplasty.  Degenerative\nchanges are seen in the lumbar spine with endplate sclerosis, osteophytosis\nand facet arthropathy.  Dense sclerotic lesions in the left ilium and left\npubic symphysis are stable, likely reflecting sclerotic bone islands.  No\nacute focal or destructive osseous lesion.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. In comparison to the most recent study from ___, there has\nbeen slight interval progression of the extensive adenopathy.\n2. There has also been interval increase in the mesenteric and omental soft\ntissue infiltration/stranding suggestive of progression of infiltrative\nlymphomatous disease.\n3. Mild, stable splenomegaly compared to the most recent study from ___.\n4. Prostatemegaly.\n5. For neck and chest findings reference is made to their respective reports\nof CT studies done 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. \nThere is 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 normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\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.\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: The previously seen enlarged retroperitoneal lymph nodes are now\nmostly normal in size. The largest retroperitoneal lymph nodes measures 0.4\ncm, previously 1.5 cm.  No new enlarged retroperitoneal lymph nodes.  No\nenlarged mesenteric lymph nodes. The ill-defined infiltrative appearing soft\ntissue density surrounding the ileocolic branch of the SMV is substantially\nimproved with mild residual.  There is no pelvic or inguinal lymphadenopathy. \nMultiple retrocrural lymph node also decreased in size.  For example a right\nretrocrural lymph node measures 0.9 cm, previously 1.7 cm.  Scattered\nparaesophageal nodes have also decreased in size, with the largest measures\n0.5 cm, previously 0.8 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. \nThe patient is status post left total hip arthroplasty.  Bone island in the\nleft iliac bone and left superior pubic ramus are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval improvement of disease including decrease in size of the abdominal\nlymphadenopathy and decreased infiltrative soft tissue density around the\nileocolic branch of the SMV.  No new abdominopelvic lymphadenopathy.\n2. Please see separate report performed on same day for detailed evaluation of\nthe 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. \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. \nSubcentimeter hypodensity within left kidney is too small to likely small\nrenal cyst, unchanged from ___ CT.  There is no evidence of\nsuspicious solid renal lesions or hydronephrosis.  There is no 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.  There is more conspicuous stranding and soft\ntissue thickening along the ileo colic branch of the superior mesenteric vein\nand artery, similar in appearance when compared to the ___ CT\nabdomen pelvis (5:80).  However distal to these vessels is a new hyperdense\nmass  situated along the mesenteric side of the cecum measuring 1.7 x 1.2 cm\n(5:84).  This finding was identified in the same day ___ FDG\nPET-CT where it demonstrated FDG avidity.  Remainder of the colon is notable\nfor scattered diverticula without acute diverticulitis.  The appendix is not\ndefinitively seen.  The rectum is normal in appearance.\n\nPELVIS: Urinary bladder is collapsed, limiting assessment. The distal ureters\nare unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is obscured by artifact from the left total\nhip hardware.\n\nLYMPH NODES: Previously seen of scattered conspicuous posterior mediastinal\nparaesophageal nodes as well as retroperitoneal para-aortic nodes remain\nsubcentimeter in size and appear to have minimally decreased in size since ___.  A representative 9 mm right para-aortic node measured 9.3 mm\nin ___ (5:49).  A representative aortocaval node measuring 3 mm\nin short axis previously measured 3.6 mm in short axis in ___\n(5:67).  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Increased soft tissue thickening and surrounding fat stranding\nalong the length of the ileocolic branch of the superior mesenteric vein and\nartery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nLeft total hip arthroplasty hardware in situ without visualized hardware\nrelated complications.  Chronic moderate anterior wedge compression deformity\nof L1 vertebrae is similar to prior.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Increased soft tissue mural thickening of the ileo colic ___ of the\nsuperior mesenteric vein and artery when compared to the most recent ___ CT abdomen and pelvis.  Additionally, distal to these vessels\nalong the mesenteric side of the cecum is a new hyperdense 1.7 x 1.2 cm mass\nwhich demonstrated FDG avidity on same day ___ FDG PET-CT.  This\nlesion is highly suspicious for lymphoma.\n2. Overall similar to minimally decreased size of few scattered posterior\nmediastinal paraesophageal as well as the retroperitoneal conspicuous lymph\nnodes when compared to the ___ CT abdomen and pelvis.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:35 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 suspicious focal lesion.  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement.  The known soft tissue mass\nalong the ileocolic vessels on the mesenteric side of the cecum is less\nconspicuous on today's exam.  Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening or fat stranding. The appendix is not\nvisualized.\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 by size\ncriteria.  There is redemonstration of a prominent but not pathologically\nenlarged right periaortic lymph node, which now measures 0.8 x 1.1 cm (series\n5, image 80), previously 0.9 x 1.3 cm.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.  There is mild stranding surrounding the ileocolic branch of\nthe superior mesenteric vein, similar to slightly improved compared prior CT\ndated ___ (series 5, image 123).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate degenerative changes of the right femoroacetabular joint with joint\nspace narrowing, osteophyte formation.  Unchanged wedge deformity of the L1\nvertebral body.  Patient is status post left total hip replacement.  No\nobvious hardware related complications identified.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No new or enlarging intra-abdominal or pelvic lymph nodes.\n2. Redemonstration of a prominent but not pathologically enlarged right\npara-aortic lymph node, which has slightly decreased in size compared to prior\nCT dated ___.\n3. The known small pericecal soft tissue mass is less conspicuous on today's\nexam.  Stranding along the ileocolic branch of the superior mesenteric vein is\nslightly less conspicuous compared to prior.\n4. Cholelithiasis without"
        },
        {
            "input": "LOWER CHEST: For chest findings reference is made to CT chest report of the\nsame day\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Cholelithiasis without evidence\ncholecystitis.\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.  The bladder's\ncollapsed state limits its assessment.\n\nGASTROINTESTINAL: Small hiatal hernia.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement. Apparent wall thickening of the\nsigmoid colon is most likely secondary to a combination of diverticulosis and\nits collapsed state.  Appendix is not seen\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.\n\nLYMPH NODES: The right retrocrural lymph nodes appear similar compared to\nprior.  No new or enlarging intra-abdominal or retroperitoneal lymph nodes.\n\nVASCULAR: Ill-defined soft tissue along the ileocolic vascular pedicle with\nmild wall thickening of the cecum (series 2, image 157) is decreased compared\nto serial priors.  There is no abdominal aortic aneurysm.\n\nBONES: Left hip prosthesis in situ.  Beam hardening artifact partially\nobscures the pelvis.  Bone island in the left ilium is unchanged. \nDegenerative bony changes.  No lytic/destructive bony lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No new or enlarging lymph nodes in the abdomen or pelvis.\n2. Stable appearance of the previously described slightly prominent right\nretrocrural para-aortic lymph node.\n3. Ill-defined soft tissue density along the ileocolic vascular pedicle with\nassociated pericecal soft tissue thickening appears decreased compared to\nserial priors.\n4. Cholelithiasis without evidence of cholecystitis.\n5.  For chest findings reference is made to CT chest report of 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. \nMultiple, subcentimeter hepatic hypodensities are too small to characterize\nbut likely cysts or 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.\n\nADRENALS: The right and 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 left renal cyst.  Bilateral subcentimeter renal\nhypodensities, which are too small to characterize, though statistically\ncysts.  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 unremarkable.  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.  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 within 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Stable 2.3 cm duodenal\ndiverticulum.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. Scattered diverticula of the sigmoid colon is\nnoted, without evidence of wall thickening or 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: Patient is status post hysterectomy and bilateral\nsalpingo-oophorectomy.  There is no evidence of suspicious soft tissue\nthickening or adnexal lesions.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild noncalcified\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. No evidence of metastases in the abdomen or pelvis."
        },
        {
            "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 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 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. A duodenal\ndiverticulum is noted, arising at the junction of the ___ and ___ portion of\nthe duodenum.  There are few scattered colonic diverticula, without evidence\nof acute diverticulitis.  The appendix is normal. No mesenteric or omental\nsoft tissue nodules.\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 total abdominal hysterectomy and\nbilateral salpingo-oophorectomy.  No free fluid within the pelvis.  There are\nsymmetric soft tissue density masses at the cephalad portion of the vaginal\ncuff.  On the  right measuring 3.3 x 2.2 cm, and to the left measuring 2.0 x\n4.3 cm.  These could represent post-surgical change versus local recurrence.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. Two symmetric soft tissue masses at the cephalad portion of the vaginal\ncuff, measuring up to 4.3 cm.  These could represent post-surgical change\nversus local recurrence, and close imaging follow up or correlation with\nPET-CT is recommended. No lymphadenopathy.\n2. Colonic diverticulosis without evidence of acute diverticulitis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  Close interval follow up or correlation with PET-CT is\nrecommended."
        },
        {
            "input": "LOWER CHEST: Please see same-day chest CT for detailed 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 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Redemonstration of a 2.3 cm\nduodenal diverticulum (2:69).  The remainder of the small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or fat stranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post total abdominal hysterectomy and bilateral\nsalpingo oophorectomy, there is redemonstration of the 2 x 3 cm right and 3.9\nx 2 cm left asymmetric soft tissue on both sides of the vaginal cuff (2:110),\npreviously reported on ___ FDG PET CT as showing no increased FDG\navidity relative to background.  Stable appearance of these soft tissue\ndensities favor postsurgical change, continued attention on 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Healed midline abdominal wall incisional scar from prior total\nabdominal hysterectomy.",
            "output": "1. Decreased conspicuity of the asymmetric soft tissue thickening within both\nsides of the vaginal cuff status post total abdominal hysterectomy, which is\nlargely unchanged since ___ CT abdomen pelvis and without FDG\navidity on PET-CT of ___, likely represents postoperative\nchanges/scarring.\n2. No evidence of metastases in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: For full description of the lung bases please see chest CT report\nfrom the same day.\n\nABDOMEN:\n\nHEPATOBILIARY: Multiple liver lesions are again noted.  These are unchanged\ncompared to prior examination there is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  The gallbladder contains a small stone on\nseries 5, ___ 76..\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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 small calcifications along the capsule\nof the spleen possibly post traumatic.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 suture line is\nidentified in the left lower quadrant on series 5 ___ 102.  An ostomy is\nidentified in the left lower quadrant on series 5 ___ 81.  The patient is\nstatus post low anterior resection.\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 aneurysmal dilatation of the infrarenal aorta to 2.9 cm. \nMild atherosclerotic disease is noted.  An IVC filter is noted in\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe patient is status post posterior laminectomy at L4 and L5.\n\nSOFT TISSUES: An anterior abdominal wall hernia is identified containing small\nbowel on series 5 ___ 91.  There is a small epigastric hernia that contains a\nloop of collapsed transverse colon.  There is no evidence for obstruction.",
            "output": "1. Stable liver metastases\n2. Large ventral hernia containing small bowel.  No evidence for obstruction.\n3. Small epigastric hernia is about 3.6 cm in size and contains collapsed\ntransverse colon.  There is no evidence for obstruction\n4. No evidence for new intestinal primary within the limitations of a CT scan."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions, relatively unchanged from\nprior study with consolidations seen in both lower lobes.  Borderline heart. \nCoronary calcification.\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 with a 2.3 cm calculus (3:84).\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 mildly enlarged measuring up to 13.8 cm in maximal\ndimension, 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.  Small nonobstructive calculi in the right kidney measuring\nup to 4 mm (3:91).  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Peg placement through the anterior abdominal wall, well\nplaced into the stomach with no evidence of contrast extravasation to the\nperitoneum.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  The colon and rectum are within normal limits.\n\nPELVIS: The bladder is well distended with an indwelling Foley catheter and\npostprocedural large gas foci in the anterior aspect.  Unchanged position of a\n4 mm calculus within the distal right ureter (3:185).  Mild perihepatic\nascites and small quantity free fluid in the pelvic cul de sac.  Mild\nanasarca.\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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Recent anterior midline incision with several staples in place.",
            "output": "1. Unchanged position of a nonobstructed right distal ureterolithiasis.\n2. Well placed gastrostomy tube with no evidence of contrast leakage to the\nperitoneum.\n3. Redemonstration of small bilateral pleural effusions associated to\nconsolidations in the lower lobes with morphology suggestive of aspiration\nrelated pneumonia or pneumonitis in the left lower lobe."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 without\nwall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is moderately atrophic, without evidence of focal\nlesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen measures 12.8 cm, top-normal, with normal attenuation\nthroughout.  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 a\nnonobstructing 3 mm stone in the distal right ureter (2:65).  There is\nredemonstration of a 3 mm stone in the right lower pole calyx (02:32).  There\nis mild perinephric soft tissue stranding bilaterally, nonspecific.\n\nGASTROINTESTINAL: The distal esophagus is patulous.  There is interval removal\nof the gastrostomy tube.  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 normal.\n\nPELVIS: The urinary bladder is unremarkable.  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\nare prominent bilateral inguinal lymph nodes measuring 1.4 cm on the left and\n1.0 cm on the right (2:73 and 2:76).  There is no 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 or acute fracture.\n\nSOFT TISSUES: Just superficial to the prominent right inguinal lymph node is a\nperipherally hyperdense, centrally hypodense lesion measuring 2.2 x 1.5 cm,\nwhich may represent a necrotic lymph node or an overlying focal fluid\ncollection (2:73). There is nonspecific stranding and skin thickening\noverlying the dominant left inguinal lymph node measuring 3.9 x 1.4 cm (2:72).",
            "output": "1. Prominent bilateral inguinal lymph nodes measuring up to 1.4 cm on the left\nand 1.0 cm on the right.  Just superficial to the prominent right inguinal\nlymph node is a peripherally hyperdense, centrally hypodense lesion measuring\nup to 2.2 cm, which may represent a necrotic lymph node or a focal fluid\ncollection. Nonspecific soft tissue stranding and skin thickening overlying\nthe dominant left inguinal lymph node measuring up to 3.9 cm is also seen.\n2. Nonspecific stranding around the bilateral kidney's.  Correlate with\nurinalysis.\n3. Stable 3 mm right renal and distal ureteral stones without evidence of\nhydroureteronephrosis.\n4. Cholelithiasis without evidence of 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 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: There is partial fatty replacement 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 solid renal lesions or hydronephrosis.  There is a\nsmall nonobstructive renal stone in 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. 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 grossly within\nnormal limits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic lymphadenopathy.  The superficial lymph nodes of the bilateral\ninguinal regions are surrounded by inflammatory soft tissue changes.  There\nare several subcentimeter lymph nodes bilaterally.\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. Superficial lymph nodes of the bilateral inguinal regions are surrounded by\ninflammatory soft tissue changes.  There are several subcentimeter lymph nodes\nbilaterally.  Overall the size of lymph nodes has decreased since prior\nultrasound.  There is no abdominal or pelvic 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: 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 is mildly distended with 18 cm gallstone.  Trace\npericholecystic may reflect third spacing.  No wall thickening.  Overall,\nappearance is similar to prior CT in ___.\n\nPANCREAS: The pancreas is atrophic with slight surrounding peripancreatic\nstranding which extends into the retroperitoneum near the celiac and SMA\norigins and into the mesentery, which appears new from prior 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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  Multiple punctate nonobstructive calculi present in both\nkidneys measuring to 4 mm on the right.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: An enteric tube terminates in the stomach.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout. The colon is mildly decompressed.  There is slight diverticulosis\nwithout evidence of diverticulitis.  Trace residual oral contrast.\n\nPELVIS: The urinary bladder contains a Foley catheter and is decompressed. \nSlight bladder wall thickening likely reflects decompression.\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.  A right femoral approach central venous catheter terminates\nin the right common iliac vein.  Mild subcutaneous edema in the gluteal\nregions without drainable fluid collection identified.\n\nBONES: There 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 peripancreatic stranding extending into the mesentery and adjacent\nretroperitoneum may be due to third spacing or acute pancreatitis.  Please\ncorrelate with lipase. No drainable fluid collection.\n2. No definite abdominopelvic infectious source.\n3. Please see separate report for description of the intrathoracic findings.\n4. Hepatic steatosis.\n5. Cholelithiasis without specific findings for cholecystitis.\n6. Nonobstructive renal calculi."
        },
        {
            "input": "LOWER 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 gallstone without\nsurrounding inflammation.  There is mild gallbladder wall thickening likely\ndue to third spacing.\n\nPANCREAS: The pancreas is atrophic, without evidence of focal lesions or\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 13.7 cm,, unchanged from prior CT. \nThere is no focal splenic lesion.  Small accessory spleen is noted.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: 4 mm nonobstructive calculus is seen in the right interpole,\nunchanged from prior exam.  The kidneys are of normal and symmetric size with\nnormal nephrogram.  There is no evidence of focal renal lesions or\nhydronephrosis.  There is mild perinephric abnormality, nonspecific.\n\nGASTROINTESTINAL: There is a nasogastric tube in place.  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.  There is a rectal tube\nin place.  There is a trace volume fluid in the abdomen and pelvis.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter.\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Third spacing is noted in the soft tissues.",
            "output": "1. No organized fluid collection/abscess in the abdomen or pelvis.  No bowel\nwall thickening or lack of enhancement noted.  There is no pneumatosis or\nportal venous gas to suggest bowel wall ischemia.\n2. Stable 4 mm nonobstructing calculus in right renal interpolar region.\n3. Cholelithiasis, stable splenomegaly, sigmoid diverticulosis are additional\nincidental findings.\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 the report from the concurrent CT chest for\nintrathoracic 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 new periportal edema, presumably\nsecondary to hydration status.  The gallbladder contains gallstones but is\notherwise unremarkable.\n\nPANCREAS: The pancreas is atrophic without evidence of focal lesions or ductal\ndilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 13.3 cm, overall unchanged from\nprior.  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. \nThere is no hydronephrosis.  Re-demonstrated is a 4 mm nonobstructive calculus\nin the right midpole.  No focal lesion.  Mild perinephric stranding\nbilaterally, unchanged, and is nonspecific.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is present.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout. \nThe colon and rectum are within normal limits.  A rectal tube is present.  The\nappendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ntrace free pelvic fluid.\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 mild diffuse subcutaneous edema.  Nodular densities\nproject over the subcutaneous tissues of the anterior abdominal wall, likely\nrelated to injections.",
            "output": "1. No abdominopelvic infection.  Trace abdominopelvic ascites and periportal\nedema, likely secondary to hydration status."
        },
        {
            "input": "LOWER CHEST: Bilateral consolidation and effusions are seen, 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 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 a 2.4 cm gallstone.\n\nPANCREAS: The pancreas is atrophic but 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: The spleen is minimally enlarged, measuring 13.3 cm.  There is no\nevidence of focal lesions.\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 4 mm lithiasis in the right distal ureter,\nunchanged from prior.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrostomy tube is present.  Small bowel\nloops demonstrate normal caliber and wall thickness throughout.  There is\ncolonic diverticulosis.  The appendix is normal.\n\nPELVIS: There is a Foley catheter in the urinary bladder.  There is 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is cutaneous edema in the abdominal wall, likely due to\nthird spacing.",
            "output": "1. Redemonstration of trace free fluid with distal right ureteral lithiasis.\n2. Consolidation and pleural effusions, please refer to separate report of CT\nchest performed same day for description of the thoracic findings."
        },
        {
            "input": "The chest is reported separately.\n\nThere is no biliary dilatation.  No focal liver lesions are identified.  The\ngall bladder is mostly empty.  The pancreas appears normal.  Spleen is normal\nin size and appearance.  Adrenals are unremarkable.  Kidneys appear normal.\n\nStomach is mildly distended.  Small bowel appears normal.  Quantity of stool\nthroughout most of the colon is moderately prominent.\n\nBladder, uterus and adnexa appear normal.  There is no ascites.  No\nlymphadenopathy.  Edema is widespread in subcutaneous soft tissues, however. \nVascular calcification is mild.  Major vascular structures appear widely\npatent.\n\nDiastasis of the rectus musculature.  There are no suspicious bone lesions.",
            "output": "No evidence of malignancy.  Anasarca.  Moderately prominent stool content\nthroughout the colon.  Mildly distended stomach."
        },
        {
            "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: There are multiple calcified granulomas at the right lung base. \nMinimal atelectasis is noted in the lung bases. There is no 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,\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.  There is an 8 mm splenule adjacent to the splenic\ntip.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Multiple subcentimeter hypodensities within the kidneys bilaterally\nare too small to characterize, but likely represent simple cysts.  There is a\nsmall amount of scarring at the right upper pole.  Otherwise, kidneys are of\nnormal and symmetric size with normal nephrogram. There is no evidence of\nstones, solid 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. Colon and rectum are within normal limits.  The\nappendix is fluid-filled measuring up to 8 mm, without any secondary signs of\ninflammation to suggest appendicitis.  The appendix can measure up to 12 mm in\na patient of this age.  There 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.  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: There are moderate degenerative changes within the lumbar spine.  There\nis moderate levoconvex scoliosis of the lumbar ___ about L2.  There\nis a 2.5 x 2.4 cm lytic lesion with a sclerotic rim within the left femoral\nintertrochanteric region, which is characteristic in location and appearance\nfor an intraosseous lipoma.\n\nSOFT TISSUES: Multiple injection granulomas within the buttocks bilaterally. \nOtherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of biliary ductal dilation, focal pancreatic lesions, or\npancreatitis.\n2. Moderate atherosclerosis without focal stenosis.\n3. Moderate degenerative changes within the lumbar spine."
        },
        {
            "input": "VASCULAR:\n\nThe infrarenal abdominal aorta is tortuous and enlarged measuring 3.1 x 2.8 cm\nsuperior to the iliac bifurcation.  There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries.  There is a replaced left\nhepatic artery.  The right common iliac artery is enlarged measuring 1.7 cm. \nThe left common iliac artery measures 1.5 cm.  Single bilateral renal\narteries, SMA and ___ are patent.  The celiac axis origin arises at the level\nof the diaphragmatic crura and is mildly narrowed.\n\nLOWER CHEST: Subsegmental 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.  A calcified granuloma is seen in the dome of\nthe liver.  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 with normal nephrogram.\nThere is no evidence of stones, focal renal lesions, or hydronephrosis. \nPunctate nonobstructing lower pole right renal calculus is noted.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Diverticulosis of the colon is noted without\nevidence of wall thickening or surrounding fat stranding.  Appendix is not\nvisualized.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are normal.\n\nBONES: Degenerative changes are seen in the lumbar spine.  There is grade 1\nanterolisthesis of L4 on L5.\n\nSOFT TISSUES: A right inguinal hernia containing fat is noted.",
            "output": "1. A 3.1 x 2.8 cm infrarenal abdominal aorta without evidence of complication.\n2. Diverticulosis of the colon without evidence of diverticulitis."
        },
        {
            "input": "Lungs and Heart: There is minimal bibasilar atelectasis, left greater than\nright.  There is a small amount of pericardial fluid seen posteriorly.\n\nLiver, Gallbladder: 1.9 and 2.0 cm hypodensities in segments 2 and 4A of the\nliver are consistent with hepatic cysts and are not significantly changed from\nthe prior examination. Other subcentimeter hypodensities are seen throughout\nthe liver and are too small to characterize. The hepatic and portal veins are\npatent. The gallbladder is unremarkable.\n\nSpleen: The spleen is normal in size and attenuation.\n\nPancreas: The pancreas is normal without evidence of focal lesions or\npancreatic ductal dilatation.\n\nKidneys, Adrenals: There are multiple hypodensities seen throughout both\nkidneys, which are too small to characterize. A 1.9 cm in the lower pole of\nthe left kidney is consistent with a simple cyst.  There is a duplicated left\nrenal collecting system with 2 ureters, which fuse distally. Note is made of\nsome fullness in the upper pole moiety.  The adrenal glands are normal\nbilaterally.\n\nBowel: The patient is status post hemicolectomy with post surgical changes\nseen.  There is bowel wall thickening of the colon seen in the left lower\nquadrant with minimal adjacent fat stranding which may represent a focal area\nof colitis.  There is diverticulosis of the colon as well as in a cortically\ninflamed diverticulum in the left lower quadrant, which may represent a focus\nof diverticulitis. The small bowel is unremarkable with no evidence of\nobstruction.  There is no evidence of free air or drainable fluid collection.\n\nVessels: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The bladder is unremarkable. There is no pelvic sidewall\nlymphadenopathy\n\nOsseous Structures: There are no suspicious lytic or blastic lesions seen in\nthe visualized osseous structures.  Bilateral fat containing inguinal hernias.\nPostsurgical changes are seen along the anterior abdominal wall.",
            "output": "Mild bowel wall thickening of the colon in the left lower quadrant with\nadjacent mild pericolonic fat stranding suggestive of colitis (infectious vs\ninflammatory vs ischemic) vs possible diverticulitis.  Extensive colonic\ndiverticulosis within and equivocally inflamed diverticulum in the left lower\nquadrant, of which may represent a focus of diverticulitis.\n\n\nNOTIFICATION:\n\nThese findings were communicated to Dr. ___ telephone by Dr. ___\nat 13:30 on ___"
        },
        {
            "input": "CTA abdomen/pelvis:\n\n-Abdominal aorta:Patent\n-Celiac axis: Patent\n-SMA: Patent\n-___: Patent\n-Renal arteries: 2 renal arteries on the right are Patent.  Left, Patent\n-Left common iliac: Patent with minimal calcification\n-Right common iliac: Moderate stenosis (<50%)\n-Left external iliac: Moderate stenosis (<50%)\n-Right external iliac: Native right iliac artery is occluded, unchanged since\n___.  Ilio-popliteal bypass graft is occluded, unchanged since ___.\n-Left internal iliac: Moderate stenosis (<50%)\n-Right internal iliac: Moderate stenosis (<50%)\nCTA run-off RLE:\n\n-Common femoral artery: Native common femoral artery is occluded, unchanged\nsince ___.  Femoral femoral bypass is occluded near the left anastomosis\n(3a:146), new since ___.\n-Superficial femoral artery: Native superficial femoral artery is occluded,\nunchanged since ___.  Iliopopliteal bypass graft is occluded,\nunchanged since ___.  Femoral popliteal bypass is occluded, new since ___.\n-Deep femoral artery: Patent, and filling through collaterals from the\ninternal iliac artery and retrograde filling.\n-Popliteal artery: Occluded\n-Anterior tibial artery: Patent, however diminutive and occluded at mid calf\n(3a:417).\n-Posterior tibial artery: Patent, though diminutive.  Minimal blood flow is\nseen in the plantar branches.\n-Peroneal artery: Occluded\n-Dorsalis pedis: Occluded.  No significant arterial flow is seen in the foot.\nCTA run-off LLE:\n\n-Common femoral artery: Patent\n-Superficial femoral artery: Patent\n-Deep femoral artery: Patent\n-Popliteal artery: Patent\n-Anterior tibial artery: Patent\n-Posterior tibial artery: Patent\n-Peroneal artery: Patent, though diminutive.\n-Dorsalis pedis: Patent\nAtherosclerotic plaques: Moderate involving infrarenal aorta, bilateral iliac\narteries.  Minimal involving the lower extremities.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.\nThere is new occlusion of the femoral femoral bypass graft at the left femoral\nanastomosis.  There is a 2.9 x 3.7 cm aneurysmal dilatation of the right\nfemoral popliteal anastomosis site near the ___ canal, new since ___, though no significant changed since ___.  However, there is\nno contrast in the sac, concerning for complete occlusion, new since ___.  Numerous collaterals are seen with retrograde filling of these\ndistal short segment of anterior tibial artery and posterior tibial artery. \n2.8 x 2.0 cm aneurysmal sac in the right groin is unchanged since ___.\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 contains stones, without\nevidence of gallbladder 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 and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 sigmoid diverticulosis without evidence\nof diverticulitis.  Appendix contains air, has normal caliber without evidence\nof fat stranding and appears to be exiting the peritoneum into the inguinal\ncanal.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS:  Prostate demonstrates central calcifications but are\notherwise unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is fat containing ventral hernia.",
            "output": "1. New complete occlusion of femoral-femoral bypass graft, as well as new\ncomplete occlusion of right femoral-popliteal bypass graft since ___.\nAneurysmal dilation at the distal anastomosis of the right femoral-popliteal\ngraft, measuring approximately 3.7 x 2.9 cm just above the knee (3A:274),\nstable since ___.\n2. Chronic occlusion of ileo-popliteal graft and previous right fem-pop graft,\nunchanged.\n3. Right deep femoral arterial supply is provided via collateralization from\nthe internal iliac artery and retrograde filling.\n4. Occlusion of the right popliteal artery, with anterior and posterior tibial\narterial reconstitution below the level of the knee via collateral\ncirculation.\n5. No visualized filling of anterior tibial filling below the mid tibia. \nOcclusion of the peroneal artery.\n6. Plantar arch supply via the right posterior tibial artery is diminished,\nbut remains patent.  Minimal supply to the distal right foot.\n7. Extensive right lower extremity subcutaneous edema.\n8. Cholelithiasis in a nondistended gallbladder.\n9. Small right inguinal hernia containing appendix.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\n___ surgery resident) on the telephoneon ___ at 8:00 ___, 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 has been interval transgastric drain placement with pigtail catheter\nremaining in the left hepatic lobe with minimal surrounding fluid (4:18,\n7:21).  Previously seen subhepatic fluid collection has also resolved in the\ninterval.  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 top-normal in size measuring 13.0 cm.  New 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: The stomach is 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.  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: There 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 the previously seen hepatic and subhepatic abscesses. \nTransgastric left hepatic drainage catheter remains in situ."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 cortical scarring at the right upper pole.  There is no evidence of\nsolid 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: The prostate gland is enlarged.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy. There is mild stranding in the\nmesentery associated with nonenlarged mesenteric nodes, unchanged from prior.\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": "Resolved hepatic segment 2 fluid collection."
        },
        {
            "input": "Lung Bases: Please refer to concurrently performed chest CT for findings above\nthe diaphragm.  Mediastinal drains are seen entering the upper abdomen\nextending craniad as well as adjacent pacing leads.\n\nAbdomen: Heterogeneous enhancement of the liver likely reflects hepatic\ncongestion.  Perihepatic ascites is small in volume.  The main portal vein and\ncentral branches appear patent.  The SMV is patent distally.  No portal venous\ngas is seen.  Wedge-shaped hypodensity along the superior pole of the spleen\nis concerning for acute infarction.  The adrenals appear normal.  Lobular\ncontour of the kidneys is likely due to chronic infarctions.  Areas of linear\nhypodensity within the left renal cortex, seen on series 601 image 40, may\nrepresent areas of small infarction.  The abdominal aorta is normal in course\nand caliber with mild atherosclerosis.  The celiac, SMA and ___ appear patent\nproximally.  No retroperitoneal adenopathy.  The gallbladder contains layering\nstones.  The pancreas appears somewhat atrophic.  A nasogastric tube descends\ninto the distal stomach.  The stomach and duodenum appear otherwise\nunremarkable.\n\nPelvis: Multiple segments of small bowel appear abnormal with evidence of\npneumatosis and no discernible mucosal enhancement, concerning for ischemia. \nSeveral small bowel loops appear dilated though there is no obstruction. \nThere is no free air.  Small volume ascites is noted.  The colon is\ndecompressed and appears normal.  The uterus and adnexal regions appear\nnormal.  Urinary bladder is decompressed around a Foley catheter.  A right\nfemoral venous catheter is seen in appropriate position.  Significant body\nwall edema is noted.\n\nBones: No worrisome lytic or blastic osseous lesion is seen. Degenerative\ndisease at L5-S1 noted.",
            "output": "1. Findings concerning for small bowel ischemia with pneumatosis and small\nvolume ascites.  No portal venous gas.\n2. Acute splenic infarct, possible small renal infarcts on the left.\n3. Heterogeneous enhancement of the liver likely reflects hepatic congestion.\n\nPlease refer to separately dictated CT of the chest for findings above the\ndiaphragm."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  There is a 1.7 x\n1.5 cm hypodense lesion in the body of the pancreas (05:24), decreased in size\nfrom 2.0 x 1.8 cm on CT from ___.  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 of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: Fiducial seeds are noted in the pelvis.  There is a\nfibroid uterus.  The bilateral adnexa are within normal limits.  The known\ncervical mass is not well evaluated by CT, though grossly decreased in size. \nA left Bartholin cyst is less conspicuous than on recent 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.  A coil in the region of the left uterine artery is again seen,\nconsistent with coil embolization.\n\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\nare numerous subcutaneous and intramuscular enhancing nodules throughout the\nvisualized abdomen and pelvis.  The previously seen nodules in the chest wall\nhave increased in size.  For example, a 1.9 cm nodule within the left\nlatissimus dorsi (5:4), previously 1.4 cm, and a subcutaneous nodule overlying\nthe right lateral chest wall measures 1.1 cm (5:6), previously 0.6 cm. \nAdditional representative nodules as follows: A 1.8 cm subcutaneous nodule in\nthe left groin (5:86), a 1.5 cm nodule in the right ileo psoas (5:85), and a\n1.7 cm subcutaneous nodule in the left gluteal fold (5:90).",
            "output": "1. Progression of numerous subcutaneous and intramuscular enhancing nodules\nthroughout the visualized abdomen and pelvis and partially visualized lower\nchest.\n2. Interval decrease in size of hypodense lesion in the body of the pancreas,,\nnow demonstrating thickened walls suggestive of metastatic disease rather than\nan IPMN.\n3. Decreased size of known cervical mass, suboptimally evaluated by 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: Interval decrease in size of a rim enhancing lesion in the body of\nthe pancreas measuring now 7 x 10 mm, previously measuring 15 x 17 mm (series\n6, image 28).  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. Moderate amount of\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: Fiducial seeds are noted in the pelvis.  Fibroid uterus. \nBilateral adnexa are within normal limits.  The known cervical mass is not\nwell evaluated by CT.\n\nLYMPH NODES: In the interim, interval increase in size of left perirenal\nnodule, the largest measuring 1.3 x 1.3 cm (series 4, image 68), previously\nmeasuring 6 x 5 mm.  Additional adjacent subcentimeter nodules are seen in the\nright and left posterolateral fascia (series 4, image 75 and 76).\n\nInterval important worsening of the subcutaneous and intramuscular enhancing\nimplants involving the pelvis, abdomen and thoracic.  In fact, there are new\nnodules and progression of the majority of the nodules.\n\nFor example:\n\n-A right pelvic nodule measures 2.2 x 2.1 cm, previously measuring 1 x 1 cm\n(series 4, image 99).\n-A left inguinal nodule measuring 3.1 x 2.1 cm, previously measuring 1.8 x 1.3\ncm (series 4, image 132).\n-A right abdominal subcutaneous implant measures 2.6 x 2.2 cm, previously\nmeasuring 1.3 x 1.3 cm (series 4, image 74).\nVASCULAR: 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. Progression of numerous subcutaneous and intramuscular enhancing nodules\nthroughout the visualized portion of the abdomen and pelvis as well as lower\nchest with new lesions seen\n2. Interval increase in size of left pararenal nodules.\n3. Interval decrease in size of the pancreatic lesion.\n4. Please refer to separate chest CT done the same day for thoracic finding."
        },
        {
            "input": "LOWER CHEST: Please refer to same day CT chest report for intrathoracic\nfindings.\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.  Previously noted rim enhancing\nfocus in the pancreas has resolved.  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 sub-centimeter hypo-attenuated focus in lower pole the right kidney\n(4:73) which is too small to characterize and unchanged from CT abdomen pelvis\n___.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Oral contrast is seen to the ileum.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement 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: Fiducial seeds are noted in the region the cervix.  The\nuterus is lobulated, likely representing a fibroid uterus.\n\nLYMPH NODES AND SOFT TISSUES:\n\nRe-demonstrated are multiple soft tissue nodules in both perirenal regions,\nwhich appear increased in size as compared to CT abdomen pelvis ___.  A reference nodule in the posterior right perirenal region measures up\nto 0.8 cm (4:69), previously 0.5 cm.  A reference nodule in the anterolateral\nleft perirenal region measures up to 1.1 cm (4:70), previously 0.8 cm. \nAnother reference nodule in the anterolateral left perianal region measures\n0.9 x 1.4 cm (4:61), previously 0.7 x 1.3 cm.  There is a soft tissue nodule\nin the left retroperitoneal region inferior to the spleen which measures up to\n0.7 cm (04:57), previously 0.5 cm.  Re-demonstrated are multiple soft tissue\nmasses in the bilateral inguinal regions which are increased in size.  A\nreference necrotic mass in the right inguinal region measures 4.4 x 3.2 cm\n(4:116), previously 1.9 x 1.8 cm.  A reference centrally necrotic nodule in\nthe left inguinal region measures 3.0 x 3.7 cm (4:121), previously 2.3 x 3.1\ncm.\n\nThere are multiple soft tissue nodules, most of which demonstrate central\nnecrosis, in the subcutaneous tissues and within the muscles of the abdomen\npelvis which are increased in size from ___.  A reference\ncentrally necrotic nodule in the left paraspinal muscles, at the level of\nL1-L2 measures 2.4 x 3.1 cm (4:64), previously measuring 1.0 x 1.4 cm.  A\nreference soft tissue nodule in the left adductor musculature measures 3.2 x\n3.1 cm (4:125), previously 2.4 x 2.2 cm.  There is anasarca.  The\n\nVASCULAR: 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. Multiple soft tissue nodules in the abdomen (retroperitoneum), subcutaneous\ntissues, and muscles, have increased in size as compared to CT abdomen and\npelvis ___, compatible with progression of disease.  Most of\nthese nodules demonstrate central necrosis.\n2. Previously noted rim enhancing focus in the pancreas body has resolved."
        },
        {
            "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: No atelectasis is noted in the lung bases. There is no 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,\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: There is an approximately 15 cm segment of distal ileum\ndemonstrating mild enhancement and bowel wall thickening with prominence of\nmesenteric vessels (series 601, image 34).  There is focal narrowing of the\nrectum which could be related to peristalsis versus inflammatory bowel\ndisease.  There is fluid within the colon.  There is no evidence of mesenteric\nlymphadenopathy.  The appendix is not well visualized.\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 bilateral adnexae are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Hyperemia and wall thickening involving approximately 15 cm the distal\nileum, representing terminal ileitis and concerning for inflammatory bowel\ndisease.\n2. Focal narrowing of the rectum may be related to peristalsis versus\ninflammatory bowel disease.\n3. No evidence of active extravasation, including in the bowel."
        },
        {
            "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: The visualized lung bases are unremarkable.  There is no pleural\nor 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 filled with hyperdense\nmaterial, likely vicarious excretion of contrast, 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 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: Again seen is a segment of the distal ileum which\ndemonstrates mild hyperemia, though less well seen due to decompression, with\nredemonstration of prominence of the mesenteric vessels and hypertrophy the\nsurrounding fat (301:15).  Remaining small bowel loops demonstrate normal\ncaliber, wall thickness and enhancement throughout. Colon and rectum are\nwithin normal limits. There 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.  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.  A right corpus\nluteum cyst 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. Distal ileitis is better demonstrated on prior CT.  Findings are most\nsuggestive of inflammatory bowel disease.\n2. No active hemorrhage identified.  No CT findings directly correlating to\nthe reported recent history of bright red blood per rectum."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: There is a tiny hiatal hernia.  Otherwise the stomach is\nunremarkable.  Right extrarenal pelvis.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits.\n\nPELVIS: There is an encapsulated minimally complex fat and fluid containing\n10.4 x 14 x 14.8 cm well-defined mass, with a coarse left peripheral 1.5 cm\ncalcification, originating from the right adnexa, most consistent with ovarian\nteratoma.  The lesion smoothly displaces the adjacent structures without\nevidence of compression.  No features of malignant transformation is noted in\nthis lesion.\n\nNormal right ovarian parenchyma is visualized.\n\nThe left ovary and adnexa are unremarkable.\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 to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes of the lumbosacral spine.\n\nSOFT TISSUES: Tiny fat containing umbilical hernia.  No suspicious soft tissue\nabnormality.",
            "output": "1. Right adnexal minimally complex ___ cm encapsulated mass containing fat,\nfluid and peripheral calcification, most consistent with teratoma.  No\nevidence of malignant transformation.\n2. No suspicious focal liver lesions.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 16:38 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  Note is made of significant\nchronic mass to, particular on the left. The imaged portion the heart and\npericardium are normal. There is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular, in keeping with the\npatient's history of cirrhosis. Innumerable hepatic nodules are noted, with a\ndominant mass in the inferior right hepatic lobe, compatible with the\npatient's history of a hepatocellular carcinoma.  The size and attenuation of\ndominant mass appears unchanged from ___.  The previously\ndescribed foci of gas within this lesion are no longer appreciated.  Tumor\nburden of HCC and assessment for residual tumor cannot be evaluated given the\nsingle phase imaging technique.  Extensive, presumed to be enhancing portal\nvenous thrombus is again noted.  There has been interval increase in the\namount of thrombus seen within the superior mesenteric vein (5:37, 6b:31),\nwhich is felt to be bland. There is no frank intra or extrahepatic biliary\nductal dilatation.  Extensive gallbladder wall edema and mucosal\nhyperenhancement appears unchanged.  Large volume simple ascites appears\ngrossly unchanged as compared to ___.  Extensive perisplenic,\nesophageal, and perirectal varices are again noted, with a recannulized\nparaumbilical vein.\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 17.1 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. Loops of small bowel again\ndemonstrate mild wall thickening, which is felt relate to third spacing in the\nsetting of ascites. There is no evidence of small bowel obstruction.  There is\nno intraperitoneal free air.  The large bowel is mostly collapsed.  The\nappearance of the rectum is unchanged from ___.  The appendix is\nnot definitely visualized.\n\nPELVIS: The urinary bladder is unremarkable.  There is a large amount of free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Numerous prominent retroperitoneal and mesenteric lymph nodes\nappear stable. 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. Cirrhosis, with numerous ill-defined hepatic lesions, compatible with the\npatient's history of hepatocellular carcinoma.  The dominant lesion in the\ninferior right hepatic lobe appears hypodense in this study, likely related to\nposttreatment change.  The previously described punctate foci of gas within\nthis lesion are no longer identified.  Extent of disease burden cannot be\nevaluated on this single-phase examination.\n2. Extensive portal vein tumor thrombus. Interval increase in probable bland\nthrombus within the superior mesenteric vein.\n3. Sequela of portal hypertension including splenomegaly, varices, and large\namount of simple ascites.  If there is concern for SBP, recommend further\nevaluation with diagnostic paracentesis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___\non the ___ ___ at 5:03 ___, 20 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: The hepatic metastases are worse.  For example, a new 0.8 cm\nmetastases on series 4, image 54; a new 0.7 cm metastases on series 4, image\n58; new 1 cm on series 4, image 57 and a new 0.8 cm metastases in the right\nhepatic lobe on series 4, image 69.  The previous right hepatic metastases\nmeasuring 1.1 cm is now 0.9 cm, not significantly changed accounting for slice\nselection.  A few stable cysts and hypodense lesion too small to characterize\nare again seen.\n\nPANCREAS: The pancreas is unremarkable.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.  Scratch\n\nURINARY: The right kidneys unremarkable without hydronephrosis.  There is new\nmild left hydroureteronephrosis up to the mid third of the ureter where there\nis a rind of soft tissue around the ureter, more conspicuous on the delayed\nimages on series 4, image 74 which could be related to metastatic disease. \nSimilarly there is increased linear soft tissue in the left retroperitoneum on\nseries 7, image 40.\n\nGASTROINTESTINAL: No intestinal obstruction demonstrated.  Mild diffuse wall\nthickening of the left hemicolon is again noted and could be sequela of\ntreatment.  There is increased soft tissue in the omentum, for example at the\nlevel of the splenic flexure on series 4, image 64 and in the omentum on\nseries 4, image 68 concerning for carcinomatosis.\n\nPELVIS: There is a small amount of free pelvic fluid, as on prior. \nHysterectomy changes are redemonstrated.  The adnexa appear within normal\nlimits for age.  Linear calcification from the sacral promontory to the\nvaginal cuff can be correlated with remote colpopexy.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes are demonstrated.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The hepatic vasculature is\npatent.\n\nBONES: Widespread osseous sclerotic metastases are not significantly changed.\n\nSOFT TISSUES: There is increased soft tissue in the left paraspinal soft\ntissues measuring 3 cm, previously 2.5 cm.",
            "output": "1. Interval worsening of disease evidenced by multiple new hepatic metastases,\npossible new carcinomatosis, increasing soft tissue in the left paraspinal\nregion and new soft tissue in the left retroperitoneum, the latter causing\nmild left hydronephrosis.\n2.   Widespread sclerotic osseous metastases, not significantly changed and\nadditional findings as above.\n3.   Please refer to findings in the thorax dictated separately by the\nthoracic radiology service on same day CT chest."
        },
        {
            "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 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 is enlarged measuring up to 17.2 cm, similar to prior. \nSubcentimeter hypodensities in the spleen measuring up to 7 mm (5:71) are\nnonspecific.\n\nADRENALS: The right 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 renal cysts measuring 1.3 cm in the right mid kidney.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: As before, there is a moderate sized hiatal hernia, which\ncontains a small amount of simple fluid.  The 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 or fat stranding. The appendix is not\nvisualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  As before,\nthere is small volume simple free fluid (5:106).\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  The seminal vesicles are\ngrossly 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.  There is a linear hypodensity within the proximal splenic vein\n(5:75), which is likely due to venous mixing.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a chronic fracture deformity in the posterior right twelfth rib.\n\nSOFT TISSUES: There are small bilateral fat containing inguinal hernias.",
            "output": "1. No lymphadenopathy in the abdomen or pelvis.\n2. Trace ascites is again noted, although this remains nonspecific.\n3. Redemonstration of marked splenomegaly.\n4. Moderate-sized hiatal hernia."
        },
        {
            "input": "Chest is largely reported separately.\n\nGall bladder appears normal.  There is no biliary dilatation.  No focal liver\nlesions are identified.  Pancreas is unremarkable.  The spleen is again\nenlarged.  Its anteroposterior dimension measures up to 17.1 cm in length,\nwhich is not significantly changed.  Nonspecific hypodense focus measuring\nabout 8 mm in the spleen does not appear significantly changed.  Each adrenal\nshows of thinning compared to usual expectation, although unchanged.  No\nevidence for stones, solid masses or hydronephrosis involving either kidney. \nCouple of unchanged small hypodense foci in the right kidney are too small to\ncharacterize, but doubtful in clinical significance.\n\nThere is a small hiatal hernia.  Small bowel is unremarkable.  Sigmoid\ndiverticulosis is mild to moderate.\n\nMildly increased visualized lower mediastinal fluid of low attenuation, non\norganized, including trace new ascites along the splenic hilum.\n\nBladder appears normal.  Prostate is moderately enlarged with central\nhypertrophy and corpora amylacea calcification.  Seminal vesicles appear\nnormal.  Major vascular structures appear widely patent.  Iliac arteries are\ntortuous.  Atherosclerotic changes are mild.  There is no lymphadenopathy\nfound in the abdomen or pelvis.  Very tiny fat containing umbilical hernia.\n\nThere are no suspicious bone lesions.  Bones appear demineralized.",
            "output": "Minimal increase in fluid along the lower mediastinum including trace free\nfluid about the splenic hilum.  Unchanged splenomegaly.  No lymphadenopathy\nfound in the abdomen or pelvis.  Thinning of each adrenal gland; not\nnecessarily significant clinically but possibility of adrenal insufficiency on\nmight be considered clinically.  Adrenal thinning can also be seen with\nchronic steroid use."
        },
        {
            "input": "Partially imaged portions of the lung bases demonstrates small bilateral\npleural effusions, right greater than left with adjacent compressive\natelectasis, new on the right, increased on the left.\n\nSpleen is enlarged measuring 17 cm in greatest AP ___.  Previously\nhypodense focus in the spleen better appreciated on prior examination.  Liver,\nadrenal glands, gallbladder, and pancreas are unremarkable.\n\nKidneys enhance symmetrically and there is no hydronephrosis.  Right renal too\nsmall to characterize hypoattenuating lesions unchanged.\n\nThe visualized portions of the gastrointestinal tract demonstrates a small\nsliding-type hiatal hernia.  There is no evidence of bowel obstruction.  There\nare few colonic diverticulosis.  There is long segment wall thickening of the\nsigmoid colon suspicious for underlying colitis.\n\nThe urinary bladder is unremarkable.  No discrete intrapelvic mass.  There are\nsmall fat containing bilateral inguinal hernias.  Prostate calcifications are\nstable.\n\nThere is increasing small amount of intra-abdominal intrapelvic ascites. \nThere is no free air.\n\nSmall fat containing umbilical and bilateral inguinal hernias are stable. \nThere is increasing severe diffuse body wall subcutaneous edema.\n\nNo acute fracture or suspicious osseous lesion.  There are mild degenerative\nchanges of the spine.  Healed right 12 rib fracture.",
            "output": "1. Fluid within the large bowel, which is consistent with diarrhea.  Long\nsegment, borderline wall thickening of the sigmoid colon, which is equivocal\nfor underlying colitis.  Scattered colonic diverticula without evidence of\ndiverticulitis.\n2. Increasing small intra-abdominal and intrapelvic ascites.\n3. Increasing small bilateral pleural effusions with right greater left with\nbibasilar atelectasis.\n4. Splenomegaly.\n5. Severe anasarca."
        },
        {
            "input": "The lung bases are clear. There is no pericardial or pleural effusion. The\nheart size is normal. The patient is post left mastectomy.\n\nThe liver density is low, compatible steatosis.  No focal hepatic lesion is\ndetected.  There is no intra or extrahepatic bile duct dilation.  The\ngallbladder is decompressed, and appears normal.  No ductal stones are seen.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size is within normal limits.  An accessory spleen is present\n(series 2, image 64).\n\nThe adrenal glands are normal in size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.\n\nThe bladder is decompressed, and appears normal.\n\nThe uterus is anteverted, and normal in size.  No concerning adnexal lesions\nare detected.\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber.\n\nThere are no osseous lesions concerning for malignancy or infection.\n\n\nThe inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches.\n\nLEFT:\nBranching pattern: Type 2\nPerforators:\n1.8 mm, 33 mm to the left and 10 mm below the umbilicus, (series 605, image\n51)\n1.5 mm, 62 mm to the left and 10 mm below the umbilicus, (series 605, image\n51)\n1.5 mm, 28 mm to the left and 29 mm inferior to the umbilicus, series 605\nimage 54\n\nRIGHT:\nBranching pattern: Type 1\nPerforators:\n2.0 mm, 50 mm to the right and at the level of the umbilicus, (series 605\nimage 48)\n1.8 mm, 30 mm to the right and 11 mm below default (if above, no more than 1\ncm) the umbilicus, (series 605, image 51)\n1.2 mm, 52 mm to the right and 67 mm inferior to the umbilicus, series 605,\nimage 61\n1.6 mm, 13 mm to the right and 77 mm inferior to the umbilicus, series 605,\nimage 64).",
            "output": "1. Patent inferior epigastric arteries bilaterally, as detailed above.\n2. No abdominopelvic lymphadenopathy or metastasis."
        },
        {
            "input": "Study is mildly limited by motion.  Within this limitation:\nLOWER CHEST: There is mild bilateral basilar atelectasis.  There is no\nevidence of pleural or pericardial effusion.  There is moderate coronary\nartery calcifications.  There is heavy calcification of the aortic valve.\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.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\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.  1.7 cm\nhyperdense lesion in the spleen likely represents a hemangioma (5; 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 with normal nephrogram. \nNo hydronephrosis.  There is a 2.5 x 2.8 x 2.3 cm heterogeneously enhancing\nlesion concerning for renal cell carcinoma (5; 18).  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\namount of fecal loading.  Scattered sigmoid diverticulosis is noted without\nevidence of diverticulitis.  The appendix is not visualized.\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a large mass posterior to the bladder,\nindistinguishable from the prostate with mass effect on the bladder anteriorly\nmeasuring 7.0 x 5.6 x 8.3 cm (5; 62).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  A 0.6\ncm lymph node is noted anterior to the bladder (5; 66).  A prominent right 0.9\nx 1.6 cm pelvic sidewall lymph node is noted (5; 57).  There is no inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Multiple recent traumatic fractures of the thoracolumbar spine is again\ndemonstrated including the T11 spinous process fracture, the T12 burst\nfracture extending to the right facet and left lamina, the L1 vertebral body\nfracture, the L1 transverse process fractures, similar to prior.  Moderate\nmultilevel degenerative changes are also noted most notable from L3-L4 through\nL5-S1.\n\nEvaluation of previously noted epidural hematoma is significantly limited on\nCT, and should be further evaluated by MR if there is ongoing clinical\nconcern.\n\nSOFT TISSUES: There are bilateral fat containing inguinal hernias, a 0.9 x 1.2\ncm nodule is noted within the left inguinal hernia concerning for a lymph node\n(5; 70).  Subcutaneous air is noted in the right lower anterior abdomen,\ncorrelate with history of subcutaneous injections.  1.1 cm cyst is noted\nwithin the skin of the lower anterior pelvic wall (5; 66).",
            "output": "1. Large mass posterior to the bladder is indistinguishable from the prostate\nwith mass effect on the bladder pushing it anteriorly, overall measuring 7.0 x\n5.6 x 8.3 cm.\n2. 2.8 cm heterogeneously enhancing left upper pole mass concerning for renal\ncell carcinoma.\n3. Large amount of fecal loading.\n4. No evidence for acute intra-abdominal infection.\n5. Prominent lymph nodes are noted anterior to the bladder, within a left\ninguinal hernia containing fat, as well as a right pelvic sidewall lymph node.\n6. Subcutaneous air in the right lower anterior abdomen is noted, correlate\nwith history of subcutaneous injections.\n7. Evaluation of previously noted epidural hematoma is significantly limited\non CT, and should be further evaluated by MR if there is ongoing clinical\nconcern."
        },
        {
            "input": "The imaged lung bases are clear, and the imaged heart and pericardium are\nunremarkable. There are small layering bilateral pleural effusions.\n\nAssessment of the solid visceral structures of the abdomen and pelvis is\nlimited without IV contrast.\n\nABDOMEN: Multifocal hypodense liver lesions are compatible with known liver\nmetastases. The heterogeneous appearance of the liver on this non-contrast\nscan somewhat limits evaluation for intrahepatic biliary ductal dilation. The\npatient is status post cholecystectomy.  There is no extrahepatic biliary\nductal dilation.  The pancreas, spleen, and adrenal glands are normal. The\nkidneys are without stones, concerning solid lesion (within the limitation of\nnon-contrast technique), or hydronephrosis.  The stomach and duodenum are\nnormal.  The small bowel and large bowel are normal in caliber and there is no\nmesenteric fat stranding.  The appendix is normal.  A prominent porta hepatis\nlymph node measures 13 mm in short axis, unchanged since ___. Otherwise\nthere is no evidence of retroperitoneal or mesenteric lymphadenopathy. There\nis no fluid collection or pneumoperitoneum.  A trace amount of intraperitoneal\nfluid layers along the inferior left lateroconal fascial.  The abdominal aorta\nis normal in caliber without aneurysm or dilatation.\n\nPELVIS:\n\nThe rectum is normal.  The urinary bladder is without focal wall thickening or\nmass.  The reproductive organs are grossly normal.  There is no pelvic mass. \nThere is no evidence of pelvic sidewall or inguinal lymphadenopathy by CT size\ncriteria.\n\nMUSCULOSKELETAL:\n\nDiffuse mixed osteolytic and osteosclerotic lesions involving the visualized\nthoracolumbar spine and pelvis, including the imaged proximal femurs\nbilaterally, are not appreciably changed since ___. The thoracolumbar\nvertebral bodies demonstrate normal alignment.  There is no evidence of\nfracture.",
            "output": "1. No evidence of acute intra-abdominal or intrapelvic process.  No evidence\nof retroperitoneal hematoma.\n2. Multifocal hypodense liver lesions, compatible with known hepatic\nmetastases.\n3. Stable diffuse mixed osteolytic and osteosclerotic bone lesions, as above.\n4. Small bilateral layering simple pleural effusions."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar dependent atelectasis, lung bases\nare 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 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: Mild left hydroureteronephrosis is noted without obstructing stone. \nFindings likely reflect recent stone passage.  Right kidney is normal.  No\nworrisome renal lesion.  A tiny right renal upper pole cortical hypodensity is\nlikely a cyst though too small to accurately characterize.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  No bowel\nobstruction.  The patient is likely status post colectomy with J-pouch.\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 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 left hydroureteronephrosis without ureteral stone may reflect recent\nstone passage.\n2. J-pouch and small bowel are unremarkable."
        },
        {
            "input": "LOWER CHEST: Bilateral diaphragmatic hernias with colon and stomach herniation\non the left and liver herniation on the right.  Visualized lung fields are\nwithin 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 or\nextrahepatic 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: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple bilateral renal cortical hypodensities are too small fully\ncharacterize.  A 1.8 x 1.7 cm cystic lesion in the left upper pole kidney\nmeasures intermediate density and may contain internal septations (series 2,\nimage 39).  No hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  There are multiple fluid-filled and\nslightly dilated small bowel loops measuring up to 3.2 cm.  There is gradual\ntapering of the small bowel in the region of the distal ileum in the right mid\nlateral abdomen, concerning for a partial small bowel obstruction (601:18). \nThe terminal ileum is relatively decompressed.  There is no evidence of\npneumatosis.  The small bowel loops otherwise demonstrate normal enhancement\nand wall thickening.  The colon appears slightly under distended.  Otherwise,\ncolon and rectum are within normal limits. The appendix is not visualized. \nThere is no intraperitoneal air or 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 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: Soft tissue loss overlying the right mid anterior abdominal wall\nmay be related to prior intervention.",
            "output": "1. Multiple dilated small bowel loops with gradual transition in the right mid\nabdomen in the distal ileum is concerning for a partial small bowel\nobstruction, possibly due to adhesions.\n2. 1.8 cm intermediate density left upper pole cystic lesion which may contain\ninternal septations.  Recommend further evaluation with nonemergent renal\nultrasound.\n3. Bilateral diaphragmatic hernias containing liver on the right and stomach\nand colon on the left.\n\nRECOMMENDATION(S):  Nonemergent renal ultrasound."
        },
        {
            "input": "LOWER CHEST: With the exception of bibasilar atelectasis, the lung bases are\nclear.  Bilateral diaphragmatic hernias are again seen.  No pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion 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 has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.  There are\nbilateral renal cysts, with the left renal cystic lesion appearing fairly\nsimilar compared to prior imaging measuring up to 1.7 cm.  There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: Mild gastric malrotation secondary to the hernia appear\nsimilar compared to prior.  Small bowel loops demonstrate normal caliber and\nwall thickness, except for a mildly distended proximal small bowel loop in the\nleft upper quadrant, but there is no evidence of obstruction.  The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS: There is no free 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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic 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": "No evidence of a retroperitoneal hematoma.  No acute findings in the abdomen\nor pelvis.\nBilateral diaphragmatic hernia appear similar compared to prior.\nAgain noted is bilateral renal cystic lesions, if not previously performed\nconsider renal ultrasound study."
        },
        {
            "input": "CHEST: The imaged lung bases are clear without pleural effusion or\nconsolidation.  The heart is normal in size with no pericardial 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 with no\nstones.  The pancreas is normal in attenuation with no surrounding\ninflammation.  The spleen is normal in size with a small subcapsular\nhypodensity medially (02:22), possibly a cyst.  The adrenal glands are\nmorphologically normal bilaterally.  The kidneys enhance and excrete contrast\nsymmetrically.\n\nThe distal esophagus, stomach, and small bowel are normal in caliber without\nobstruction.  The appendix is normal without surrounding inflammation.  The\nlarge bowel is unobstructed with no evidence of colitis.  There is no\nmesenteric or retroperitoneal lymphadenopathy.  No intra-abdominal free air or\nfree fluid.\n\nPELVIS:  The urinary bladder is normal.  The prostate and seminal vesicles are\nunremarkable.  There is no pelvic free fluid or lymphadenopathy.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No evidence of rib, thoracic or lumbar spine, or pelvic\nfracture.  Small left flank/buttock subcutaneous hematoma is noted without\nsigns of active bleeding.",
            "output": "1. No traumatic injury in the solid organs of the abdomen or pelvis.  No\nosseous injuries are seen.\n2.  Focal left buttock/flank subcutaneous hematoma."
        },
        {
            "input": "The study is limited due to poor penetration, and a portion of the anterior\nabdominal wall is not included in the study due to patient body habitus.\n\nLOWER CHEST: There are mild diffuse ground-glass opacities, which may\nrepresent pulmonary edema or air trapping.  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 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 2.4 cm hypodensity in the lower pole of the left kidney and subcentimeter\nhypodensity in the lower pole of the right kidney are unchanged.  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: In the right adnexa, there is a poorly defined region of soft tissue\nmeasuring approximately 8.6 x 5.6 cm, in the region of previously seen known\ntubo-ovarian abscess, previously 9.3 x 5.9 cm.  The structure abuts the right\nlateral abdominal wall, similar to prior.  In the left adnexa, there is a soft\ntissue structure measuring 5.1 x 4.0 cm, previously 4.9 x 3.4 cm.\n\nThe urinary bladder and distal ureters are unremarkable.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 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: A large, wide neck ventral hernia is again seen, containing\nloops of nonobstructed bowel.",
            "output": "The study is limited by poor penetration and incomplete field-of-view.  Within\nthis limitation, there is redemonstration of bilateral adnexal masses,\npreviously characterized as tubo-ovarian abscesses, not significantly changed\nin size from prior."
        },
        {
            "input": "Evaluation limited by patient body habitus, with incomplete imaging of the\nleft anterolateral abdomen.\n\nLOWER CHEST: There is minimal atelectasis in the imaged lung bases. . No\npleural or pericardial effusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver and gallbladder are unremarkable.\n\nPANCREAS: There is fatty atrophy of the pancreas.\n\nSPLEEN: The spleen is unremarkable.\n\nADRENALS: The adrenal glands are unremarkable.\n\nURINARY: A 2.5 cm hypoattenuating lesion in the left lower renal pole and\nsubcentimeter hypoattenuation lesion in the right lower renal pole are\nunchanged.  No new focal mass lesions.  No hydronephrosis.\n\nGASTROINTESTINAL: Small and large bowel loops are normal in caliber.\n\nPELVIS: The urinary bladder is unremarkable.\n\nIn the region of the right adnexa, at site of known tubo-ovarian abscess,\nthere is an ill-defined region of soft tissue material measuring approximately\n7.0 x 6.1 cm (2:67), previously 8.6 x 5.6 cm.  This structure appears to\nenhance, without convincing evidence of significant fluid contained within. \nThis is again noted to extend to the anterolateral abdominal wall.  There is\nbeen interval placement of a right anterolateral approach percutaneous drain,\nwhich has retracted and is now outside of this structure, at the outer margin\nof the abdominal wall (2:66).\n\nA heterogeneous fluid collection measuring 5.5 x 4.5 cm again seen in the\nregion of the left adnexa, previously 5.1 x 4.0 cm.\n\nThe uterus is grossly unremarkable.\n\nLYMPH NODES: No enlarged abdominal or pelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: No suspicious osseous lesions or acute fracture.\n\nSOFT TISSUES: Redemonstration of a large, wide-necked ventral hernia\ncontaining nonobstructed bowel loops.",
            "output": "1. Evaluation limited by patient body habitus, with incomplete imaging of the\nleft anterolateral abdomen.\n2. Interval placement of a right anterolateral approach percutaneous drain,\nwhich has retracted, with the tip now at the outer margin of the abdominal\nwall, outside of the right adnexal collection.\n3. The right adnexal collection is mildly smaller at 7.0 cm, previously 8.6\ncm.  There is no convincing CT evidence to suggest persistent fluid contained\nwithin this collection.  Would recommend repeat MRI pelvis prior to any\nattempts at further drainage.\n4. A 5.5 cm heterogeneous left adnexal fluid collection is mildly bigger,\npreviously 5.1 cm."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are notable for minimal atelectasis at the\nlung bases bilaterally.  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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas demonstrates fatty atrophy, as on prior, 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. \nA hypoattenuating lesion in the left lower pole measures 2.5 cm, unchanged in\naddition to a subcentimeter hypoattenuating lesion in the right lower pole,\nwhich is also unchanged.  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.\n\nPELVIS/REPRODUCTIVE ORGANS: The urinary bladder and distal ureters are\nunremarkable.  No free fluid is identified.  The uterus is unremarkable.\n\nAgain seen in the region of the right adnexa is an rounded and ill-defined\nheterogeneous collection measuring approximately 7.2 x 6.2 cm (2:68), grossly\nunchanged from prior.  Additionally in the region of the left adnexa is an\nill-defined heterogeneous collection measuring approximately 4.3 x 4.3 cm (02:\n68), previously measuring up to 5.5 x 4.5 cm, also grossly unchanged from\nprior, with a soft tissue component peripherally.  Both lesions likely\ncorrespond to cystic adnexal lesions seen 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: A large ventral hernia containing a loop of nonobstructed bowel\nis re-demonstrated and unchanged.  Additionally multiple venous varicosities\nare demonstrated throughout the anterior abdominal wall, as on prior.  The\nabdominal and pelvic wall is within normal limits.",
            "output": "1. Bilateral rounded ill-defined heterogeneous adnexal collections similar in\nsize and appearance compared to CT of ___ likely corresponding to\ncystic adnexal lesions seen on same-day pelvic ultrasound.  No definite\nfindings of tubo-ovarian abscess identified though evaluation limited\nsecondary to technical considerations from body habitus.  Further\ncharacterization could be obtained with repeat MR pelvis is concerns for\ntubo-ovarian abscess persist.\n2. No findings of colitis identified."
        },
        {
            "input": "Study is limited by patient body habitus with incomplete imaging of the left\nanterolateral abdomen and extensive noise artifact.\n\nLOWER CHEST: There is minimal bibasilar atelectasis.  Otherwise, 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. \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 redemonstration of a hypoattenuating lesion in the lower pole of the\nleft kidney measuring 2.5 cm, unchanged from prior study.  Additionally, there\nis a 1.2 cm hypoattenuating lesion in the lower pole of the right kidney,\nunchanged from prior study.  There is no evidence of hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction or bowel wall thickening is seen.  The\nappendix is normal.\n\nPELVIS: Again seen in the right adnexa is a rounded and ill-defined\nheterogeneous lesion measuring approximately 7.5 x 6.0 cm, previously\nmeasuring 7.2 x 6.2 cm (2:62).  In the region of the left adnexa is an\nill-defined, heterogeneous lesion measuring approximately 4.8 x 4.4 cm,\npreviously measuring 4.3 x 4.3 cm (2:62).  There is bilateral interval\ndecrease in central hypodense areas of the lesions, which may be related to\ntechnique or suggests a decrease in the cystic components.  There is no\nevidence of rim enhancement to suggest abscess.  No free fluid.  Overall\nappearance is grossly unchanged from prior study.  The urinary bladder and\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: There is no 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 ventral abdominal wall hernia containing a loop\nof nonobstructed bowel, unchanged.  There are multiple venous varicosities\nthroughout the anterior abdominal wall, similar to prior study.",
            "output": "1. Study is limited by patient body habitus with incomplete imaging of the\nleft anterolateral abdomen and extensive noise artifact.\n2. No substantial interval change in the size of the bilateral adnexal\ncollections/soft tissue lesions compared to prior study dated ___. \nInterval decrease in the central hypodense areas of the lesions, which may be\nrelated to technique or suggest a decrease in the cystic component.  While no\ndefinite evidence of tubo-ovarian abscess, an acute component is difficult to\nexclude.  Further characterization with MR pelvis could be obtained if concern\nfor tubo-ovarian abscess persists."
        },
        {
            "input": "The patient body habitus contacts the CT gantry causing streak artifact that\nlimits the evaluation of the abdomen and pelvis.\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 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 redemonstration of hypoattenuating structure in the lower pole of the\nleft kidney measuring up to 2.5 cm, unchanged from prior.  Additionally there\nis a 1.5 cm hypoattenuating structure within the inferior pole of the right\nkidney which is grossly unchanged from prior.  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.\n\n\nPelvis/REPRODUCTIVE ORGANS: Bilateral heterogeneously enhancing enlarged\nadnexa measuring 7.1 x 7.3 cm on the right, previously measured 10.5 x 6.0 cm,\nand 5.5 x 4.5 cmm on the left, previously 6.6 x 6.2 cm; with associated\nperiadnexal fat stranding and multiple internal areas of heterogeneous\nhypoenhancement, the largest in the right adnexa measuring 2 cm (601:31) the\nlargest within the left adnexa measuring 2.2 cm (2:64).  There is no evidence\nof a gross rim enhancing drainable fluid collection on either adnexa.  Once\nagain the ovaries and fallopian tubes are not well delineated.\n\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 degenerative changes with\n\nSOFT TISSUES: Again noted is a wide-mouth anterior pelvic wall, fat and bowel\ncontaining hernia.  Several varicose superficial veins are demonstrated in the\nlower anterior abdominal wall, unchanged to prior.",
            "output": "1. The study is markedly limited by patient body habitus.\n2. Interval decreased size of bilateral heterogeneously enhancing adnexa,\nwhich in the setting of known bilateral prior infectious process, likely\nrepresent involuting ___.\n3. No definite evidence of a drainable fluid collection on CT."
        },
        {
            "input": "CHEST:   The bases of the lungs are clear. The visualized heart and\npericardium are unremarkable.\nABDOMEN:  The study is limited due to patient body habitus, with extensive\nartifact around the anterior aspect of the abdomen.\n\nThe liver is normal without evidence of focal lesions or intrahepatic biliary\nductal dilatation. The gallbladder is normal. The spleen is homogeneous and\nnormal in size. The pancreas is normal without evidence of focal lesions or\npancreatic duct dilatation. The adrenal glands bilaterally are normal. The\nright kidney demonstrate hypodense lesions too small to characterize by CT but\nlikely secondary to simple renal cyst. There is no evidence of hydronephrosis.\nThe left kidney demonstrates a hypodense lesion measuring approximately 1.6 cm\nx 1.6 cm series 2, image 51, unchanged compared to the prior exam, however\nalso likely secondary to a simple renal cyst, however cannot be characterized\nby CT given significant scatter secondary to patient's body habitus.\n\nThere is a lower abdominal wide-mouth ventral hernia, unchanged compared to\nthe prior exam. Small bowel loops measure up to 3 cm in diameter (upper limit\nof normal) proximal to the hernia, there is no transition point and no\nsignificantly dilated loops are present, to suggest obstruction.  Furthermore,\nassessment of the anterior abdomen is limited due to patient's body habitus. \nNote is made of an enlarged 1.2-cm left pre-aortic lymph-node (2;49),\nunchanged compared to the prior exam. There is no evidence of incarceration.\nThere is no free air, or free fluid.\nPELVIS:  The bladder, rectum and sigmoid colon are normal. There is a 9 cm x 8\ncm x 9 cm multi lobulated lesion in the right adnexa, increased in size\ncompared to the prior CT from ___, measuring up to 7 cm at that time,\ncharacterized by MRI in ___ as an hydrosalpinx.  Redemonstrated is a\nsmall amount of pelvic free fluid.  In the left adnexa, posterior to the\nuterus, there is a 6.4-cm lesion, also previously characterized by MRI as an\nhydrosalpinx, however with an increased soft tissue density component compared\nto the prior CT.\n\nBONES AND SOFT TISSUES:\nNo focal lytic or blastic lesions concerning for malignancy are identified.\nNote is made of mild retrolisthesis of L5 on S1.",
            "output": "1.  Limited study given body habitus resulting in significant streak artifact.\nVentral abdominal hernia, with small bowel loops up to 3 cm in diameter\nproximal to this (upper limits of normal), but no transition point or\nsignificantly dilated loops to suggest obstruction.\n\n2.  Large right adnexal 9 cm multilobular hypodense lesion has increased in\nsize compared to the prior CT, and has been characterized by the prior MRI\nfrom ___ of this year as a hydrosalpinx.\n\n3.  In the left adnexa, posterior to the uterus, there is a 6.4-cm\nintermediate density abnormality, appearing increased from prior CT.  I note\nthat followup MRI pelvis has been previously recommended. I would recommend\nperforming this at this time, given apparent change since previous CT. Please\nalso note prior MRI recommendation for large bore MRI scan, potentially with\nsedation if patient requires.\n\nNOTIFICATION:  ___ findings d/w Dr. ___ by Dr. ___ by phone at\n10A on ___."
        },
        {
            "input": "URINARY: Partially visualized right kidney is unremarkable.  No gross\nperinephric abnormality.\n\nGASTROINTESTINAL: Radiopaque oral contrast is seen throughout the ascending,\ntransverse, and portions of the visualized descending colon.  Few descending\ncolonic diverticula are seen without evidence of acute diverticulitis.\n\nPELVIS: Urinary bladder is decompressed with a Foley catheter and locules of\nair consistent with recent instrumentation.  The distal ureters are\nunremarkable.  Trace pelvic free fluid noted.\n\nREPRODUCTIVE ORGANS: In comparison to ___ there is interval placement\nof bilateral drains within the bilateral adnexal collections with increased\nfat stranding in comparison to ___.  Given absence of IV contrast\nthere is limited evaluation of known bilateral hydrosalpinx.  After contrast\ninjection into bilateral drains, on the right there is collection of contrast\nalong the looped end of the catheter lateral to adnexal mass, with some\ncommunication along the inferolateral margin of the adnexal mass.  On the\nleft, after injection of contrast ___ accumulates along the lateral and\nposterior margin of the adnexal mass.\nThere is no contrast in the uterus.\nLargest collection on the left measures 10 x 10 cm (03:23) (previously 8.6 x\n9.2 cm).  There is persistent mass effect along the sigmoid colon.\n\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 severe degenerative arthritis of bilateral sacroiliac joints. \nDegenerative changes in the visualized lower lumbar spine\n\nSOFT TISSUES: A small bowel containing ventral hernia is noted. No\nobstruction. No fat stranding. No focal fluid collection. The abdominal and\npelvic wall is otherwise within normal limits.",
            "output": "1. Bilateral drains within two large bilateral adnexal masses, left greater\nthan right.  Left collection has increased in size since ___ with\nincreased fat stranding which may represent superinfection in the appropriate\nclinical setting.  Right adnexal mass is mildly decreased.\n2. No obvious fistulous connection with uterus or colon 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.  A\n1.6 x 1.4 cm rounded partially exophytic hypodensity in the the left hepatic\nlobe 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.  Note is made of 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 subcentimeter hypodensity in the interpolar region of the left kidney is too\nsmall to fully characterize, but likely represents a 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 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute process in the abdomen or pelvis.  No evidence of infection.\n2. No abnormal lymphadenopathy within the abdomen or pelvis.\n3. Rounded hypodensity arising from the left lobe of the liver likely\nrepresents a cyst.\n4. Please see separate chest CT report for details of intra 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 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. \nTiny hypodensity in the right upper pole is too small to characterize.  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.  There is a\nmoderate fecal load within the 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: 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": "No acute intra-abdominal or pelvic findings.  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 a nodular and cirrhotic morphology with\nheterogeneous hypoenhancement consistent with hepatic steatosis.  A right\nhepatic lobe hypodensity measuring 1.2 cm is again seen and unchanged\ncorresponding to hepatic cyst seen on prior ultrasound.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is\nsurgically absent.  Trace abdominal ascites is demonstrated predominantly\nperihepatic and perisplenic in nature.  The portal vein, SMV, and splenic vein\nare all widely patent.  Multiple portosystemic varices are demonstrated\nincluding esophageal, paraesophageal, and rectal.\n\nPANCREAS: 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 19.6 cm though demonstrates\nnormal 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. \nA plate like hypodensity in the lower pole of the left kidney measures up to\n2.3 cm and could represent a laceration though no surrounding hematoma is\npresent though could also represent scarring.  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 noted throughout predominantly in the transverse and\nascending colon thickening of the large bowel is demonstrated throughout most\nconsistent with portal colopathy.  The appendix 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: A borderline porta hepatis node measures 9 mm (02:48).  There is\nno retroperitoneal or mesenteric lymphadenopathy by CT 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: An umbilical hernia containing fluid is noted.",
            "output": "1. Left lower renal platelike hypodensity could represent scarring versus\nlaceration though no associated fracture or surrounding hematoma identified. \nOtherwise no traumatic injury identified within the abdomen or pelvis.  No\nfracture identified.\n2. Cirrhotic and steatotic liver with stigmata of portal hypertension\nincluding splenomegaly, trace abdominal ascites, portal colopathy, and\nmultiple portosystemic varices.  Patent portal vein.\n3. Diverticulosis of findings 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 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 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 is collapsed.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The endometrial canal is distended and there is a focus\nof enhancement noted in the right endocervix, nonspecific.  Evaluation of the\nendometrium and parametrium is limited based on CT.  No gross abnormality seen\nin the parametrium.  The right fallopian tube appears to be distended\ncontaining high-density material likely representing hematosalpinx.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. Distended endometrial cavity.  A small focus of increased enhancement is\nseen in the right endocervix, nonspecific.  Evaluation of endometrium and\nparametrium is limited on the CT.  No definite parametrial abnormality noted,\nalthough this would be better evaluated with MR pelvis if clinically needed.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings"
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes. \nTrace right pleural effusion.  2 mm right lower lobe nodule (series 2, image\n5) is unchanged from prior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion within the limitations of an unenhanced scan.  There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  Large\nvolume ascites, increased from prior.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  There is no suspicious\nrenal lesions, within the limitations of an unenhanced scan.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: Small hiatal hernia Small bowel loops demonstrate normal\ncaliber and wall thickness. Diverticulosis of the sigmoid colon is noted,\nwithout evidence of wall thickening or fat stranding. The appendix is not\nvisualized.\n\nPELVIS: Pelvic ascites is demonstrated.\n\nREPRODUCTIVE ORGANS: Patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.  Redemonstrated bilateral cystic and solid masses in\nthe pelvis are incompletely assessed on this noncontrast study however\ndemonstrate interval enlargement measuring 10.9 x 6.1 cm on the right and 9.3\nx 5.5 cm on the left (series 2, image 60).  Additional metastatic nodules in\nthe left external iliac chain and left mid abdomen are stable to increased in\nsize compared to prior.  Redemonstrated diffuse omental caking and stranding\nin the upper abdomen is intervally progressed.\n\nVASCULAR: Moderate atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nLYMPH NODES: Interval large mint of 1.2 cm epicardial lymph node (series 2,\nimage 7).\n\nSOFT TISSUES: 1.5 x 2.6 cm nodule in the right lower abdominal wall consistent\nwith metastatic disease is unchanged (series 2, image 52).  1.5 cm soft tissue\ndensity in the right chest wall is also unchanged as well.",
            "output": "1. No evidence of acute abdominal or pelvic abnormality.\n2. Interval progression of large pelvic masses, omental caking and soft tissue\nnodules in the body wall and pelvis are consistent with metastatic disease,\nincompletely assessed on this noncontrast study.\n3. Interval increase in large volume abdominal ascites, malignant in origin."
        },
        {
            "input": "LOWER CHEST: There is a moderate right and small left pleural effusion with\nassociated bibasilar 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 surgically absent.\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: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal 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. Within the limitations of a nonenhanced scan, there is interval\nincrease in omental caking and peritoneal implants, and large volume abdominal\nascites compared to prior study dated ___.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\ninterval increase in pelvic ascites compared to prior study.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.  There is continued interval increase in size of the\nbilateral adnexal cystic and solid masses measuring 8.1 x 5.5 on the right\n(2:70), previously measuring 7.9 x 5.5 cm, and 7.7 x 4.1 cm on the left\n(2:70), previously measuring 7.2 x 4.0 cm\n\nLYMPH NODES: There is redemonstration of multiple enlarged bilateral common\niliac lymph nodes, not substantially changed from prior study (2:57 and 55)\nmultiple enlarged retroperitoneal lymph nodes are grossly similar.\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 fluid containing umbilical hernia, unchanged.  A 2.6\ncm soft tissue nodule along the right anterolateral abdominal wall is\nunchanged.",
            "output": "1. No acute process in the abdomen or pelvis.  Specifically, no evidence of\nsmall-bowel obstruction.\n2. Within the limitations of a nonenhanced scan, there is interval disease\nprogression with increase in omental caking and peritoneal implants and\npossible mild increase in size of the mixed solid and cystic bilateral adnexal\nlesions compared to prior study dated ___.\n3. Interval increase in large volume abdominopelvic ascites and small to\nmoderate bilateral pleural effusions."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is nodular consistent with cirrhosis.  There is no\nsuspicious focal lesion.  There is small volume perihepatic ascites.  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: There is splenomegaly, measuring up to 16.4 cm.  No focal lesions.\n\nADRENALS: The adrenal glands are within normal limits bilaterally.\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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: Stomach demonstrates some thickening towards the distal\naspect, which is nonspecific could reflect third spacing.  The known\nulceration is not visualized.  Small bowel demonstrates normal caliber\nenhancement throughout.  The colon and rectum are within normal limits.  There\nare surgical clips adjacent to the rectosigmoid junction and descending colon.\n\nPELVIS:  There is a small amount of abdominopelvic ascites which is\nnonhemorrhagic.  The bladder is grossly unremarkable.  A surgical clip in the\nleft pericolic gutter as well as within the deep pelvis are again\ndemonstrated, similar to the prior study.\n\nREPRODUCTIVE ORGANS: The uterus is grossly within normal limits.  The adnexae\nare unremarkable.\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.  Incidental note is made of a common hepatic artery origin\nfrom the aorta.  There is a prominent recanalized umbilical vein as well as\nperisplenic and perigastric varices.  No evidence of intraluminal\nextravasation of contrast.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\nno retroperitoneal hematoma.",
            "output": "1. No evidence of active extravasation within the abdomen and pelvis.  No\nretroperitoneal hematoma.\n2. Cirrhotic liver morphology with splenomegaly, a recanalized umbilical vein,\nmultiple small perigastric varices and small volume simple ascites."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis.  No consolidation is noted at the\nlung bases. There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is enlarged but demonstrates homogeneous attenuation\nthroughout without focal lesions or hematoma within the limitations of an\nunenhanced scan.  A prominent recanalized umbilical vein is noted, as seen on\nprior MR. ___ 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 up to 18.4 cm.  Otherwise, the spleen\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.  Several punctate foci of air\nalong bowel loops in the right lower quadrant likely reflect diverticuli\n(3:72).  Small bowel loops demonstrate normal caliber and wall thickness.  The\ncolon and rectum are within normal limits. Again seen is a surgical clip in\nthe left paracolic gutter, similar to the referenced CT.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A surgical\nclip is noted in the pelvis next to the rectum (3:79).  There is trace fluid\nin the anterior pelvis along bowel loops and the uterus (3:78).\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 evidence of hematoma, perihepatic fluid, or organized fluid collections\nin the abdomen or pelvis.\n2.  Trace low-attenuation free fluid in the pelvis."
        },
        {
            "input": "VASCULAR:\n\nThe abdominal aorta is densely calcified.  The celiac artery, superior\nmesenteric artery, left renal artery and inferior mesenteric artery are widely\npatent. There is ostial narrowing of the right renal artery.  The previously\nthrombosed right common iliac artery is now patent.\n\nThe pelvic vasculature including the common iliac arteries, internal iliac\narteries, external iliac arteries and common femoral arteries are patent but\nmarkedly narrowed which is suggestive of hypovolemia.  An irregular\npseudoaneurysm arising from the left common femoral artery measures 1.2 x 1.4\ncm (series 4 a, image 178; series 4B, image 465 and series 7, image 179).\n\nLOWER CHEST: Minimal atelectasis in the lung bases. 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 contains high-density\nmaterial which likely represents vicarious excretion 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: The spleen shows normal size 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 areas of wedge-shaped hypo enhancement throughout the right\nkidney appear stable compared to the prior CT abdomen exam ___ and\nagain presumably represent embolic infarcts. Adjacent to the left kidney there\nis retroperitoneal hemorrhage which tracks down along the retroperitoneum\nadjacent to the psoas muscle and deep into the pelvis.\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\nPELVIS: The urinary bladder is collapsed and contains a Foley catheter. There\nis no evidence of pelvic or inguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  A lesion in the L4 vertebral body\nwith coarse trabecula most likely represents a hemangioma.  Abdominal and\npelvic wall is within normal limits.",
            "output": "1. Irregular pseudoaneurysm of the left common femoral artery measuring 1.2 x\n1.4 cm.\n2. A moderate left retroperitoneal hematoma tracks along the left\nretroperitoneum from the level of the kidney, along the iliopsoas muscle and\ndeep into the pelvis.\n3. Marked narrowing of the pelvic vasculature raises concern for hypovolemia.\n4. Stable appearance of presumable right renal embolic infarctions.\n5. The right common iliac artery was previously thrombosed and is now patent.\n\nNOTIFICATION:  At the time dictation the patient had returned from the\noperating room."
        },
        {
            "input": "CTA ABDOMEN AND PELVIS:\n\nPatient is status post right axillofemoral graft bypass, which is widely\npatent. The patient is status post resection of the infrarenal aorta with\nstable postsurgical changes. The remaining abdominal aorta is normal in course\nand caliber without evidence of aneurysm or dissection. Mild calcified\natherosclerotic plaques are seen along its course. The celiac axis, SMA an\nbilateral renal arteries are grossly patent.  Patient is status post right to\nleft femoral bypass, which is also widely patent.\n\nABDOMEN:\n\nPunctate calcifications are again seen in the liver, otherwise the liver is\nnormal in shape and contour. The portal venous system is patent. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.\n\nThe previously described likely splenic hemangioma is not apparent in the\nstudy, likely due to the timing of scan.\n\nThe gallbladder and pancreas are normal.\n\nA small stable adrenal nodule is again with no enhancement characteristic,\nconsistent with adrenal adenoma. The right adrenal gland is normal appearing.\n\nThe kidneys enhance symmetrically and are without suspicious 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.  There is\nmoderate fecal burden throughout the colon. There is no free abdominal fluid\nor pneumoperitoneum.\n\nThere is no retroperitoneal lymphadenopathy by CT size criteria.\n\nPELVIS:\n\nThe bladder wall is slightly thickened likely related to distention.\nCalcifications are again seen within the uterus, and are likely from\ndegenerated fibroids. There is no pelvic side-wall or inguinal lymphadenopathy\nby CT size criteria. No free pelvic fluid is identified.\n\nOSSEOUS STRUCTURES:\n\nMultilevel, multifactorial degenerative changes are seen within the visualized\nspine.  Severe compression fraction is again seen of T12 and L3. L4-L5 fused\nvertebral bodies are again seen in keeping with history of diskitis and\nosteomyelitis. No new fractures are identified. No focal lytic or sclerotic\nlesion concerning for malignancy.",
            "output": "1. Patient is status post right axillofemoral graft bypass and right to left\nfemoral bypass, which are both widely patent.\n2.  Stable left adrenal nodule, most likely adrenal adenoma.\n3.  Unchanged T12 and L3 compression fractures. Unchanged L4-L5 fused\nvertebral bodies.  There are no new fractures."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 hypoattenuating lesion with peripheral nodular enhancement\nmeasuring up to 2.6 cm in segment 2  (601:20), is consistent with a\nhemangioma.  A second hypodense lesion in segment 4 B best seen on series 2,\n___ 21 is indeterminate, however statistically most likely also represents 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 kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 (2:61).  There is no evidence of\nintraperitoneal 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 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: There is a small fat containing umbilical hernia.",
            "output": "1. No acute intra-abdominal or intrapelvic pathology.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. Incidentally noted A hepatic hemangioma measuring 2.6 cm in segment 2.  A\n1.1 cm hypodense lesion in segment 4 B is indeterminate but statistically most\nlikely also represents a hemangioma.\n\nRECOMMENDATION(S):  Liver ultrasound could be considered"
        },
        {
            "input": "LOWER CHEST: Minimal basilar atelectasis is seen. No pleural or pericardial\neffusion is seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  2.6\ncm hemangioma in the left lobe of the liver seen on the recent prior contrast\nenhanced CT was better assessed on contrast enhanced CT.  Small hypodensity in\nsegment 4B is more subtle on this noncontrast enhanced CT.  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.  There is no evidence\nof focal renal lesions within the limitations of an unenhanced scan.  There is\nno hydronephrosis.  There is no nephrolithiasis.  Very subtle bilateral\nsymmetric perinephric stranding may relate to decreased renal function.\n\nGASTROINTESTINAL: No bowel obstruction or bowel wall thickening is seen. \nThere is colonic diverticulosis without acute 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. \nSome punctate calcifications are seen 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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is sacralization of L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No renal, ureteral, or bladder calculus seen.  No hydronephrosis or\nhydroureter.  Minimal subtle symmetric bilateral perinephric stranding may\nrelate to decreased renal function.  Otherwise, no acute CT findings seen."
        },
        {
            "input": "Lower Thorax: There is consolidation/ atelectasis at both lung bases.\n\nSoft tissues: There is complex fluid seen in the posterior abdominal wall soft\ntissues, posterior to the lumbar spinous processes from T12-L4 with no rim\nenhancement, that may represent seroma or reactive fluid. There is similar\nfluid seen tracking along the right lateral gluteal region.\n\nPeritoneal Cavity: There is no free air or focal fluid collection.  There has\nbeen an interval evolution and decrease in hemoperitoneum seen within the\npelvis and in both perihepatic and perisplenic locations.\n\nLiver: There are unchanged and evolving liver lacerations involving the right\nhepatic lobe and segment IV B. There is no new focal liver lesion.\n\nGallbladder and Biliary System: The gallbladder is not distended and there are\nno calcified gallstones.There is no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: There is an evolving large splenic laceration involving at least 50%\nof the splenic parenchyma with decreased perisplenic hematoma and interval\ndecrease in density.\n\nKidneys and Adrenals: There is improved enhancement of the right kidney with\nsome persistent heterogeneous enhancement post-contrast that is likely\nperfusional. There is bilateral excretion of contrast into the collecting\nsystems.\nThe adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits with\nno evidence of bowel obstruction.\n\nPelvis: There is a Foley catheter within the collapsed bladder, which also\ncontains air.The prostate gland is within normal limits.\n\nLymph Nodes: There is no significant mesenteric, pelvic or retroperitoneal\nlymphadenopathy.\n\nVessels: There are embolization coils seen in the region of the mid splenic\nartery. The renal arteries and veins appear patent with no detectable\nthrombus.  The splenic, portal and hepatic veins appear patent.\n\nBones: There is unchanged mild anterior wedging of the T12 vertebral body with\nno evidence of new suspicious bone lesion or fracture.  There unchanged\nposterior right lower rib fractures. There is posterior fusion of L4/5 that is\nalso unchanged.",
            "output": "1. Bilateral lower lobe airspace opacities that may be related to aspiration\nor contusion, therefore superimposed infection should be considered.\n2. No evidence of abscess or other intra-abdominal source of infection.\n3. Interval evolution of splenic and hepatic lacerations with decrease in hemo\nperitoneum. Improvement in contrast enhancement and perfusion of the right\nkidney."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. \n2.2 cm left lower pole simple cyst.  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 unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is heterogenous in appearance without\nevidence of discrete fluid 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPostoperative changes noted at L3-4 with intervertebral disc spacer and\nhardware between the spinous processes.  L1 and L2 laminectomy changes are\nalso noted.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Heterogenous appearance of the prostate without evidence of discrete fluid\ncollection.\n2. Otherwise unremarkable exam without acute intra-abdominal process."
        },
        {
            "input": "VASCULAR:\nIn the right inguinal region adjacent to the common femoral artery there is a\nlobulated hyperattenuating focus measuring 1.4 x 0.9 cm (series 3:388) likely\nrepresenting a pseudoaneurysm.  There is no definite evidence of active extra.\nThere is mild background atherosclerotic disease.  There is no evidence of\nretroperitoneal hematoma.\n\nLOWER CHEST: There is mild dependent atelectasis in bilateral lower lobes..\nThere 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 is 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.  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 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 small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  There\nis sigmoid colonic diverticulosis without evidence of diverticulitis. \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 bladder is decompressed by presence of  a Foley catheter within\nit.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is a bony island in S1.  There is lumbarization of S1.  There is mild\nfacet arthropathy.\n\nSOFT TISSUES: There is subcutaneous stranding and edema in the right groin\nwithout evidence of a well-defined fluid collection.",
            "output": "1.  In the right adrenal region adjacent to the common femoral vein, there is\na lobulated hyperattenuating focus measuring 1.9 x 0.9 cm (series 3:380)\nlikely representing a pseudoaneurysm.\n2. No evidence of retroperitoneal hematoma or active extravasation.\n\nNOTIFICATION:  The findings were discussed by Dr. ___  with Dr. ___\n___ on the telephone on ___ at 11:46 pm, 5 minutes after discovery of\nthe findings."
        },
        {
            "input": "LOWER CHEST: Bibasilar dependent atelectasis is present, but no pleural\neffusion or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  Mild\nintrahepatic biliary dilatation and pneumobilia is grossly unchanged since the\nprior study.  Pneumobilia is compatible with history of recent Whipple\nprocedure. No focal liver lesion identified. The gallbladder is surgically\nabsent.\n\nPANCREAS: Patient is post Whipple procedure with an unremarkable\npancreaticojejunostomy. Multiple prior drains terminating in the region of the\nhepaticojejunostomy have been removed.\n\nSPLEEN: The spleen is normal in size with an unchanged calcified granuloma\n(6b:42).\n\nADRENALS: The left adrenal gland is thickened, as seen on the prior study, but\nno discrete nodule is identified (5:20). The right adrenal gland is\nunremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nA right extrarenal pelvis is again noted. No hydronephrosis or focal renal\nlesions.\n\nGASTROINTESTINAL: Small hiatal hernia is again seen.  Again, oral contrast\npasses through the gastrojejunostomy without issue.  The hepaticojejunostomy\nis unremarkable.  Remaining bowel loops are normal in caliber without signs of\nobstruction.  The colon and rectum are within normal limits.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: A left paraaortic node is prominent, but not enlarged by CT\nsize criteria (5:29).\n\nVASCULAR: There is no abdominal aortic aneurysm. There is moderate calcium\nburden in the abdominal aorta and great abdominal arteries.  The left common\nfemoral vein is enlarged and hypoenhancing, in comparison with the right,\nconsistent with the deep venous thrombosis identified on the recent Doppler\nultrasound (5:78).\n\nPELVIS: The urinary bladder contains a focus of air, presumably due to recent\nFoley catheter placement or instrumentation.  The previously described 7.7 cm\nrim enhancing fluid collection in the pouch ___ is almost resolved post\nCT-guided drainage.  Currently, and measures 2.9 x 1.2 cm (5:65).  A\nhyperdense clip is again seen within or adjacent to the collection.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nMild lumbar spine degenerative changes are again seen.  There has been\nimprovement in the degree of subcutaneous emphysema tracking along the\nanterior abdominal wall, particularly on the left, and presumably post-\noperative in nature.",
            "output": "1.  Status post CT-guided drainage of the 7.7 cm rim enhancing fluid\ncollection in the pouch of ___. Currently, this measures 2.9 x 1.2 cm.  No\nnew fluid collections identified.\n\n2.  Status post Whipple procedure, with expected postsurgical changes and\nunremarkable anastomotic sites.  Multiple drains have been removed since the\nCT from ___.\n\nNOTIFICATION:  The above findings were communicated via telephone by Dr.\n___ to Dr. ___ at 15:20 on ___, 10 min after discovery."
        },
        {
            "input": "VASCULAR:\n\n The inferior epigastric arteries are patent bilaterally from the external\niliac artery to the perforator branches. There are 3 perforators on the right\nand 3 perforators on the left.\n\nThe perforators on the right measure: lateral 1 mm, intermediate 2 mm, medial\n2 mm.\nThe perforators on the left measure: lateral 1 mm, intermediate2 mm, medial 1\nmm.\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  The celiac artery, common\nhepatic artery, splenic artery, SMA, bilateral renal arteries, and ___ are all\nwidely patent without evidence of stenoses.\n\nLOWER CHEST: The visualized lung bases are within normal limits.  There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.5 cm hypodensity within segment 2 of the liver which likely\nrepresents a hepatic cyst versus biliary hamartoma (03:15).  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 is normal in appearance.  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: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: Multiple sclerotic foci are visualized throughout the pelvis and sacrum\nwhich are most consistent with bone islands.  For example there is an 8 mm\nfocus within the right sacrum (3:96) as well as a 6 mm focus within the right\nilium (3:127) 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. Patent inferior epigastric arteries bilaterally. The largest perforator on\nthe right is intermediate and measures 2 mm. The largest perforator on the\nleft is intermediate and measures 2 mm.\n2. Multiple sclerotic foci within the hips and pelvis, as described above,\nmost consistent with bone islands however, if there is concern of metastatic\ndisease a bone scan could be obtained as clinically indicated."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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: Within the right adnexa is a bilobed 4.9 x 6.3 x 8.8 cm\n(TV by AP by CC) heterogeneous lesion composed predominantly of fat, with a\nsoft tissue density nodule noted superiorly as well as fat fluid level\ndependently, compatible with a dermoid cyst.  Compared to the prior\nultrasound, the dermoid cyst appears to have increased in size, previously\nmeasured 4.4 x 3.8 x 5.9 cm.  No adjacent right adnexal stranding or evidence\nof rupture is seen.  Uterus is slightly displaced to the left due to the right\nadnexal dermoid.  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.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.",
            "output": "1. 4.9 x 6.3 x 8.8 cm right ovarian dermoid cyst, increased in size when\ncompared to the prior pelvic ultrasound when it measured 4.4 x 3.8 x 5.9 cm. \nNo evidence for rupture or CT findings to suggest ovarian torsion, but\nclinical correlation with physical exam and history is recommended for torsion\ngiven the size of the dermoid.  Additionally, referral to OB-GYN for\nconsideration of surgical excision is suggested given interval growth and\nsize.\n2. No acute abnormality otherwise identified in the abdomen or pelvis.  Normal\nappendix."
        },
        {
            "input": "Findings are limited by the lack of IV contrast.\n\nLower Thorax: There is consolidation/atelectasis of the right lung base with\nair bronchograms - please see CT thorax from same day for further details.\n\nPeritoneal Cavity: There is a small amount of intra-abdominal ascites.  There\nare multiple ___ drains in place from anterior approach - the\nright-sided drain with tip in the pelvis/ right lower quadrant and 2\nleft-sided drains with tip in the left upper quadrant and left mid abdomen. \nThere has been interval laparotomy with an open surgical wound seen anteriorly\nand abdominal contents abutting the overlying peritoneum.  There is expected\npost-operative air, as well as packing material.\n\nLiver: The liver is grossly normal with no focal lesion.\n\nGallbladder and Biliary System: The gallbladder demonstrates layering contrast\nfrom recent CT scan. There are no calcified gallstones or evidence of\ncholecystitis.There is no significant intra or extrahepatic biliary ductal\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 is no focal splenic lesion.\n\nKidneys and Adrenals: On the left, the previously noted large cyst in the\nlower pole has ruptured.  There are additional left-sided renal cysts that\nappear grossly unchanged and likely one on the right that is not well seen\nwithout contrast.  There is no hydronephrosis bilaterally. The adrenal glands\nare normal bilaterally.\n\nBowel:  There is irregular bowel wall thickening of some of the anterior small\nbowel loops near the laparotomy site that are likely reactive in nature to\nrecent surgery. There is no suspicious mass or evidence of bowel obstruction. \nThe patient is status post sigmoid resection with an unchanged and\nuncomplicated colostomy in the left lower quadrant.  There are prominent small\nbowel loops seen in the upper abdomen which are also likely reactive in\nnature.\n\nPelvis:  There is a Foley catheter within the urinary bladder, which is\ncollapsed.The prostate gland is within normal limits.\n\nLymph Nodes: There is no significant mesenteric, pelvic, inguinal or\nretroperitoneal lymphadenopathy.\n\nBones: There is no suspicious bone lesion.",
            "output": "Interval laparotomy with multiple JP drains left in place and wound left open.\nThere is a small amount of intra-abdominal ascites and expected postoperative\nfree air, but no abscess or other definite source of intra-abdominal infection\nidentified."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  There is mild bibasilar\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  Mild periportal edema is noted.  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 are multiple stones in the bilateral kidneys, with the heavy or stone\nburden on the right.  The largest stones measure up to 1.2 cm in the right\nupper and lower poles (series 601: Image 36, 35), respectively.  Multiple\nsmaller stones are visualized in the left kidney, the largest of which\nmeasures up to 2 mm in the upper pole left kidney.  There is no evidence of\nhydronephrosis bilaterally.  No stones are visualized within the ureters.\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, likely physiologic.\n\nREPRODUCTIVE ORGANS: The endometrium is filled with fluid and measures up to\n1.6 mm (series 602: Image 32).\n\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": "Multiple stones in the bilateral kidneys measuring up to 1.2 cm in the right\nupper and lower poles.  Multiple stones in the left kidney measure up to 2 mm.\nNo evidence of hydronephrosis bilaterally.  No stones visualized in the\nureters.  No additional findings to explain patient's symptoms."
        },
        {
            "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. 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 a multilocular cystic mass involving the pancreatic body\nand tail measuring approximately 6.1 x 3.1 cm overall, with a solid component\nmeasuring approximately 2.7 cm (3:91), not significantly changed.  This lesion\nhas contact with the splenic artery and vein, however the remainder of the\nmajor intra-abdominal vessels are not involved.  Multiple additional small\ncystic lesions in the pancreatic head and neck are not significantly changed.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): Overall 6.1 x 3.1 cm, with a 2.7 cm\nsolid component.\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\n\n___ involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\n\nVariant anatomy: none\n\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: 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\n\nSPLEEN: The spleen shows normal size and attenuation throughout, 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, left greater than right,\nsimilar to prior.  Subcentimeter cortical hypodensities bilaterally are too\nsmall to characterize likely representing cysts.  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.  There is diverticulosis of the sigmoid colon,\nwithout evidence of acute diverticulitis.  Appendix contains air, has normal\ncaliber without evidence 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: Fibroid uterus.  The bilateral adnexae are within normal\nlimits.\n\nBONES: Degenerative changes the lumbar spine are not significantly changed,\nwith levoconvex scoliosis centered at L3.  There is no evidence of worrisome\nosseous lesions or acute fracture.\n\nSOFT TISSUES: There is a new 1.9 cm soft tissue nodule in the subcutaneous\ntissues of the lower left anterior abdominal wall (3:152).",
            "output": "1. No significant change in a multilocular cystic pancreatic mass with a solid\ncomponent measuring approximately 2.7 cm, concerning for mucinous\nadenocarcinoma.  There is contact with the splenic artery and vein, with no\ninvolvement of the remainder of the major intra-abdominal vasculature.\n2. New 1.9 cm soft tissue nodule in the subcutaneous tissues of the lower left\nanterior abdominal wall is nonspecific, correlate with history of subcutaneous\ninjections.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is moderate calcium burden in the\nabdominal aorta and great abdominal arteries.  There is >50% stenosis of the\nleft renal artery secondary to atherosclerotic plaque.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Isoattenuating solid\ncomponents within a multiloculated cystic mass\nSize (maximal axial dimension in cm): 6.7 x 3.7 cm overall, with a 3.6 cm\nsolid component, previously 6.1 x 3.1 cm with a 2.7 cm solid component.\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\n\nSMA involvement: absent\n\nCeliac Axis involvement: absent\n\nCommon hepatic artery involvement: absent\n\nVariant anatomy: none\n\n\nVenous evaluation\n\nMPV involvement: absent\n\nSMV involvement: absent\n\n\nSplenic vessels: There is persistent contact with the splenic artery and vein,\nwith increased narrowing of the splenic vein as it courses posteriorly to the\nmass.\n\nExtrapancreatic evaluation\nLiver lesions: absent\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: absent\nOther extrapancreatic disease (invasion of adjacent structures): The mass\nagain abuts the gastric wall, however invasion cannot be determined.\n\n\nLOWER CHEST: Fibrotic changes at the lung bases are not significantly changed.\nThere is a new 7 mm subpleural nodular opacity at the right lung base (3:6). \nThere 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: A multiloculated cystic mass involving the pancreatic body and tail\nmeasures approximately 6.7 x 3.7 cm, compared with 6.1 x 3.1 cm previously. \nThe solid component of the mass measures up to 3.6 cm in diameter, compared\nwith 2.7 cm previously.  This mass again abuts the adjacent gastric wall\n(4:44).  There is persistent contact with the splenic artery and vein, with\nincreased mild narrowing of the splenic vein as it courses posteriorly. The\nremainder of a major intra-abdominal vessels are not involved.  Multiple\nadditional cystic lesions in the pancreatic head and neck not significantly\nchanged.\n\nSPLEEN: The spleen shows normal size and 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 somewhat atrophic compared with the right. \nSubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however not significantly changed from prior, likely\nrepresenting cysts.  There is no evidence of stones or hydronephrosis. There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber and wall\nthickness throughout.  There are multiple sigmoid colonic diverticula without\nevidence of acute diverticulitis.  Appendix contains air, has normal caliber\nwithout evidence of fat stranding (4:118-120).  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: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: Multilevel degenerative changes in the lumbar spine are not\nsignificantly changed.  There is no evidence of worrisome osseous lesions or\nacute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  A 1.2 cm soft\ntissue nodule in the subcutaneous tissues of the lower left anterior abdominal\nwall is decreased in size from prior, previously measuring 1.9 cm, consistent\nwith a resolving subcutaneous injection site.",
            "output": "1. Interval overall increase in size of a multiloculated cystic mass in the\npancreatic body/tail, with increase in size of the solid component, compatible\nwith known adenocarcinoma.  The mass again abuts the adjacent gastric wall,\nand has persistent contact with the splenic artery and vein, with increased\nmild narrowing of the splenic vein as it courses posteriorly.  However the\nremainder of the major intra-abdominal vasculature is not involved.\n2. No evidence of distant metastatic disease in the abdomen or pelvis.\n3. New 7 mm subpleural nodular opacity at the right lung base, for which\ndedicated CT chest is recommended.\n\nRECOMMENDATION(S):  CT chest.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:07 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  As before, there is a\ngreater than 50% stenosis of the left renal artery secondary to\natherosclerotic plaque.\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. \nThere are multiple, scattered subcentimeter hypodensities which are too small\nto characterize, but new since the prior study.  A 1.5 cm hypodense lesion in\nthe left hepatic lobe (2:70), previously measured 7 mm in ___. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits, without stones or gallbladder wall\nthickening.\n\nPANCREAS: Re-demonstrated is a multiloculated cystic mass involving the\npancreatic body and tail measuring approximately 7.8 x 4.2 cm, previously 6.7\nx 3.7 cm (2:90).  The solid component measures up to 3.9 cm in diameter,\npreviously 3.6 cm.  As before, the mass abuts the adjacent gastric wall (2:\n90) and is in persistent contact with the splenic artery and vein.  However,\nthe splenic vein is now occluded where it comes in contact with the mass. \nAdditionally, the mass now abuts the main portal vein (2:95) at the level of\nthe portal splenic confluence.  New splenic collateral vessels are present.\n\n PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): isoattenuating\nSize (maximal axial dimension in cm): 7.8 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\n\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\n\nVenous evaluation\n\nMPV involvement: present.  The pancreatic mass now closely abuts the main\nportal vein at the portal splenic confluence.\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\n___ involvement: absent\n\nExtrapancreatic evaluation\nLiver lesions: suspicious\nPeritoneal or omental nodules: present.  Since ___, there are\nmultiple new omental nodules.  For example, multiple peritoneal implants are\nlocated adjacent to the falciform ligament anteriorly (2:85, 81).  There also\nimplants in the right upper quadrant adjacent to the ascending colon, the\nlargest of which measures 1.4 cm (2:106).  Additional nodules are seen more\ninferiorly, between the ascending colon and the anterior abdominal wall\n(2:117, 120).\nAscites: absent\nSuspicious lymph nodes: absent\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 left kidney is atrophic compared to right, as before.  Multiple\nsubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however, these are unchanged and likely represent cysts.  There\nis no 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 thickness\nand enhancement throughout.  Sigmoid diverticulosis is noted without evidence\nof acute diverticulitis.  Appendix contains air, has normal caliber without\nevidence of fat stranding (2:160).  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: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes are again noted throughout the lumbar spine\nwith significant disc height loss L2-3, L3-4 and L5-S1.  There is also mild\nretrolisthesis of L4 on L5.\n\nSOFT TISSUES: A small fat containing umbilical hernia is noted.",
            "output": "1. Interval increase in size of the multiloculated cystic mass in the\npancreatic body/tail consistent with known adenocarcinoma.  The mass again\nabuts the adjacent gastric wall and has persistent contact with the splenic\nartery.  New occlusion of the splenic vein.  Additionally, the mass now\nclosely abuts the main portal vein at the portal splenic confluence.  The\nremainder of the major intra-abdominal vasculature is not involved.\n2. New since the prior exam are numerous peritoneal implants located in the\nright upper quadrant between the ascending colon and anterior abdominal wall\nas well as anterior to the falciform ligament.  There has also been interval\nincrease in size and number of multiple hypodense hepatic lesions.  These\nfindings are concerning for metastatic disease.\n3. Please refer to dedicated CT chest performed on the same date for\ndescription of intrathoracic findings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal lesions. The gallbladder is\nnormal with no radio-opaque gallstones.  The pancreas is normal with no\nperipancreatic fat stranding or fluid collections.  The spleen is normal in\nsize and homogeneous in attenuation.  The adrenal glands are normal in size\nand morphology. The kidneys enhance symmetrically and display prompt contrast\nexcretion with no focal lesions, hydronephrosis, or radio-opaque stones.\n\nThe distal esophagus and stomach are normal.  The duodenum and proximal small\nbowel are normal. Beginning at the distal ileum, there is wall thickening and\nsome reactive mesenteric lymphadenopathy compatible with ileitis, most\nprominent along the terminal ileum. The adjacent appendix appears within\nnormal limits.\n\nThere is no intraabdominal free air or free fluid.\n\nPELVIS: The distal ureters and urinary bladder are normal.  1.5 cm cyst is\nnoted in the left adnexa, likely physiologic. The uterus is unremarkable. \nThere is no pelvic side-wall or inguinal lymphadenopathy by CT size criteria.\nNo free pelvic fluid is identified.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Enteritis mostly involving the distal and terminal ileum. Etiologies\ninclude infectious causes; however inflammatory bowel disease is not excluded.\n\n2.  No evidence of acute appendicitis."
        },
        {
            "input": "LOWER CHEST: Platelike atelectasis identified in the right lower lobe.  No\npleural effusions or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is post laparoscopic partial liver section for\npolycystic liver disease.  Innumerable hepatic cysts of simple fluid\nattenuation are seen throughout the liver, comprising practically the entirety\nof the left hepatic lobe.  There is no evidence of significant intrahepatic or\nextrahepatic biliary dilatation. The presumed gallbladder is within normal\nlimits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A 1.0 cm rounded hypodensity in the pancreatic\nbody may be a pancreatic cyst or IPMN (02:39).  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS:  The 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 parapelvic renal cysts are identified. There are also multiple\nbilateral subcentimeter renal hypodensities, which are too small to\ncharacterize, but statistically likely to be cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is is not well distended, but grossly\nunremarkable. Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout.  The colon and rectum are within normal limits. \nThe appendix is normal.  No free intraperitoneal air is identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus contains multiple fibroids, some of which are\ncalcified.  Periuterine varices with reflux of contrast into the left gonadal\nvein can be seen in pelvic congestion syndrome (2:  59, 77).\n\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 AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nMultilevel Mild degenerative changes of the thoracolumbar spine are\nidentified, and most pronounced at L2-L3, were there is osteophytosis and disc\nspace narrowing.  Except for mild anterior abdominal subcutaneous fat\nstranding, presumably postsurgical in nature, the abdomen and pelvic walls are\nunremarkable.",
            "output": "1.  No evidence of free intraperitoneal air or bowel obstruction.\n\n2.  Patient is post partial laparoscopic liver resection for polycystic liver\ndisease, evidenced by innumerable hepatic cysts.\n\n3.  Multiple pelvic varices with reflux of contrast into the left gonadal\nvein, which can be seen in patients with pelvic congestion syndrome. \nCorrelate clinically for such symptoms.\n\n4.  1.0 cm hypodense rounded lesion in the pancreatic body, likely a cyst or\nside branch IPMN.  Comparison with outside studies, if available, is\nrecommended."
        },
        {
            "input": "VASCULAR:\n\nInfrarenal abdominal aorta is ectatic to 2.4 cm, but there is no abdominal\naortic aneurysm.  There is severe calcium burden in the abdominal aorta and\ngreat abdominal arteries. The celiac axis, SMA, and ___ are patent, however\nthere is severe narrowing at the origin of the celiac axis (03:48).  Focal\natherosclerotic calcification within the distal SMA contributes to moderate\nnarrowing (3:68).  Moderate focal narrowing at the origin of the ___.   There\nis complete occlusion of the right common iliac artery, as well as the\ninternal and external iliac branches, unchanged compared to CTA from ___.  There is distal reconstitution of flow within the right internal iliac\nand right common femoral artery.  There is high-grade stenosis versus\nocclusion of the left internal iliac artery proximally, and multifocal mild to\nmoderate narrowing within the left external iliac vein.  Both renal arteries\nare patent with mild atherosclerotic narrowing proximally.\n\nLOWER CHEST: Bilateral pulmonary emboli are partially visualized at the\nbilateral lower lobes (3:1, 3:10).  Moderate to severe cardiomegaly with\nenlargement of right atrium, right ventricle, and IVC, and reflux of contrast\ninto the hepatic veins compatible with right heart dysfunction.  Mild\nstraightening of the interventricular septum may be secondary to right heart\ndysfunction, however possibility of right heart strain due to pulmonary emboli\ncannot be definitively excluded.  Aortic valvular calcifications are\ndemonstrated.  Small bilateral nonhemorrhagic pleural effusions with adjacent\natelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation throughout\ncompatible with congestive hepatopathy.  There is no evidence of focal\nlesions. There is similar common bile duct dilatation without intrahepatic\nbiliary dilatation.  The gallbladder is is resected.\n\nPANCREAS: The pancreas appears slightly atrophic, without evidence of focal\nlesions or 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 appear atrophic bilaterally with evidence of cortical\nscarring, possibly secondary to prior infection or ischemia.  There is\nunchanged appearance of a hypodense exophytic lesion at the left upper renal\npole measuring 1.5 cm (03:51), likely compatible with simple renal cyst. \nThere is no evidence of stones, concerning focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout.  Diverticulosis of the sigmoid\ncolon is noted.  Mild bowel wall thickening involving the rectum and sigmoid\ncolon, with mild mucosal hyperemia, possibly reflects early proctocolitis. \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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.  Presacral stranding is likely related to volume overload similar to\nthat seen on the prior CT.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative change of the lumbar spine.  Chronic deformity again seen at\nthe sacrococcygeal junction.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  Mild diffuse\nanasarca is noted.",
            "output": "1. Bilateral pulmonary emboli at the partially visualized lower lobes. \nFurther evaluation with dedicated CTA chest should be considered to fully\nassess for clot burden.\n2. Enlarged right atrium and right ventricle with mild straightening of the\ninterventricular septum may be secondary to chronic right heart dysfunction as\nseen on previous studies, however possibility of worsening right heart strain\ndue to pulmonary emboli cannot be definitively excluded.  Correlation with\nechocardiography is recommended.\n3. Congestive hepatopathy with reflux of contrast in the hepatic veins\ncompatible with underlying right heart dysfunction.\n4. Possible early proctocolitis involving the distal sigmoid colon and rectum,\nand correlation with clinical symptoms is recommended.\n5. Extensive atherosclerotic disease, including redemonstration of complete\nocclusion involving the right common iliac artery and the right internal and\nexternal iliac branches, with distal reconstitution of flow, as unchanged\ncompared to CTA from ___.  Left internal iliac artery appears to\ndemonstrate high-grade stenosis versus short-segment occlusion.\n6. Moderate to severe multifocal narrowing involving the mesenteric vessels\nsecondary to focal atherosclerotic calcification, as described above including\nsevere stenosis of the celiac artery at its origin.\n7. Small bilateral pleural effusions with adjacent atelectasis.\n\nRECOMMENDATION(S):  Dedicated chest CTA."
        },
        {
            "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.  9 mm\nhypodense lesion at the dome of the liver, in segment 7 seen bordering a 3 mm\ncalcification, likely a 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: Both ovaries are unremarkable.  An IUD is noted in the\nendometrial cavity, the uterus is otherwise unremarkable.\n\nLYMPH NODES: Multiple small lymph node seen in the right lower quadrant, these\nare nonspecific, they could be reactive but we see no evidence of inflammatory\nchanges in the abdomen and pelvis.  There is no retroperitoneal\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStatus post dynamic hip screw for a remote intertrochanteric fracture of the\nleft hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No finding to explain pain.  No concerning findings."
        },
        {
            "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 concerning focal lesions.  Subcentimeter hepatic\nhypodensities are too small to characterize but are likely hepatic cysts or\nbiliary hamartomas and are unchanged compared to prior.  There is no evidence\nof intrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: A 3.1 x 2.3 cm hypoenhancing lesion is seen abutting the tail of the\npancreas, similar to prior (2; 25).  There is mild prominence of the\npancreatic duct which measures up to 4 mm in the pancreatic body.  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. \nIncidental note is made of a left duplex collecting system.  There is no\nevidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: A small hiatal hernia, otherwise the stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. There is concentric wall thickening of a segment\nof sigmoid colon with surrounding fat stranding (601; 34).  The appendix is\nnot definitively visualized.  There is trace free fluid in the abdomen.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nsmall volume of free fluid in the pelvis.  A small rounded hyperattenuating\nfocus is seen in the pelvis which is nonspecific and may represent peritoneal\nenhancement, recommend attention on follow-up (2; 61).\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. Circumferential thickening of a segment of sigmoid colon with surrounding\ninflammation concerning for colitis which may be infectious, inflammatory, or\nless likely ischemic in etiology.  Given degree of thickening recommend\nfurther evaluation with outpatient colonoscopy.\n2. Stable 3.1 cm hypoenhancing peripancreatic mass.  Recommend MR and or\ntissue sampling for further evaluation.\n3. Enlarged fibroid uterus.\n4. Small volume free fluid in the abdomen and pelvis.  A focus of\nhyperattenuation along the peritoneum in the right pelvis may reflect mild\nperitonitis."
        },
        {
            "input": "Please see the dedicated CT chest report for detailed evaluation of thorax.\n\nLIVER: The liver enhances homogeneously, without concerning focal lesion. \nAgain seen is pneumobilia, expected given the biliary stent.  The intrahepatic\nportal veins appear patent, but the main portal vein is narrowed as it enters\nthe large mass at the root of the mesentery, unchanged.  Increased stranding\nand possible mass effect on the gallbladder may represent gallbladder fossa\ninvolvement.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: There is again a large heterogeneous mass at the root of the\nmesenteric, extending into the lesser sac, with multiple fiducial seeds. \nThere is increased hypodensity adjacent to the seeds, possibly representing\ntumor necrosis/response to therapy. The tumor encases the celiac axis, with\nobliteration of the vessel as it courses through the ___ the mass.\nAlthough the vessel was narrowed previously, this obliteration is new compared\nto ___.\n\nADRENALS: The adrenal glands are not well visualized.\n\nKIDNEYS: The kidneys demonstrate symmetric nephrograms and excrete contrast\npromptly. There is no focal lesion or hydronephrosis.\n\nGI:The stomach is decompressed, but there is no obvious intraluminal mass or\nwall thickening.The small and large bowel are within normal limits, without\nwall thickening or evidence of obstruction.\n\nRETROPERITONEUM: The aorta is normal in caliber, without atherosclerotic\ncalcifications.There is no retroperitoneal or mesenteric lymph node\nenlargement by CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid. \nThe uterus appears somewhat heterogeneous, likely related to fibroids.\n\nOSSEOUS STRUCTURES:No focal lesion suspicious for malignancy present.",
            "output": "1. Large heterogeneous mass at the root of the mesentery, with extension into\nthe lesser sac, overall unchanged in size but with increased\nencasement/obliteration of the celiac axis as it courses through the ___\nthe mass.  Increased hypodensity adjacent to the fiducial seeds could\nrepresent tumor necrosis/response to therapy.\n2. Increased fat stranding and mass effect upon the gallbladder may represent\ninvolvement of the gallbladder fossa.\n3. Expected pneumobilia after biliary stent placement."
        },
        {
            "input": "LUNG BASES:  Please see dictation for separately reported CT Chest\nexamination.  The right ventricular free wall is noted to be diffusely fatty.\n\nCT ABDOMEN:\nAgain seen is diffuse pneumobilia in the anti-dependent portions of the left\nlobe of the liver, not appreciably changed since prior exam, expected in the\nsetting of CBD stent.  The CBD stent is seen in unchanged, grossly appropriate\nposition.  Mild diffuse intrahepatic biliary ductal dilation is unchanged. \nThere is diffusely heterogeneous perfusion throughout the liver consistent\nwith new portal vein occlusions including the main portal vein and proximal\nportion of the left portal vein ; both left and right portal veins\nreconstitute within the liver presumably via collaterals.  There are multiple\narterially-hyperenhancing hepatic lesions identified, the largest of which is\nlocated in segment ___ and measures 2.7 x 3.9 cm, increased in size.  A lobule\njust superior to this in segment 7 measures 1.4 x 1.7 cm (6:82).  Multiple\nadditional smaller foci are identified, for example, in segment II, a 12 mm\nfocus is new since prior (series 4, image 13).  Just superior and medial to\nthis and segment IV-A, an 11 mm hyperenhancing is also new (series 4, image\n11).  More laterally and inferiorly in segment VIII, a 7 mm arterial\nhyperenhancing focus is seen (series 4, image 22).  Smaller subcentimeter foci\nare seen in the right hepatic lobe (for example, see series 4, image 33).  In\nthe setting of known neuroendocrine tumor, these are concerning for multifocal\nhepatic metastases.\n\n Again seen is the large, heterogeneous but predominantly arterial\nhyperenhancing mass centered at the base of the mesentery, with multiple\ninternal fiducial markers, currently measuring 5.5 x 4.1 x 4.4 cm (TV x AP x\nCC), compatible with known neuroendocrine tumor, not appreciably changed in\nsize since prior CT from ___. The main portal vein is occluded as it\napproaches the right lateral portion of the mass and the CBD stent, with\nnon-visualization of much of the proximal portion of the main portal vein (for\nexample, see series 6 image 83- 86); the SMV also appears narrowed as it\napproaches its confluence with the main portal vein, but is widely patent\nproximally (series 6, images 91-93).  The splenic vein is occluded.  There is\nunchanged encasement and obliteration of the celiac axis.  Superior mesenteric\nartery remains patent.  The distal hepatic arteries are patent, likely\nreconstituted from collateral vessels.\n\n\nThe gallbladder does not demonstrate evidence of stones.  Marked splenomegaly\nwith a craniocaudal diameter 13.2 cm is new from prior exam.  The adrenal\nglands are unremarkable.\n\nSmall right renal cortical hypodensities are too small to characterize by CT. \nOtherwise, there is normal symmetric renal enhancement.  There is no\nhydronephrosis.\n\nThere is a small hiatus hernia.  Nondilated small bowel loops are normal in\ncourse and caliber without evidence of wall thickening or obstruction.  The\ncolon is unremarkable.  The appendix is not directly visualized, however there\nare no secondary signs of appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation.  Apart from previously described celiac axis occlusion, major\nproximal tributaries appear patent.\n\nScattered mesenteric lymph nodes do not meet CT size criteria for\nlymphadenopathy.  There is no retroperitoneal lymphadenopathy by CT size\ncriteria. There is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nA simple right adnexal cyst is low density and measures 1.7 cm, probably\nrepresenting normal follicular activity.  A 1.5 cm hypoenhancing structure\narising from the posterior uterine body is compatible with a intramural\nfibroid.  An overall heterogeneous appearance to the uterus is compatible with\nmultiple additional small fibroids.  Otherwise, the imaged pelvic organs\nincluding the bladder and terminal ureters are unremarkable.  There is no\nevidence of pelvic sidewall, iliac chain, or inguinal lymphadenopathy.  There\nis no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is mild multilevel degenerative change of the imaged thoracolumbar\nspine.  Alignment is normal.  There is no evidence of concerning focal lytic\nor sclerotic osseous lesion.",
            "output": "1. Multiple arterially-hyperenhancing hepatic lesions throughout the right and\nleft hepatic lobes measuring up to 2.7 cm, consistent with neuroendocrine\nmetastases, are new to increased in size in the interval.\n2. Interval stability of heterogeneous, predominantly\narterially-hyperenhancing 5.5 x 4.1 x 4.4 cm known neuroendocrine tumor. \nUnchanged obliteration of the celiac trunk.  Patent distal hepatic arteries\nlikely due to reconstitution from collateral vessels.\n3. Interval development of occlusion of the main portal vein extending to the\norigins of the intrahepatic portal branches with occlusion of the proximal\nleft portal vein but distal reconstitution of both right and left intrahepatic\nportal branches.\n4. Occlusion of the splenic vein, with new splenomegaly.\n5. Please see separate report for intrathoracic findings from same-day CT\nchest."
        },
        {
            "input": "VASCULAR:\n\nThe patient is status post endovascular repair of an fusiform infrarenal\nabdominal aortic aneurysm.  A surgical graft extends from the level of the\ndiaphragm through the common and external iliac arteries with multiple coils\nwithin the bilateral internal iliac arteries.  The celiac axis, SMA, and ___\nare widely patent.  High density on arterial phase imaging within the lower\naneurysm sac, compatible with an endoleak, secondary to supply from the\ninferior mesenteric artery (series 9, image 80).  Overall size of the aneurysm\nsac, not largely changed measuring 6.3 x 4.6 cm just below the level of the\nrenal arteries (series 9, image 22) additional region of fusiform dilation\njust above the level of the iliac bifurcation also unchanged measuring\napproximately 3.9 x 3.4 cm (series 9, image 78). Venous vasculature is also\npatent.  There is a small amount of hematoma and gas around the right common\nfemoral artery as well as hematoma around the left common femoral artery,\nlikely postsurgical.\n\nLOWER CHEST: There are small bilateral pleural effusions, nonhemorrhagic, new\nfrom prior.  There is bibasilar atelectasis including subtle ground-glass\nopacity at the left lung base.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances ___ homogeneously and is without focal\nlesions.  There is no intrahepatic biliary duct dilation.  There is\ncholelithiasis without evidence of acute cholecystitis.  The vein is patent.\n\nPANCREAS:  Multiple cystic lesions are present within the pancreas including\ntwo cystic lesions within the tail of the pancreas measuring 12 mm, (9, image\n41) and 10 mm (series 9, image 31).  An additional cystic lesion is present\nwithin the pancreatic head measuring 14 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:  There are multiple renal hypodensities, compatible with simple cysts\nthe largest is in the left lower pole measuring 4.2 cm.  A 12 mm hyperdense\nrenal lesion within the right interpolar region, is of high density and\nnoncontrast studies and most compatible with a hyperdense cyst (series 7,\nimage 53).  There is new hypodensity involving the lower pole of the left\nkidney, concerning for renal infarction.  There is no hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: There is a large diaphragmatic defect containing small bowel\nand stomach, unchanged.  The small bowel is normal in caliber without focal\nwall thickening.  The large bowel is also normal in caliber without wall\nthickening.  The appendix is not visualized but there are no secondary signs\nof appendicitis within the right lower quadrant.  There is extensive\ndiverticulosis without evidence of diverticulitis.  There is no mesenteric\nadenopathy by CT size criteria.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is no evidence of retroperitoneal hematoma.\n\nPELVIS: The bladder is decompressed with a Foley catheter.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  Severe degenerative changes are\npresent within the lumbar spine, most pronounced at L4/5.  Abdominal and\npelvic wall is within normal limits.  There is diffuse anasarca.",
            "output": "1. Postsurgical changes from endovascular repair of a bilobed fusiform\ninfrarenal abdominal aortic aneurysm with bilateral fusiform aneurysms of the\ninternal iliac vessels.  Patent SMA, celiac axis, and ___.\n2. Type II endoleak with supply from the inferior mesenteric artery, without\nsignificant change in size of aneurysm sac.\n3. New hypodensity involving the lower pole of the left kidney, compatible\nwith renal infarction.\n4. Multiple cystic pancreatic lesions measuring up to 14 mm, likely\nrepresentative of side branch IPMNs, can be re-evaluated on followup imaging.\n5. Intermediate density right interpolar renal lesion, likely representative\nof a hyperdense cyst, this finding can also be re-evaluated on followup\nimaging.\n6. Normal appearance of the small and large bowel.  No CT evidence of bowel\nischemia."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  There is mild origin\nnarrowing of the superior mesenteric artery.\n\nLOWER CHEST: Minimal atelectasis is noted in the left lung base.  There is a\nsmall nonhemorrhagic, dependent, layering right pleural effusion with\nassociated atelectasis.  Heart is mildly enlarged.  There is coronary artery\ncalcifications.  Mitral annular calcifications.\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 appears distended without\nevidence of gallbladder wall thickening, cholelithiasis, or pericholecystic\nfluid.\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 wedge-shaped areas of decreased enhancement in the spleen,\nsimilar to prior, may represent subacute splenic infarcts.  There are areas of\ncapsular retraction in the spleen, consistent with chronic splenic infarcts,\nstable.\n\nADRENALS: The right and left adrenal glands 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\nis a nonobstructing stone in the lower pole of left kidney measuring 0.3 cm. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is increased enhancement and thickening of\nthe ascending colon with adjacent fat stranding and edema, concerning for\ncolitis.  Additionally, there are tiny locules of extraluminal air adjacent to\nthe ascending colon, minimally decreased since prior, consistent with\nmicroperforation.  There focal areas of decreased enhancement within the lower\nlateral wall of the proximal ascending colon, which may represent site colonic\nwall injury series 3B   image 313, 304.  There is no pericolonic organized\nfluid collection to suggest abscess.  The remaining colon and rectum appear\nnormal.  Appendix is normal in caliber, and is unchanged since prior.  There\nis no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: A Foley catheter is noted in the urinary bladder.  There is no\nevidence of distal hydroureter.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  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.  A\ncortical deformity of the posterolateral aspect of the left ninth rib likely\nrepresents chronic fracture (series 3: Image 247).  There is chronic deformity\nof the upper margin greater trochanter, stable since prior there is left\nfemoral head chronic AVN, similar.\n\nSOFT TISSUES: There is mild anasarca.  There is fat only containing bilateral\ninguinal hernias.",
            "output": "1. Inflammatory changes surrounding the right colon colonic wall thickening\nwith associated fat stranding and edema is concerning for colitis. Tiny\nlocules of extraluminal air seen in the right paracolic gutter are compatible\nwith microperforation, and are minimally decreased.   Focal area suboptimally\nenhancing wall of the ascending colon may represent site of colonic wall\ninjury.\n2. No abscess.\n3. Small dependent, layering, nonhemorrhagic right pleural effusion is new\nsince the prior study.\n4. No hematoma"
        },
        {
            "input": "Lung Bases:  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, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber.  No lymphadenopathy, free air or free fluid is seen.  The stomach\nand duodenum appear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is not visualized though there are no secondary\nsigns of appendicitis.  The colon contains a moderate fecal load.  A right\novarian corpus luteum is noted.  Trace free fluid is likely physiologic.  The\nuterus is surgically absent.  The urinary bladder is only partially distended\nappearing normal.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "No findings to account for pain."
        },
        {
            "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN: Regions of geographic fat sparing in the liver are suggestive of\nhepatic steatosis.  Otherwise, the liver parenchyma is unremarkable.  There is\nmild intrahepatic ductal dilatation involving the left hepatic ducts as well\nas the common bile duct, similar to prior MRCP.  The gallbladder is\nunremarkable.\n\nScattered coarse calcifications in the pancreas, consistent with sequela of\nchronic pancreatitis.  Minimal pancreatic ductal dilatation is noted.  No\nfocal masses are identified.  There is no peripancreatic stranding.\n\n Changes of partial splenectomy are noted, with calcifications seen in the\nanterior border of the remnant spleen.\n\n Focal thickening of the medial limb of the left adrenal gland is again\ndemonstrated, also seen on prior MRCP.  The right adrenal gland is\nunremarkable.\n\nA simple cyst is seen in the lower pole of the right kidney.  Other small\nbilateral hypodensities are too small to characterize.  Cortical defect and\ndistortion involving the upper pole of the left kidney may represent sequela\nof previous trauma (601:42). Otherwise, the kidneys are unremarkable.\n\nGASTROINTESTINAL: No bowel obstruction.  There is no ascites.\n\nPELVIS: Prostatic calcifications are noted.\n\nLYMPH NODES: There is no lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ncalcifications more prominent in the distal abdominal aorta and common iliacs.\n\nBONES: There is no evidence of worrisome osseous lesions.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Scattered coarse pancreatic calcifications, consistent with sequela of\nchronic pancreatitis.\n2. Stable mild biliary ductal dilatation, similar to prior MRCP.\n3. No primary malignancy or metastatic disease demonstrated in the abdomen or\npelvis."
        },
        {
            "input": "LOWER CHEST: Apart from minimal dependent atelectasis in both lower lobes, the\nvisualized lung fields are clear.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nWithin the periphery of segment ___ is a 7 mm hypodensity which is too\nsmall to fully characterize, but may reflect a small cyst or biliary hamartoma\n(6:14)..  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is contracted but otherwise within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nPunctate subcentimeter right lower pole hypodense lesion is too small to fully\ncharacterize, potentially a tiny cyst.  There is no evidence of solid renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A small hiatal hernia is visualized.  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits. The\nappendix is surgically absent.4\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: A few shotty retroperitoneal and pelvic sidewall lymph nodes do\nnot meet CT criteria for pathologic enlargement.  There is no mesenteric 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: Tiny umbilical hernia containing fat is noted.",
            "output": "1. No abnormality identified to account for the patient's pain in the left\nlower quadrant.  Specifically, no colonic diverticulosis or 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 are multiple small, hypodense lesions in bilateral hepatic lobes, the\nlargest in segment VI measuring 1.1 x 0.6 cm, unchanged from prior CT dated ___, compatible with 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.  The main pancreatic duct is mildly dilated.  There is no\nperipancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a coarse, calcified lesion adjacent to\nthe spleen measuring 0.7 cm, likely a calcified splenic artery aneurysm,\nunchanged from prior 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 an extrarenal pelvis in the right kidney.  There is no evidence of\nfocal renal lesions or hydronephrosis.  There is no perinephric abnormality. \nThere is gas in the bladder, which may be related to recent\ninstrumentation/catheterization.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is a large\nstool burden within the colon.  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.\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": "No findings to account for rectal bleeding."
        },
        {
            "input": "LOWER CHEST: Small bilateral pleural effusions with passive atelectasis.  Lung\nbases, visualized pleural spaces, and lower mediastinal structures otherwise\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  There is evidence of mild periportal edema,\nfavored related to known history of fluid resuscitation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size (12 cm) and attenuation throughout,\nwithout evidence of focal lesions.  Incidental note is made of an accessory\nspleen in the left upper quadrant.\n\nADRENALS: The right adrenal gland is normal.  The left adrenal gland is mildly\nbulky without discrete nodule.\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.\n\nGASTROINTESTINAL: Unremarkable large bowel.  Normal stomach and normal small\nbowel.\n\nPELVIS: Normal urinary bladder.\n\nREPRODUCTIVE ORGANS: Above the uterus, note is made of tubular fluid-filled\nstructure surrounded by multiple pockets of fluid.  Most of this is seen in\nthe right hemipelvis.  There is surrounding inflammatory change in free-fluid.\nAppearance is concerning for tubo-ovarian abscess, in the appropriate clinical\ncontext.  In the left adnexa, there is similarly cystic spaces, with the\ndominant pocket measuring approximately 2.7 x 1.8 cm in AP and transverse\ndimension (series 3, image 73).\n\nLYMPH NODES: No inguinal, pelvic, or mesenteric lymphadenopathy.  Scattered\nmildly bulky retroperitoneal lymph nodes (series 3, image 40), potentially\nreactive in nature.\n\nVASCULAR: Abdominal aorta normal in caliber.  Major branch vessels are patent.\n\nBONES: No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.\n\nPERITONEUM: No free intra-abdominal air.",
            "output": "1. Suspected tubo-ovarian abscess in the right hemipelvis.  Most of the fluid\nappears to be tubal in location.  There are surrounding pockets of fluid which\nappear external to the fallopian tube.\n2. In the left adnexa, there are similarly cystic spaces, but the dominant\npocket is fairly small, measuring up to 2.7 cm in AP dimension.\n3. Small bilateral pleural effusions and periportal edema, likely related to\nfluid resuscitation.  Bibasilar atelectasis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  Interval\nresolution of small bilateral pleural effusions 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 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 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. The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There\nremains a trace of free fluid within the pelvis.\n\nREPRODUCTIVE ORGANS: Interval placement of a right-sided pelvic drain is noted\nwith the drain terminating within a right adnexal collection.  The collection\nnow measures approximately 5.5 x 4.4 cm compared with 10 x 6.5 cm on the\nprevious study.  The distal end of the drain lies outside largest locule.  The\nleft adnexal collection now measures 2.9 x 3.6 cm compared with 2.7 x 2.0 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.  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 improvement in the appearances of  the right multiloculated\nadnexal collection is demonstrated however there remains a collection\nmeasuring approximately 5.4 x4.4 cm.  The distal end of the pelvic drain\nappears to lie outside the most dominant locule.\n2. The left collection has increased slightly from 2.7 x 2.0 cm to 2.9 x 3.6\ncm.\n3. Interval resolution of small bilateral pleural effusions.\n4. No left upper quadrant abnormality to explain patients pain.\n\nRECOMMENDATION(S):  CT-guided adjustment of right-sided pelvic drain to allow\neffective drainage of residual right adnexal collection.  The patient may need\na left adnexal drain as well if it continues to grow on follow-up imaging."
        },
        {
            "input": "CHEST:  On the coronal images of the chest note is made of multiple large\nright-sided lobar, segmental, and subsegmental pulmonary emboli and possible\nsubsegmental pulmonary emboli on the left. Please see chest separate chest CT\nreport for details of additional thoracic findings.\n\nABDOMEN: The liver enhances homogeneously without focal lesions. There is\npersistent pneumobilia. The gallbladder is decompressed and does not contain\nany radiopaque gallstones. The common bile duct stent is in place.\n\nThere is been no significant change in the size of the mass the head of the\npancreas, which now measures 4.3 x 3.1 cm (6:72). The degree of pancreatic\nductal dilatation is unchanged, and abrupt tapering of the duct is noted at\nthe location of the mass. There is mild peripancreatic fat stranding.  The\ntumor encompasses approximately 50% of the circumference of the SMV an\napproximately 30% of the circumference of the SMA, which is unchanged. The\nportal vein, superior mesenteric vein, superior mesenteric artery, and splenic\nvein remain patent. There has been slight increase in size of a node adjacent\nto the common hepatic artery, which now measures 1.2 cm, previously 1 cm\n(5:20). No other enlarged nodes are identified.\n\nThe spleen is normal in size. There is a new peripherally located,\nwedge-shaped hypodensity in the spleen, which likely represents an infarct.\n\nThe adrenal glands are unremarkable.\n\nThe kidneys are normal in size and display symmetric nephrograms and contrast\nexcretion. In the upper pole of the left kidney there is a nonobstructing\nstone, which measures 8 mm, and is unchanged. There is a left-sided extrarenal\npelvis. There are no focal masses or hydronephrosis. There are no perinephric\nabnormalities seen.\n\nThe distal esophagus is normal appearing with no hiatal hernia. The stomach is\nunderdistended, but grossly normal. The small bowel is partially opacified\nwith contrast, and does not show abnormal wall thickening or dilatation. The\nlarge bowel contains feces and does not show obstructive mass lesions, or wall\nthickening. There is no intraperitoneal free air or free fluid.\n\nThere are no pathologically enlarged pelvic sidewall or inguinal lymph nodes\nby CT size criteria.\n\nAs before, there is fusiform dilatation of the infrarenal abdominal aortic,\nmeasuring up to 2.9 cm.\n\nPELVIS: The bladder is underdistended, but grossly normal. The prostate is top\nnormal in size. There are no pathologically enlarged pelvic sidewall or\ninguinal lymph nodes by CT size criteria. There is persistent borderline\ndilatation of the common iliac arteries bilaterally. There is aneurysmal\ndilatation of the common femoral arteries bilaterally. There is no pelvic free\nfluid. The sigmoid and rectum are unremarkable.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No concerning lytic or sclerotic lesions\nare seen.",
            "output": "Please note that thoracic findings will be detailed on a separate chest CT\nreport.\n\n1. Right sided lobar, segmental, and subsegmental pulmonary emboli. Possible\nsubsegmental left sided pulmonary embolism as well.\n\n2. Stable appearing mass in the head of the pancreas with persistent\npancreatic ductal dilatation and adjacent peripancreatic fat stranding.\n\n3. Slight interval increase in size of a lymph node adjacent to common hepatic\nartery.\n\n4. New peripherally located wedge-shaped hypodensity in the spleen likely\nrepresents an 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:\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 focus of fundal\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.  There is a small accessory spleen (5:56).\n\nADRENALS: The 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 too small to\ncharacterize by CT, statistically likely a cyst (5:75).  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 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRedemonstration of degenerative changes throughout the lumbar spine, with an\nunchanged Schmorl's node at the superior endplate of L4.\n\nSOFT TISSUES: Re-demonstration of paraumbilical rectus diastasis along with a\ntiny para-umbilical fat containing hernia to the left of midline.",
            "output": "1.  No evidence of intra-abdominal or intrapelvic lymphadenopathy by CT size\ncriteria.\n\n2.  Please refer to the dedicated CT chest report of the same date 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 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.  The stomach is otherwise\nunremarkable, not well assessed on CT.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is normal.  No free fluid in the abdomen.\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. \nFollicular changes are noted in the bilateral adnexa, normal for the patient's\nage.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  There are few scattered mildly\nprominent mesenteric 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: The abdominal and pelvic wall is within normal limits.",
            "output": "No acute process in the abdomen or pelvis to explain the patient's symptoms."
        },
        {
            "input": "LOWER CHEST: Mild atelectasis at the partially imaged 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. \nProminent left extrarenal pelvis.  No hydronephrosis.  No renal lesions.\n\nGASTROINTESTINAL: The stomach 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 with a diameter of\n1.6 cm, mural thickening, mucosal hyperenhancement, and adjacent free fluid\nand fat stranding.  No wall discontinuity.  No rim enhancing fluid collection.\nMild reactive inflammation of the adjacent terminal ileum and cecum.\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 atherosclerotic disease\nis noted.\n\nBONES: 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 a small amount of adjacent free fluid.  No well-formed\nabscess.\n\nNOTIFICATION:  The findings were discussed with ___, Medical Student\nby ___, M.D. on the telephone on ___ at 12:22 am, less than\n10 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 mild central intrahepatic\nbiliary dilatation and prominence of the CBD, likely due to\npostcholecystectomy status and unchanged 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 normal size and attenuation throughout, without\nevidence of focal lesions.  There is a small unchanged accessory spleen\n(5:61).\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Mild atherosclerotic disease\nis noted.  Incidental note made of a right femoral port, which continues\nsuperiorly in the IVC and out of view.  Of note, there is a small amount of\nthrombus adjacent to the infrarenal portion of the line (9:19, 5:74).\n\nBONES: There is no evidence of worrisome osseous lesions.  There is\nlevoscoliosis of the lumbar spine with multilevel moderate to severe\ndegenerative changes.\n\nSOFT TISSUES: Patient is post TRAM flap reconstruction, with asymmetric\nabsence of the right rectus abdominus muscle.",
            "output": "1.  No evidence of intra-abdominal or intrapelvic malignancy or metastatic\ndisease.\n\n2.  Incidental note made of a small amount of thrombus adjacent to the\ninfrarenal portion of the right common femoral Port-A-Cath line.\n\n3.  Please refer to the dedicated CT chest report the current date for the\nintrathoracic findings.\n\nNOTIFICATION:  The above findings were entered by Dr. ___ the\n___ Imaging Findings Dashboard for communication to the ordering\nclinician at 17:13 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. \nNumerous subcentimeter hypodense lesions throughout the liver are new compared\nto ___.  Mildly dilated intra and extrahepatic bile ducts are likely\nrelated to post cholecystectomy 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. \nThere is no evidence of focal renal lesions 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 visualized.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  Subcentimeter focus of coarse\ncalcification is noted in left adnexa.\n\nLYMPH NODES: Markedly enlarged lymph nodes are identified in the celiac,\nsuperior mesenteric, and retroperitoneal regions, new compared to ___.\nThe largest lymph node conglomerate is located superior to the celiac artery\nand measures 4.7 x 3.6 cm (12:13).\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: Postsurgical changes are noted in the anterior abdominal wall.",
            "output": "1. New mesenteric and retroperitoneal lymphadenopathy are concerning for nodal\nmetastasis.\n2. New numerous subcentimeter hypodense lesions throughout the liver\nsuspicious for liver metastasis."
        },
        {
            "input": "LOWER 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 seen innumerable subcentimeter liver lesions\nhave decreased or near completely resolved except for 2 lesions which have\nincreased in size from prior exam including a 1.6 cm segment 4 lesion\npreviously measured 1.1 cm and 1.2 segment 7 lesion previously measured 0.8\ncm.  A small 0.7 cm segment 6 low-density lesion, is unchanged.\n\nThe gall bladder is surgically absent.  There is mild intrahepatic and\nextrahepatic biliary ductal dilatation, unchanged from 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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: Retroperitoneal lymphadenopathy has decreased in extent, for\nexample aortocaval node (series 5, image 67) measuring 1.2 cm, previously 1.7\ncm.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Sclerotic foci in the left ischium (series 5, image 114) and in left\nsacral ala (image 92) are unchanged from prior exam.  Marked scoliosis\nthoracolumbar spine is seen with extensive degenerative changes noted.\n\nSOFT TISSUES: Right abdominal rectus muscles has been harvested.",
            "output": "1. Interval improvement of retroperitoneal metastatic lymphadenopathy.\n2. Interval improvement of multiple liver lesions except for 2 lesions which\nhave increased in size, indeterminate.\n3. Stable sclerotic foci in the left ischium and in left sacral ala.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings"
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  In the right lobe\nof the liver, in segment VIII/VII, there is a 2.5 cm hypoattenuating lesion\nwith ill-defined borders.  Lesion demonstrates progressive fill-in on the\ndelayed 3 minutes images, and is consistent with a benign hemangioma.  No\nadditional liver lesions are identified otherwise.  Portal and hepatic veins\npatent.  Gallbladder is partially distended.  No focal abnormality noted.  No\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS pancreatic parenchyma normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (9 cm).  No focal parenchymal lesions\nidentified.\n\nADRENALS: Adrenal glands normal.\n\nURINARY: Normal kidneys.  No focal parenchymal lesions.  No hydronephrosis.\n\nGASTROINTESTINAL: Normal stomach.  Normal large bowel and small bowel. \nSurgical suture material at the cecal pole, likely related to prior\nappendectomy.\n\nPELVIS: Normal urinary bladder.\n\nREPRODUCTIVE ORGANS: Slightly bulky uterus with thickening of the endometrial\nstripe (up to 2 cm).  No adnexal mass.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: Abdominal aorta normal in caliber.  Major branch vessels patent.\n\nBONES: Patient is status post L2-L4 laminectomy for intradural L3 Ewing\nsarcoma.  Post-operative fluid collection in the laminectomy bed identified on\nthe MRI performed ___ has decreased in size, now measuring 0.9 x 1.2\nx 6.5 cm, previously 1.4 x 1.4 x 6.9 cm.  There is surrounding fat stranding\nand dependent edema.  No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: Prior abdominal wall mesh repair.  Mild residual diastasis of\nthe rectus abdominus at the level of the umbilicus.  Several clips from the\nmesh repair within the omental fat.",
            "output": "1. No evidence of metastatic disease to the abdomen or pelvis.  Solitary\nlesion localized to the right liver lobe is consistent with a benign\nhemangioma.  Note that findings pertaining to the chest will be reported\nseparately.\n2. Changes of L2-L4 laminectomy.  Known postoperative fluid collection in the\nlaminectomy bed has decreased in size when compared to the MR performed ___.\n3. Thickening of the endometrial stripe (up to 2 cm).  Please correlate with\nmenopausal status and consider a dedicated pelvic ultrasound for further\ncharacterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate linear bibasilar and left\nrounded atelectasis.  There is a trace left pleural effusion. There is no\nevidence of pericardial effusion.  Mediastinal clips are noted.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse hypoattenuation, consistent 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.  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 medial limb of the right adrenal gland appears thickened.  There\nis a 1.4 cm indeterminate left adrenal nodule, most likely representing an\nadenoma.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small Bochdalek's hernia (3:18).  There is a\nsmall to moderate hiatal hernia; otherwise, the stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber and wall thickness throughout. \nThere is mild diverticulosis; otherwise, the colon and rectum are within\nnormal 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 grossly within\nnormal limits.  Air is noted within the vaginal canal.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is a hooked appearance to the celiac trunk, nonspecific. \nThere is no abdominal aortic aneurysm.  No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nPartially visualized sternal wires appear intact.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Diffuse hepatic hypoattenuation consistent with steatosis.  Steatohepatitis\nor more advanced forms of hepatic disease cannot be excluded.\n2. Slightly hooked appearance of the celiac trunk is nonspecific in the\nabsence of intravenous contrast.  Median arcuate ligament syndrome could be\nconsidered in the appropriate clinical presentation.\n3. Indeterminate 1.4 cm left adrenal nodule which probably represents an\nadenoma.  If there is no history of malignancy, this is probably benign.\nFollow up dedicated adrenal CT or MR in 12 months could be considered. If\nthere is a history of malignancy, a dedicated adrenal CT is recommended. \nRecommendations based on ___ ACR guidelines:\n___\n4. Small to moderate hiatal hernia.  Small Bochdalek's hernia."
        },
        {
            "input": "The visualized lung bases are clear. The heart and pericardium are within\nnormal limits.\n\nCT abdomen: In the absence of IV contrast the liver is normal in size and\nattenuation. A subcentimeter hypodensity in the right lobe of the liver is\nunchanged in size from the prior examination and is too small to characterize\nhowever most likely represents a cyst. There is no intrahepatic biliary ductal\ndilatation.  The patient is status post cholecystectomy with clips in the\ngallbladder fossa. The spleen is normal-appearing. The pancreas is\nunremarkable with no focal pancreatic lesion identified or peripancreatic fat\nstranding. The adrenal glands are normal bilaterally. There is a 2 mm area of\ncalcification in the interpolar region of the left kidney which most likely\nrepresents a vascular calcification but may also represent a non-obstructing\nrenal stone. The kidneys are normal bilaterally with no evidence of\nhydronephrosis. A small duodenal lipoma is unchanged from prior exam. The\nsmall bowel is filled with contrast and shows no sign of obstruction.  The\nabdominal aorta is normal in caliber. There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria.\n\nPelvis: There is extensive diverticulosis of the sigmoid colon with wall\nthickening of the sigmoid and adjacent fat stranding consistent with acute\ndiverticulitis. On series 601b, image 23 and series 2, image 64 there is a\ntract that communicates from the sigmoid colon to the dome of the bladder with\na tiny amount of oral contrast seen leaking into the bladder consistent with a\nsmall fistula. There is a small focus of air seen anti-dependently within the\nbladder which may be due to recent instrumentation or secondary to the\nfistula. The rectum is unremarkable. There is no pathologic pelvic sidewall or\ninguinal lymphadenopathy. There are bilateral fat containing inguinal hernias.\n\nOsseous structures: No suspicious lytic or blastic lesions are identified.",
            "output": "Acute diverticulitis of the sigmoid colon with a small fistula between the\nsigmoid and the bladder dome with a tiny amount of oral contrast and air seen\nwithin the bladder.\n\n2 mm calcification within the interpolar region of the left kidney which most\nlikely represents a vascular calcification however small non-obstructing stone\nis a consideration."
        },
        {
            "input": "There is moderate-sized bilateral non-hemorrhagic pleural effusions with\nsevere bilateral atelectasis, right greater than the left.\n\nA feeding tube terminates within the jejunum. Oral contrast was administered\nthrough the feeding tube which progressed throughout the small bowel\nunobstructed. 100 cc of Gastrografin was administered through the colostomy,\nfilling the transverse and ascending colon. There are no spillage of contrast\nto suggest a leak.  The patient is now post left colectomy.\n\nThe patient is post pancreatic debridement and drainage, with residual\ncollection spanning approximately 15 cm by 3.5 cm along the expected location\nof the pancreas, overall smaller since the preoperative study on ___. A drainage tube terminates within the collection at the level of the\npancreatic body.\n\nThe portal vein is patent. The splenic vein is moderately attenuated but\nappears patent. The superior mesenteric vein is severely attenuated at the\nportal-SMV confluence. The splenic artery, superior mesenteric artery, and\nabdominal aorta are patent without evidence of pseudo-aneurysm.\n\nThere is minimal residual non-hemorrhagic intra-abdominal fluid along the\nbilateral paracolic gutters and anterior pararenal spaces.  There has been\nmarked reduction of intrapelvic fluid reflecting recent debridement and\nwashout.  Extensive subcutaneous soft tissue stranding reflects a combination\nof anasarca and recent laparotomy.\n\nThe liver enhances homogeneously without focal lesion or intrahepatic biliary\nduct dilation. The nondistended gallbladder is within normal limits, without\nwall thickening or pericholecystic fluid.\n\nThe spleen is homogeneous and normal in size.\n\nThe adrenal glands are unremarkable.\n\nThe kidneys are normal appearing. There is no focal lesion or hydronephrosis.\nThe urinary bladder and distal ureters appear normal.\n\nThere is no lymph node enlargement by CT size criteria in the mesentery,\nretroperitoneum, inguinal canal, or pelvis.\n\nThere are no osseous lesions suspicious for infection or malignancy.",
            "output": "1.  No colostomy leak detected.\n2.  Post left colectomy, pancreatic debridement and abdominal/pelvic washout\nwith interval decrease in size of a main peripancreatic collection, which now\ncontains a large-bore drain.  No new organized fluid collection."
        },
        {
            "input": "Lungs and Heart: There is bibasilar atelectasis. There are no pleural\neffusions identified. The heart and pericardium are normal.\n\nLiver, Gallbladder:  The attenuation of the liver borderline for fatty\ninfiltration, but areas of relative sparing in a typical distribution seem\nconfirmatory . There is no intra or extrahepatic biliary ductal dilatation.\nThe portal vein is patent.  The gallbladder is normal appearing. There is a\nsmall amount of free fluid seen in the abdomen.\n\nSpleen: The spleen is normal appearing.\n\nPancreas: The pancreas is diffusely enlarged with decreased attenuation noted\nin the pancreatic head as well as considerable peripancreatic fat stranding\nand free fluid tracking along the prerenal fascia and along the pericolic\ngutters consistent with acute pancreatitis.  However the parenchyma probably\nenhances throughout.  A small focus of calcification along the uncinate\nprocess suggests a history of chronic pancreatitis; this is very close to a\nrelatively large inferior pancreaticoduodenal artery but the caliber of the\nartery is fairly uniform and calcification associated with the artery is less\nlikely.  Pancreatic ductal anatomy is not well visualized but there is no\ndilatation of the duct.\n\nKidneys, Adrenals: The adrenal glands are normal bilaterally .  The kidneys\nare unremarkable undisplaced symmetric nephrograms.\n\nBowel: The stomach is grossly normal. The small and large bowel are normal\nappearing.\n\nVessels: The abdominal aorta is not aneurysmal in its major branches appear\npatent.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy by CT\nsize criteria.\n\nPelvis: There is moderate free fluid seen in the pelvis.  The bladder is\nunremarkable.  The uterus is normal appearing. The rectum and sigmoid colon\nare normal. There is no pelvic sidewall lymphadenopathy.\n\nOsseous Structures: There are no suspicious lytic or sclerotic lesions\nidentified.",
            "output": "1.  Diffusely enlarged pancreas with diminished enhancement of the pancreatic\nhead with significant peripancreatic fat stranding and free fluid tracking\nalong the prerenal fascia and bilateral pericolic gutters consistent with\nsevere acute pancreatitis.  Hypodensity of portions of the pancreatic head may\nindicate a potential risk for necrosis although the whole parenchyma seems to\nenhance on this study.  Although findings include ill-defined surrounding\nacute fluid, there is no organized collection or vascular complication. \nCalcification in the uncinate suggests a history of chronic pancreatic\ninflammation.\n\n2.  Suspected fatty infiltration of the liver.\n\n3.  No biliary dilatation."
        },
        {
            "input": "Examination is motion degraded despite repeat acquisition.  Within this\nlimitation the following observations are made:\n\nLOWER CHEST: Dependent ground-glass opacity at the lung bases could\npotentially be due to atelectasis.  Coronary artery and aortic root\ncalcifications are noted.  There is no pericardial or pleural effusion.\n\nABDOMEN: Evaluation of the abdominal structures is also limited secondary to\npatient's arm overlying the region.\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is vague hypodensity centered in segment ___ (4:15) which corresponds to\npreviously characterized hemangioma.  More focal hypodensities in segments\nseven and two versus on prior and have slightly enlarged in the interval. \nThere is no evidence of new 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: Cystic pancreatic lesions at the head and uncinate process were\nbetter evaluated by prior MRI.  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: There are bilateral renal hypodensities and renal sinus cysts.  One\nhypodensity at the at the upper pole of the left kidney has thin peripheral\ncalcifications.  Nonobstructing calculus noted at the lower pole the left\nkidney.  No hydronephrosis.  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. Sigmoid colon containing left inguinal hernia is noted without\nobstruction.  There is colonic diverticulosis without diverticulitis.  The\nappendix is normal.\n\nPELVIS: There is high-density material within the lumen of the bladder on the\nright.  The bladder is otherwise unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Significant enlargement of the prostate measuring 6.5 cm\nTRV and it 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic deformity of the left inferior and superior pubic rami suggest prior\nfractures.  Sclerotic lesion in the left iliac bone is unchanged from prior. \nMild anterior vertebral body height loss at T12 is chronic in appearance.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits besides\nleft inguinal colonic containing hernia.",
            "output": "1. Exam is degraded by both motion and artifact from patient's arms.\n2. High density material within the bladder, potentially blood products though\nunderlying lesion cannot be excluded on this examination.\n3. Nonobstructing left renal calculus.\n4. Nonobstructing colon containing left inguinal hernia.\n5. Other incidental findings as above."
        },
        {
            "input": "LOWER CHEST: There is interstitial thickening and cysts at the lung bases\nbilaterally, suspicious for fibrosing interstitial lung disease.  Heart is\nmildly enlarged, without a pericardial effusion.  Heavy aortic valvular and\ncoronary calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY:  Innumerable hepatic cysts are again demonstrated.  The largest\nlesion in the hepatic dome measures 8.1 x 6.5 cm, with several septations\n(3:10).  Dominant cyst along the right inferior lobe of the liver measures 8.4\nx 8.2 cm (3:32).  The dominant cyst in the left lobe of the liver measures\n11.1 x 7.0 cm, previously measuring 10.0 x 6.2 cm on ___ (3:29) ;\nthis most likely corresponds to the recently aspirated cyst.  No intrahepatic\nbiliary dilatation.  CBD measures 9 mm, likely within normal limits for\npatient's age.  The gallbladder is within normal limits.  Portal veins are\npatent.\n\nPANCREAS: Pancreas is normal attenuation throughout, without evidence of\npancreatic ductal dilation.  There are multiple hypodense pancreatic lesions,\nthe largest in the pancreatic head measuring 1.7 x 1.1 cm (3:35).  There is\nanother cystic lesion abutting the pancreatic body that measures 1.2 x 1.0 cm\n(3:37).  These most likely represent cysts given the background of innumerable\nhepatic cysts.  No peripancreatic fat stranding.\n\nSPLEEN: Spleen is normal in size and attenuation throughout.  There is a 5.4 x\n5.3 cm hypodense lesion containing peripheral 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 with normal nephrogram. \nNo hydronephrosis.  Dominant left renal cyst measures 3.5 x 3.4 cm. \nAdditional bilateral subcentimeter hypodensities are 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.  Normal caliber appendix.  No ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is grossly 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStatus post left total hip arthroplasty.  Prior vertebroplasty at L2. \nCompression fractures at T11 and T12 are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Innumerable hepatic cysts with the dominant left hepatic cyst increased in\nsize currently measuring 11.1 x 7.0 cm, previously 10.0 x 6.2 cm in ___.  This most likely corresponds to the recently aspirated lesion.\n2. Multiple hypodense pancreatic lesions measuring up to 1.7 x 1.1 cm, likely\npancreatic cysts.\n3. Mild cardiomegaly.  Heavy aortic valvular and coronary calcifications.\n4. Evidence of basilar fibrosing interstitial lung disease.\n5. Unchanged T11, T12 and L2 compression fractures, with evidence of prior\nvertebroplasty at L2."
        },
        {
            "input": "LOWER CHEST: There is mild dependent atelectasis in the 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 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 parapelvic simple cyst in the lower pole of the right kidney\nmeasuring 1.6 cm (02:40).\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is minimal\ncecal diverticulosis without evidence of diverticulitis.  The appendix is\nnormal.\n\nPELVIS: There is contrast in the bladder.  There is free fluid and stranding\nin 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.  Mild atherosclerotic disease\nis noted.  There is a circumaortic left renal vein.\n\nBONES: There is grade 1 anterolisthesis of L4 over L5.  There are moderate\ndegenerative changes at L5-S1. there is a 0.4 cm well-defined sclerotic focus\nin the left iliac bone (02:52) likely represents a bony island.\n\nSOFT TISSUES: New from prior is a supraumbilical fat containing hernia with\nsome stranding of the herniated fat, correlate for focal pain.  Small locules\nof gas in the left lower quadrant abdominal wall may be related to recent\nsurgical intervention.",
            "output": "1. Small to moderate volume fluid and fatty stranding in the pelvis, within\nexpected limits given surgery 5 days ago.\n2. Moderate fat and fluid filling supraumbilical ventral hernia.\n3. No evidence of fluid collection.  Appendix is normal.  No obstruction."
        },
        {
            "input": "LOWER CHEST: Small left and trace right pleural effusion, with compressive\natelectasis in the left lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY: Redemonstrated cirrhotic hepatic morphology.  Post embolization\nlipiodol staining of right hepatic lobe lesions.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  Cholelithiasis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan.  No pancreatic\nductal dilatation.  Interval development nonspecific hazy opacity along the\npancreatic head/hepatic hilum, this may reflect post treatment change status\npost tace, can not completely rule out early changes of acute pancreatitis. \nNo drainable fluid collections.\n\nSPLEEN: Splenomegaly measuring up to 18 cm, similar to prior\n\nADRENALS: Unremarkable bilaterally.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal 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 decompressed limiting evaluation.  No\nabnormally dilated loops of bowel.  The appendix is normal in caliber.\n\nPELVIS: High-density material with in the partially distended urinary bladder,\nthis may reflect residual intravenous contrast from prior procedure.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Limited evaluation given unenhanced technique.  Redemonstrated\nscattered prominent porta hepatis lymph node, likely reactive in the setting\nof chronic liver disease.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  Extensive portosystemic collaterals.  Trace ascites.\n\nBONES: No destructive osseous lesions.\n\nSOFT TISSUES: Mild anasarca.",
            "output": "1. Cirrhotic hepatic morphology with manifestations of portal hypertension\nincluding splenomegaly and extensive portosystemic collaterals.  Trace\nascites.\n2. Edematous appearance of the porta hepaticas/pancreatic head, this may\nreflect post embolization changes, can not completely rule out early changes\nof acute pancreatitis, clinical correlation is recommended.  No drainable\nfluid collections.\n3. Cholelithiasis in a nondistended gallbladder.  Pericholecystic edematous\nappearance, could be related to post embolization change."
        },
        {
            "input": "LOWER CHEST: Consolidative patchy opacities are seen in both basilar lobes\nwith associated small pleural effusion.  There is no pneumothorax.  Heart size\nis within normal limits.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is shrunken with a nodular contour consistent with\ncirrhotic changes.  A few foci of calcification is seen in right lobe. \nEvaluation of liver masses is not possible given the lack of IV contrast. \nPlease refer to MRI of liver dated ___.  TIPS in place.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains gallstones without wall thickening or evidence of inflammation.\n\nPANCREAS: Evaluation of pancreatic masses is not possible given the absence of\nIV contrast.  There is no pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: Spleen is mildly enlarged measures 15 cm.  Hyperdense material is seen\nat the hilum of the spleen suggestive of prior coil embolization.  There is a\nperipheral wedge-shaped area of hyperdensity, which may represent an area of\nretained contrast.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size.  Retained contrast is\nseen in bilateral renal parenchyma.  There is no 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.  There is a few prominent small\nbowel loops measures up to 3 cm, containing fluid levels.  The colon and\nrectum are within normal limits. Appendix is not visualized, however there is\nappears of stranding or edema.\n\nPELVIS: The distal ureters are unremarkable.  There is diffuse bladder wall\nthickening.  Residual contrast is seen within the bladder lumen.  Small to\nmoderate size fluid is seen with density higher than simple fluid suggestive\nof hemoperitoneum.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Diffuse haziness is seen in mesentery.  There are prominent\nsubcentimeter mesenteric lymph nodes, likely reactive.  There is no pelvic or\ninguinal lymphadenopathy.\n\nVASCULAR: Multiple collateral are seen in mid mesentery.  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: Bilateral gynecomastia is noted.",
            "output": "1. Moderate size hemoperitoneum.\n2. Cirrhotic liver with sequela of portal hypertension including splenomegaly\nand multiple collaterals.  New TIPS and splenorenal shunt embolization.\n3. Prominent small bowel loops measures up to 3 cm contain fluid level which\nlikely represent ileus secondary to hemoperitoneum.\n4. Persistent nephrograms in both kidneys, which may represent hepatorenal\nsyndrome or acute kidney injury.\n5. Small bilateral pleural effusions with compressive atelectasis in the lung\nbases.\n6. Cholelithiasis without evidence of acute cholecystitis\n\nRECOMMENDATION(S):  Imaging results discussed with primary team Dr. ___\nby F"
        },
        {
            "input": "LOWER CHEST: Small left effusion with adjacent atelectasis.  Scattered\ncoronary artery and vascular calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Redemonstrated shrunken nodular liver consistent with\ncirrhosis.  Stable foci of calcification in the right lobe.  A TIPS is\nidentified extending from the right portal vein to the left hepatic vein. \nSuboptimal for evaluation of focal lesions due to lack of intravenous\ncontrast.  Contracted gallbladder with gallstones.\n\nPANCREAS: Atrophic.  Evaluation of pancreatic mass is not possible given the\nabsence of intravenous contrast.  No evidence of pancreatic ductal dilatation.\n\nSPLEEN: Splenomegaly measuring up to 16 cm, perisplenic varices, large\nsplenorenal shunt is noted.  Embolization coil material noted at the splenic\nhilum.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Minimal perinephric inflammatory stranding, likely physiologic.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Mildly prominent fluid filled\nsmall bowel loops in the left upper quadrant containing fluid level measuring\nup to 3 cm, no interval change the colon and rectum are within normal limits.\nThe appendix is within normal limits\n\nPELVIS: Mild diffuse urinary bladder wall thickening with subtle inflammatory\nstranding despite partial distention.  Small volume ascites\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Once again noted is diffuse haziness of the mesentery with\nprominent subcentimeter mesenteric abdominopelvic lymph nodes, likely reactive\nin etiology.  No pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Incidental note made of retroaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: No acute findings.  Right gynecomastia.",
            "output": "Stable mildly prominent fluid-filled small bowel loops in the left upper\nquadrant, likely ileus.  No definite evidence of bowel obstruction\n\nCirrhotic liver with sequelae of portal hypertension including splenomegaly,\nsystemic collaterals and small volume ascites..  Tips shunt in place.\n\nInterval resolution of right pleural effusion.  Stable to slight interval\nincrease in left pleural effusion with atelectasis.\n\nCholelithiasis with no evidence of acute cholecystitis."
        },
        {
            "input": "PELVIS:  The prostate gland is enlarged measuring 7.5 x 5.7 cm and\ndemonstrates heterogeneous enhancement centrally.  No focal rim enhancing\ncollection in the prostate to suggest an abscess.  The partially visualized\nsmall and large bowel are unremarkable. The urinary bladder and distal ureters\nare unremarkable. There is no free fluid in the pelvis.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Patent with minimal atherosclerotic disease noted.\n\nBONES: 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, heterogeneously enhancing prostate gland, which may represent BPH\nand/or acute prostatitis - this is difficult to assess given the lack of prior\ncomparison imaging and clinical correlation is advised.  No prostate abscess."
        },
        {
            "input": "LOWER CHEST: Centrilobular ground-glass nodularity in the anterior segment of\nthe left lower lobe, present in association with fissural nodularity, new from\nthe chest CT performed ___.  Given the recent onset of this\nfinding, this is consistent with an infectious/inflammatory process.  Lung\nbases, visualized pleural spaces, and lower mediastinal structures otherwise\nunremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: Moderate diffuse low-attenuation of the liver parenchyma,\nconsistent with liver steatosis.  No morphologic features of cirrhosis.  No\nfocal parenchymal lesions.  Portal and hepatic veins patent.  Normal\ngallbladder.  CBD is distended to 11 mm in diameter.  It does taper normally\ntowards the ampulla.  No intrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is mildly atrophic but normal in attenuation. \nNo focal parenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: Spleen is not enlarged (11 cm).  No focal parenchymal lesions.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Normal symmetric perfusion of the renal parenchyma.  There is a\nsimple cyst at the upper pole of the right kidney.  No parenchymal lesions\notherwise.  No hydronephrosis.  No nephrolithiasis.\n\nGASTROINTESTINAL: Normal stomach.  Normal small bowel.  Scattered\nuncomplicated sigmoid diverticula.  Large volume of stool throughout the large\nbowel.  Normal appendix.\n\nPELVIS: Normal urinary bladder.\n\nREPRODUCTIVE ORGANS: Patient is status-post hysterectomy.  Vaginal vault\ngrossly unremarkable.  No adnexal mass.\n\nLYMPH NODES: Scattered small periportal lymph nodes, within normal limits. \nSingle mildly prominent para-aortic lymph node measuring up to 9 mm in short\naxis. No retroperitoneal lymphadenopathy otherwise. No inguinal, pelvic, or\nmesenteric lymphadenopathy.\n\nVASCULAR: Mild atheromatous calcification of the abdominal aorta.  No\naneurysmal dilatation.  Major branch vessels patent.  Pelvic vasculature\npatent.\n\nBONES: No acute or focal destructive osseous lesions.  Multilevel degenerative\nfacet arthropathy lumbar spine.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.\n\nPERITONEUM: No intra-abdominal free air.  There is small volume free pelvic\nfluid.",
            "output": "1. New centrilobular ground-glass nodularity in the anterior segment of the\nleft lower lobe, present in association with fissural nodularity.  Given the\nrecent onset of this finding, this is likely inflammatory or infectious in\nnature.  Follow-up to resolution is recommended with chest CT in approximately\n3 months time.\n2. No obstructive pelvic pathology to explain patient's symptoms.  Stable\nchanges of hysterectomy with unremarkable vaginal vault.  No pelvic\nlymphadenopathy or pelvic vascular pathology.\n3. CBD is dilated up to 11 mm in diameter, but tapers normally towards the\nampulla.  In the absence of abnormal liver enzymes (dated ___ and\nin the absence of associated pancreatic ductal or intrahepatic ductal\ndilatation, this is likely related to sphincter of Oddi dysfunction.\n\nRECOMMENDATION(S):  Please see impression 1."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  Otherwise, visualized lung\nfields are within normal limits.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The visualized portions of the liver demonstrates homogenous\nattenuation throughout.  A 4 mm hyperdense lesion in hepatic segment 7 is\nincompletely characterized but compatible with a hemangioma (2:4).  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.  A 7 mm 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 bilaterally.  There are multiple\npunctate calcifications in the Left kidney, largest in the lower pole\nmeasuring 5 mm (02:34).  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.  There is\nextensive pericolonic stranding and wall thickening involving the mid sigmoid\ncolon without evidence of extraluminal air or a drainable fluid collection\n(2:66).  The overall extent of inflammation is disproportionate to the extent\nof diverticular disease within the colon.  However, there is no evidence of\nunderlying mass or lesion.    The appendix is normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\ntrace amount of free fluid within the pelvis, likely physiologic (2:72).\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. Severe acute sigmoid diverticulitis without evidence of extraluminal air or\nabscess.  The amount of inflammation is disproportionate to the extent of\ndiverticular disease.  Follow-up to resolution is recommended to confirm the\nabsence of underlying lesions.\n2. Multiple punctate nonobstructing left renal stones measuring up to 5 mm.\n3. 4 mm hyperdense lesion in hepatic segment 7, incompletely characterized but\nlikely a hepatic hemangioma.\n\nNOTIFICATION:  Updated wet read was discussed with ___ MD by ___\n___ MD on ___ and 10:00 AM.  Patient recommended to follow-up with\noutpatient surgery in a few days for further evaluation and to confirm\nresolution."
        },
        {
            "input": "LOWER 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 calcified granulomas are noted throughout the liver.  Previously\ndescribed hypodense hepatic lesions are all visualized on the current study. \nThere has also been interval improvement in the degree of intrahepatic biliary\ndilatation since the most recent exam on ___.   The gallbladder is\nlargely 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: Spleen is normal in size.  Other than multiple calcified granulomas\nsuggesting prior granulomatous exposure, no other 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. \nNo hydronephrosis.  Multiple bilateral renal hypodensities are incompletely\ncharacterized.  Largest measures up to 1.2 cm in the right upper pole (02:58),\nwhich was previously characterized as a septated cyst on the renal ultrasound\nperformed ___.  Several subcentimeter lesions are seen in the left\nupper pole, which were T2 hypointense on the prior spine MRI performed ___, and may represent hemorrhagic 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 top-normal in size measuring\nup to 8 mm, but contains normal intraluminal air.  There is no fat stranding\nto suggest acute inflammation.  No ascites.\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 in appearance.  No\nadnexal masses are identified.\n\nLYMPH NODES: Several retroperitoneal lymph nodes, the largest measuring up to\n0.8 cm along the left para-aortic chain at the level of the left renal vein\n(2:71).  This is unchanged from the prior study in ___.  No 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable subcentimeter retroperitoneal lymph nodes.\n2. Multiple bilateral renal lesions, one of which was characterized as a\nseptated cyst in the right upper pole.  Additional incompletely characterized\nleft renal hypodensities may represent hemorrhagic cysts.\n3. Chest CT dictated 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: The liver demonstrates homogenous attenuation throughout,\nnoting multiple previously described calcified granulomas throughout.  New\nfocal lesion detected.  Minimal intrahepatic biliary dilatation is somewhat\ndecreased from the prior study.  The gallbladder is within normal limits.\n\nPANCREAS: 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 size.  Multiple calcified granulomas again\nidentified 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 with normal nephrogram. \nAs before, several bilateral renal hypodensities are incompletely\ncharacterized, and measure up to 1.0 cm in the right upper pole.  This was\npreviously characterized as a septated cyst on the renal ultrasound in ___. 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 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: Several prominent retroperitoneal lymph nodes are not enlarged by\nCT size criteria.  A 0.6 cm para-aortic chain node at the level of the left\nrenal vein is again noted (2:68).  No mesenteric or inguinal lymphadenopathy\ndetected.\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.  Compared with the CT abdomen pelvis of ___, no significant\ninterval change.  Stable subcentimeter retroperitoneal lymph nodes.\n\n2.  Please refer to the dedicated CT chest report of the same date for\nintrathoracic findings."
        },
        {
            "input": "LOWER CHEST: There are 2 solid nodules in the right middle lobe measuring up\nto 4 mm (2:4), unchanged since ___ and likely consistent with\ngranulomas.  The visualized lung fields are otherwise within normal limits. \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 or\nextrahepatic biliary dilatation.  The gallbladder contains a gallstone 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.\n\nADRENALS: There is a hypodense lesion in the right adrenal gland measuring 1.6\nx 1.2 cm (02:25).  A hypodense nodule in the left adrenal gland measures 1.6 x\n1.1 cm (02:29).  These likely represent adrenal adenomas and are minimally\nincreased in size compared to ___.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis.  There is a 1.2 cm hypodensity in the left mid\nkidney which is too small to characterize.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: As before, the patient is status post sleeve gastrectomy. \nStomach appears unremarkable.  Small bowel loops demonstrate normal caliber,\nwall thickness, and enhancement 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\ntrace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is again mildly prominent, which may represent\nunderlying fibroids or adenomyosis.  There is a 2.8 x 2.5 cm hypodense\nstructure in the left adnexa, which likely represents a 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.  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 pathology.  Normal appendix.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Diverticulosis without evidence of acute diverticulitis.\n4. Subcentimeter pulmonary nodules in the right middle lobe are unchanged\nsince ___ and likely represent granulomas.\n5. Bilateral adrenal nodules are minimally increased in size compared to\n___ and likely represent adenomas.\n6. Small volume pelvic free fluid and 2.8 cm left corpus luteal cyst."
        },
        {
            "input": "The patient is post-operative day 9 from anterior and right radical\nhemi-vulvectomy.\n\nThere is a 4.1 x 2.3 cm area of fluid and multiple foci of gas without a\ndefinite rim, concerning for phlegmon or developing abscess in the\nsubcutaneous space inferior to the mons pubis and superior to the right labia.\n\nA small foci of gas in the bladder is likely secondary to prior intervention. \nOtherwise, the urinary bladder and distal ureters are unremarkable.  There is\nno free fluid in the pelvis.\n\nThere is diverticulosis without evidence of diverticulitis.\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\nThere is a small fat containing umbilical hernia.",
            "output": "1. The patient is post-operative day 9 from anterior and right radical\nhemi-vulvectomy.\n2. 4.1 x 2.3 cm area of fluid and multiple foci of gas without a definite rim,\nconcerning for phlegmon or developing abscess in the subcutaneous space\ninferior to the mons pubis and superior to the right labia.  This does not\nrepresent a drainable fluid collection."
        },
        {
            "input": "LOWER CHEST: There is redemonstration of a loculated left pleural effusion\nwith subtle pleural enhancement, which is decreased in size from CT dated ___ CT.\n\nABDOMEN:\nThere is redemonstration of a pigtail catheter within a left subdiaphragmatic\nrim enhancing fluid collection, which is persistent but overall decreased in\nsize, now measuring 4.4 x 5.6 cm at the main part (previously measuring 7.4 x\n6.4 cm on CT dated ___.  There is a small focus of gas at the\nanterior aspect of this collection.\n\nThere has been interval removal of a left lower quadrant percutaneous drain. \nThe collection at this site is unchanged in size and appearance, and remains\nnearly completely collapsed.  The left upper quadrant rim enhancing fluid\ncollection is decreased in size, now measuring 2.2 x 1.3 cm (previously\nmeasuring 2.8 x 1.8 cm) series 2, image 20.\n\nHEPATOBILIARY: The liver is hypoattenuating diffusely, compatible steatosis. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  There is a 6 mm hyperdensity within the\ngallbladder which is likely sludge.  Please note, evaluation of the liver is\nlimited to nonvisualization of the dome due to technical factors.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 normal with a normal nephrogram.  Again seen is a\nslight attenuated delayed nephrogram of the left kidney, which is improved. \nSmall defect at the left medial kidney is stable, compatible with cortical\nscar.  There is no evidence of focal renal lesions or hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: In the fundus of the stomach, there is a round, slightly\nhyperattenuating 1.4 cm mass (series 2, image 13).  This may represent food\ncontents as it was not seen on prior exams.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The small bowel\nanastomosis is patent, located in the epigastric region.  The colon and rectum\nare 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 patient is status post hysterectomy.  No adnexal\nabnormalities 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": "1. Small, residual left subdiaphragmatic rim enhancing fluid collection.  The\ndrain appears in to be located in appropriate position.  Stable to improved\nappearance of additional intra-abdominal fluid collections as described above.\n2. Interval decrease of loculated left pleural effusion.\n3. Steatosis of the liver.  Limited evaluation of the liver with\nnonvisualization of the dome due to technical factors."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  There has been interval\nimprovement in reticular opacification in the right middle lobe and left upper\nlobe with mild traction bronchiectasis.  There is a trace loculated left\npleural effusion, stable compared to prior.  There is no evidence of\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates hypoattenuation 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.  A pigtail catheter is seen along the superior\nmargin of the spleen, there has been interval decrease in size of the\nsubdiaphragmatic fluid collection with a small amount of residual fluid\nwithout evidence of enhancing rim.\n\nThe left upper quadrant rim enhancing fluid collection has decreased in size\nnow measuring 1 x 0.7 cm, previously 2.2 x 1.3 cm (2; 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. \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\nsmall bowel resection and anastomosis.  There is no evidence of obstruction. \nA loop of small bowel which is mildly dilated is unchanged in position\ncompared to prior and may be tethered to the anterolateral abdominal wall (2;\n45).  There is scattered diverticula throughout the colon.  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 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.  No 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 anterior abdominal wall.",
            "output": "1. Interval decrease in size of a left subdiaphragmatic fluid collection with\na small amount of residual fluid.\n2. Interval decrease in size of a left upper quadrant rim enhancing fluid\ncollection now measuring 1 x 0.7 cm.\n3. Stable loculated left pleural effusion.\n4. Interval improvement in right middle lobe and left upper lobe\nconsolidations."
        },
        {
            "input": "CHEST: The lung bases show right basilar scarring and persistent ground glass\nopacities. The heart is top normal in size, and the right atrium is enlarged.\nThere is no pericardial effusion.\n\nABDOMEN:  The liver is normal in size and homogeneous in enhancement. There\nare no focal liver lesions.  The portal and hepatic veins are patent and there\nis no intra or extrahepatic biliary ductal dilatation. The gallbladder is\ndecompressed, and contains a single radiopaque stone, which appears to be in\nthe region of the gallbladder neck. The common bile duct is not dilated.\n\nThe spleen is normal in size and homogeneous in enhancement. The adrenal\nglands are normal in size and shape. The pancreas enhances homogeneously\nwithout focal lesions. There is no pancreatic ductal dilatation or\nperipancreatic fat stranding.\n\nThe kidneys are normal in size and demonstrate symmetric nephrograms and\ncontrast excretion. The ureters are normal in caliber along their visualized\ncourse to the bladder.  There are no concerning mass lesions or stones seen\nwithin the kidneys. There are no perinephric abnormalities present.\n\nThere is a small hiatal hernia.. The stomach is underdistended, but grossly\nnormal. The small bowel is partially opacified with contrast, and does not\nshow obstructive mass lesions or wall thickening. The large bowel contains\nfeces, without evidence of obstructive mass lesions or wall thickening. The\nappendix is surgically absent. There is no intraperitoneal free air or free\nfluid.\n\nThere is no aneurysmal dilatation of the abdominal aorta. The aorta and its\nmajor branches are patent. There is mild atherosclerotic calcifications seen\nin these vessels.\n\nThere are no pathologically enlarged retroperitoneal or mesenteric lymph nodes\nby CT size criteria.\n\nPELVIS:  The bladder is under distended, but grossly normal. The uterus is\nanteverted, and demonstrates a small fibroid. The adnexa are unremarkable. \nThe rectum and sigmoid are unremarkable. There is no pelvic free fluid. There\nare no pathologically enlarged pelvic sidewall or inguinal lymph nodes by CT\nsize criteria.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: There are no concerning lytic or\nsclerotic lesions seen.",
            "output": "No acute findings to account for abdominal pain.  Cholelithiasis without signs\nof acute cholecystitis."
        },
        {
            "input": "VASCULAR:\n\nThere is no evidence of abdominal aortic aneurysm or dissection.  There are 2\nrenal arteries bilaterally.  There is moderate atherosclerotic calcification\nof the abdominal aorta and its major branches, including the ostium of the\nceliac artery, SMA, and the larger of the 2 renal arteries bilaterally.  The\n___ is patent.  There is mild stenosis of the left common iliac artery. \nPortions of the bilateral common femoral arteries are severely stenotic\n(7:189) but are opacified distally.\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 is nodular in contour with hypertrophy of the left\nhepatic lobe, compatible with cirrhosis.  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 is 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 stones or hydronephrosis.  Sub cm hypodensities in\nboth kidneys are too small to characterize.  There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Co there is colonic diverticulosis without CT\nevidence of acute diverticulitis.  Appendix is not visualized.  There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is collapsed around a Foley catheter and contains\nfoci of nondependent air.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is a small amount of free fluid in the abdomen and\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: Metallic streak artifact from a right total hip arthroplasty limits\nevaluation of adjacent structures.  No worrisome lesions or acute fractures\nare seen.\n\nSOFT TISSUES: There are 2 thin-walled fluid collections in the right inguinal\nregion and a small amount of fluid surrounding the right common femoral artery\nand vein, likely related to recent intervention. The larger of the 2 fluid\ncollections measures up to 3.3 cm.  These may represent seromas/hematomas. \nThere is diffuse body wall edema.",
            "output": "1. No evidence of abdominal aortic aneurysm or dissection.  The major branches\nare patent.  Portions of the bilateral common femoral arteries are severely\nstenotic but opacified distally.\n2. Nodular liver contour with left lobe hypertrophy and ascites, compatible\nwith cirrhosis.  Given the patient's cardiac history, this may be cardiogenic\nin nature.\n3. Colonic diverticulosis without CT evidence of acute diverticulitis.\n4. 2 hematomas in the right inguinal region and a small amount of fluid\nsurrounding the right common femoral artery and vein, likely related to recent\nintervention.  The larger of the 2 hematomas measures up to 3.3 cm."
        },
        {
            "input": "LOWER CHEST:\n\nVisualized lung fields are within normal limits. There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nGASTROINTESTINAL:  There is a thin walled intramural collection of fluid on\nthe lateral wall of the cecum measuring 1.6 x 1.1 x 2.8 cm.  This cystic\nstructure can also be identified retrospectively in the prior CT from ___.  Colon and small bowel loops demonstrate normal caliber and wall\nthickness.\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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 gallbladder wall thickening.\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\nSPLEEN:  The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\nADRENALS:  The bilateral adrenal glands are normal in size and shape.\nURINARY: There are multiple simple renal cysts on the right kidney, largest of\nwhich measuring 0.9 cm. There are 2 large renal cysts on the left kidney, the\nlarger cyst measuring 9.7x 8.8 x 11.2 cm, and a smaller one measuring 3.5 x\n3.5 x 4.1 cm.  There is no evidence of hydronephrosis.  There is no\nperinephric abnormality.\nRETROPERITONEUM:  There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\nVASCULAR: There is moderate calcium burden in the abdominal aorta .\n\nPELVIS:\n\nThe bladder is unremarkable.  There is senescent calcification in the\nprostate.  There is no evidence of pelvic or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.",
            "output": "1.  There is a thin-walled intramural collection of fluid in the lateral wall\nof the cecum. This cystic structure can also be seen retrospectively in the\nprior CT from ___. The finding may represent a duplication cyst and\nseems like to correspond to the endoscopy findings. There is no suspicion for\nsolid lesion.\n\n2.  The two large cysts in the left kidney and multiple small cysts in the\nright kidney are stable since ___."
        },
        {
            "input": "Lungs and Heart: The lung bases are clear bilaterally. The visualized heart\nand pericardium are normal.\n\nLiver, Gallbladder: The liver is normal in size and attenuation. No focal\nhepatic lesions are identified. The hepatic and portal veins are patent. There\nis no intra or extrahepatic biliary duct dilatation. The gallbladder is\nnormal.\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\nKidneys, Adrenals: The adrenal glands are unremarkable bilaterally. The\nkidneys display symmetric nephrograms with no evidence of hydronephrosis or\nmass lesion in either kidney.  The ureters are symmetrical in their course to\nthe bladder.\n\nBowel: The stomach and small bowel are unremarkable in the absence of oral\ncontrast.  The large bowel is normal appearing.  Fecal loading is moderate.\n\nVessels: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The ovaries are normal.  The uterus is normal appearing. The bladder\nis unremarkable. The rectum and sigmoid colon are normal.  There is small\nvolume free fluid in the pelvis.\n\nOsseous Structures:  No suspicious lytic or sclerotic lesions.",
            "output": "No acute intra-abdominal process.  Trace free fluid in the pelvis, likely\nphysiologic.  Moderate fecal loading.  Normal appendix."
        },
        {
            "input": "CT ANGIOGRAM: The abdominal aorta is normal in caliber with no significant\natherosclerotic calcifications along its course. Hepatic arterial anatomy is\nconventional. The celiac axis, SMA, ___ and ___ bilateral renal arteries\nare patent. There is satisfactory runoff into the bilateral common iliac,\nexternal iliac, common femoral, and proximal superficial and femoral deep\narteries.  Small perihepatic hemoperitoneum is stable from 9:17am, 5 hours\nearlier) without evidence of active extravasation into the fluid.  However, a\nlarge vessel within the dominant right hepatic mass is noted (6:64-66, 15:21)\nwith adjacent hemoperitoneum and may represent a site of tumor rupture. Within\nthe right groin, a linear jet of arterial contrast extends from the right\ncommon femoral artery (06:36), which slightly increases on the portal venous\nphase (10:136) with a 10 x 7 mm right common femoral artery pseudoaneurysm and\nassociated hematoma. There is surrounding fat stranding in the right inguinal\nregion. Additionally, the common femoral vein is diminutive but appears\npatent, likely due to mural thrombus.\n\nLOWER CHEST: There are trace bilateral pleural effusions with adjacent\ncompressive atelectasis.\n\nABDOMEN:  Again seen is lipiodol staining throughout the right hepatic lobe\nwith multiple hepatic masses with concentrated lipiodol uptake, described in\ndetail on noncontrast CT from 09:17. The left hepatic lobe enhances\nhomogenously without focal mass identified. The dominant mass in the right\nhepatic lobe measures 13.5 x 11.1 cm.  No lipiodol stain is seen at the\ninferomedial portion of the dominant mass which demonstrates some peripheral\nenhancement, suggesting viable tissue, but incompletely evaluated on this\nstudy.\n\nHyperdensity within the gallbladder is likely vicarious excretion of contrast.\nThe spleen, pancreas and right adrenal gland are normal. Again seen is a 1.9\ncm left adrenal nodule, characterized as an adenoma on the noncontrast CT. The\nkidneys enhance symmetrically without hydronephrosis. There is no bowel\nobstruction.  Small hemoperitoneum without evidence of active extravasation is\nstable since ___. There is no free intraperitoneal air. No enlarged\nmesenteric or retroperitoneal lymph nodes are identified.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  Hemoperitoneum tracks into\nthe pelvis. Prostate and seminal vesicles are unremarkable.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. There is a large right groin hematoma with subcutaneous stranding as\ndetailed above.",
            "output": "1.  Right groin hematoma with 10 mm right common femoral artery\npseudoaneurysm, which could not be seen on the subsequent ultrasound.\n2.  Stable small hemoperitoneum since ___ without active extravasation\ninto the hemo peritoneum.  A large vessel in the dominant right hepatic mass\nwith adjacent hemoperitoneum may represent a site of tumor rupture.\n3.  Post TACE changes in the right hepatic lobe with lipiodol uptake in\nmultifocal HCC.  The dominant right hepatic mass has increased in size since\nMRI ___.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___. \n___ (___) on the telephone on ___ at approximately 2:30PM, 5 minutes\nafter discovery of the findings.  A right groin ultrasound was subsequently\nperformed.\n\nAdditionally, Dr. ___ the findings to Dr. ___ ___\nresident) in person at 4pm.  Dr. ___ the findings with Dr. ___\n___ (Hospitalist) by phone at 4:05pm on ___."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\nLIVER:  The distribution of lipiodiol in multiple lesions within the right\nlobe is unchanged from the prior CT.  The largest necrotic mass measuring 8.9\nx 10.5 x 8.7 cm (TV x AP x CC) in segment VI has decreased in size from the\nprior CT, which was performed while a percutaneous drainage catheter with\nstill in place.  Although it is more heterogeneous, there is still extensive\nnodular arterial enhancement at the inferomedial aspect of the mass (series 4,\nimage 44).\n\nSeveral treated lesions in segments II, III, and IV are now hypodense to the\nliver parenchyma on all phases, although there is minimal peripheral arterial\nhyperenhancement in the largest segment II lesion without definite washout on\nlater phases (series 4, image 14).\n\nThere are 3 concerning arterially hyperenhancing lesions with washout kinetics\nin hepatic segment VIII.  The superior lesion is 2.1 x 1.6 cm (series 4, image\n3 and series 5, image 8).  The middle lesion measures 3.2 x 2.6 cm, contains\nlipiodiol centrally with enhancement peripherally (series 4, image 7 and\nseries 5, image 12).  The inferior lesion measures 2.4 x 2.2 cm (series 4,\nimage 14 and series 5, image 21).  The superior and inferior lesions do not\ncontain lipiodiol.\n\nThe gallbladder and biliary tree are normal. The pancreas is normal, without\nfocal lesion or duct dilation. The spleen is normal in size, without focal\nlesion.  There is a left adrenal adenoma, characterized on a prior MRI. A 6 mm\nright adrenal nodule is too small to characterize but stable from ___ (series 5, image 31). The kidneys enhance normally and excrete contrast\nbriskly. There are no solid renal lesions or hydronephrosis. The stomach and\nduodenum are normal. The small bowel and large bowel are normal in caliber,\nwithout wall thickening or mass.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy. The prostate and seminal vesicles are\nunremarkable.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. Largest segment VI mass still features nodular arterial hyperenhancement\nalong the inferomedial aspect, but there is no definitive washout.\n2. Three arterial enhancing masses in segment VIII, two of which are new since\n___, feature washout kinetics and therefore consistent with disease\nprogression. The other has been previously treated but features peripheral\nenhancement.\n3. Other treated lesions in segments II, III, and IV are mostly hypoenhancing\nand necrotic."
        },
        {
            "input": "The visualized osseous structures are unremarkable.  No suspicious lytic or\nsclerotic lesions.  There is a benign appearing 6 x 9 mm sclerotic focus along\nthe left superior pubic ramus.\n\nNo abnormal soft tissue masses.\n\nThe visualized portion of the intrapelvic bowel is unremarkable.\n\nThe bladder and distal ureters are within normal limits.\n\nNo free fluid. No lymphadenopathy.",
            "output": "No intrapelvic osseous metastasis."
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nEvaluation of the abdomen is limited by extensive streak artifact generated by\nmetallic hardware.  Within these limitations:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple subcentimeter hepatic hypodensities throughout the liver,\nwhich are too small to characterize definitively but likely cysts and\nhamartomas.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is distended, without wall thickening or adjacent\nfat 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 an 8 mm hypodensity in the left mid kidney, which is too small to\ncharacterize, but likely represents a simple cyst, unchanged.  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. Surgical sutures\nare visualized in the right lower quadrant.  The colon and rectum are within\nnormal limits. The appendix is normal.\n\nPELVIS: As before, the patient is status post bladder reconstruction with the\nexpected appearance.  Trace free fluid is seen within the pelvis.  Uterus and\novaries are not well visualized but there are no masses evident.\n\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. \nRe-demonstrated is a right hip arthroplasty as well as posterior fusion\nhardware and disc spacers spanning the visualized thoracolumbar spine.\n\nSOFT TISSUES: Partially imaged are bilateral breast implants.",
            "output": "1. Limited study due to extensive streak artifact generated by metallic\nhardware.  Within these limitations, there is no acute intra-abdominal or\nintrapelvic process.\n2. As before, the patient is status post bladder augmentation, which has the\nexpected appearance.  No hydronephrosis."
        },
        {
            "input": "ABDOMEN:\n\nThere are multiple small hypodensities within the liver, the largest of which\nmeasures 1.2 cm in segment ___ (2:15) - these are too small to further\ncharacterize but likely represent small biliary hamartomas. No concerning\nliver lesions. The portal and hepatic veins are patent. The common bile duct\nis mildly dilated measuring up to 1 cm in diameter with mild prominence of the\ncentral intrahepatic ducts.  There appears to be a small choledochocele at the\nmajor papilla (2:27). The gallbladder is unremarkable.\n\nThere are subcentimeter hypodensities within the upper and lower poles of the\nleft kidney that are too small to be further characterized. No concerning\nrenal lesions. No hydronephrosis. The adrenals and spleen are within normal\nlimits. The pancreas is unremarkable.\n\nThe small and large bowel are within normal limits. No free air or fluid\nwithin the abdomen or pelvis. Note is made of soft tissue density material and\npockets of gas within the subcutaneous fat of the anterior abdominal wall,\npresumably due to subcutaneous injections.\n\nNo mesenteric or retroperitoneal adenopathy. The abdominal aorta is of normal\ncaliber.  There is a 3 mm nodule within the left lower lobe (2:2). The lung\nbases are otherwise clear.  The visualized portion of the heart and\npericardium is unremarkable.\n\nPELVIS:\n\nThe bladder is within normal limits. The patient is status post hysterectomy\nand bilateral salpingo-oophorectomy. No pelvic adenopathy.\n\nOSSEOUS STRUCTURES:\n\nDegenerative disc disease is noted at L4-5 and L5-S1. No concerning sclerotic\nor lytic lesions are identified within the osseous structures of the abdomen\nor pelvis.",
            "output": "1.  Mild dilatation of the central intrahepatic ducts and the common bile duct\nwith a small choledochocele at the major papilla. Correlation with LFTs and\nERCP are recommended for further evaluation.\n\n2. 3 mm nodule within the left lower lobe. If the patient is of high risk,\nfollow-up CT chest in 12 months is recommended. If the patient is of low risk,\nno further follow-up is required."
        },
        {
            "input": "There is an acute subcapital fracture on the left, as seen on the recent\nradiograph performed earlier on the same date.  This is associated with\nimpaction and varus angulation.  No definite evidence of an underlying lesion\nto suggest a pathological fracture.  Faint ill-defined sclerosis in the\nfemoral neck may be due to fracture-related trabecular compression or a prior\nmedullary infarct.  No other fractures are identified.\n\nNote is made of crescentic areas of mild subchondral sclerosis separated from\nnormal bone by linear serpiginous areas of more dense sclerosis.  Findings are\nconsistent with bilateral avascular necrosis.  Slightly more inferiorly along\nthe inferior medial surface of the left femoral head, there is a surface\nconcavity/deformity (2:75, 400b:67), which appears to be separate from the\nfovea capitis.  This raises the possibility of subchondral collapse, although\nnotably its inferior location is atypical. Two ghost tracks are seen in the\nleft mid femoral shaft.\n\nLimited evaluation of the knee joints reveals a small non-hemorrhagic effusion\non the left (2:242).  There has been prior surgical fixation of a tibial\nplateau fracture, without evidence of hardware loosening.  Nonspecific\noval-shaped sclerosis along the posterior aspect of the medial femoral condyle\nmeasures 1.6 x 0.8 cm (2:250).\n\nDegenerative changes are noted in the lower lumbosacral spine, with\nintervertebral disc space narrowing and vacuum disc phenomena at L5-S1.  Mild\ncalcification projecting posterior to the L5-S1 intervertebral disc space is\nlikely due to disc pathology.\n\nImaged small and large bowel loops are normal in caliber. Bladder is mildly\ndistended. Uterus is grossly unremarkable, within the limitations of this\nnoncontrast CT. No adnexal masses are identified. No free fluid in the pelvis.",
            "output": "1. Acute left subcapital fracture with impaction and varus angulation.  No\ndefinite evidence of an underlying lesion to suggest a pathological fracture. \nHowever, note that subtle osseous lesions may be obscured by the fracture\nitself.\n2. Bilateral femoral head osteonecrosis.  Non-specific concavity along the\ninferior medial surface of the femoral head raises the possibility of\nsubchondral collapse, although its location is atypical.\n3. 1.6 x 0.8 cm sclerotic focus along the posterior aspect of the medial\nfemoral condyle, non-aggressive in appearance, but of unclear clinical\nsignificance.\n4. Small left knee joint effusion.\ns\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 5:36 ___, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.  Incidental note is made of a\nright hepatic artery replaced to the SMA.  The portal, SMV, and splenic veins\nare patent.\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. \nSubcentimeter hypodensity within segment 4 is too small to characterize but\nlikely represents a hepatic cyst or biliary hamartoma.  There is no evidence\nof suspicious 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: 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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is distended.  The distal ureters are\nunremarkable.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are within normal\nlimits.\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 abnormality within the imaged abdomen and pelvis.  No evidence of\nacute or chronic pancreatitis.\n2. No evidence of atherosclerotic disease or vascular stenosis."
        },
        {
            "input": "LUNG BASES:  Please see separately dictated CT Chest report from same day.\n\nCT ABDOMEN:\nAgain seen is a small, 5 mm, circular hypodensity in segment 7 of the liver,\nstable since ___, likely a simple cyst or biliary hamartoma.  The\nportal vein is patent. The gallbladder does not show stones or wall\nthickening. There is no splenomegaly. The pancreas enhances homogenously.\nThere is no peripancreatic stranding or ductal dilatation.\n\nThere is unchanged diffuse thickening of the left adrenal gland. The right\nadrenal gland is unremarkable. An atrophic left kidney with superior pole\ncalyceal hyperdensities, representing calculi versus early excretion of\ncontrast, is unchanged in appearance, compared to the most recent study. \nAgain seen is a duplicated left renal collecting system. The right kidney\ndemonstrates a normal nephrogram.\n\nOral contrast extends to the descending colon. Non-dilated loops of small\nbowel are normal in course and caliber. There is no wall thickening or sign of\nobstruction.  There is scattered colonic diverticulosis without evidence of\nactive diverticulitis. The colon is otherwise unremarkable.  The appendix is\nnormal. There is no evidence of mesenteric or retroperitoneal lymphadenopathy.\n\nThere is aneurysmal dilation of the infrarenal abdominal aorta up to 3.3 cm,\nunchanged from prior exam from ___ (series 5, image 69).  Additionally,\nthere is a significant mural calcification burden and mixed atherosclerotic\nplaque throughout the abdominal aorta, most prominent at the aortoiliac\nbifurcation and proximal common iliac arteries, and extending into and\ninvolving the external and internal iliacs and the imaged portions of the\nproximal right greater the left femoral arteries. There is a large proximal\nleft renal artery mixed atherosclerotic plaque causing high-grade stenosis, as\non prior exam.\n\nThre is no intra-abdominal free air or fluid.\n\nCT PELVIS: The bladder and terminal ureters are normal.\n\nBONE WINDOW:  There is minimal degenerative joint disease seen at the\nthoracolumbar spine. Alignment is normal. There are no concerning osteolytic\nor osteosclerotic lesions identified.",
            "output": "1. No evidence of intra-abdominal or intrapelvic metastasis. No\nlymphadenopathy.\n2. Unchanged 3.3 cm aneurysm of infrarenal abdominal aorta.\n3. Stable high-grade left renal artery stenosis with unchanged left kidney\natrophy.  Duplicated left renal collecting system.\n4. Left superior pole calyceal hyperdensities, calculi versus excreted\ncontrast.  Further evaluation can be performed with abdominal x-ray or non\ncontrast abdominal CT.\n5. Extensive mixed atherosclerotic disease of the abdominal aorta and the\nimaged iliac and femoral vessels, as on prior.\n6. Stable subcentimeter segment 7 hypodense liver lesion, likely a simple cyst\nor biliary hamartoma.\n7. Stable 3 mm left upper lobe lung nodule."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  104 ___ on contrast scan (normal >100HU) was again an 7\nmm hyperdense lesion in segment 7 is seen best on the coronal view a (series\n6, image 33), likely cyst or hamartoma. There is no other focal lesion.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is contracted, without stones by CT.\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 adrenal glands are normal in size and shape.  The left adrenal\nslightly thickened with no discrete mass and no interval changes numerous\nprevious scans.\nURINARY:\nThe right kidney is normal in size, 10.1 cm, with normal nephrogram.  The left\nkidney mildly atrophic, 8 cm with slightly delayed nephrogram, likely\nsecondary to rule renal artery stenosis as there is an area mixed\ncalcified-soft plaque at the origin of the left renal artery. There is no\nevidence 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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & MESENTERY:\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement.  No solid or cystic mass.\nVASCULAR:\nThere is a stable 3.5 cm abdominal aortic aneurysm with no intraluminal clot. \nThere is moderate calcium burden in the abdominal aorta and great abdominal\narteries with more severe calcium deposits in the common iliac arteries\nbilaterally.  Left renal artery stenosis described above under urinary\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.  There is no\npelvic mass The uterus appears atrophic or post partial hysterectomy\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. No evidence of metastatic disease in the abdomen pelvis\n2. Atherosclerotic disease with stable 3.5 cm infrarenal abdominal aortic\naneurysm and left renal artery stenosis with resultant mild left renal atrophy"
        },
        {
            "input": "PELVIS:  Large colonic stool burden.  The partially visualized small and large\nbowel are otherwise unremarkable. The urinary bladder is distended.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNo dislocation.  Mild degenerative changes are seen involving both\nfemoroacetabular joints.  No diastases of the pubic symphysis or sacroiliac\njoints.  Spleen scarring is also seen involving both sacroiliac joints. \nMultilevel degenerative changes of the imaged lower lumbar spine are noted\nwith vacuum disc phenomenon, osteophyte formation, and facet arthropathy.\n\nSOFT TISSUES: There is asymmetric enlargement and stranding about the right\ngluteal musculature which appears slightly hyperdense suggestive of an\nintramuscular hematoma, incompletely assessed on this exam.",
            "output": "1. No pelvic fracture or dislocation.\n2. Right gluteal musculature intramuscular hematoma, incompletely assessed."
        },
        {
            "input": "LOWER 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 suspicious\nrenal 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. There is a large stool burden\nthroughout the 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 uterus is retroflexed and there are calcifications\nwithin the uterus, most consistent with calcified 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. No evidence of metastatic disease within limitations of an unenhanced scan.\n2. Please refer to separately dictated report of the chest for the findings\nabove the diaphragm."
        },
        {
            "input": "ABDOMEN:\n\nThe fat stranding and wall thickening that was previously identified\nsurrounding a diverticulum within the mid to distal descending colon is no\nlonger identified. Multiple diverticula are noted throughout the colon without\nevidence of diverticulitis. No free air or fluid within the abdomen or pelvis.\nThe patient is status post Billroth II gastrectomy. The small bowel is\nunremarkable.\n\nThe liver is within normal limits. No focal liver lesions. The portal and\nhepatic veins are patent. No intra or extrahepatic duct dilatation. The\npatient is status post cholecystectomy with multiple clips noted in the\ngallbladder fossa.\n\nThere are subcentimeter hypodensities within the interpolar region and lower\npole of the left kidney and the interpolar region of the right kidney that are\ntoo small to further characterize but are unchanged since previous.\nSpecifically, the 1 cm exophytic lesion within the lower pole of the left\nkidney that appears concerning for a low-grade tumor on the previous MRI is\nunchanged in size (5:46). The kidneys are otherwise unremarkable.  No\nhydronephrosis. There is a circumaortic left renal vein. The adrenals are\nwithin normal limits.\n\nMultiple low-density lesions are again identified within the spleen - these\nwere T2 hyperintense on MRI and appear unchanged in size, likely representing\nhemangiomas.  The spleen is otherwise unremarkable.  The pancreas is markedly\natrophic and there are multiple calcifications within the body and tail of the\npancreas, unchanged since previous.\n\nNo mesenteric or retroperitoneal adenopathy.  The abdominal aorta is of normal\ncaliber.  Note is made of postsurgical change within the anterior abdominal\nwall, consistent with the previous ventral hernia repair. The right rectus\nabdominis muscle is absent.\n\nThe lung bases are clear. Note is made of mitral valve calcification on the\nimages of the heart. The visualized portion of the heart and pericardium is\notherwise unremarkable.\n\nPELVIS:\n\nThe bladder is within normal limits. The patient is status post hysterectomy. \nNo pelvic adenopathy.  Multiple calcified densities are identified within the\nsubcutaneous fat of the buttocks, consistent with buttock granulomas.\n\nOSSEOUS STRUCTURES:\n\nWell-defined foci of sclerosis are noted within the left iliac bone and the\nsacrum and are consistent with bone islands.  There are old healed rib\nfractures of the posterior left ___ to 11th ribs. There are also old healed\nfractures of the left transverse processes of L2-4.  No concerning sclerotic\nor lytic lesions are identified within the osseous structures of the abdomen\nor pelvis.",
            "output": "1.  Resolution of the previously identified wall thickening and fat stranding\nsurrounding a diverticulum within the mid to distal descending colon.\n\n2.  Colonic diverticulosis, without evidence of diverticulitis.\n\n3.  Multiple low-density lesions within the spleen, unchanged since previous\nand likely representing hemangiomas.\n\n4.  1 cm exophytic lesion within the lower pole of the left kidney which\ncannot be further characterized on the current study but was concerning for a\nlow-grade tumor on the previous MRI.  Continued follow-up with MRI recommended"
        },
        {
            "input": "LOWER CHEST: There is trace linear atelectasis at the right lung base.  There\nis 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 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 is top normal in size, stable.  Multiple hypodense lesions\nthroughout the spleen are not significantly changed and were previously\ncharacterized 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. \nA 11 mm left lower pole hypodense lesion is not significantly changed, most\nlikely a angiomyolipoma as seen on prior imaging.  There is no hydronephrosis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Patient is status post Roux-en-Y gastric bypass, stable in\nappearance.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Diverticula of the colon are noted, without evidence\nof wall thickening and fat stranding. 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 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.  Incidental note is made of a circumaortic left renal vein.  The\nportal vein, splenic vein and SMV are patent.\n\nBONES: Degenerative changes in the lower thoracic and lumbar spine are not\nsignificantly changed.  Small areas of serpiginous sclerosis in the bilateral\nfemoral heads are not significantly changed, compatible with small areas of\navascular necrosis.  There has been no interval cortical collapse.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are stable postsurgical changes along the anterior\nabdominal wall.  No new ventral hernia.  Numerous calcified granulomas in the\nposterior soft tissues are similar to prior.  A previously noted small fluid\ncollection along the left anterior abdominal wall is decreased in size,\ncurrently measuring 17 x 5 mm, previously 26 x 14 mm, likely resolving\npostoperative seroma.",
            "output": "1. No acute process in the abdomen or pelvis.\n2. Stable postsurgical changes.\n3. Diverticulosis with no evidence of acute diverticulitis."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  Portal and hepatic veins patent.  Patient is\nstatus post cholecystectomy.  They were multiple surgical clips in the\ngallbladder fossa, creating regional streak artifact.  There is no\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is diffusely atrophic.  No focal parenchymal\nlesions.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (12 cm).  There is diffuse heterogeneity of\nthe splenic parenchyma related to phase of enhancement.  Additionally, there\nare multiple scattered hypoattenuating lesions throughout the spleen, which\nmeasure up to 9 mm in diameter (series 5, image 39).  These lesions were\npresent on a remote CT performed in ___.  Some of the larger lesions\nvisualized on the MR performed ___ demonstrated perfusion\ncharacteristics suggestive of multifocal splenic hemangiomas.\n\nADRENALS: Adrenal glands are unremarkable.\n\nURINARY: 1.1 x 1.0 cmd heterogeneous lesion arising from the lower pole of the\nleft kidney, exophytic, series 7, image 30, stable since at least ___, previously characterized as an angiomyolipoma.  No hydronephrosis.\n\nGASTROINTESTINAL: Patient is remotely status-post Roux-en-Y gastric bypass. \nThere is an unremarkable jejunostomy in the left hemiabdomen.  Anastomotic\nsuture is intact.  There is uncomplicated pancolonic diverticulosis.  No\nfindings of acute diverticulitis.  No mural thickening throughout the colon. \nNo luminal distention.\n\nPERITONEUM: No intra-abdominal free air or free fluid.\n\nPELVIS: Urinary bladder is decompressed.  No gross abnormality noted.\n\nREPRODUCTIVE ORGANS: Patient is status-post hysterectomy.  There is no adnexal\nabnormality.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is mild background atherosclerosis.  There is a common\nceliacomesenteric trunk.  It is patent.  Origins of the renal arteries and ___\nare patent.  Portal vein, portal confluence, SMV, and splenic vein patent.\n\nBONES: No acute or focal destructive osseous lesions.  Degenerative facet\narthropathy and degenerative disc disease lumbar spine.\n\nSOFT TISSUES: Multiple calcified granulomas within the subcutaneous pre\ngluteal fat.  Additional calcified granulomas lower anterior abdominal wall. \nPrior abdominal wall mesh repair.",
            "output": "1. No acute abdominal pathology.  Specifically, no evidence of acute\ndiverticulitis.\n2. Multifocal splenic lesions, seen on remote studies dating back to ___.  On\nprior MR, the largest lesions demonstrated perfusion characteristics\nsuggestive of hemangiomas.\n3. Redemonstrated changes of Roux-en-Y gastric bypass.  No acute bowel\npathology identified.\n4. Stable 1.1 cm heterogeneous exophytic lesion arising from the lower pole of\nthe left kidney, previously characterized as an angiomyolipoma."
        },
        {
            "input": "LOWER CHEST: There is dense coronary artery calcification.  There is no\npericardial effusion.  There is chronic-appearing right lung base\nconsolidation with associated mild bronchiectasis, which appears overall\nimproved comparison to the CT from ___.  There is right lung base\npleural calcification.  There is mild left lung base atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: There is a subcentimeter low-attenuation lesion in the right\nhepatic lobe, too small to characterize.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is distended and grossly\nunremarkable.\n\nPANCREAS: The pancreas is grossly unremarkable.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: There is significant wall thickening of the pylorus and\nproximal duodenum which may be secondary to pyloric/duodenum ulcer disease\nversus infection (series 2, image 21).  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. The colon and rectum are\nwithin normal limits. The appendix is not visualized.\n\nPELVIS: The urinary bladder is significantly distended and grossly\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is grossly unremarkable.  There is a 8.0 x 5.2\nx 6.5 cm cystic lesion likely arising from the right adnexal region, new since\nthe PET-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 to severe\natherosclerotic disease is noted.  There is significant proximal celiac trunk\nand SMA stenosis with patent distal branch.\n\nBONES: There is grade 1 anterolisthesis of L3 on L4 with bilateral pars defect\nunchanged from previous study.  There is moderate degenerative changes of the\nthoracolumbar spine.  There is mild dextroscoliosis of the lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Wall thickening of the pylorus and proximal duodenum which could reflect\ninflammation from ulcer disease or infection.  No focal fluid collection or\nperforation.\n2. A 8.0 x 5.2 x 6.5 cm right pelvic cystic lesion likely rising from the\nright ovary is new since ___. OBGYN consult and further evaluation with\nnonurgent pelvic MRI are recommended.\n3. Interval improvement of chronic right lower lobe consolidation since the ___ examination, with mild bronchiectasis."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 nodule in the left hepatic lobe (2:15), too small to\ncharacterize.  There is no suspicious 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. \nBilateral subcentimeter hypodense cortical structures, indeterminate however\nlikely cysts (2:33).  There is no evidence of solid 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.\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\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 findings suggestive of malignancy or of infectious processes within the\nabdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: Masses in the imaged lung bases measure up to 5.4 cm in the left\nlower lobe.  Please refer to separate report of CT chest performed on the same\nday for a detailed 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 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 bilateral adrenal glands are unremarkable.\n\nURINARY: The left kidney is surgically absent.  A subcentimeter hypodensity in\nthe right kidney (3:68) is too small to characterize, but is unchanged.  No\nfocal mass lesions 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.\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 grossly\nunremarkable.\n\nLYMPH NODES: No pathologically enlarged abdominopelvic lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: No suspicious osseous lesions or acute fracture.  Grade 1\nanterolisthesis of L4 on L5 is unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post left nephrectomy without evidence of recurrent or metastatic disease\nin the abdomen or pelvis.\n2. 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 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 unremarkable.\n\nURINARY: Patient is status post radical left nephrectomy.  There is no\nevidence of local recurrence in the surgical bed.  The right kidney\ndemonstrates normal size and 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: 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 is no evidence of worrisome osseous lesions or acute fracture. \nGrade 1 anterolisthesis of L4 on L5 is likely degenerative.  There is endplate\nsclerosis and vacuum disc phenomenon at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post left nephrectomy without evidence local recurrence.\n2. 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 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 status post left nephrectomy with no evidence of local\nrecurrence or suspicious nodule in the nephrectomy bed.  There is no evidence\nof focal right 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Small volume\nsimple appearing free fluid 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. \nDegenerative bony changes are seen.  There is an anterolisthesis of L4 over\nL5.  There is a disc herniation at L5-S1 migrating inferiorly in the spinal\ncanal, containing ex vacuo phenomenon, there is no significant central canal\nstenosis, but the disc herniation does touch the exiting nerve root of S1 on\nthe right these findings are stable.\n\nSOFT TISSUES: Within the gluteus maximus, 2 area of enhancement are noted\nmeasuring 26 mm and 25 mm (series 2 image 111 and 121).  These are concerning\nfor metastatic spread.",
            "output": "1.  Status post left nephrectomy for RCC, with interval development of small\nvolume simple appearing ascites.\n2. Two left gluteal lesions as described above, concerning for metastatic\nspread. Attention on follow-up."
        },
        {
            "input": "LOWER CHEST: Please see report of CT chest from same day.\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: Status post left nephrectomy.  No soft tissue mass is seen at the\nresection bed.  The right kidney is normal in size and there is no evidence of\na focal renal abnormality 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.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There\nremains a trace of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The previously identified arterially hyperenhancing left gluteal\nlesions measuring 25 mm and 26 mm are no longer evident.  No new subcutaneous\ntissue nodules are seen.",
            "output": "1. Status post left nephrectomy.  No local recurrence at resection bed.\n2. Interval resolution of arterially hyperenhancing nodules in the left\ngluteal muscle.\n3. Persistent trace pelvic ascites.\n4. No new sites of visceral or bone metastases in the abdomen or pelvis.\n5. Please see report of CT chest from same day for details of intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Please refer to same day chest CT report for supradiaphragmatic\nfindings.\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: Status post total left nephrectomy.  The right kidney is of normal\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.  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. \nMild anterolisthesis of L1 over L2 and L5 over S1.  Grade 1 anterolisthesis of\nL4 over L5.  Tiny round sclerotic foci in the vertebral body of L3 and both\nfemoral heads (407: 258, 526 and 536), stable and likely bone islands.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  No\nabnormally enhancing lesions within the visualized soft tissues.",
            "output": "1. Status post laparoscopic left total nephrectomy due to a renal cell\ncarcinoma.  No lesions suspicious for recurrence in the surgical bed.  Please\nnote that concurrent left adrenalectomy was not performed.\n2. No lesions suspicious for metastatic disease within the abdomen or pelvis."
        },
        {
            "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 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: Status post laparoscopic left total nephrectomy, without lesions\nsuspicious for recurrence in the surgical bed.  The right kidney has normal\nnephrogram, and excretion, without evidence of solid renal lesions or\nhydronephrosis.  There is 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. The appendix 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 grossly 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: Stable tiny round sclerotic foci in L3 vertebral body and bilateral\nfemoral heads, likely representing bone islands.  There is mild\nanterolisthesis of L1 over L2 and L5 over S1.  Grade 1 anterolisthesis of L4\nover L5.  There 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 left nephrectomy for RCC.\n2. No evidence of metastases in the abdomen or pelvis.\n3. Unremarkable right kidney, with normal nephrogram and excretion."
        },
        {
            "input": "LOWER CHEST: For chest findings reference is made to CT chest report of the\nsame day\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 patient is status post left nephrectomy.  Right kidney is normal.\nThere is no evidence of focal right renal lesions or hydronephrosis.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: There is narrowing of the aorto SMA interval measuring 9 mm\nin AP diameter with mild dilation of the duodenum and stomach proximal to this\nwhich could be seen in the setting of SMA syndrome if the patient is\nclinically symptomatic.  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. \nDegenerative bony changes with grade 1 anterolisthesis of L4 on L5\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patient is status post left nephrectomy.\n2. No evidence disease recurrence or metastatic disease in the abdomen or\npelvis.\n3. Mild narrowing of the aorto SMA interval with proximal dilation the\nduodenum and stomach which could represent SMA syndrome in the correct\nclinical setting\n4.  For chest findings reference is made to CT chest report of the same day"
        },
        {
            "input": "LOWER CHEST: Dependent changes in the bases of the visualized lung fields.\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 collapsed.\n\nPANCREAS: There is fatty infiltration of the pancreatic head, without evidence\nof focal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The colon and rectum are within normal limits. \nThe appendix is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nPERITONEUM/RETROPERITONEUM:  Diffuse ascites is present.  Plate like soft\ntissue density in the omentum is concerning for tumor deposits.  There is no\nevidence of retroperitoneal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta.\n\nPELVIS:  A 2.2 cm enhancing lesion is within the endometrial cavity with\nadjacent calcification in the myometrium (series 2, image 71).  A mixed solid\nand cystic lesion is in the left adnexa measuring 3.3 x 5.5 cm (series 2,\nimage 75) with soft tissue nodules along the peritoneum of the pelvis (series\n2, image 69).  The urinary bladder is unremarkable.  There is no evidence of\npelvic or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES: Degenerative changes are seen in the lumbar spine most\nprominent L4-L5 with endplate sclerosis. The abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. mixed solid and cystic lesion in the left adnexa with soft tissue nodules\nalong the peritoneum of the pelvis, soft tissue infiltration of the omentum\nand ascites is concerning for  metastatic ovarian carcinoma.\n2. A 2.2 cm indeterminate enhancing lesion within the endometrial cavity\npossibly uterine fibroid versus endometrial polyp or carcinoma"
        },
        {
            "input": "LOWER CHEST:\nPacer wires are partially imaged at the cardiac base.  There is minimal\nbibasilar dependent atelectasis.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously.  No intrahepatic\nbiliary ductal dilation noted.  There are no focal liver lesions.\nThe gallbladder is surgically absent.\nPANCREAS: There is homogeneous enhancement the pancreatic parenchyma without\nmain duct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  There is a 10 mm right adrenal indeterminate nodule that is\nunchanged on multiple prior scans dating back to ___.\nURINARY: No hydronephrosis seen on either side.  There is a 9 x 8.7 cm cystic\nlesion arising from the lower pole of the right kidney with no enhancing\nnodules or septations.  Another simple appearing cyst is also seen arising\nfrom the lower pole of the left kidney, unchanged.  No solid enhancing renal\nmasses identified.\nGASTROINTESTINAL: There is no bowel obstruction.  There are scattered colonic\ndiverticuli including scattered diverticuli in the descending colon without\npresence of associated inflammation.  A normal appendix containing air is\nnoted in the right lower quadrant.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: The abdominal aorta is tortuous and demonstrates moderate calcified\natherosclerotic plaque within it without aneurysmal dilation.\n\nPELVIS:\nThe bladder is moderately distended and unremarkable.  Prostatomegaly noted. \nPart of the pelvis is obscured by beam hardening artifact from the left hip\nprosthesis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  Multilevel degenerative changes of\nthe thoracolumbar spine noted.",
            "output": "1. There is no evidence of diverticulitis or other acute process in the\nabdomen or pelvis.\n2. Numerous incidental findings include a stable 10 mm right adrenal adenoma\n(dating back to ___ prostatomegaly; left hip prosthesis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are notable for trace basilar atelectasis.\nThere is no evidence of pleural or pericardial effusion.  Pacemaker leads are\ndemonstrated in the right atrium and right ventricle.  Heart is mildly\nenlarged.  Aortic valvular calcifications are noted along with CABG clips.\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: Unchanged 8 mm right and 7 mm left adrenal nodules compatible with\nadenomas are noted.\n\nURINARY: The kidneys are of normal and symmetric size.  A 9 cm right lower\npole renal simple cyst is again seen and unchanged.  Additional 15 mm left\nlower pole simple renal cyst is noted.  Otherwise, there is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  No renal or\nureteral calculi.  There is no hydronephrosis.  There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber and wall thickness throughout.\nDiverticulosis of the sigmoid colon is noted, without evidence of wall\nthickening or 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 up to 5.4 cm in\ntransverse diameter.\n\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 visualized throughout the imaged\nportion of the thoracolumbar spine without worrisome osseous lesions or acute\nfracture.  Status post left hip arthroplasty with streak artifact slightly\nlimiting assessment of the deep pelvic structures.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Median\nsternotomy wires are incompletely imaged.",
            "output": "1. No acute intra-abdominal or pelvic abnormalities identified within the\nlimitations of a noncontrast enhanced scan.  No urolithiasis or\nhydroureteronephrosis.  Normal appendix.\n2. Bilateral renal cysts.\n3. Colonic diverticulosis without acute diverticulitis.\n4. Prostatomegaly.\n5. Unchanged subcentimeter bilateral adrenal adenomas."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: There is an enlarged, fibroid uterus, with a large\npedunculated fibroid measuring 0.7 x 7.0 x 7.9 cm.  There is a right corpus\nluteum.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES/SOFT TISSUES: There are small foci of air at the gluteal cleft,\noverlying the inferior sacrum, within a region of soft tissue edema.  The\nedema extends to the sacrum along a 4 cm contiguous segment, though the\nunderlying bone is intact.  There is no fluid collection.  There is no\nevidence of worrisome osseous lesions or acute fracture.",
            "output": "There are small foci of air at the gluteal cleft, overlying the inferior\nsacrum, within a region of soft tissue edema measuring approximately 3.9 x 1.2\ncm x 4 cm.  The underlying bone is intact. There is no drainable fluid\ncollection."
        },
        {
            "input": "LUNG BASES: Streaky opacities at the left lung base are compatible with\nsubsegmental atelectasis. Otherwise the partially imaged lungs are clear.\nThere is no pleural or pericardial effusion.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion. There is no\nintrahepatic biliary ductal dilation. The portal vein is patent. The\ngallbladder does not show evidence of stones or wall thickening.  The pancreas\nenhances homogeneously. There is no peripancreatic stranding or ductal\ndilation. Multiple small eccentrically-shaped fluid collections surrounding\nspleen likely relate to minimal third spacing in the setting of recent\nsurgery. Otherwise, there is no splenomegaly or focal splenic lesion. The\nadrenal glands are normal. There is normal symmetric renal enhancement. There\nis no hydronephrosis.\n\nOral contrast extends to the ileostomy site. Non-dilated loops of small bowel\nare normal in course and caliber without evidence of wall thickening or\nobstruction. A right lower quadrant ileostomy is identified which demonstrates\nnormal enhancement; contrast is seen in a extracorporeal collection bag,\nindicating a patent ileostomy. There is mild diffuse stranding of the adjacent\nsurrounding subcutaneous soft tissues and fascia, not unexpected after recent\nsurgery. However, minimally abutting the superolateral aspect of the ileostomy\nis an ill-defined, 3.7 x 2.8 x 2.3 cm more confluent focus of stranding and\ninflammatory change, with some internal fat and small foci of internal gas\n(series 5, image 50, and series 8, image 23).  Most apparent on sagittal\nimages, there appears to be surrounding herniated mesenteric/omental fat\nadjacent to the ileostomy, in the ___ which is situated the previously\ndescribed focus of inflammatory change. These findings are most consistent\nwith a focus of fat necrosis within a small herniation of omental/mesenteric\nfat (series 8, image 26); less likely, this represents a focus of\npostoperative hematoma/seroma. There is no discrete fluid collection or other\nevidence to suggest an abscess. The area does not contain contrast, nor appear\nto communicate with the ileostomy.\n\nA small amount of layering simple fluid is seen within the more dependent\nportions of the intraperitoneal cavity along the left pericolic gutter, as\nwell as multiple small foci of intraperitoneal air as well as small foci of\nair within the anterior abdominal wall soft tissues and musculature, all of\nwhich are normal findings in the setting of recent surgery.\n\nThe abdominal aorta is normal in caliber without aneurysm or dilation.\nProximal tributaries appear grossly patent. There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria.\n\nCT PELVIS:\nMinimal enhancement of the wall of the rectal stump is noted.  There is no\nfree pelvic fluid. There are multiple small foci of intraluminal bladder air;\ncorrelate with recent instrumentation. Smaller foci of extraluminal,\nintrapelvic air most likely relates to recent surgery.  Otherwise, the imaged\npelvic organs are unremarkable. There is no pelvic sidewall or inguinal\nlymphadenopathy.\n\nOSSEOUS STRUCTURES:\nThe imaged thoracolumbar vertebral bodies demonstrate normal alignment. No\nconcerning focal lytic or sclerotic osseous lesions are seen.",
            "output": "1. A 3.7 x 2.8 x 2.3 cm confluent focus of inflammatory change containing fat\nand small foci of air just superior and lateral to the right lower quadrant\nileostomy, situated within what appears to be a herniated portion of\nmesenteric/omental fat. These findings are most compatible with fat necrosis.\n2. No evidence of abscess.\n3. Status post recent proctocolectomy and ileostomy.  Normal appearing ostomy.\n4. Sequelae of recent surgery, including abdominal wall fascial thickening,\nsubcutaneous soft tissue stranding, small foci of subcutaneous and\nintraperitoneal air and a small amount of simple-appearing layering\nintraperitoneal fluid, as above.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 3:34 ___."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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\n2.4 x 2.4 cm vague area of hyperdensity in hepatic segment VIII correlates\nwith the previously described focal nodular hyperplasia (2:15).  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.  Patient is post subtotal\ncolectomy and J-pouch construction, with a right lower quadrant diverting\nileostomy.  There is no bowel obstruction.  The J-pouch demonstrates a\nthickened hyperenhancing wall with adjacent engorged vessels adjacent fat\nstranding and a small amount of free fluid, reflecting active inflammation\n(601b:38, series 2, image 59, 65).  No focal fluid collections are identified.\nNo free intra-abdominal 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 evidence of worrisome osseous lesions.\n\nSOFT TISSUES: Previously described area of fat stranding about the ileostomy\nhas improved.",
            "output": "1.  Inflamed J pouch, without adjacent focal fluid collections.  No bowel\nobstruction or perforation.\n2.  Unchanged focal nodular hyperplasia in hepatic segment VIII, previously\ncharacterized by MR."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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. The colon and\nrectum are within normal limits.  Mild fecal loading within the 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 grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic pathology, specifically no evidence of acute\nappendicitis"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 1.3 x 1.4 x 1.4 cm hypodensity in the segment 4b of the liver\n(5:26, 6b:26) with -2.5 ___ consistent with a cyst which is unchanged from\nprevious examination.  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 is a right renal hypodensity\nwhich is too small to characterize and likely represents a cyst (05:27). \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is no\nevidence of colonic wall thickening or fat stranding.  There is moderate stool\nloading.  There appears to be minimal wall thickening in the rectum (5:54). \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 heterogeneous and enlarged consistent with\nhistory of fibroids.\n\nLYMPH NODES: There is no retroperitoneal, pelvic, or mesenteric\nlymphadenopathy.  There are several bilateral inguinal lymph nodes are not\nenlarged 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Minimal wall thickening of the rectum with mild enhancement may reflect\nmild proctitis.\n2. Unchanged liver cyst."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver is diffusely hypoattenuating and prominent suggestive\nof diffuse hepatic steatosis.  There is no evidence of focal lesions. There is\nno 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 fatty infiltration at\nthe head of the pancreas.  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 glands are normal in size and shape.The left\nadrenal is slightly nodular which could be related to adrenal hyperplasia.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 anterior scarring and tethered of the fundus of\nthe uterus to the abdominal wall in keeping with post-operative C-section\nchanges.  Fibroid uterus.  A small right hydrosalpinx is again noted as well\nas a 1.8 cm simple left adnexal cyst previously characterized by pelvic\nultrasound in ___.\n\nLYMPH NODES: There is no abdominal or pelvic lymphadenopathy.  No ascites.\n\nVASCULAR: 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 facet changes are noted at L4-5 bilaterally and L5-S1 on the\nleft.\n\nSOFT TISSUES: There is scarring in the midline of the abdomen related to prior\nsurgery.",
            "output": "1. No acute intra-abdominal process.\n2. Diffuse hepatic steatosis.\n3. Right hydrosalpinx and left cyst vs hydrosalpinx."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and distal ureters are unremarkable. There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: Patient is status post partial hysterectomy.  A cystic\nright adnexal structure measures approximately 4.5 x 4.6 cm (series 2, image\n44) and should be further evaluated with a pelvic ultrasound on a nonemergent\nbasis.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nNo evidence of a hip joint effusion or large hematoma.  Status post posterior\nfusion of L5-S1 without evidence of hardware complication.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Stranding within the\nmidline lower anterior abdominal wall is likely due to prior surgery.",
            "output": "1. No evidence of fracture or dislocation.  No hip joint effusion or large\nhematoma.\n2. Cystic right adnexal structure measuring up to 4.6 cm, which should be\nfurther evaluated with a pelvic ultrasound on a nonemergent basis.\n\nRECOMMENDATION(S):  Pelvic ultrasound."
        },
        {
            "input": "LOWER CHEST: Several pulmonary nodules in the lung bases measuring up to 15 mm\nin the right lower lobe and up to 10 mm in the left lower lobe are better\nevaluated on recent chest CT, and are concerning for metastases.  There has\nbeen interval placement of a chest tube in the left base.  Previously seen\npleural effusion on the left has resolved.  There is bibasilar atelectasis. \nNo pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post right hepatectomy.  Liver is shrunken and nodular\nconsistent with cirrhosis.  Multiple areas of hypoenhancement in segments 2,\n3, and 4 corresponds to ablation treatment cavities.  Area of potential\nrecurrence in the segment 4 treatment cavity is better evaluated on recent\nliver MRI.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nductal dilatation. There is no peripancreatic stranding.  Cystic lesion in the\npancreatic tail is better evaluated on recent MRI.\n\nSPLEEN: Spleen is enlarged measuring up to 16.2 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 stones, focal renal lesions, or hydronephrosis. There\nis no perinephric abnormality.  Subcentimeter hypodensities bilaterally better\ncharacterized as simple cysts on recent MRI.\n\nGASTROINTESTINAL: There are numerous borderline dilated proximal bowel loop\nbowel loops.  Ventral abdominal wall hernia contains small bowel loops.  There\nis new associated mesenteric free-fluid around these bowel loops in the\nhernia.  In addition, a loop of terminal ileum exiting this hernia appears\ndecompressed (13:70 and 8:86).  The cecum an proximal ascending colon are\nfluid-filled.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Bladder is densely opacified with contrast, presumably from a prior\nexam.  There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  No adnexal abnormalities are\nseen.\n\nVASCULAR: No abdominal aortic aneurysm.  There is extensive atherosclerotic\ndisease of the abdominal aorta and mesenteric vasculature.  The celiac axis,\nSMA, and bilateral renal arteries as well as the ___ appear patent.  Again\nseen is nonocclusive thrombus within the right anterior portal vein.  There is\nalso nonocclusive, enhancing thrombus with calcifications at the portal\nconfluence, likely reflecting tumor thrombus.  Extensive varices are seen in\nthe hepatic hilum and central mesenteric.  An 18 mm splenic artery aneurysm is\nunchanged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Large ventral abdominal wall hernia contains loop of small\nbowel.",
            "output": "1. Interval resolution of a left-sided pleural effusion status post chest tube\nplacement.  Multiple pulmonary nodules seen in the lung bases, again\nconcerning for metastatic disease and better evaluated on recent chest CT. \nPatient's left-sided pain with respiration may be related to the chest tube.\n2. Borderline dilated proximal small bowel loops, including within a ventral\nabdominal wall hernia, where there is new small volume free fluid and a\ndecompressed loop of terminal ileum exiting the hernia sac raising the\npossibility of early or partial small bowel obstruction.  No pneumatosis or\npneumoperitoneum.\n3. Cirrhosis with sequela of portal hypertension including extensive upper\nabdominal varices and splenomegaly.  Area concerning for recurrent disease in\na segment 4 treatment cavity is better seen on recent liver MRI.\n4. Nonocclusive thrombus in the right anterior portal vein and nonocclusive\nprobable tumor thrombus in the portal confluence."
        },
        {
            "input": "LOWER CHEST: There is mild dependent bibasilar atelectasis without pleural\neffusion.  Bilateral breast implants are 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.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 left lower renal pole is too small to characterize,\nbut statistically likely 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 reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal, mesenteric, or pelvic\nlymphadenopathy by CT size criteria.  There is a 2.0 x 1.4 cm right inguinal\nlymph node (5:98).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: A 2.2 x 1.4 cm hemagnioma is identified in the L1 vertebral body.  No\nsignificant degenerative changes are present.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.  2.0 x 1.4 cm enlarged right inguinal lymph node.\n\n2.  2.2 x 1.4 cm hemangioma in the L1 vertebral body.\n\n3.  No evidence of mesenteric, retroperitoneal or pelvic sidewall\nlymphadenopathy by CT size criteria."
        },
        {
            "input": "LOWER 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: 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:  Several lucent lesions with thick sclerotic rims and associated\ncortical thickening are present, including within the manubrium (9:38), L1\nvertebral body extending into the left pedicle (5:28), bilateral iliac bones\n(5:68, 69), and within the left superior pubic ramus (5:86).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of lymphadenopathy within the abdomen or pelvis.\n2. Several lucent lesions with a thick sclerotic rim and associated cortical\nthickening are present, as described above. Given the patient's history of\nmalignancy, these lesions are concerning for osseous involvement, although the\nlevel of activity of these lesions cannot be assessed. Several of these\nlesions would be amenable to biopsy.\n3. Please see separate chest CT report for details of intrathoracic findings.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe ___ ___ at 12:27 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER CHEST: Small anterior bilateral diaphragmatic eventration is noted.  The\nimaged lung bases appear clear.  The imaged portion of the heart appears\ntop-normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no focal lesion 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.  There is no\nevidence of focal lesion, within the limitations of an unenhanced scan.  There\nis no pancreatic ductal dilation 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.  Focal area of scarring\nalong the lower pole right kidney with cortical indentation.  There is no\ndefinite renal lesions, within the limitations of an unenhanced scan.   There\nis no perinephric abnormality.  There is no hydronephrosis or hydroureter. \nThe decompressed urinary bladder is grossly unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness. Diverticulosis of the descending and\nsigmoid colon is noted, without evidence of wall thickening or fat stranding.\nThe appendix is not visualized.\n\nPELVIS: There is no free fluid in the pelvis.  The urinary bladder is mostly\ndecompressed.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and indents the bladder base. \nOn this unenhanced exam, no discrete prostate lesion is identified.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no inguinal lymphadenopathy.  A mildly prominent lymph node in the\npelvis measuring 89 mm in short axis is likely reactive, series 2, image 69.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative changes are seen within the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Enlarged prostate with bladder base indentation.  No discrete lesion within\nthe prostate on this unenhanced exam.\n2. 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 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 subtle right urothelial hyperenhancement along the right renal pelvis\nwith subtle adjacent fat stranding, concerning for ascending infection.  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. The colon and\nrectum are within normal limits. The appendix is not visualized, no secondary\nsigns .  Small fecal load within the colon.\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": "Findings suggest right pyelitis/ureteritis, likely reflecting ascending\nurinary tract infection.  No evidence of nephritis."
        },
        {
            "input": "LOWER CHEST:\n\nThe bases of the lungs are clear, with the exception of some minimal scarring\nor atelectasis anteriorly (3:5).  There is no pleural or pericardial effusion.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\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 left kidney has a duplicated collecting system, with no evidence\nof hydronephrosis of either the upper or lower pole moieties (05:49, 601b:37).\nA 1.9 cm hyperdense exophytic cyst is noted along the lower pole of the left\nkidney, an demonstrates no enhancement on portal venous or 3 min delayed phase\nimaging (601b:34). A small parapelvic cyst is noted on the right (05:24).\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 no calcium burden in\nthe abdominal aorta and great abdominal arteries.\n\nPELVIS:\nA markedly enlarged uterus is filled with hemorrhagic material, and\ndemonstrates marked eccentric endometrial thickening along the left lateral\naspect (___), with evidence of post postcontrast enhancement and\nextravasation of contrast into the fluid-filled endometrial cavity, compatible\nwith active hemorrhage. Multiple heterogeneously enhancing fibroids are also\nnoted, better characterized on recent prior pelvic ultrasound. The ovaries are\nwithin normal limits, with a corpus luteum on the right (601b:29), and a\ndominant follicle on the left (5:62).\n\nBONES AND SOFT TISSUES:\n\nNo osseous lesion worrisome for malignancy is identified.  A very small fat\ncontaining umbilical hernia is present (05:53).",
            "output": "1. Markedly enlarged uterus with asymmetric nodular thickening of the\nendometrium and marked expansion of the cavity with blood products and\nsignificant active hemorrhage. This constellation of findings, taken together\nwith markedly elevated beta HCG, is highly concerning for molar pregnancy.\n2. No metastatic disease or lymphadenopathy is identified in the abdomen or\npelvis.\nINCIDENTAL FINDINGS:\n\n\n\n1. Uterine fibroids and ovaries are better characterized on recent prior\npelvic ultrasound.\n2. Bilateral renal cysts and duplicated left renal collecting system.\n\nNOTIFICATION:   The findings were discussed via telephone by Dr. ___ with\n___ Qui___ (ordering provider) on ___ at 4:43 ___, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "CHEST:\n\nThere is left lower lobe atelectasis, a small hiatal hernia, and trace,\nphysiologic pericardial effusion.\n\nABDOMEN:\n\n The liver enhances homogeneously, without concerning focal lesion.  There is\na sub cm hypodensity in the right lobe of the liver which is too small to\ncharacterize but stable from ___ (2:6). The gallbladder and biliary tree are\nnormal. The pancreas is normal, without focal lesion or duct dilation. The\nspleen is normal in size, without focal lesion. The adrenal glands are normal.\nThe kidneys enhance normally and excrete contrast briskly. There are no solid\nrenal lesions or hydronephrosis.\n\nThere is cecal mural edema with minimal adjacent mesenteric fat stranding and\nsimple fluid (___). Otherwise, the small bowel and remainder large bowel\nare normal in caliber.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.\n\nPELVIS:\n\nThe urinary bladder is without wall thickening or mass. The rectum is\nunremarkable.  There is no free fluid. There is no pelvic or inguinal\nlymphadenopathy. There are multiple uterine fibroids with coarse\ncalcifications, likely in the process of involution, with areas of hypodensity\nwhich may reflect degeneration.  Rounded hypodensities in the region of the\ncervix may relate to nabothian cysts.  There is no adnexal abnormality.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture.  There is severe scoliosis of the spine with\nassociated degenerative change.",
            "output": "1. Cecal wall edema and small amount of adjacent simple fluid and fat\nstranding at the site of patient's reported polypectomy, most c onsistent with\npostpolypectomy electrocautery syndrome.  No evidence of perforation.\n2. Multiple uterine fibroids, some of which may be degenerating.Rounded\nhypodensities in the region of the cervix may relate to nabothian cysts. \nFindings could be confirmed on nonurgent 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 probable hepatic steatosis.  A 1.0 cm ovoid hypodensity within the\nright hepatic lobe (02:15) is unchanged in size and is too small to\ncharacterize but likely represents a cyst or biliary hamartoma.  Other\nsubcentimeter hypodensities near the liver dome (2:8) and caudate lobe (02:22)\nare too small to characterize but likely cysts or biliary hamartomas as well. \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. \nA 4.9 cm simple cyst in the interpolar region of the left kidney (02:44) has\nincreased in size, previously measuring 1.7 cm.  A 2.1 cm exophytic simple\ncyst arising from the upper pole of the left kidney has increased in size as\nwell.  Few other subcentimeter hypodensities throughout the bilateral kidneys\nare too small to characterize but likely cysts as well.  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\nscattered minimal pancolonic diverticulosis without evidence of\ndiverticulitis.  The appendix is not seen; patient is reported status post\nappendectomy.\n\nPELVIS: Few phleboliths are seen about the urinary bladder.  The urinary\nbladder and distal ureters are unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged.  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": "1. No acute findings within the abdomen or pelvis to explain the patient's\nreported symptoms.  No bowel obstruction.  No hydronephrosis.\n2. Interval increase in size of simple cysts within the left kidney measuring\nup to 4.9 cm.\n3. Prostatomegaly.\n4. Diverticulosis without evidence of acute diverticulitis.  Status post\nappendectomy."
        },
        {
            "input": "LOWER 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 7 mm hyperdense lesion in hepatic segment VII becomes\nisodense to the hepatic parenchyma on the 3 min delayed phase, and is likely a\nflash filling hemangioma (2:56).  This was less conspicuous, but present, on\nthe scan from ___.  The remaining liver enhances homogeneously\nwithout focal lesion.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The nondistended 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: Bilateral subcentimeter renal hypodensities are too small to\ncharacterize but likely cysts (601b:38, 41).  An area of focal cortical\nthinning in the interpolar right kidney is unchanged and may be sequela of\nprior infection.  No hydronephrosis or perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is moderately well distended and unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout. Colon and rectum are distended with stool, and unremarkable. \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 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. \nThe intermediate density lesion at the level of the right L5-S1 neural foramen\n(2:89) is unchanged and compatible with a nerve sheath tumor, as characterized\non the ___ MRI. Abdominal and pelvic wall is within normal limits.",
            "output": "1.  The rectum is distended with stool, and unremarkable in appearance.\n\n2.  Unchanged nerve sheath tumor the right L5-S1 neural foramen.\n\n3.  Please see dedicated CT chest from the current date for 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. \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: Patient is status post right adrenalectomy.  The left adrenal gland\nis normal size and shape.\n\nURINARY: Patient is status post right nephrectomy.  The left kidney is of\nnormal size.  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.  Ileocolic anastomosis is\nunremarkable.  Oral contrast is seen to the level of the mid transverse colon.\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: A 3.9 cm right adnexal cyst and 2.1 cm left adnexal cyst\nare not significantly changed from prior exam.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Expected postsurgical changes are seen in the anterior abdominal\nwall.  Otherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post right nephrectomy and adrenalectomy.\n2. No evidence of obstruction.\n3. No significant change in size of bilateral adnexal cysts.  Recommend\ncontinued yearly pelvic ultrasound surveillance.\n\nRECOMMENDATION(S):\n-Yearly pelvic ultrasound surveillance for bilateral adnexal cysts."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  No large pleural effusion or pericardial\neffusion.  Coronary artery calcifications are moderate.\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 1.1 x 1.5 cm hypodense cystic lesion the proximal pancreatic body\nappears increased in size compared to ___ where it measured 0.6 x\n0.7 cm (02:25).  This is associated with soft tissue stranding about the\npancreatic head and body (for example 2:26, 601:23).  No pancreatic ductal\ndilatation is identified.\n\nSPLEEN: The spleen shows normal size.  Subtle peripheral hypodensity in the\nspleen likely reflects prior infarct, age indeterminate but new from prior\nexam.\n\nADRENALS: The right adrenal gland is normal in size and shape.  A 1.3 x 1.3 cm\nleft adrenal nodule is unchanged compared to ___ and was previously\ncharacterized as an adrenal adenoma (02:20).\n\nURINARY: Mild right renal cortical scarring.  Multiple bilateral renal cystic\nstructures measure up to 2.6 x 2.4 cm in the right upper pole kidney.  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. The colon and\nrectum are within normal limits. The appendix is not visualized, however there\nare no definite 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 unremarkable.\n\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. Mild focal soft tissue stranding surrounding the pancreatic head and body\nmay reflect a mild acute pancreatitis in the setting of elevated lipase.\n2. 1.5 cm proximal pancreatic body cystic lesion may represent a pseudocyst\nand appears slightly increased in size compared to ___.  This may be\nfurther evaluated with dedicated MRCP.\n3. Small splenic hypodensity likely reflects an age-indeterminate infarct, new\ncompared to ___.\n\nRECOMMENDATION(S):  Nonemergent MRCP."
        },
        {
            "input": "VASCULAR:  There is no abdominal aortic aneurysm.  There is severe calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: There is atelectasis at the bilateral lung bases.  There are\nextensive coronary artery calcifications.  Mild cardiomegaly is noted with\naortic valvular calcification.  Calcification at the left ventricular apex may\nreflect prior infarction.\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 resected.\n\nPANCREAS: The pancreas has normal attenuation throughout.  Redemonstrated 1.3\ncm pancreatic body cystic lesion is unchanged compared to prior (series 3,\nimage 63).\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 nodule measures 1.3 x 1.4 cm, not significantly changed compared\nprior, in previously characterized as an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size.  No hydronephrosis\nbilaterally.  There are bilateral renal cysts redemonstrated and measure up\n2.3 cm in the upper pole of the right kidney.  There are no urothelial lesions\nin the kidneys or ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hernia.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.  No secondary signs\nof appendicitis.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: There is hyperenhancement of the mucosa of the bladder wall without a\nwall thickening and surrounding fat stranding.  There is no evidence of pelvic\nor 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: Metallic focus likely a foreign body is noted in the right\nposterior chest wall on series 3, image 12.  Otherwise the body wall is\nunremarkable.",
            "output": "1. Findings concerning for cystitis.  Correlation with urinalysis is\nrecommended.\n2. Cystic pancreatic lesion is unchanged and better characterized on prior\nMRI.\n3. Stable left adrenal gland adenoma.\n4. Extensive atherosclerotic burden.\n5. Mild cardiomegaly with aortic valvular calcification and coronary artery\ncalcification.  Probable chronic infarct at the left ventricular apex given\nmural calcification."
        },
        {
            "input": "LOWER CHEST: Mild, dependent atelectasis is demonstrated in both lower lobes. \nNo pleural or pericardial effusion. The heart is mildly enlarged.  A focal\ncalcification and thinning of the left ventricular apex likely reflects prior\ninfarct. Coronary artery calcifications are partially imaged.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. Mild intrahepatic biliary dilatation\nmay be secondary to cholecystectomy.  No common bile duct dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: The pancreas is normal attenuation throughout but diffusely\natrophic.  A cystic lesion within the pancreatic neck measures 1.4 cm,\nunchanged in size (2:49), previously characterized on MRI.  No main 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 adrenal gland is unremarkable.  A left adrenal nodule\nmeasures 1.4 cm, unchanged, previously characterized as an adenoma.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nMultiple hypodense renal lesions measure up to 2.3 cm, likely cysts.  Other,\nsmaller, subcentimeter renal hypodensities are too small to characterize. \nFocal areas of cortical thinning are demonstrated within the right kidney,\nwhich may reflect the sequela of prior infection or infarction.  There is no\nperinephric abnormality.  No hydroureteronephrosis.\n\nGASTROINTESTINAL: Small hiatal hernia.  Stomach is otherwise unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits.\n\nPELVIS: Mild circumferential wall thickening of the bladder and\nhyperenhancement is visualized with minimal adjacent fat stranding, slightly\nimproved in the interval.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are within normal\nlimits.  Extensive calcifications are demonstrated along the penile shaft.\n\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. \nChronic fracture deformity of the right superior pubic ramus is unchanged.\n\nSOFT TISSUES: Tiny, fat containing umbilical hernia.",
            "output": "1. No evidence of nephrolithiasis or hydroureteronephrosis.\n2. Mild circumferential wall thickening of the bladder and minimal adjacent\nfat stranding, slightly improved in the interval, concerning for cystitis. \nUrinalysis is recommended for further assessment.\n3. Unchanged 1.4 cm cystic lesion in the pancreatic neck, as seen on prior\nMRI.\n4. Redemonstration of left adrenal adenoma."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder wall is thickened, similar appearance compared to prior. \nThere is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are degenerative changes of bilateral hips.  Chronic right superior and\ninferior pubic rami fractures are noted.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There is\nno evidence of gas within the subcutaneous soft tissues.",
            "output": "1. No evidence of gas within the subcutaneous soft tissues of the pelvis or\ngroin.\n2. Redemonstration of thickening of the bladder wall.  Recommend correlation\nwith urinalysis."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. \nPartial colonic resection at the rectosigmoid junction and multiple\ndiverticuli are noted.  There is no acute inflammatory changes to suggest\ndiverticulitis.  The urinary bladder containing a catheter and instrumentation\nrelated nondependent gas and distal ureters are unremarkable. There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus has been removed.  No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: There is mildly angulated intertrochanteric and basicervical fracture\nof the right proximal femur with fracture line extending to the lesser\ntrochanter.  The fractured greater trochanter is displaced posteromedially by\n8 mm (3:87).  There is mild impaction of the femoral neck.  No other fracture\nis identified.  Linear lucency through the proximal femoral diaphysis (602:56)\nis likely a nutrient channel.\nThere is nonunion of the posterior elements of L5 and S1.  No definite sacral\nfracture is identified.\n\nSOFT TISSUES: There is a small joint effusion.  There is no intrapelvic\nhematoma.  There is mild stranding and mild enlargement of the thigh muscles,\nlikely due to trauma.  No large drainable fluid collection is seen.",
            "output": "1. Mildly angulated comminuted intratrochanteric and basicervical fracture of\nthe right proximal femur with slight impaction.  Fracture line extends to the\nlesser trochanter.\n2. Minimal intramuscular enlargement and stranding, likely related to trauma. \nNo drainable fluid collection.  Trace joint effusion.\n3. Diverticulosis and postsurgical changes of the rectosigmoid junction."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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.\n\nADRENALS: The 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 right kidney, too small too characterize,\nlikely a cyst.  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. The colon and\nrectum are within normal limits. The appendix is normal.\n\nPELVIS: The urinary bladder is distended and within normal limits.  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.  Major mesenteric vessels are\npatent.\n\nBONES: There 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 abdominal or pelvic abnormality to explain symptoms of\nabdominal pain.  The appendix is normal."
        },
        {
            "input": "LOWER CHEST: The heart is normal in size.  There is no pericardial effusion. \nGround-glass opacities at the lung bases and bronchiolectasis may be due to\ninterstitial lung disease better characterized by prior 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 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 shows normal size 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 renal mid to lower pole 4.9 x 5.9 x 5.4 cm\nheterogeneous mass.  There is a left renal midpole low-attenuation lesion\nmeasuring 1.2 cm likely a cyst.  There is a 6 mm calculus visualized in the\nright renal lower pole.  There is no hydronephrosis or hydroureter.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. There is diffuse\nsigmoid 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 prostate is mildly enlarged measuring 4.9 cm\ntransverse..\n\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 chronic deformity of the right iliac wing.  There is moderate\nmultilevel degenerative changes of the thoracolumbar spine with anterior\nosteophyte formation.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right renal 4.9 x 5.9 x 5.4 cm heterogeneous mass concerning for\nmalignancy.\n2. Diffuse sigmoid diverticulosis without evidence of diverticulitis.\n3. Mild prostatomegaly.\n4. Chronic right iliac wing deformity."
        },
        {
            "input": "PELVIS:  A percutaneous jejunostomy tube is in situ.  A large amount of stool\nseen within the colon.  The urinary bladder and distal ureters are\nunremarkable. There is trace free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  No adnexal abnormality is\nseen.\n\nLYMPH NODES: Prominent bilateral pelvic lymph nodes are seen measuring up to 1\ncm (2; 37, 39, 42).\n\nVASCULAR: Mild atherosclerotic disease is noted.\n\nBONES: The patient is status post partial right hip arthroplasty with\nassociated metallic artifact which limits evaluation of the right hip. \nHeterotopic calcification is seen along the right hip. Hypodense fluid is seen\nlayering along the gluteus muscles posterosuperior to the right hip (2; 46). \nSmall locules of gas are seen within the hip joint (601; 34).  Compared to the\nprior there is interval decrease in iliopsoas fluid.  Right trochanteric\nbursitis has resolved.  There is severe degenerative disc disease in the\nlumbar spine, worse at L5-S1.\n\nSOFT TISSUES: Confluent soft tissue edema seen surrounding the right hip.",
            "output": "1. Evaluation of the right hip is severely limited by artifact from right hip\narthroplasty.  Hypodense fluid is seen posterosuperior to the right hip, with\ninterval increase in edema surrounding the right hip, and small locules of gas\nwithin the hip joint concerning for infection."
        },
        {
            "input": "LOWER CHEST: Mild atelectatic changes in both 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 surgically removed.\n\nPANCREAS: Post distal pancreatectomy, normal enhancement of the remaining\npancreas without focal lesion identified.  There is no peripancreatic\nstranding.\n\nSPLEEN: Spleen is surgically absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is a new area of hypoenhancement at the middle third of left\nkidney, that could be concerning for nephritis/pyelonephritis, less likely\ninfarcts.  Bilateral simple renal cysts.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Left abdominal percutaneous\njejunostomy tube is seen.  Soft tissue thickening and edema bordering the\njejunostomy site. The colon and rectum are within normal limits. The appendix\nis normal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  New small\namount of free fluid located in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Multiple retroperitoneal lymph nodes unchanged.\n\nThere are stable pelvic lymph nodes thickest measuring 10 mm in the on the\nleft .\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: )  Since ___, there has been removal of a right hip\nprosthesis.  Surgical bed demonstrating collection of fluid and gas in the\njoint capsule and also extending posteriorly and laterally to the vastus\nmusculature for a length of approximately 16 cm.  Posteriorly we see air and\nedema involving the gluteus musculature and there is extensive soft tissue and\nsubcutaneous edema of the right hip area and right thigh.\n\nSOFT TISSUES: No abdominopelvic hernia.",
            "output": "1. Hypoenhancing area involving the left kidney could represent\npyelonephritis.\n2. Interval removal of right hip prosthesis, gas containing collection now\nseen at this level and involving the right thigh.  Postsurgical changes can\nhave this aspect, although this is concerning for superinfection.  Correlate\nclinically."
        },
        {
            "input": "Lung Bases: The imaged lung bases are clear.  The imaged portion of the heart\nis unremarkable.\n\nAbdomen: Liver enhances normally.  A tiny hyperdense focus is again noted\nwithin segment 4B on series 2, image 24 possibly representing a small\nhemangioma, appearing unchanged in overall size measuring up to 6 mm and\nunchanged from ___.  No additional liver lesion.  Main portal vein is patent.\nNo biliary ductal dilation.  The gallbladder is normal.  The pancreas enhances\nnormally.  The spleen is normal in size.  Adrenals are normal in size and\nconfiguration bilaterally.  The kidneys enhance symmetrically.  No worrisome\nrenal lesion.  The abdominal aorta is mildly calcified and normal in caliber. \nThere is no retroperitoneal adenopathy.  A tiny hiatal hernia is present.  The\nstomach is unremarkable as is the duodenum.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction.  No\nmesenteric abnormality is seen.  The appendix is not reliably visualized\nthough there are no secondary signs of appendicitis in the right lower\nquadrant.  The colon contains a mild fecal load.  No evidence of colitis or\ndiverticulitis.  No free air or free fluid.\n\nAgain seen, is a uterine mass which is complex containing a large cystic\ncomponent and peripheral solid partially septated components measuring\napproximately 12.0 x 10.8 x 11.0 cm.  This lesion is not significantly changed\nin size from the most recent prior CT exam though appears increased in size\nfrom more remote priors suggesting slow growth.  This appearance is most\nsuggestive of a slow growing neoplasm rather than a degenerating fibroid. \nThere is no adnexal mass.  There is no pelvic sidewall or inguinal adenopathy.\nThe urinary bladder is decompressed.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  Facet\narthropathy is noted in the lower lumbar spine.",
            "output": "1. No acute findings in the abdomen or pelvis.\n2. Large uterine mass similar in overall size to most recent prior exam from ___ though appears slow growing when compared with more remote priors\ndating back to ___.  This appearance is most suggestive of a slow growing\nmalignancy and surgical consultation is advised.\n3. Tiny hyperdense liver lesion within segment 4B is most likely a hemangioma\nand is unchanged from priors.\n\nNOTIFICATION:  Findings discussed with Dr. ___ at the time of initial\nreview."
        },
        {
            "input": "Depending, bibasilar atelectasis is noted. Mild cardiomegaly. There is no\nevidence of pericardial effusion.\n\nABDOMEN:\n\nThe examination is limited secondary to the lack of intravenous contrast.\nWithin this limitation, the non-contrast enhanced appearance of the liver,\ngallbladder, pancreas, and bilateral adrenal glands, and kidneys are normal. \nThe extrahepatic CBD is mildly prominent, but stable from the prior\nexamination. There is no intrahepatic biliary ductal dilation. The spleen is\nenlarged.\n\nThe stomach, small bowel, and large bowel are unremarkable in appearance\nwithout dilation or wall thickening. The appendix is air-filled and normal in\nappearance. Numerous prominent retroperitoneal lymph nodes are identified,\nnone of which are pathologically enlarged by CT size criteria. There is no\nfree abdominal fluid or pneumoperitoneum. The aorta and its major branches\ncontain calcifications.\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.\n\nOSSEOUS STRUCTURES:  Multilevel degenerative changes are seen throughout the\nvisualized thoracolumbar spine. On the left, there is a recent-appearing ___\nrib fracture and chronic fractures of the left ___ and 9th ribs. No focal\nlytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  No acute intra-abdominal process. Normal appendix.\n2.  Splenomegaly, similar to prior examinations.\n3.  Recent appearing left seventh rib fracture."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  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 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 symmetric in size and nephrogram.  There is a 5 mm\nnonobstructing renal stone in the left interpolar kidney (series 2:25).  No\nhydronephrosis.  No stones or hydronephrosis in the right kidney.  There is a\nsubcentimeter hypodensity in the interpolar right kidney, too small\ncharacterize by CT but likely representing a simple cyst.  No perinephric\nabnormality.  No ureteral stones are visualized.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Few scattered air\nfluid levels in non-dilated small bowel.  Diverticulosis of the sigmoid colon\nis noted, without evidence of wall thickening or fat stranding.\n\nPELVIS: The urinary bladder wall is mildly thickened, possibly secondary to\nunder distension.  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": "1. Left-sided 5 mm nonobstructing renal stone.  No hydronephrosis.\n2. Mild thickening in the urinary bladder wall may be due to under distension.\nHowever recommend correlation with urinalysis for possible cystitis.\n3. Few scattered air-fluid levels in nondilated small bowel, nonspecific but\ncould possibly reflect mild gastroenteritis.\n4. Sigmoid diverticulosis without evidence of acute diverticulitis."
        },
        {
            "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: Emphysematous changes are noted at the lung bases.  A 3 mm\npulmonary nodule is noted at the left lung base (series 3A, image 10).  There\nis no pleural or pericardial effusion.  Cardiomegaly 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,\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:  There is a small hiatal hernia.  Rounded soft tissue and\npartially calcified hypodensity along the greater curvature of the stomach\nmeasures 2.1 x 1.9 cm.  This appears to have a soft tissue component.  2\nadditional lesions along the greater curvature of the stomach on image 34 and\n31 to not have soft tissue components and are entirely calcified.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nHyperdense material within several loops of small bowel and the sigmoid colon\nare present on the noncontrast images and likely represent ingested material. \nColon and rectum are within normal limits.  Appendix contains air, has normal\ncaliber without evidence 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: Brachytherapy seeds are noted in the prostate.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSubchondral cystic changes noted at the right sacroiliac joint.\n\nSOFT TISSUES: At the proximal most portion of the left inguinal canal there is\na small focus of soft tissue, likely post surgical.  There is a small fat\ncontaining umbilical hernia.",
            "output": "1. No evidence of GI bleed.\n2. 2.1 cm lesion along the greater curvature of the stomach.  Contains\ncalcifications but also has a soft tissue component.  As 2 additional\ncompletely calcified lesions are seen in this location these may represent\ncalcified, torsed epiploic appendages, however the appearance of the largest\nlesion is unusual due to its larger soft tissue component in 3 months followup\nwith MRI is recommended to exclude a gist tumor.\n3. Small hiatal hernia.\n4. A small focus of soft tissue at the proximal-most portion of the left\ninguinal canal is nonspecific.  Correlation with prior surgery is recommended.\n5. 3 mm pulmonary nodule at the left lung base.\n\nRECOMMENDATION(S):  1.  3 months followup MRI for evaluation of lesion along\nthe greater curvature of the stomach\n2. The ___ society pulmonary nodule recommendations\nare intended as guidelines for follow-up and management of newly incidentally\ndetected pulmonary nodules smaller than 8 mm, in patients ___ years of age or\nolder. Low risk patients have minimal or absent history of smoking or other\nknown risk factors for primary lung neoplasm. High risk patients have a\nhistory of smoking or other known risk factors for primary lung neoplasm.\n\nIn the case of nodule size <= 4 mm: No follow-up needed in low-risk patients.\nFor high risk patients, recommend follow-up at 12 months and if no change, no\nfurther imaging needed.\n\nNOTIFICATION:  An email sent to the to ED QA nurses by Dr. ___ at 11:01"
        },
        {
            "input": "Please see the dedicated CT chest report from ___ for thoracic\nfindings.\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, bilateral adrenal\nglands, and right kidney are unremarkable in appearance. There are two small\nleft renal hypodensities, which are too small to characterize on the current\nexam, but  appear unchanged in appearance from the prior study.\n\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare normal in caliber and without evidence of wall thickening.  There is a\nsmall fat-containing umbilical hernia. There is no retroperitoneal\nlymphadenopathy by CT size criteria. There is no free abdominal fluid or\npneumoperitoneum. The aorta contains minor and is normal in course and\ncaliber. The celiac trunk and SMA are grossly patent.\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.  There is a 3.7 x 2.7 cm left paratubal rounded\nhypodensity (5:111), with attenuation less than 20 Hounsfield units. This\nlikely represents a simple cyst.  It is larger than seen on the prior study,\nin which it measured 3.4 x 2.4 cm.  Pelvic ultrasound is recommended for\nfurther characterization and evaluation.\n\nOSSEOUS STRUCTURES:  The spine is scoliotic. Multilevel, multifactorial\ndegenerative changes are seen within the visualized thoracolumbar spine. No\nfocal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1.  No evidence of intrapelvic or intra-abdominal malignant disease.\n2. 3.7 x 2.7 cm left paraovarian lesion, which is slightly enlarged from the\nprior exam.  However, pelvic ultrasound is recommended for further evaluation\nand characterization."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 dilated, measuring up to 8\nmm in diameter, and fluid-filled, with mildly hyperemic and thickened walls,\nconcerning for acute appendicitis.  No significant periappendiceal fat\nstranding or focal fluid collections.  No appendicolith.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis within physiologic limits.\n\nREPRODUCTIVE ORGANS: The uterus is normal.  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.  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.\n2. Small volume pelvic free fluid is within physiologic limits.\n\nNOTIFICATION:  Findings discussed with ___, MD by ___,\nMD via telephone at 22:47 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: The liver enhances normally without concerning focal liver lesion. \nThe main portal vein is patent.  No biliary ductal dilation.  The gallbladder\nis mostly decompressed.  The common bile duct is normal in size.  The pancreas\nenhances normally without signs of inflammation.  The spleen is normal in\nsize.  No discrete focal splenic lesions.  Adrenals are normal bilaterally. \nThe kidneys enhance symmetrically.  No hydronephrosis or worrisome renal\nlesion.  The abdominal aorta is normal in course and caliber.  There is no\nadenopathy, free air or free fluid.  The stomach and duodenum appear normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or\nobstruction.Appendix is normal.  The colon contains a mild fecal load.  No\nsigns of colitis or pericolonic inflammation.  Trace free fluid in the pelvis\nis likely physiologic.  A collapsed right ovarian corpus luteum is noted.  The\nleft ovary is normal.  Uterus is unremarkable.  Urinary bladder is partially\ndistended appearing normal.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion.",
            "output": "1.  No acute findings to account for symptoms provided.\n2.  Normal appendix visualized."
        },
        {
            "input": "LOWER CHEST: There is subsegmental atelectasis of the left lower lobe.  There\nis 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: There is a staghorn calculus in the collecting system of the left\nkidney that measures 3.1 cm in greatest craniocaudal dimension.  There are\nmultiple calculi in the right kidney, the largest of which measures 4 mm x 6\nmm.  Incidental note is made of a tiny dot of air it dependently and left\nkidney probably representing nitrogen gas within a noncalcified stone.  There\nis no ureterolithiasis.  There is no hydronephrosis.  There is no perinephric\nabnormality.  There is no evidence of focal renal lesions.  There is no\nevidence 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 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 lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Staghorn calculus in the left kidney which measures 3.1 cm in greatest\ncraniocaudal dimension.\n2. Multiple calculi in the right kidney, the largest of which measures 4 mm x\n6 mm."
        },
        {
            "input": "LOWER CHEST: There is bilateral dependent atelectasis.  A small left lower\nlobe calcified granulomas again demonstrated.  There is no evidence of pleural\nor pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are several subcentimeter hypodensities seen again throughout both\nhepatic lobes, which appear unchanged size compared to the prior study. \nFindings are too small to characterize by CT but likely represent simple cysts\nor biliary hamartomas.  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: The spleen shows normal size 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 ureteral stent placement on the left, with\nremoval of a previously demonstrated large staghorn calculi.  The inferior tip\nof the ureteral stent is coiled within the decompressed bladder.  The superior\ntip is coiled within the left renal collecting system.  There is air seen\nwithin the collecting system with this which is presumably postprocedural. \nThere are few scattered foci of hyperdensity consistent with tiny retained\nstones, measuring up to 5 mm (series 2 image 47, 50, 53).  No hydronephrosis\nbilaterally.  Several nonobstructing right renal calculi are re-demonstrated,\nmeasuring up to 8 mm in the inferior right pole (series 3, image 52).\n\nThere is mild retroperitoneal edema within the posterior renal fascia with\nsmall foci of air consistent with recent percutaneous procedure.  No fluid\ncollection.\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: Air is layering posteriorly within the bladder, presumably\npostprocedural.  There is a dependent 5 mm stone within the bladder (series 3,\nimage 125).\n\nREPRODUCTIVE ORGANS: The uterus and bilateral adnexae are grossly 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.  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. Status post left renal staghorn calculus extraction with left ureteral\nstent placement.  There is air seen within the left-sided collecting system\nand the bladder which is most likely postprocedural.  Postprocedural changes\nare seen along the posterior fascia without fluid collection.\n2. Multiple nonobstructing stones are demonstrated within the left renal\ncollecting system measuring up to 5 mm.  No hydronephrosis.\n3. Dependent 5 mm stone within the bladder.\n4. Multiple nonobstructing right renal stones as on prior measuring up to 8\nmm."
        },
        {
            "input": "LOWER CHEST: Compared to the prior CT CT dated ___, there has been\ninterval development of a small to moderate-sized nonhemorrhagic right-sided\npleural effusion.  The small left-sided pleural effusion appears stable. \nThere is associated bilateral compressive atelectasis.  There is no evidence\nof pericardial effusion.  The degree of pneumomediastinum has reduced\nmoderately since prior examination.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere are multiple simple appearing hypodensities throughout the liver, the\nlargest of which measures 2 cm, which are likely representative of hepatic\ncyst.  There is eventration of the right hemidiaphragm.  There is no evidence\nof focal 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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Compared to prior CT on ___, there has been\nsignificant interval decrease in the pneumoperitoneum with near resolution,\nhowever there is interval increase in ascites.  There has been moderate\ninterval decrease in pneumo retroperitoneum.  The stomach is unremarkable. \nSmall bowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  There is borderline dilatation of the transverse colon measuring\nup to 6.7 cm.  Interval resection of the prior side-by-side colonic\nanastomosis in the left colon.  In the left pericolic gutter, there is\nincreased volume of intermediate density fluid with apparent rim enhancement\nmeasuring 8.9 x 3.3 cm (5:32) in the region of the prior anastomotic leak,\nwhich is concerning for postoperative infection or abscess.  This fluid\ncollection also tracks up to the tail of the pancreas and the posterior aspect\nof the greater curvature of the stomach.  Without enteric contrast, there is\nno obvious communication between this fluid collection and the bowel.\n\nDiverticulosis of the ascending colon is again noted.\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.  No atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged appearance of the small sclerotic focus within the left femoral\nneck, most likely representing a bone island.\n\nSOFT TISSUES: There are postsurgical fluid collections and stranding deep to\nthe midline incisional wound, which most likely represent seromas.",
            "output": "1. Interval resection of the side-by-side colonic anastomosis in the left\ncolon with increased volume of intermediate fluid density in the left\npericolic gutter with rim enhancement measuring 8.9 x 3.3 cm.  As this rim\nenhancing intermediate fluid density collection is within the region of the\nprior anastomotic leak, this is most concerning for an abscess.  Given there\nis no enteric contrast, there is no obvious communication between this fluid\ncollection and the bowel.\n2. Interval development of a small to moderate-sized nonhemorrhagic\nright-sided pleural effusion and stable appearing small left-sided pleural\neffusion with associated compressive atelectasis.\n3. Interval improvement and near resolution of pneumoperitoneum and\nimprovement of retro pneumoperitoneum and pneumomediastinum.\n\nNOTIFICATION:  The findings were discussed with ___, m.D. by\n___, M.D. on the telephone on ___ at 11:51 am, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Interval decrease in size of a small, nonhemorrhagic left pleural\neffusion.  There is overlying atelectasis.  No pericardial effusion.  Interval\nresolution of right-sided pleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nNumerous hypodensities are again demonstrated, measuring up to 2.1 cm the\nright hepatic lobe and 1.4 cm in the left hepatic lobe, which are stable since\nat least ___ and consistent with simple cysts.  A focal area\nrelatively increased enhancement is noted in hepatic segment VIII (series 10,\nimage 12), suggestive of transient hepatic enhancement differences.  No intra\nor extrahepatic biliary ductal dilatation.  The gallbladder is within normal\nlimits.  There is trace subhepatic fluid which is improved from the prior\nstudy.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  Stranding and thickening near\nthe pancreatic tail is due to the underlying abscess described below.\n\nSPLEEN: Persistent perisplenic fluid now with scalloping along the superior\nand posterior aspect (series 10, image 15), slightly increased in prominence\ncompared to the prior study.  The collection measures approximately 4.3 x 1.2\ncm.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: No bowel obstruction.  There is redemonstration of a\npercutaneous left upper quadrant drain.  There is substantial improvement in\nthe previously demonstrated pericolonic abscess.  After administration of\nwater-soluble contrast, there is a persistent fluid collection around the\ndrain spanning approximately 7.7 cm by 3.2 cm in maximum ___, with\nsurrounding wall thickening which extends along the greater curvature of the\nstomach and along the inferior aspect of the spleen.  The thickening abuts the\ncolon in the left upper quadrant near the splenic flexure without\ndemonstration of intraluminal contrast.\n\nThere is some fluid and thickening along the posterior aspect of the greater\ncurvature of the stomach.  The small bowel demonstrates normal enhancement and\ncaliber throughout.  An area of focal thickening and mesenteric distortion\nleft upper quadrant is consistent with the surgical anastomosis.  There is\npersistent left anterior mesenteric thickening.  There is diverticulosis of\nthe right and left colon.  The appendix is normal.\n\nThere is substantial improvement in previously demonstrated ascites, with a\nsmall amount of residual pelvic fluid anterior to the lower sigmoid measuring\napproximately 6.4 x 3.1 cm (series 10, image 59), without contrast enhancement\nto indicate abscess formation.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\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 substantial\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.  A\nsubcentimeter sclerotic focus in the left femoral neck is unchanged and\nconsistent with a bone island.\n\nSOFT TISSUES: Postsurgical changes are again seen at the anterior abdominal\nwall evidence of subcutaneous fluid collection.",
            "output": "1. Substantial interval improvement in a left pericolonic abscess, with a\npersistent and thickened cavity measuring up to 7.7 cm in maximal ___. \nNo fistula detected following contrast administration through the drain.\n2. Interval improvement in abdominopelvic ascites with persistent free fluid\nwithin the upper pelvis with some interloop extension spanning 6.4 x 3.1 cm\nwithout evidence of peripheral enhancement.  Scalloping and slight increased\nprominence of a perisplenic fluid collection measuring 4.3 x 1.2 cm.\n3. Improvement in small nonhemorrhagic left pleural effusion.  Resolution of\nright pleural effusion.\n4. Right and left 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. \nThere are numerous scattered, well-defined hypodensities measuring up to 2.0\ncm in segment ___ (05:16), likely representing hepatic cysts.  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. Ascending and\ndescending colonic diverticulosis is present without wall thickening or\nadjacent fat stranding.  There is a 1.6 x 2.6 x 1.3 cm lesion in the proximal\ndescending colon near the splenic flexure which demonstrates fat density\n(5:26, 7:30).  This appears well-circumscribed and is benign in appearance. \nNo additional masses are seen in the descending colon.  The appendix is\nnormal.\n\nPELVIS: The bladder demonstrates circumferential wall thickening, which can be\nseen in an inflammatory process such as cystitis.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is mildly enlarged measuring up to 5.2 cm in\nmaximum transverse diameter (5:76).\n\nLYMPH NODES: There are multiple prominent mesenteric lymph nodes, however,\nthese are not pathologically enlarged by CT size criteria.  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.  There is subtle focal edema surrounding the proximal SMA (08:39).\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild degenerative disease at L5-S1.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. 2.6 cm lesion in the proximal descending colon near the splenic flexure is\nbenign in appearance and likely represents a colonic lipoma.  No additional\nmasses are seen in the descending colon.\n2. Circumferential bladder wall thickening can be seen in inflammatory\nprocesses such as cystitis.  Recommend correlation with urinalysis.\n3. Presence of multiple prominent mesenteric lymph nodes as well as subtle\nedema surrounding the proximal SMA may represent mesenteric adenitis.\n4. Colonic diverticulosis without evidence of acute diverticulitis.\n5. Mild prostatomegaly.\n\nRECOMMENDATION(S):  Correlation with urinalysis."
        },
        {
            "input": "LOWER CHEST: There is a small left pleural effusion which is nonhemorrhagic. \nMild bibasilar atelectasis.  Pneumomediastinum and pneumopericardium is\nsecondary to extension of intra-abdominal free air.\n\nABDOMEN:\n\nHEPATOBILIARY: The hepatic parenchyma demonstrates homogeneous enhancement\nthroughout.  There are multiple scattered hepatic cysts, the largest measuring\n2 cm in segment IV, and subcentimeter hypodensities too small to characterize,\nunchanged compared to prior CT of the abdomen/pelvis from ___. \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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  A small amount of\nair in the urinary bladder is most likely due to prior catheterization.\n\nPERITONEUM/RETROPERITONEUM:\nThere is moderate to large pneumoperitoneum and extensive air within the\nretroperitoneal spaces. There is a small amount of abdominopelvic ascites.\n\nGASTROINTESTINAL: Oral contrast has progressed to the ascending colon.  The\npatient is status post left hemicolectomy.  There is a small amount of\nlow-density fluid and locules of air adjacent to the colonic anastomosis and\nalong the left paracolic gutter (series 7, image 30, series 4, image 35),\nraising concern for anastomotic leak, however evaluation is limited as oral\ncontrast has not reached the surgical site.  No bowel obstruction.  There is\nextensive diverticulosis of the ascending colon.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: No lymphadenopathy by CT size criteria.\n\nVASCULAR: No atherosclerotic disease is seen.  No abdominal aortic aneurysm.\n\nBONES: A small sclerotic focus in the left femoral neck is unchanged from the\nprior study and likely represents a bone island.  There is no evidence of\nworrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A moderate abdominal wall anasarca diffusely.  Anterior\nabdominal wall surgical changes are demonstrated without focal soft tissue\nfluid collection.",
            "output": "1. Moderate to large pneumoperitoneum and extensive air within the\nretroperitoneal spaces.  Patient is status post left hemicolectomy.  Small\namount of low-density fluid and locules of air adjacent to the colonic\nanastomosis and along the left paracolic gutter raises concern for anastomotic\nleak, however evaluation is limited as oral contrast has not reached the\nsurgical site.\n2. Pneumomediastinum and pneumopericardium secondary to extension of\nintra-abdominal free air.\n3. Small nonhemorrhagic left pleural effusion.\n4. Small amount of abdominopelvic ascites.\n5. Extensive diverticulosis of the ascending colon."
        },
        {
            "input": "LOWER CHEST: No interval change in a small left pleural effusion.  Bibasilar\natelectasis is again demonstrated.  No pericardial effusion.  There is\npartially visualized pneumomediastinum, similar in extent compared to the\nprior study.\n\nABDOMEN:\n\nHEPATOBILIARY: No acute change within the liver.  Multiple hypodense lesions\nwhich are incompletely characterized are unchanged.  The gallbladder is\nnormal.  No intra or extrahepatic biliary duct dilatation.  The portal vein is\npatent.  There is redemonstration of small volume sub hepatic fluid.\n\nPANCREAS: The pancreas is within normal limits.\n\nSPLEEN: Fluid and air seen along the spleen with interval increase in the\namount of fluid.  The splenic parenchyma is normal.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Similar extent of substantial perirenal emphysema and small amount of\nfluid along the left kidney, with a small amount of air seen along the right\nkidney.  Normal nephrograms bilaterally.  No focal lesions or hydronephrosis.\n\nGASTROINTESTINAL: Previously administered contrast has extended past the\nsurgical anastomosis without evidence of frank extraluminal contrast.  There\nis a slight interval increase in fluid along the surgical anastomosis with\nredemonstration of numerous locules of air (series 5, image 38).  Fluid along\nthe left pericolic gutter is minimally increased compared to the prior study,\nmeasuring intermediate density.\n\nThere is redemonstration of substantial free intraperitoneal air and\nretroperitoneal air, not substantially changed compared to the prior study.\n\nNo bowel obstruction.  Diverticulosis of the ascending colon is again\ndemonstrated.\n\nPELVIS: The urinary bladder contains excreted contrast, small amount of air in\nthe bladder is again seen and likely from prior catheterization.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: No lymphadenopathy by CT size criteria.\n\nVASCULAR: There is no abdominal aortic aneurysm.  No atherosclerotic disease\nis noted.\n\nBONES: Small sclerotic focus in the left femoral neck is unchanged, likely\nrepresenting a bone island.  There is no evidence of suspicious osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Moderate abdominal wall anasarca is again demonstrated.  There\nare surgical changes again seen along the anterior abdominal wall without\nevidence of focal fluid collection.",
            "output": "1. Status post partial left hemicolectomy. Mild increase in low density fluid\nwith unchanged extent of pneumoperitoneum and pneumoretroperitoneum. Fluid and\nlocules of air adjacent to the colonic anastomosis are again demonstrated and\nmay represent postsurgical changes or a sealed off anastomotic leak. No\nevidence of contrast leak or perforation at this time.\n2. Otherwise no acute change compared to the prior study performed at 12:12\na.m., ___.\n3. Small nonhemorrhagic left pleural effusion and small volume abdominopelvic\nascites."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 suspicious focal lesion.  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 mild right hydroureteronephrosis associated with a delayed\nright nephrogram secondary to a 3 mm obstructing stone at the right\nureterovesical junction (4:156).\n\nThe left kidney demonstrates a normal nephrogram.  No left hydronephrosis.  No\nradiopaque stones seen in the left kidney or left ureter.  No suspicious mass\nlesions.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal (4:17).\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Redemonstration of an enlarged fibroid uterus.  A 3.4 cm\nleft adnexal cystic structure corresponds to hemorrhagic cyst seen on prior\npelvic ultrasound study.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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": "Mild right hydroureteronephrosis secondary to a 3 mm obstructing stone at the\nright ureterovesicular junction."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  Accessory left renal artery is\npresent.\n\nLOWER CHEST: Mild right basilar atelectasis is present.  The heart is normal\nin size.  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 not well 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 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.  Sigmoid and distal colon diverticulosis is\npresent without evidence of diverticulitis.  Appendix is not visualized.  A\nsmall peripancreatic lymph node is noted measuring 7 mm in short axis, similar\nto the prior study (series 4, image 51) 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: The prostate is enlarged.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: A left anterior abdominal wall hernia containing fat is present.\nThe abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. No evidence of recurrence of pancreatic neuroendocrine tumor or evidence of\nmetastatic disease."
        },
        {
            "input": "THORAX: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\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 unremarkable. The appendix is normal.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.  Of note, the celiac artery and superior\nmesenteric artery arise from a common origin.\n\nLYMPH NODES: There are a few prominent lymph nodes adjacent to the ascending\ncolon with no pathological enlargement. There are no pathologically enlarged\nretroperitoneal or mesenteric lymph nodes by CT size criteria.\n\nPELVIS: The uterus measures 13 x 6.8 x 7.5 cm, similar in size to recent\nultrasound.. The ovaries are normal bilaterally. The rectum and sigmoid colon\nare normal-appearing. The bladder is unremarkable.\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "No cause for pain identified in the abdomen or pelvis."
        },
        {
            "input": "VASCULAR:\n\nThere is an aortic dissection involving the infrarenal abdominal aorta\n(3:102-109), not significantly changed in comparison to the prior study dating\nback to ___.    There is moderate calcium burden in the abdominal\naorta and great abdominal arteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases.  Small bilateral\npleural effusions, right greater than left.  Sternotomy wires are present. \nThere is cardiomegaly.\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 demonstrates diffuse wall\ncalcification.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 multiple wedge-shaped hypodensities within the interpolar\nregion and lower pole of the right kidney.  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: A PEG tube is present. There are a few loops of\nhypoenhancing bowel in the right upper quadrant (3:106).  There is no\npneumatosis intestinalis.  Intraperitoneal free air is related to prior PEG\ntube placement is unchanged from the prior study dated ___.  Colon\nand rectum are otherwise within normal limits.  A rectal tube is present. \nAppendix is not visualized.  There is no evidence of mesenteric\nlymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is opacified, likely related to prior contrast\nenhanced CT.  There is no evidence of pelvic or inguinal lymphadenopathy. \nThere 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. \nMild multilevel degenerative changes of the visualized spine. Median\nsternotomy wires are present.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nBilateral fat containing inguinal hernias.",
            "output": "1. Chronic infrarenal abdominal aortic dissection.\n2. Multiple wedge shaped hypoattenuating areas within the right kidney. \nDifferential considerations include infarct, infection or vasculitis in the\nappropriate clinical setting.  Correlation with urinalysis and culture may be\nhelpful.\n3. A few hypoenhancing loops of small bowel in the right upper quadrant are\nsuspicious for early ischemia.  No pneumatosis intestinalis or portal venous\ngas.\n4. Intraperitoneal air is unchanged since the prior CT from ___.\n5. Gallbladder wall calcification is unchanged since ___.\n\nNOTIFICATION:  The findings and recommendations were communicated to Dr.\n___ and ___, NPvia telephone at 3:19 pm on ___\nby 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.  The gallbladder is surgically absent. \nMild central intrahepatic biliary ductal dilatation is likely secondary to\npost cholecystectomy.  No evidence of 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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. Status post appendectomy.\n\nPELVIS: The urinary bladder is underdistended, limiting its evaluation.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is unremarkable.  There is a simple 2.3 x 2.2\ncm right adnexal cyst (2:68).\n\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 focal sclerosis at the posterior left sacroiliac joint\n(02:58).  There 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 to account for patient's symptoms.\n2. 2.3 cm right adnexal cyst is likely physiologic.  No further follow-up 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 mild central intrahepatic\nbiliary dilatation is likely secondary to cholecystectomy.  No extrahepatic\nbiliary 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.\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nFocal sclerosis at the posterior left sacroiliac joint is stable from ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of small-bowel obstruction.\n2. No acute intra-abdominal pathology 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. Mild prominence of the central\nintrahepatic bile ducts is unchanged from prior and likely related to prior\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: The right and left adrenal glands 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.\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 not visualized.\n\nPELVIS: Under distension of the bladder limits evaluation.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium is thickened, better evaluated on pelvic\nultrasound from the same day.\n\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 dorsal spondylosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute process within the abdomen or pelvis to explain the patient's\nsymptoms.\n2. Chronic mild dilatation of the central intrahepatic bile ducts, likely\nrelated to prior cholecystectomy, and unchanged from prior studies.\n3. Thickened endometrium, better evaluated on pelvic ultrasound from the same\nday."
        },
        {
            "input": "Lung Bases:  The imaged lung bases are clear.\n\nAbdomen:  Liver is low in attenuation, suggestive of fatty liver. The spleen,\ngallbladder, adrenal glands, and pancreas appear unremarkable. There is a 3 mm\nstone in the distal right ureter at the pelvic brim with upstream mild\nhydroureteronephrosis and right perinephric stranding.  Three 1mm\nnonobstructing renal calculi are identified in the left kidney.  The abdominal\naorta is normal in course and caliber with scattered atherosclerotic\ncalcifications. Peripherally calcified splenic artery aneurysm measures 9mm.\nNo lymphadenopathy, free air or free fluid is seen.  The stomach and duodenum\nappear normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is unremarkable. There are bilateral fat containing\ninguinal hernias.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.  There is\ntransitional anatomy at the lumbosacral junction with partial sacralization of\nL5.",
            "output": "1. There is an obstructing 3 mm stone in the distal right ureter at the pelvic\nbrim with upstream mild hydroureteronephrosis and right perinephric stranding.\n\n2. Hepatic steatosis.\n\n3.  Chronic appearing 9mm splenic artery aneurysm.\n\nNOTIFICATION:  The updated with read was discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 12PM"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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. \nNo hydronephrosis.  There is a 1.2 cm left renal cortical cyst.  Additional\nhypodensities are seen bilaterally and are too small to characterize by CT but\nstatistically likely represent additional cysts..  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The appendix is edematous and dilated up to 1.2 cm with\nmural edema and hyperemia.  A hyperdensity near the proximal appendix is\nconsistent with represent a fecalith (series 2, image 71).  There is severe\nright lower quadrant stranding with trace, nonenhancing fluid.  There is also\nthickening of the cecum and the terminal ileum, which is likely reactive to\nthe adjacent inflammation (series 2, image 74).  Tiny foci of extraluminal air\nare concerning for perforation (series 601, image 31).  The stomach and small\nbowel are otherwise within normal limits.  There is diverticulosis of the\ncolon.\n\nPELVIS: The urinary bladder is normal.  There is some prominence of the right\nmid to distal ureter as it passes near the appendiceal inflammation (series 2,\nimage 73).  Otherwise the ureters are normal.\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 substantial\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. Appendicitis with dilatation of the appendix to 1.2 cm near the tip.  Trace\nfoci of free air are concerning for perforation.  A focal area of high density\nnear the base of the appendix could represent an appendicolith.  There is a\nsmall amount of free fluid.  Small volume fluid at the base of the cecum, with\nno evidence of organized drainable collection.\n2. Adjacent to the appendicitis there is substantial right lower quadrant\nstranding and thickening involving the nearby cecum and terminal ileum as well\nas a focal area of prominence of the mid to distal ureter, most likely\nsecondary to the appendicitis."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\nThere are fluid dilated loops of jejunum measuring up to 3.6 cm within a\ntransition point at the ileum within the right upper quadrant (601b: 27).  No\nobstructing mass is detected.  The downstream ileum is decompressed.  The\nlarge bowel is normal in caliber and contains stool. There is no mesenteric\nfree fluid or free air. A nasogastric tube terminates in the stomach.\n\nThe liver and gallbladder are normal. The pancreas and adrenal glands are\nunremarkable.  The patient is post splenectomy, reportedly for trauma, with a\nsmall residual or accessory spleen (series 2 iamge 13).\n\nThe kidneys enhance symmetrically with no hydronephrosis. Bilateral extrarenal\npelvises are demonstrated.\n\nPELVIS: Urinary bladder is mostly decompressed. The prostate and seminal\nvesicles are normal. There is no pelvic free fluid or lymphadenopathy. The\nrectum and sigmoid are normal in caliber.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy. A healed left inferior pubic ramus fracture is noted.",
            "output": "Small bowel obstruction with a transition point within the ileum at the right\nupper quadrant.  No obstructing mass.  No free air."
        },
        {
            "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: Bibasilar atelectasis is greater on the right. There is no\npleural or pericardial effusion. The heart is normal in size.\n\nABDOMEN:\n\nHEPATOBILIARY: Diffuse low-density of the liver is consistent with steatosis. \nThere are no suspicious focal liver lesions.  A 3.0 x 1.7 cm lesion along\nsegment ___ with capsular retraction is again noted, consistent with a chronic\nhematoma.  Mild central intrahepatic biliary duct dilatation is noted with\ndilation of the common bile duct. This appears stable compared to the prior\nMRCP.  The distal CBD tapers as expected without evidence of focal lesions. \nThe gallbladder is nondistended.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation.  A hypodensity along the ventral aspect of the\npancreatic body is again noted, compatible with a chronic hematoma (series 3,\nimage 52).  A small amount of stranding adjacent to the pancreatic head is\nnew.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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, concerning focal renal lesions, or\nhydronephrosis.  Several punctate hypodensities in both kidneys are too small\nfor further characterization.  There are no urothelial lesions in the kidneys\nor ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable in appearance.  A small amount\nof stranding and fluid is present adjacent to the second portion of the\nduodenum and the pancreatic head.  The remaining small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout. Colon and rectum\nare within normal limits.  Appendix is not visualized.  A small amount of free\nfluid is present in the right lower quadrant.  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. A small amount of free fluid\nis present pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa 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. Hepatic steatosis without evidence of concerning focal hepatic lesions.\n2. New mild stranding adjacent to the duodenum and pancreatic head, compatible\nwith mild pancreatitis after ERCP.\n\n3. Stable CBD and intrahepatic ductal dilation.\n4. Stable hepatic and pancreatic fluid collections, previously characterized\nas chronic hematomas."
        },
        {
            "input": "Lung Bases: 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.  No concerning liver lesion.  Main\nportal vein is patent.  There is mild intrahepatic and extrahepatic biliary\nductal dilation.  The common hepatic duct measures 10 mm at the level of the\nporta hepatis.  CBD appears normal in caliber.  Please correlate clinically. \nThe gallbladder appears normal.  Spleen is normal in size.  Adrenal glands are\nnormal bilaterally.  The pancreas is unremarkable.  Kidneys enhance\nsymmetrically.  There is excretion of contrast noted bilaterally.  Bilateral\nrenal cortical hypodensities are most likely simple cysts.  The aorta is\nmoderately calcified though normal in caliber.  There is no adenopathy, free\nair or free fluid.  The stomach is decompressed.  The duodenum appears normal.\n\nPelvis: Loops of small bowel demonstrate no signs of ileus or obstruction. \nThe appendix is normal.  Colon is thin walled and contains a mild fecal load. \nDiverticulosis is noted without evidence of acute diverticulitis.  The uterus\nis surgically absent.  There is no adnexal mass.  Distal ureters appear to\nopacify normally.  The urinary bladder is moderately distended appearing\nnormal.  There is mild pelvic floor descent.  No pelvic free fluid.  No pelvic\nsidewall or inguinal adenopathy.\n\nBones: The imaged osseous structures appear intact.  Multilevel degenerative\ndisc disease within the lumbar spine is noted.  No compression fracture is\nseen.\n\nSoft tissues: Surgical clips are noted in the left low anterior chest wall.  A\nnodular structure in the right medial breast is seen on series 2, image 6\nmeasuring 10 x 14 mm, correlate with breast exam.",
            "output": "1.  Normal appendix.\n2.  Mild prominence of the intrahepatic biliary ducts with mild prominence of\nthe common hepatic duct up to 10 mm.  Please correlate clinically.\n3.  Nodular lesion in the right breast measuring up to 14 mm, correlate with\nbreast exam.\n4.  Additional nonemergent findings as above."
        },
        {
            "input": "LOWER CHEST: Small left pleural effusion.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Patient is status post TIPS procedure.  The liver demonstrates\nhomogenous attenuation throughout.  There is no evidence of focal lesions.\nMild focal intrahepatic biliary dilatation seen in the left lobe.  No\nextrahepatic biliary dilation 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, measuring 12.6 cm in largest dimension,\nand 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.\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 focal intrahepatic biliary dilatation is seen in the left lobe."
        },
        {
            "input": "LOWER CHEST: Again seen is a right lower lung mass measuring 2.9 x 2 cm. \nPlease refer to separate the report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThe previously described conglomerated metastases indenting the hepatic dome\nappears unchanged in size measuring 6.3 x 4 cm previously 6 x 4.1 cm (series\n11, image 82).\nThe intrahepatic segment VIII liver dome lesion is also unchanged in size,\nmeasuring 16 mm (series 11, image 73).  No new liver lesion.\nPreviously described subcentimeter hemangiomas are unchanged (series 7, images\n23, 29, 48).\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is within normal limits.\n\nPANCREAS: The pancreas is slightly atrophic.  No main duct dilatation.  No\nfocal lesion.\n\nSPLEEN: The spleen shows normal size 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 nephroureterostomy stents in place.  There is\nnew mild to moderate right hydronephrosis and mild left hydronephrosis.\nThere is new striated nephrogram within the bilateral kidneys, left greater\nthan right as well as mild urothelial enhancement on both sides.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. We again see\nscarring in the right lower quadrant mesentery next to a clip.  Unchanged 1 cm\nmesenteric lymph node (series 11, image 149) in the mid lower abdomen.\nThe colon and rectum are within normal limits. The appendix is normal.\n\nUnchanged few subcentimeter peritoneal nodules are seen on series 11, images\n129, 133.\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 to moderate\natherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\nUnchanged 1 cm lytic lesion of the right iliac bone (series 11, image 146)\nthat did not show uptake on the Dotatate scan.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged metastatic disease involving the liver, abdominal\nlymphadenopathy, peritoneal implants and bilateral pelvic masses\n2. Bilateral nephroureteral stents with new bilateral mild to moderate\nhydronephrosis.  Mild bilateral urothelial enhancement may be related to\npresence of the nephroureteral stents.\n3. New striated nephrogram within the bilateral kidneys, left greater than\nright may be related to superimposed pyelonephritis.\n4. Please refer to separate chest CT done the same day for thoracic findings.\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 17:53 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 previously described conglomerate\nperihepatic/subdiaphragmatic metastatic lesion indenting the hepatic dome\nappears similar in size measuring 6.4 x 3.9 cm (8:83), previously measuring\n7.2 x 4.2 cm on the PET-CT of ___, and 6.3 x 4.0 cm on the most\nrecent contrast enhanced CT of ___.\n\nAllowing for differences in technique, a segment VIII hypodense lesion\nmeasuring 2.0 cm (8:80) is similar in size compared to the PET-CT of ___ when it measured 1.9 cm, but measured 1.6 cm on the most recent\ncontrast enhanced study performed ___.  Also allowing for\ndifferences in technique, 0.8 cm (8:82) and 0.9 cm (8:97) hypodense lesions\nwithin the right hepatic lobe are unchanged in size compared to the PET-CT of\n___.  Other Dotatate avid lesions seen on the aforementioned\nPET-CT are not clearly correlated on the current study due to difference in\ntechnique.\n\nPreviously described subcentimeter hemangiomas (06:21, 27, and 47) are\nunchanged.  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: Bilateral percutaneous nephrostomy tubes appear appropriately\npositioned.  Again noted is moderate left-sided hydronephrosis, similar\ncompared to prior.  Fullness of the right renal pelvis without frank\nhydronephrosis is similar to prior as well.  Enhancement of the bilateral\nureteral walls most likely secondary to indwelling nephrostomy tubes.  UTI\ncan't be excluded.  The right kidney is smaller in size with thinned cortex in\ncomparison to the left, similar to prior. Bilateral nephrograms are grossly\nsimilar. No evidence of focal renal lesions.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Patient is status\npost right hemicolectomy.  Scarring and surgical clips within the right lower\nquadrant mesentery are again seen, unchanged.  The remaining colon and rectum\nare unremarkable.  The appendix is surgically absent.\n\nNodules measuring up to 1.0 cm in the right paracolic gutter are unchanged (8:\n132, 134).  Additionally, a 0.9 cm lower mesenteric nodule is unchanged as\nwell (8:72).  No new nodules identified within the sensitivity of CT. \nRetroperitoneal nodule superior to the left kidney (series 8, image 93)\nmeasuring 9 mm in diameter is similar compared to most recent PET-CT, but\nslightly more prominent compared to prior CT of ___ when it\nmeasured 5 mm.  Multiple small nodules in ___'s pouch appears fairly\nsimilar compared to prior.\n\nPELVIS: The urinary bladder is decompressed, limiting its assessment.  The\ndistal ureters inferior to the pelvic masses are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate appears similar to prior.  Bilateral ovoid\npelvic masses extending involving the seminal vesicles, measure 5.1 x 3.3 cm\non the right and 5.1 x 2.4 cm on the left.  These masses measured 4.8 x 3.3 cm\non the right and 5.5 x 2.5 cm on the left on the PET-CT of ___,\nand 5.1 x 3.8 cm on the right and 5.5 x 2.6 cm on the left on the most recent\ncontrast enhanced CT of ___.\n\nLYMPH NODES: Metastatic 1.1 cm aortocaval lymph node (8:97) is unchanged. \nElsewhere, there is no new retroperitoneal, mesenteric lymphadenopathy,\npelvic, or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: A 1.1 cm lytic lesion within the right iliac bone (8:143) which was\nwithout abnormal dotatate uptake on the most recent PET-CT is unchanged\ncompared to prior, previously measuring 1.0 cm.  There is no acute fracture.\n\nSOFT TISSUES: Mild diastasis of the abdominal wall is again seen.",
            "output": "1. Evaluation is limited given difficulty comparing contrast enhanced CT to\nthe most recent Dotatate PET CT.\n2. Allowing for this limitation, intra-abdominal metastatic disease appears\nfairly similar compared to prior.\n3. There is similar size of multiple hepatic and perihepatic metastatic\nlesions when compared to the most recent PET-CT of ___. \nAdditionally, multiple previously described Dotatate-avid hepatic metastatic\nlesions are not well evaluated on the current contrast-enhanced CT.  Hepatic\nlesions appear similar to very minimal decreased in size compared to prior\nPET-CT done ___\n4. Similar size of abdominal lymphadenopathy, peritoneal and retroperitoneal\nimplants, and bilateral pelvic masses compared to both the most recent PET-CT\nand contrast enhanced CT.\n5. Well-positioned bilateral percutaneous nephrostomy tubes.  Left\nhydronephrosis and fullness of the right renal pelvis as described above. \nEnhancement of the ureteral walls bilateral is again noted.  This enhancement\nis nonspecific and may be reactive due to nephrostomy tubes in situ, but UTI\ncannot be excluded\n6. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  Please note that Dotatate PET CT would be more sensitive\nfor comparison as multiple lesions are not seen on anatomical images compared\nto Dotatate PET 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 homogenous attenuation throughout. \nAgain seen is the sub diaphragmaticd dome lesion that measures 3.9 x 3.8 cm,\nunchanged from prior (series 2, image 16).  Additional right hepatic lesions\nin segment 8 is unchanged measuring 2.0 cm and in segment 7 measuring 0.8 cm. \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: Re-demonstrated are bilateral percutaneous nephrostomy tubes appear\nin stable position.  There is new severe hydronephrosis of the right kidney\nand right hydroureter.  Hydroureter extends into the pelvis and appears to be\na obstructed due to a previously known pelvic mass.  The left kidney\ndemonstrates interval resolution of mild hydronephrosis.  There is no evidence\nof 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.  Surgical clips\nare seen scattered throughout the abdomen.  Patient is status post right\nhemicolectomy.  Otherwise, the colon and rectum are within normal limits. The\nappendix is surgically absent.\n\nPreviously known nodules in the right pericolic gutter, perisplenic and\nMorison's pouch are unchanged.  (Series 2, image 46, 19).\n\nPELVIS: Re-demonstrated are ovoid pelvic masses that measure 3.8 x 5.0 cm and\n6.2 x 2.8 cm, previously 3.5 x 5.2 cm and 3.8 x 7.0 cm respectively (series\n601, 42).  Bladder is decompressed.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostate gland is the upper limit of normal for size.\n\nLYMPH NODES: 1.1 cm aortocaval lymph node is unchanged (series 2, image 22). \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. \nUnchanged 1.2 cm lytic lesion in the right iliac bone (series 2, image 50).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Progressed right hydroureteronephrosis, now moderate to severe, and\ninterval resolution of left hydroureteronephrosis.  Bilateral percutaneous\nnephrostomy tubes are in unchanged positions.\n2. Stable metastatic disease involving the liver, lymph nodes, peritoneal and\nretroperitoneal implants, pelvic masses and possible right iliac bone.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:10 am, 5 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrate the presence of a solid\nenhancing lesion in the right base, that extends into the adjacent\nhemidiaphragm.  There is no evidence of pleural or pericardial effusion. \nPlease refer to the concurrent CT of the chest for detailed thoracic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable hepatic dome heterogeneously enhancing lesion measuring approximately\n3.1 x 6.2 x 3.4 cm (8:84), that extends into the right hemidiaphragm. \nAnterior to this lesion is a 2.2 cm hypoenhancing lesion (8:78) not\nsignificantly changed compared to prior.  0.8 cm lesion in segment 7, is\nunchanged compared to prior.\nThere is a subcapsular hypoenhancing lesion adjacent to the gallbladder\nmeasuring up to 1.8 cm, not significantly changed compared to prior (8:113).\nThere are 2 arterially enhancing lesions in segment VIII (6:17) and VII\n(6:25), with a more subtle focus of arterial enhancement in segment VI (6:42),\nwhich are not significantly changed compared to prior.\nThere has been interval enlargement of multiple capsular soft tissue nodules\nalong the liver, the most prominent along the inferior margin measuring 6\nmm(14:67) , previously 3 mm; and right subphrenic (14:35).  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\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.  1.5 cm splenule along the inferior margin of the\nspleen.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is atrophic, and demonstrate decreased enhancement\ncompared to contralateral, likely sequela of chronic inflammation.  There are\nbilateral percutaneous nephrostomy tubes in place.  There has been interval\nresolution of the previously visualized right hydroureteronephrosis.  There is\nno evidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Patient is status post ileocolectomy (___).  The stomach is\nunremarkable.  Small bowel loops demonstrate normal caliber, wall thickness,\nand enhancement throughout. The colon and rectum are within normal limits.\nStatus post appendectomy.\n\nPERITONEUM: There are at least 3 enhancing peritoneal soft tissue nodules,\nlikely representing metastatic deposits (8:136, 134, 95), not significantly\nchanged compared to prior.\nThere is an ill-defined soft tissue nodule anterior to the surgical clips of\nthe mesentery of the right lower quadrant (6:72), measuring up to 1.3 cm,\nlikely representing metastatic deposit and unchanged compared 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 is not enlarged.  The are bilateral\nhyperenhancing pelvic masses, likely arising from the seminal vesicles,\ngrossly unchanged compared to prior, the right measuring 4.4 x 3.5 cm\n(previously 4.7 x 3.4 cm), the left measuring 5.3 x 2.2 cm (previously 5.4 x\n2.2 cm).  The left pelvic mass, is in contiguity with adenopathy along the\nlower left common iliac station.\n\nLYMPH NODES: Stable aortocaval (8:99) and left common iliac (8:171)\nadenopathy.  No new abdominal or pelvic lymphadenopathy.  Prominent but not\npathologically enlarged lymph nodes along the right hemidiaphragmatic region\n(6:18) and left pelvic wall (8:188), are not significantly changed compared to\nprior.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Interval slight decrease in size of the lytic lesion of the right\nposterior iliac bone now measuring 1.4 cm (6:81), previously 1.2 cm.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias.",
            "output": "1. Interval increased size of liver capsular metastatic implants, and right\niliac lytic lesion.\n2. Interval resolution of the previously visualized right\nhydroureteronephrosis.\n3. Stable metastatic disease involving the liver, lymph nodes,\nperitoneal/retroperitoneal implants and bilateral seminal vesicle masses."
        },
        {
            "input": "LOWER CHEST: As before, consolidation at the right lung base with\nheterogeneous enhancement is likely due to chronic atelectasis.  There is mild\ndependent atelectasis on the left.\n\nABDOMEN:\n\nHEPATOBILIARY: The previously described metastatic lesion at the liver dome is\nunchanged in size since the prior study (2:13).  Subcentimeter hypodensity at\nthe liver dome, previously described as a probable hemangioma, is grossly\nunchanged (601:36).  Hyperenhancing foci previously characterized as\nhemangiomas (02:12, 16) are compatible with hemangiomas.  No new focal lesion\ndetected.  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: Delayed nephrogram on the right is unchanged since at least ___.  There is persistent severe right hydroureteronephrosis, now\nwith an indwelling ureteral stent.  At the distal ureter, the obstructing mass\nis similar in size, measuring 4.5 x 3.5 cm (2:66).  Mild left renal fullness\nhas increased since the prior study, but there is also an appropriately placed\nureteral stent on the left.  There is increased right perinephric stranding,\nwhen compared with the prior study.\n\nGASTROINTESTINAL: Multiple surgical clips again seen scattered throughout the\nabdomen.  The stomach is unremarkable.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout.  The colonic anastomosis\nin the right hemiabdomen is unremarkable.  Remaining colon and rectum are\nunremarkable.  No evidence of bowel dilatation.  The appendix is not directly\nvisualized.\n\nPELVIS: Previously described lobulated soft tissue density masses in the\npelvis are unchanged from the prior study.  In addition to the right pelvic\nmass described above, causing upstream ureteral dilatation, the elongated left\nhemipelvis mass measures approximately 5.8 cm in craniocaudal dimension,\nunchanged (601:50).  The inferior portion of this mass is contiguous with the\nseminal vesicle on the left, as before.  The urinary bladder is unremarkable,\nnoting the indwelling bilateral ureteral stents.  There is no free pelvic\nfluid.\n\nREPRODUCTIVE ORGANS: The prostate is unremarkable.  The above described pelvic\nmasses involve the left seminal vesicle.\n\nLYMPH NODES: Previously described subcentimeter nodules in the right pericolic\ngutter likely represent metastatic disease and are unchanged (2:45).  Several\naortocaval nodes are also unchanged to the prior study (2:21).  No new\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.",
            "output": "1.  Compared with the prior study, there is increased perinephric stranding\nabout the right kidney, with persistent delayed nephrogram.  This may be due\nto obstruction or ascending infection, therefore correlation with urinalysis\nis recommended.\n\n2.  Interval placement of bilateral ureteral stents, appropriately positioned,\nwith persistent severe right hydroureteronephrosis.\n\n3.  Metastatic disease in the abdomen and pelvis, including the liver,\nmultiple lymph nodes, and several pelvic masses, not substantially changed\nsince ___."
        },
        {
            "input": "Lung bases clear.\n\nUnenhanced liver, pancreas and adrenals are unremarkable. Splenomegaly, 14.3\ncm.  Multiple nonobstructing calculi are demonstrated within both kidneys. The\nlargest measures 2 mm within the lower pole right kidney item. Note is made of\nslight hyperdensity of the bilateral medullary pyramids.  No definite ureteral\ncalculi are demonstrated with multiple pelvic and venous phleboliths. No\nbladder calculi.\n\nIngested material within stomach. Prominent stool throughout the colon. No\nsmall bowel dilatation.\n\nNormal caliber abdominal aorta. No apparent abdominal adenopathy.\n\nNo focal bladder wall thickening. No free pelvic fluid. No pelvic adenopathy.\nSmall sclerotic foci within the bony pelvis, presumed enostoses.",
            "output": "-Multiple nonobstructing bilateral ureteral calculi, largest 2 mm.  Hyperdense\nappearance of bilateral medullary pyramids may reflect small calculi, although\nmedullary nephrocalcinosis may also have this appearance.\n-Splenomegaly, 14.3 cm."
        },
        {
            "input": "LOWER CHEST: Reference is made to CT chest report of the same date.\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: 15 mm left adrenal nodule is indeterminate.  The right adrenal is\nnormal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nA couple of simple appearing right renal cysts, the largest measuring 21 mm in\ndiameter.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Gastrostomy tube in situ.  Mild pneumoperitoneum, likely\nrelated to the gastrostomy tube placement.  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: 41 x 34 mm left adnexal soft tissue lesion.  Nonspecific\nhypodense lesion in relation to the proximal vagina (series 2, image 126).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHemangioma in the left lateral aspect of the T7 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. 4 cm left adnexal soft tissue lesion for which pelvic ultrasound is\nrecommended.\n2. Nonspecific hypodense lesion in relation to the proximal vagina.  Clinical\ncorrelation advised.\n3. 15 mm left adrenal nodule is indeterminate.\n4. Mild pneumoperitoneum likely related to recent gastrostomy tube placement.\n5. Reference is made to CT chest report of the same day for chest findings.\n\nRECOMMENDATION(S):  Pelvic ultrasound.\n\n Incidentally 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: Visualized lung 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: Patient is status post distal pancreatectomy with\npancreaticojejunostomy.  There remaining pancreas appears normal.  No\npancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: 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. \n6 mm nonobstructive renal calculus in the left upper pole.  There is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Patient is status post\npancreaticojejunostomy.  Stable dilatation of the jejunojejunostomy\nanastomosis.  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.  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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable focal sclerosis of the left acetabulum, consistent with bone island. \nMultilevel degenerative changes of the thoracolumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "No evidence of small-bowel obstruction."
        },
        {
            "input": "LOWER CHEST: There are bilateral nonhemorrhagic small pleural effusions, which\nhave increased since prior, with adjacent mildly more prominent compressive\natelectasis.  Partial visualization of the replaced aortic valve.  The\npreviously described left lower lobe pulmonary nodule is not well seen on the\ncurrent study.  There is aortic valve replacement.  Sternotomy.  Coronary\nartery 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 within normal limits. \nTrace perihepatic fluid is new.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Tiny right adrenal nodule is stable.  Left adrenal gland is normal.\n\nURINARY: Multiple bilateral simple cysts are unchanged since the study from 3\ndays prior.  No evidence of hydronephrosis or perinephric abnormality.  There\nare no striated nephrograms on either side.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Patient is post\nileocecectomy, with similar appearance of the intact anastomosis.  There is no\nextraluminal contrast, although p.o. contrast did not travel to the level of\nthe anastomosis.  Persistent fat stranding along the anterior mesentery is\nlikely postsurgical in nature and similar in appearance from the prior study.\n\n There is a persistent 9.3 x 1.5 cm fluid collection in the anterior abdominal\nwall musculature with less foci of gas, unchanged in size since 3 days prior\n(4:38).  No change in the positioning of the previously described right lower\nquadrant approach drain, terminating just left of midline (4:34), not in any\nfluid collection.\n\nPELVIS: There is some air within bladder, which is likely from recent bladder\ninstrumentation, if there has been no bladder instrumentation, consider\ninfection or bladder enteric fistula.  .  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: Coarse calcifications again seen in the prostate.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Previously described external iliac\nnodes are prominent, but not pathologically enlarged.\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. \nExtensive degenerative changes of the lumbar spine are unchanged since the\nstudy from 3 days prior.  There is grade 1 L3 on L4 anterolisthesis, with\nbilateral L3 pars interarticularis defect, stable.  Degenerative changes\nsacroiliac joints.\n\nSOFT TISSUES: The previous left inguinal hernia no longer contains a loop of\nbowel.  There is small right inguinal hernia containing small segment of the\nurinary bladder, as seen on prior.",
            "output": "1.  Compared with the study from 3 days prior, no relevant change.  Patient is\npost ileocecectomy repair of the midline hernia.  Persistent 9.3 x 1.5 cm\nfluid collection just deep to the anterior abdominal musculature, may be\npostsurgical, superimposed infection cannot be absolutely excluded, with\ninterval resolution of previously seen internal foci of air.  .\n\n2.  No evidence of a new extraluminal fluid collection.\n\n3.  No change in the positioning of the right lower quadrant approach drain,\nwhich terminates in the anterior abdominal soft tissues just slightly to the\nleft of midline.  This drain is not located within any fluid collection.\n\n4.  Bilateral inguinal hernias."
        },
        {
            "input": "LOWER CHEST:  A large dystrophic calcification is seen adjacent to the\nsternum/xiphoid process.  This is overall minimally changed compared with the\nprior study ___.  A chronic appearing rib deformity is seen in the\nright sixth rib.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  A small amount of focal fat is noted\nat the falciform ligament (02:20), unchanged from prior studies.  Trace\nleft-sided intrahepatic biliary dilatation is nonspecific and unchanged from\nthe prior study.  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 convincing evidence of pyelonephritis.  There is no evidence of\nfocal renal lesions or hydronephrosis.  Scattered hypodensities in bilateral\nkidneys are too small to fully characterize but likely represent simple cysts.\nThere is no worrisome renal lesion.  There is no perinephric 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.  Suture lines\nsurrounding the low sigmoid colon suggest prior bowel surgery.  The appendix\nis normal. There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nPartially to these incidentally noted.\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\nREPRODUCTIVE ORGANS: Reproductive organs are within normal limits.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.\nThere is a small fat containing umbilical hernia (02:42).",
            "output": "No acute findings."
        },
        {
            "input": "CHEST:\n\nPlease see the separate dedicated chest CT report dictated by the\ncardiothoracic imaging section.\n\nABDOMEN:\n\nThe liver again demonstrates a 4.8 x 3.3 cm cystic hepatic lesion at the\njunction of the left and right hepatic lobes (2:54), previously measuring 4.6\nx 3.5 cm on ___. However, it should be noted that this lesion\nmeasured only 2.7 x 2.0 cm on CT in ___. The remainder of the liver\nparenchyma is otherwise unremarkable, and no additional hepatic lesions are\nidentified. The portal venous system is patent. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. The gallbladder, spleen, and\nbilateral adrenal glands are normal.  A subcentimeter pancreatic head cystic\nlesion is not well identified on this examination, and better seen on recent\nMRI. The kidneys enhance symmetrically and are without suspicious 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\nair-filled and normal (601b:26). Colonic diverticulosis is present without\nevidence of diverticulitis. There is no retroperitoneal lymphadenopathy by CT\nsize criteria. There is no free abdominal fluid or pneumoperitoneum. The aorta\nand iliac branches are normal in course and caliber. The celiac trunk and SMA\nare grossly patent.  There is recanalization of the umbilical vein. The left\novarian vein is mildly enlarged, but unchanged in appearance as compared to\n___.\n\nPELVIS:\n\nThe urinary bladder and rectum are grossly unremarkable. There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nOSSEOUS STRUCTURES: A small, focal sclerotic lesion within the right femoral\nhead is stable and likely represents a bone island. No focal lytic or\nsclerotic lesion concerning for malignancy.",
            "output": "1.  4.8 x 3.3 cm cystic hepatic lesion at the junction of the left and right\nhepatic lobes. Although this lesion has only minimally increased in size\ncompared to the prior MRI abdomen dated ___, it has more than\ndoubled in volume as compared to ___. Given this interval growth,\nsurgical resection is a valid consideration.\n2. Ill-defined, subcentimeter cystic lesion within the pancreatic head, better\ncharacterized on prior MRI. Please see recommended follow up per MR imaging.\n3.  Diverticulosis without evidence of diverticulitis.\n4.  For description of the intrathoracic findings, please see the separate CT\nchest report.\n\nNOTIFICATION:  Findings were entered into the radiology dashboard by Dr.\n___ at 10:05 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. \nRe-demonstrated is hypertrophy of the left hepatic lobe with a slightly\nnodular contour in keeping with history of cirrhosis.  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. \nSubcentimeter hypodensities in the left upper pole are too small to\ncharacterize.  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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening and fat\nstranding. The appendix is normal.  Of note, the appendix lies within the\nmidline/ left lower quadrant (13:50).\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: Again seen is a small fat containing umbilical hernia.",
            "output": "1. No recurrent hepatic mass or evidence of metastatic disease in the abdomen\nor pelvis.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. Please refer to dedicated CT chest performed on the same date for\ndescription of intrathoracic findings."
        },
        {
            "input": "LOWER CHEST: Severe emphysema in the visualized lower lungs is\nre-demonstrated.  Suture material/surgical clips is again seen at the right\nlung base.  Multiple surgical clips along the left hemidiaphragm are again\nseen and unchanged.\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 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.\n\nADRENALS: A 1.4 cm low-density left adrenal nodule is re-demonstrated and\nunchanged.  The right adrenal gland is normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy.  The right kidney is\ndysmorphic in appearance with cortical scarring and moderate\nhydroureteronephrosis which tapers in the proximal ureter and enlarges in the\nmid and distal ureter to the level of the ureterovesicular junction.  Multiple\ncortical renal cysts are again seen measuring up to 1.8 cm.  There is no\nperinephric abnormality.  Multiple nonobstructing punctate renal\ncalcifications are demonstrated.\n\nThe bladder contour is irregular in appearance with bladder diverticula and\nhyperdense thickening of the posterior bladder wall though new nodularity is\ndemonstrated measuring up to 14 mm (06:44) with associated calcifications\nwhich may represent recurrent malignancy.\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 extensive fecal loading throughout the colon the appendix\nis normal.\n\nPELVIS: There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and contains calcifications.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Vascular clips along the retroperitoneum and left pelvic wall are\nre-demonstrated and unchanged.  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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Moderate right hydroureteronephrosis to the level of the bladder with\nposterior bladder wall thickening and new nodularity measuring up to 14 mm\nwith associated calcifications concerning for recurrent malignancy.\n2. No obstructing renal, ureteral, or bladder stones identified.  Multiple\npunctate nonobstructing renal stones demonstrated.\n3. Cholelithiasis without findings to suggest cholecystitis.\n4. Diverticulosis without findings of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Postoperative changes are noted at the right lung base with\nsurgical chain sutures and linear opacity compatible with scarring.  There is\na triangular 5 mm right lower lobe pulmonary nodule (02:16) which is unchanged\ndating back to ___, benign.  Bibasilar centrilobular emphysema moderate to\nsevere is unchanged.  Low attenuation of the blood pool suggests anemia. \nThere are aortic valve calcifications.  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 calcified stone but is otherwise\nunremarkable in relatively 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: A 1.5 cm left adrenal adenoma is again noted.  The right adrenal\ngland is normal in size and shape.\n\nURINARY: Patient is status post left nephrectomy.  Lobulated contour\ncompatible with areas of scarring again noted in the right kidney.  Multiple\nhypodensities are likely simple cysts.  There is moderate right\nhydroureteronephrosis as seen previously.  This is seen all the way to the\nlevel of the bladder without discrete identified cause for obstruction.  There\nis also mild right perinephric stranding.  This finding is similar compared to\nmultiple prior exams.  Punctate nonobstructing right renal calculi are 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. Richter's type hernia of the mid transverse colon is noted\nwithout secondary obstruction.  Appendix is normal.\n\nThe bladder is lobulated partially calcified soft tissue density at the dome\nseen on prior is not clearly delineated.  There is suggestion of underlying\nbladder diverticula, perhaps with some there are decompressed though\nunderlying wall thickening or possible underlying mass lesion would be\npossible.  Surgical clips seen along the left pelvic sidewall compatible\npatient's prior surgical history.\n\nREPRODUCTIVE ORGANS: Prostate is enlarged.  Soft tissues are unremarkable.\n\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: Supraumbilical both fat and colonic containing hernias are\nnoted.  Portion of the anterior wall of the transverse colon is seen within\nthe superior most hernia without obstruction.",
            "output": "1. Similar appearance of the right kidney compared to priors with moderate\nright hydroureteronephrosis and perinephric stranding.  No visualized cause of\nunderlying obstruction, no obstructing renal or ureteral calculus.  This\nappearance is similar compared to the multiple priors.  Cannot exclude the\npossibility of an underlying infection and correlation with UA is suggested.\n2. Lobulated contour of the bladder with multiple diverticula near the dome. \nApparent wall thickening may be due to underdistention though underlying mass\nis difficult to exclude on this unenhanced CT scan.  Of note, the partially\ncalcified 2.2 cm soft tissue density lesion seen on most recent prior exam\nfrom ___ is not seen today.\n3. Anterior abdominal wall supraumbilical hernias, one of which contains\nanterior wall of the transverse colon which is nonobstructed."
        },
        {
            "input": "LOWER CHEST: There is stable postoperative changes at the right lung base. \nThere is moderate to severe bibasilar centrilobular emphysema with bullae,\nunchanged from prior imaging.  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.  There is cholelithiasis without\ncholecystitis.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic 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 is a 1.9 x 1.4 cm left adrenal adenoma.  The right\nadrenal gland is normal in size and shape.\n\nURINARY: Postsurgical changes from left nephrectomy.  The right kidney has a\nlobulated contour consistent with scarring.  Again seen are multiple\nhypodensities which most likely represent simple cysts.  Again seen is\nmoderate right hydroureteronephrosis, grossly unchanged from ___ and\nslightly increased from ___.  This continues to extend down to\nthe level of the bladder without evidence of an obstructing stone or lesion. \nAgain seen is a punctate nonobstructing right renal stone.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  The appendix is\nnormal.  The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: The bladder has a lobulated contour.  There is soft tissue thickening\nof the dome of the bladder similar to ___.  There is suggestion of\nbladder diverticula.  There are no new masses or lesions.  There is no free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate measures 5.7 cm in diameter consistent with\nprostatomegaly.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 seen are supraumbilical fat and bowel containing ventral\nhernias without evidence of obstruction.There is a small left fat containing\ninguinal hernia.",
            "output": "1. Persistent right hydroureteronephrosis and perinephric stranding similar in\nappearance to ___.  There is no evidence of an obstructing stone or\nlesion.\n2. Lobulated contour of the bladder, soft tissue thickening at the dome and\nmultiple diverticula are similar in appearance to the recent imaging."
        },
        {
            "input": "There is severe emphysema. There are multiple pulmonary nodules, up to 7 mm\n(2b:91). The patient is status post prior right lower lobe wedge resection.\nThere is also evidence of left hemi diaphragmatic hernia repair with\npersistent elevation of the left hemidiaphragm.\n\nAssessment of the solid visceral structures of the abdomen and pelvis is\nlimited without IV contrast.\n\nABDOMEN:\n\nThe liver is homogeneous in attenuation, without focal lesion. The gallbladder\nand biliary tree are normal.  The pancreas and spleen are unremarkable.  There\nis a low attenuation 1.6 x 1.8 cm left adrenal nodule, compatible with a\nbenign adenoma (2a:15).  The patient is status post left nephrectomy.  There\nis no evidence of mass at the nephrectomy site, although evaluation is\nmarkedly limited by lack of intravenous contrast. There is moderate\nright-sided hydronephrosis and hydroureter without evident obstructing stone. \nThere is a 1.7 cm cyst in the right kidney (2a:35).\n\nThe small bowel and large bowel are normal in caliber and there is no\nmesenteric fat stranding.  There is no definite true ventral hernia on this\nnon Valsalva, supine examination, only eventration of the fascia.  There is no\nintra- or retroperitoneal lymphadenopathy. There is no ascites, fluid\ncollection, or pneumoperitoneum.  The abdominal aorta is normal caliber.\n\nPELVIS:\n\nThe rectum is normal.  The urinary bladder is abnormal and lobulated in\ncontour.  There is focal outpouching of the superior lateral left aspect of\nthe bladder.  There are no calcified stones. The prostate is enlarged and\nthere are coarse calcifications within it. There are small bilateral fat\ncontaining inguinal hernias.  There are surgical clips along the left pelvic\nsidewall, suggestive of prior lymph node dissection.\n\nMUSCULOSKELETAL:\n\nThere is no acute fracture.  There is no concerning destructive osseous\nlesion.",
            "output": "1. No bowel obstruction or true ventral hernia.\n2. Moderate right-sided hydronephrosis and hydroureter without obstructing\nstone evident.  The acuity is unknown, but last renal cortex is not\nsignificantly thinned. Urology followup for further evaluation is advised.\n3. Markedly abnormal bladder contour, however evaluation for mass is not\npossible without intravenous contrast. Correlation with patient's surgical and\noncologic history, as well as comparison to prior imaging is recommended.\n4. Multiple pulmonary nodules up to 7 mm should be correlated with prior\nimaging, since they could represent metastatic disease.  If imaging cannot be\nobtained, nonemergent evaluation with chest CT is recommended.\n5. Severe emphysema.\n6. Left adrenal adenoma."
        },
        {
            "input": "LOWER CHEST:  The appearance of the lungs is unchanged with a few small\nnodular opacities in the right lung base, stable. Patient is status post right\nlower lobe wedge resection and left hemidiaphragmatic hernia repair. There is\npersistent elevation of the left hemidiaphragm.\n\nABDOMEN:\n\nHEPATOBILIARY:  The liver demonstrates homogenous attenuation 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.  Accessory spleen is noted at the splenic hilum.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nADRENALS:  The right adrenal gland is normal. Stable 1.6 x 1.8 cm left adrenal\nadenoma (series 601b, image 37.\n\nURINARY: Stable, moderate right hydronephrosis and hydroureter.  No\nobstructing stone is identified.  Stable simple cysts are noted in the right\nkidney. The left kidney is surgically absent.\n\nGASTROINTESTINAL:  The small and large bowel are normal in course and caliber\nwithout obstruction. Colon and rectum are within normal limits. Appendix has\nnormal caliber without evidence of fat stranding.\n\nMESENTERY AND RETROPERITONEUM: There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy. There is no free air.\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 has a markedly abnormal appearance.  There is a\nrounded thickening of the superior bladder wall (series 601 b, image 39),\nwhich appears increased from ___. There is no evidence of pelvic or\ninguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen. Moderate fat containing ventral hernia measuring 9 cm in diameter.",
            "output": "1.  Moderate fat-containing ventral hernia without evidence of complication.\n\n2. Stable, moderate right hydronephrosis and hydroureter without obstructing\nstone identified.\n\n3.  Focal, rounded thickening of the superior bladder wall appears more\nprominent in comparison to ___. Urology followup with possible tissue\nsampling or cystoscopy is recommended.\n\n4. Stable left adrenal adenoma.\n\n5. Severe emphysema.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 13:44 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: 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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Trace perinephric fluid and stranding along the right lower quadrant\nrenal transplant kidney is within normal limits considering recent surgery. A\npercutaneous intra-abdominal drain terminates in the right lower quadrant.\nThere is a ureterostomy tube with double pigtails, the superior portion of the\ncatheter coils within the proximal ureter, the inferior pigtail coils\nappropriately within the bladder. There is a Foley balloon within a\ndecompressed bladder. Air within the bladder is presumably post\ncatheterization.\n\nNo perinephric hematoma. No hydronephrosis. The native kidneys are atrophic\nwithout hydronephrosis.  Multiple simple appearing bilateral renal cortical\ncysts are noted in the native kidneys.  No acute intra-abdominal pathology.\n\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: 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. \nOld, healed right lower rib fracture (series 2, image 49).\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Patient is status post recent renal transplant in the right lower quadrant\nas described above.\n2. No intra-abdominal collection/abscess identified.\n3. For chest findings reference is made to CT chest report of 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 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: Stomach is filled with fluid.  Mild thickening of the antrum\ncould be secondary to contraction or inflammation. 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 and bilateral adnexae are grossly 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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild thickening of the wall of the antrum could be secondary to contraction\nversus gastritis.\n2.  Normal pancreas."
        },
        {
            "input": "CT abdomen without intravenous contrast:  There is minimal platelike\natelectasis in the right lower lobe. Small pericardial effusion is noted.\nImaged portion of heart and pericardium appear otherwise unremarkable except\nfor note hypodense blood spaces within the ventricles consistent with anemia.\nThere is a small axial hiatal hernia.  The noncontrast appearance of the\nliver, spleen, pancreas, bilateral adrenal glands, appear within normal\nlimits. Gallbladder contains a small amount of layering hyperdensity that may\nrepresent sludge. Hypodense left renal lesions are seen measuring up to 5.7 cm\nthe majority of which contain internal fluid density consistent with cysts.\nThere is diverticulosis of the colon without evidence of inflammatory change.\nThe appendix is normal.  No free air or free fluid in the abdomen.  No\norganized fluid collections.  No mesenteric lymphadenopathy. The retrocrural\nlymph node is mildly enlarged measuring 11 mm, not significantly changed. \nNumerous retroperitoneal lymph nodes do not meet CT criteria for pathologic\nenlargement.\n\nCT pelvis without intravenous contrast: The bladder, distal ureters, prostate\nseminal vesicles, rectum appear unremarkable. Sigmoid colon shows\ndiverticulosis without evidence of inflammatory change. Previous left inguinal\nhernia repair noted.  No pathologically enlarged pelvic or inguinal lymph\nnodes or fluid collections.\n\nBone windows:  Degenerative change of thoracic and lumbar spine, with\nunchanged alignment of the fused with T11 through L1 vertebrae below with\nfocal kyphosis.  No suspicious lytic or sclerotic osseous lesions identified.",
            "output": "First\n\n\n1. No acute intra-abdominal process identified to suggest the etiology of\npatient's fevers.\n2. Diverticulosis without evidence of diverticulitis. Normal appendix.\n3. Mild unchanged fusion of T11 through L1 vertebrae with focal kyphosis and\ndegenerative changes of the thoracic and lumbar spine.\n4. Hypodense left renal lesions with internal fluid density most likely\nrepresenting cysts, 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 within normal 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.\n\nADRENALS: The right and left 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 stable bilateral cortical cysts and\nleft parapelvic cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  There is diffuse stranding in\nfluid throughout the mesentery with wall thickening and hyper enhancement of\nnumerous loops of small bowel as well as the ascending colon with a few loops\nof dilated small bowel measuring up to 4.6 cm.  The previously seen small\nfluid collection adjacent to the cecum has resolved.  No drainable fluid\ncollections are seen.  There is ill-defined stranding and soft tissue in the\nregion of the appendix and the appendix is not definitely visualized.  The\ndistal transverse colon, descending colon and rectosigmoid colon are normal in\ncaliber and thickness as well as enhancement.  There is colonic diverticulosis\nwithout evidence of acute diverticulitis.\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 are enlarged mesenteric lymph nodes measuring up to 1.4 cm\n(4:71).  These were also present on the prior study.  There is no pelvic or\ninguinal lymphadenopathy.  There is similar appearance of a large para soft\njail mass measuring 5.0 x 5.1 cm (04:44).\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Status post left inguinal hernia repair.  Tiny fat containing\nright inguinal hernia.  Small fat containing umbilical hernia.",
            "output": "1. No drainable fluid collections are seen.  The previously seen small\nperiappendiceal fluid collection has resolved.\n2. Add wall thickening and enhancement of the small bowel and ascending colon\nwhich are fluid filled, are favored to represent reactive change of infectious\nor inflammatory etiology, possibly related to regional inflammation.\n3. Few mildly dilated proximal loops of small bowel may represent ileus or\nearly or partial obstruction.  There is air in the rectum and throughout the\ncolon.\n4. Mesenteric lymphadenopathy and large 5.1 cm paraesophageal mass are similar\ncompared to the ___ exam but are new compared to ___."
        },
        {
            "input": "LOWER CHEST:\nThere is linear atelectasis in the left lower lobe.  No pleural effusions or\npericardial effusion noted.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: There is homogeneous enhancement of the hepatic parenchyma.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: Homogeneous enhancement of the pancreatic parenchyma without main\nduct dilation.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  There are no adrenal nodules.\nURINARY: T no hydronephrosis or solid enhancing renal masses identified.\nGASTROINTESTINAL: There is a large stool burden throughout the colon.  No\nbowel obstruction.\nNo bowel wall thickening or any obstructing mass lesions identified.\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Abdominal aorta is normal in caliber.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The uterus and\nadnexae are unremarkable.\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.",
            "output": "Large stool burden throughout the colon compatible with constipation without\nbowel obstruction.  No obstructing bowel wall mass, abdominal or pelvic\nlymphadenopathy noted."
        },
        {
            "input": "LOWER CHEST: Mild atelectasis at the partially imaged 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 is no evidence of focal renal lesions or hydronephrosis.  There is no\nevidence of nephrolithiasis or ureterolithiasis within limitations of this\ncontrast enhanced examination.  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 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.  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.",
            "output": "No evidence of acute abdominopelvic pathology."
        },
        {
            "input": "VASCULAR:\n\nAbdominal aorta is of normal caliber with moderate atherosclerotic\ncalcifications.  There is a calcified plaque at the origin of the celiac axis\nwith marked luminal narrowing however, beyond that there is normal\nopacification of the branches.  SMA appears patent.  ___ is patent as well. \nContrast opacifies distal branches.  There are no large occlusive thrombus\nidentified.  Bilateral renal arteries are patent.  Iliac vessels are patent\nbilaterally.\n\nLOWER CHEST: Dependent atelectatic changes are noted bilaterally with trace of\nbilateral pleural effusions.\n\nHEPATOBILIARY: There is homogeneous hepatic attenuation with no suspicious\nmass lesions.  There is a small area of focal fatty infiltration or\nhypoperfusion along the falciform ligament.  Portal vein is patent.  There is\nconventional hepatic arteriogram.  There is no biliary ductal dilatation. \nGallbladder appears unremarkable.\n\nPANCREAS: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious lesions.\n\nSPLEEN: No splenomegaly.\n\nADRENALS:   Unremarkable.\n\nURINARY:There is no hydronephrosis or nephrolithiasis.  There are no\nsuspicious renal masses.  There are scattered small renal cortical cysts.\n\nGASTROINTESTINAL: Stomach is unremarkable.  Small bowel loops are not dilated.\nOral contrast is present within the large bowel.  Cecum, ascending colon and\nproximal transverse colon appear unremarkable.  There is re-demonstrated\ncolonic wall thickening and luminal narrowing starting from the mid transverse\ncolon, involving the splenic flexure and proximal descending colon.  This has\nimproved compared to the most recent study.  Sigmoid colon and rectum appear\nunremarkable.\n\nPERITONEUM: There is small amount of free fluid within the pelvis\n\nLYMPH NODES: There is no adenopathy.\n\nPELVIS: Uterus is normal in size for age.  There are no adnexal masses. \nUrinary bladder is unremarkable.\n\nBONES:There are multilevel degenerative changes of the lumbar spine.\n\nSOFT TISSUES: There is diffuse subcutaneous soft tissue edema.",
            "output": "1. Interval improvement colitis of the splenic flexure.  The distribution of\nfindings is compatible with ischemic colitis.\n2. No large arterial splanchnic branch occlusion.  This does not exclude an\nischemic episode from low flow state."
        },
        {
            "input": "Lung Bases:  There is a large hiatal hernia again seen.  Tiny right pleural\neffusion noted. Imaged portion of the heart unremarkable.  The imaged lung\nbases are clear.\n\nAbdomen: The unenhanced appearance of the liver is normal. The gallbladder is\nunremarkable.  The pancreas is atrophic. Known pancreatic IPMN not visualized\non this non contrast exam.  The spleen appears normal.  Dense aortic\natherosclerotic calcification is noted without aneurysmal dilation. There is\nno retroperitoneal lymphadenopathy or hematoma. Adrenal glands are normal\nbilaterally. The kidneys appear unremarkable.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction.  A candidate appendix is seen on series 2, image 55 appearing\nnormal. Large fecal loading in the colon noted most severe in the rectum.\nThere is mild perirectal fat stranding of the possibility of mild proctitis is\nraised. Foley catheter seen within the decompressed bladder. No free pelvic\nfluid. No free air.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.    Diffuse bony\ndemineralization is noted. 3 pins stabilize the right femoral neck. There is a\ngrade 1 anterolisthesis of L4 on L5 which appears unchanged compared to ___ radiograph.",
            "output": "1. Large fecal loading of the colon, most severe in the rectum, with probable\nmild proctitis.\n2. Large hiatal hernia."
        },
        {
            "input": "VASCULAR:\nAbdominal aortic aneurysm status post endovascular aneurysm repair with stent\ngraft.  Interval increase in size of abdominal aortic aneurysm compared to\n___, now measures 5.4 cm (previously 4.6 cm and) in AP dimension.  Interval\nretraction/detachment of the left graft limb, now terminates within the distal\nabdominal aortic aneurysm sac, previously was in the left common iliac artery.\nContrast fills the distal abdominal aortic sac from the detached/retracted\nleft iliac limb.  Findings are consistent with type 1B and a leak.\n\nPatent distal thoracic aorta, abdominal aorta and stent graft.  Mild stenosis\nat the right endograft limb with intimal hyperplasia.  Mild stenosis at the\nproximal right external iliac artery and calcification at the bilateral common\nfemoral arteries.\n\nPatent celiac axis.  Mild superior mesenteric arterial stenosis.  Patent\nbilateral renal arterial stents with mild left-sided stenosis.  Retrograde\nfilling of the inferior mesenteric artery without filling of the aneurysmal\nsac.\n\nLOWER CHEST: Lingular and left lung base linear atelectasis.  Color\ncalcifications.  No pericardial effusion.  Sternotomy wires in situ.\n\nABDOMEN:\n\nHEPATOBILIARY: No suspicious lesion or ductal dilation.  Cholecystectomy.\n\nPANCREAS:  No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENALS: Unremarkable.\n\nURINARY:  Left inferior pole cyst, unchanged.  No nephrolithiasis or\nhydronephrosis.  No hydroureter.\n\nGASTROINTESTINAL: No intestinal obstruction. Nonvisualized appendix.\n\nPELVIS: Unremarkable rectum, bladder,prostate and seminal vesicles.\n\nLYMPH NODES: No adenopathy.\n\nBONES AND SOFT TISSUES: No acute fracture or suspicious osseous lesion. No\nsoft tissue mass.",
            "output": "1. S/P EVAR. Interval retraction/detachment of the distal left endograft limb\nwith contrast leak into the aneurysmal sac consistent with type 1B endoleak. \nThe endograft limb retracted from the ipsilateral common iliac into the distal\naortic aneurysmal sac.  The aneurysmal sac increased from 4.6 cm to 5.4 cm.\n\nNOTIFICATION:  Findings were communicated by Dr. ___ to Dr. ___ by\nphone on ___ at 11:25."
        },
        {
            "input": "VASCULAR:\nAbdominal aortic aneurysm status post endovascular aneurysm repair with\naortico-bifemoral stent graft complicated by left iliac limb proximal\nmigration.  The suprarenal bifurcated stent graft begins 3 cm above the renal\narteries extending to the common iliac on the right, and the external iliac on\nthe left. The left internal iliac artery has been coil embolized, but distal\nbranches are reconstituted distally (7:138).  The renal arteries are patent\nwith no evidence of ischemia.  The deep and superficial bilateral femoral\narteries and their respective adjacent soft tissues are unremarkable.  The\naneurysmal sac continues to be dilated measuring 4.8 x 4.4 cm (transverse)\nwithout endoleak.\n\nLOWER CHEST: Imaged lung is without nodule or mass concerning for malignancy\nor infection.  Coronary calcifications are noted.  There is no pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is homogeneously less dense than the spleen,\nconsistent with hepatic steatosis.  No focal liver lesion is identified.  The\npatient 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: Tiny bilateral renal hypodensities, are too small a characterize,\nstatistically most likely simple cyst.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  No evidence of bowel ischemia.  The colon and\nrectum are within normal limits.  Appendix is not visualized. There is no\nevidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nThere is no retroperitoneal hematoma.\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: There 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 left iliac endograft limb extension without endoleak or other\nendovascular stent graft complication.\n2. New left internal iliac occlusion   is noted with flow re-constituting\ndistally."
        },
        {
            "input": "VASCULAR:\n\nInfrarenal abdominal aortic aneurysm post endovascular anterior present repair\nwith aorta and by femoral stent graft.  The aneurysmal sac size is smaller\nthan on previous examination measuring 4.5 x 4.0 cm, previously 4.8 x 4.1 cm. \nThere is no evidence of endoleak.\n\nEVAR MIGRATION\nLength proximal graft to lowest renal artery: 2.3 cm above; compared to 2.4 cm\nabove previously.\n\nThe distal graft iliac components appear unchanged in position from previous\nexamination abutting the right iliac bifurcation and coursing 3.1 cm from the\nleft iliac bifurcation into the left external iliac artery, previously 3.1 cm\nfrom the iliac bifurcation.\n\nThe left internal iliac artery is thrombosed with distal recanalization,\nunchanged from previous examination (3:128).  The bilateral right iliac\narteries and left external iliac artery are patent.  Bilateral renal artery\nstents are present, patent.  The celiac axis and SMA are patent.  The ___ is\npatent and originates from the graft.\n\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 or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  High-density material within the small intestine\nis consistent swallowed tablets.  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.  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: There 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 EVAR with patent grafts, decreased aneurysmal size, and no evidence of\nendoleak.\n2. Left internal iliac artery thrombosis with distal recanalization is\nunchanged from previous examination.\n3. An addendum will be submitted with additional measurements once 3D\nreformats are available."
        },
        {
            "input": "VASCULAR:\nThere is moderate calcium burden in the abdominal aorta and great abdominal\narteries.\nInfrarenal abdominal aortic aneurysm post endovascular repair with aorta and\nbifemoral stent graft.  Bilateral external iliac arteries are stented\nproximally.  The aneurysmal sac measures 4.9 x 3.8 cm, previously measuring\n4.5 x 4.0 cm.  Re- demonstrated is a thrombosed left internal iliac artery\nwith distal re- cannulization, unchanged from the prior study.  Bilateral\nrenal artery stents are patent.  The celiac axis, SMA, and ___ are patent. \nThere is no evidence of endoleak.\n\nLOWER CHEST: The lung bases are clear.  There is no pleural or pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is steatotic. There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is is 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. \nA 1.1 cm simple cyst is seen in the lower pole of the left kidney.  There is\nno 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. Colon and rectum are within normal limits. \nAppendix is not visualized. 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: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nChronic fractures of the right twelfth posterior,, right lateral ninth rib,\nand right lateral eighth rib.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post EVAR with patent graft and no evidence of endoleak.\n2. Infrarenal abdominal aortic aneurysm is grossly unchanged in size.\n3. Left internal iliac artery thrombosis with distal recanalization is\nunchanged.\n4. An addendum will be submitted once 3D reformats are available."
        },
        {
            "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 scattered hypodensities are noted throughout the\nliver. The largest one measures 8.7 mm in segment VIII (6:41). Two additional\nhypodensities are noted, including a 3 mm lesion in segment II (6:45), and a 4\nmm hypodensity in segment III (6:51); these are also too small to\ncharacterize, but statistically likely represent cysts or biliary hamartomas.\n\nThere is intrahepatic biliary dilatation, with the remaining CBD dilated to\n10.9 mm (8b:26). Although this may be within normal post-cholecystectomy\nlimits, the wall appears to be hyper-enhancing, a finding that can be seen in\ncholangitis, and should be correlated clinically.\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 innumerable heterogeneously enhancing lesions in the spleen,\nthe largest of which measures 16 x 13 mm along the superior anterior aspect\n(6:69).  These statistically likely represent cysts or hemangiomas, and less\nlikely metastases. Spleen size is normal.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There are multiple bilateral renal cysts, the largest of which\nmeasures 88 x 87 mm in the upper pole of the left kidney. The largest on the\nright measures 59 x 51 mm arising from the lower pole. The remainder of the\nkidneys enhance homogeneously. There is no evidence of stones, suspicious\nrenal masses or hydronephrosis. There are no urothelial lesions in the kidneys\nor ureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is severely distended. There appears to be an\nill-defined heterogeneous mass in the ___ part of the duodenum measuring\n20 x 18 mm (8b:25) that is closely abutting the CBD, and may be partially\nresponsible for upstream biliary dilatation. Furthermore, this is likely\ncausing gastric outlet obstruction, as evidenced by the severely distended\nstomach. The rest of the 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.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Dense atherosclerotic\ncalcifications are noted throughout the abdominal aorta and bilateral iliac\nbranches. There is a linear hypodensity noted at the left lateral aspect of\nthe infrarenal abdominal aorta (6:58), likely representing a non-calcified\nportion of plaque.\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.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.\n\nBONES AND SOFT TISSUES:\nThe bones are diffusely demineralized. No suspicious lytic or sclerotic\nlesions that are concerning for malignancy. There is an L1 compression\nfracture involving approximately 50% loss of height, and resulting in 4 mm\nretropulsion into the central canal. This appears chronic, as there is no\nprevertebral edema and edges appear somewhat corticated. No suspicious lytic\nor sclerotic lesions that are concerning for malignancy. Abdominal and pelvic\nwall is within normal limits.",
            "output": "1. Mild intrahepatic biliary dilatation and dilated common bile duct, which\nmay be within normal post-cholecystectomy limits or mass effect from adjacent\nduodenal mass, described below. However, the CBD walls are hyper-enhancing, a\nfinding that should be correlated clinically for cholangitis.\n2. Ill-defined heterogeneous lesion in the second/third part of the duodenum\nmeasuring 20 x 18 mm, resulting in upstream gastric outlet obstruction as\nevidenced by a severely distended stomach.\n3. Innumerable heterogeneously enhancing lesions in the spleen, the largest\nmeasuring 16 x 13 mm in the superior anterior aspect. Statistically, these\nmost likely represent cysts, hemangiomas or hamartomas.  Metastases cannot be\nexcluded, but is felt to be unlikely.\n4. L1 compression fracture involving approximately 50% loss of height and\nresulting in 4 mm retropulsion, likely chronic.\n5. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  ERCP vs MRCP to evaluate dilation of the intrahepatic and\ncommon bile ducts, and duodenal lesion described above.\n\nNOTIFICATION:  Final results above, including recommendation for ERCP/MRCP\nwere telephoned to Dr. ___ by Dr. ___ on ___ at 11:57am."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.\nThe SMA orifice is severely calcified but patent with no evidence of emboli.\nRenal arteries orifices severely calcified but patent.\n___ is patent.\nBilateral common iliacs arteries and internal external arteries are patent.\nRight central line terminates in right common iliac vein.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is minimal\nright pleural effusion.\nmild cardiomegaly.  no pericardial effusion.\nS/p sternotomy, extensive calcifications of the coronaries.\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 stones, focal renal lesions, or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:\nLarge number of air-fluid levels in small and mildly large bowel.\nNasogastric tube terminates in the stomach.\ndistal ileal bowel loops demonstrated wall thickening and suggestion of mural\nair bubbles for example series 3: 126 or series 601:53.  Minimal fat stranding\nand fluid surrounds the involved segments.\n\nThe large bowel is dilated, fluid filled with large number of air-fluid\nlevels.\nAnd there is heterogeneous enhancement of several large bowel wall segments,\nwith no clear signs of ischemia.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Almost empty urinary bladder is contains Foley catheter balloon.\nThere is no evidence of pelvic or inguinal lymphadenopathy.\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: Severe degenerative changes of the lumbar spine.\nS/p right hip arthroplasty and lower lumbar internal fixation.\nThere is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "-Distal ileal bowel loops with wall thickening and suggestion of pneumatosis\nintestinalis, surrounded by mild ascites are highly suspected for bowel\nnecrosis.\n-Although there is no clear evidence of large bowel wall ischemia, diffuse\ndilatation of the large bowel associated with large quantity of fluid and\nair-fluid levels, as well as heterogeneous enhancement of its wall-raises the\npossibility of ischemic colitis.\n-Severe atherosclerotic calcifications of the aorta and major branches with no\nevidence of clear emboli."
        },
        {
            "input": "VASCULAR: There is no abdominal aortic aneurysm.  Moderate calcium burden in\nthe abdominal aorta and great abdominal arteries.  Stable calcific\natherosclerotic plaques involving the origin of the SMA and both renal\narteries.\n\nLOWER CHEST: Minimal atelectasis is noted in both lung bases.  Small left\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere are few focal hypoattenuating areas within the liver, the ones along the\nfalciform ligament may represent areas of focal fatty infiltration.  There is\na similar hypoattenuating area within segment 8 measuring approximately 9 mm\n(series 3, image 235), this was not seen on the prior CTs and is too small to\nbe characterized; however, further attention on follow-up is recommended.\n\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder 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\nis no perinephric abnormality.\n\nGASTROINTESTINAL: Partially imaged feeding tube with distal end in the\nproximal stomach.  The small bowel loops demonstrate normal caliber and\nenhancement throughout, there is a focal area of the distal ileum (series 3,\nimage 360) which shows mild-to-moderate mural stratification, new compared to\nthe prior CT.  There is no evidence of bowel obstruction.  There is stable\nmild-to-moderate dilatation of the large bowel loops which are again fluid\nfilled similar to the prior CT.  There are multiple segmental areas of mild\nmural stratification involving the colon which could be nonspecific (for\nexample series 3, image 357). There is no evidence of pneumatosis or\nportovenous gas.  Stable mild ascites.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The urinary bladder is grossly unremarkable and shows a Foley bulb in\nsitu..  There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno 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. \nStable exterior instrumentation hardware involving the lower lumbar spine. \nStable right hip arthroplasty hardware causing surrounding metallic artifact.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No findings to suggest bowel ischemia, no evidence of mechanical bowel\nobstruction.  Stable dilated fluid-filled colon with segmental areas of mild\nmural stratification, which may be nonspecific; however, a mild underlying\ncolitis cannot be excluded especially given history of antibiotic treatment,\nclinical correlate recommended.  Focal segmental wall thickening involving the\ndistal ileum could represent enteritis.\n2. Small hepatic hypodensity in segment 8, although this is too small to be\ncharacterized on this study, this is new compared to the prior CTs and\nattention on follow-up imaging is recommended."
        },
        {
            "input": "LOWER CHEST: Mild dependent atelectasis bilaterally.  No pleural or\npericardial effusion.  The heart is moderately enlarged.  Severe aortic\nvalvular and coronary calcifications.\n\nABDOMEN:\n\nHEPATOBILIARY: Status post cholecystectomy.  Mild intrahepatic biliary\ndilatation.  Linear hypodensities surrounding the bile ducts within the right\nlobe of the liver may represent the sequela of cholangitis, however there are\nno priors for comparison (series 2, image 16).  No extrahepatic biliary\ndilatation.  There is no evidence of enhancing lesions.\n\nPANCREAS: Pancreas is atrophic.  No focal pancreatic lesions.  No ductal\ndilatation.  No peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size 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 hypodensities within kidneys bilaterally, too small to\ncharacterize, but likely represent cysts.  Otherwise, the kidneys are of\nnormal and symmetric size with normal nephrogram.  There is no evidence of\nenhancing renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Large\nperiampullary duodenal diverticulum.  Otherwise, 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: 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.  Heavy atherosclerotic calcifications at the origins of the\nmajor intra-abdominal vessels.\n\nBONES: Patient is status post total right hip arthroplasty with streak\nartifact that limits evaluation in this area.  Severe degenerative changes\nwithin the lumbar spine.  Mild retrolisthesis of L3 on L4 and mild\nanterolisthesis of L4 on L5.  There is no evidence of worrisome osseous\nlesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Mild subcutaneous edema\noverlying the lumbar spine.",
            "output": "1. Mild intrahepatic biliary dilatation.  Linear hypodensities surrounding the\nbile ducts within the right lobe of the liver may represent the sequela of\ncholangitis, however there are no priors for comparison.  No focal fluid\ncollections.\n2. Incidental findings include a large periampullary duodenal diverticulum and\nsevere atherosclerosis."
        },
        {
            "input": "VASCULAR:\n\nThere are multiple areas of ectasia of the distal abdominal aorta without\nfrank aneurysmal dilatation.  There is moderate to severe, mixed calcified and\nnoncalcified, atherosclerotic plaque.  There is at least moderate narrowing of\nthe superior mesenteric axis by noncalcified atherosclerotic plaque (series\n602; image 80).  Celiac and inferior mesenteric axes are patent.\n\nLOWER CHEST: There is linear atelectasis at both lung bases without concerning\nparenchymal opacification.  There is no pleural or pericardial effusions.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions.  There is moderate intrahepatic biliary\ndilatation, of unknown etiology.  The extrahepatic common bile duct is\nenlarged, measuring approximately 1.0 cm in cross-section.  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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is left interpolar renal cortical thinning, suggestive of prior\ninsult.  Multiple bilateral renal hypodensities are too small to characterize.\nThere is no hydronephrosis.  There is no significant perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  There is dilation of the colon throughout its\ncourse with transition point in the sigmoid colon, likely due to underlying\nsoft tissue colonic mass which spans approximately 8.7 cm (series 4; image\n70).  These findings are concerning for large-bowel obstruction.  There is\nsurrounding stranding and colonic wall edema and hyper enhancement consistent\nwith colitis, most notable in the distal descending/sigmoid colon as well as\npossible pneumatosis in the cecum.  Area of irregularity and narrowing in the\ndistal sigmoid colon (series 2; image 134) may represent colocolonic\nintussusception as result of the colonic mass.  Locule of air within the\ndescending colonic wall (series 2; image 63) cannot be seen on additional\nplanes and is concerning for pneumatosis.  There are multiple locules of\nanti-dependent air in the cecum, which are also concerning for pneumatosis.\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 small volume free\nfluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is a 5.7 x 3.7 x 4.9 cm hypodensity in the left\nadnexa, which measures simple fluid in density.  This finding is incompletely\nassessed on this exam.  Uterus appears within normal limits.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are moderate degenerative changes of the visualized lumbar spine, most\nnotable at L5-S1.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Dilation of the colon throughout its course with transition point at a\nlarge 8.7 cm soft tissue mass in the sigmoid colon, highly concerning for\nunderlying colonic neoplasm.  These findings result in mild dilatation of the\nlarge bowel loops concerning for obstruction.  Area of irregularity and\nnarrowing in the distal sigmoid colon may represent a ___\nintussusception as result of the mass.  Fat stranding and colonic wall\nedema/hyperenhancement is consistent with colitis, most notable in the distal\ndescending/sigmoid colon and the cecum.  Distention and locules of anti\ndependent air in the cecum are concerning for pneumatosis.  There is no frank\nfree intraperitoneal air.\n2. 5.7 x 3.7 x 4.9 cm hypodensity in the left adnexa measures simple fluid in\ndensity.  This finding is incompletely assessed on this exam, however does\nappear to abut the colonic mass.\n3. Moderate intra and extrahepatic biliary dilatation of indeterminate\netiology.  No definite obstructive lesion is identified on CT.\n4. Moderate to severe atherosclerotic disease with ectasia of the distal\nabdominal aorta.  There is at least moderate narrowing of the superior\nmesenteric axis.  Celiac and inferior mesenteric axes are patent.\n\nNOTIFICATION:  The findings were discussed with ACS B resident, by ___\n___, M.D. after attending review on the telephone on ___ at 9:11 am,\n5 minutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Trace bilateral right greater than left pleural effusions with\natelectasis of the dependent lung bases bilaterally, with patchy airspace\nopacity in the RLL that may represent superimposed infection/aspiration. \nPacemaker wires are visualized within the right ventricle and right atrium. \nTri truncal coronary arterial calcifications.  Interventricular septum\nspontaneously ___ be seen with anemic states.\n\nABDOMEN: Lack of intravenous and oral contrast limits assessment of the solid\nabdominal organs and viscera.\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.  Probable hepatic arterial\ncalcifications.  There is trace ascites within the mesentery with omental\nstranding.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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\nhemorrhagic cyst is noted within the midpole of the left kidney.  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.  Patient is status post\nsubtotal colectomy and proctectomy, bowel anastomosis in the Left pelvis, and\ndiverting ileostomy in the right lower quadrant.  No evidence of bowel\nobstruction.\n\nPELVIS: An inflated Foley catheter bulb is noted within the urinary bladder. \nThe distal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Few prominent gastrohepatic lymph nodes, none enlarged by size\ncriteria..\n\nVASCULAR: Ectatic abdominal aorta, extensive atherosclerotic disease is noted.\n\nBONES: Demineralization, interim avulsion fracture of the Right greater\ntrochanter, may not be acute given the lack of surrounding soft tissue\nchanges, and fatty atrophy of the gluteus medius.\n\nSOFT TISSUES: Midline abdominal wall incision site noted.",
            "output": "Limited assessment due the lack of contrast.\n\n\n1. Post subtotal colectomy and proctectomy, with right lower quadrant\ndiverting ileostomy with a small amount of ascites.  No acute intra-abdominal\nprocess.\n2. Small bilateral pleural effusion, with bibasal atelectasis and superimposed\naspiration/pneumonia in the RLL."
        },
        {
            "input": "LOWER CHEST: Micronodularity within the lower lobes appears to be in a\n___ distribution suggestive of small airways disease.  No focal\nconsolidation.  Diffuse coronary artery calcifications are present and the\nheart size is normal.  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.  Coarse calcification in the liver dome likely reflects the hila of\nprior granulomas disease.  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.  Punctate calcifications in the spleen are\ncompatible the sequela prior granulomatous disease.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are atrophic bilaterally.  Simple cyst is seen exophytic\nfrom the lower pole of the left kidney.  There is no evidence of concerning\nfocal renal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  No definite nephrolithiasis with calcifications noted in the\nupper lower pole the right kidney thought to reflect vascular calcifications. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: Small hiatal hernia.  The stomach is unremarkable.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout.  The rectum is massively distended by a large stool ball with\nresultant circumferential wall thickening and adjacent fat stranding\ncompatible with stercoral proctitis.  Remainder of the colon demonstrates\nmoderate fecal loading without evidence for wall thickening.  Appendix is\nnormal.\n\nPELVIS: The urinary bladder is distended but otherwise unremarkable.  Distal\nureters are within normal limits.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: Mild haziness of the mesenteric fat is nonspecific, and may\nsuggest mesenteric panniculitis.  There is no retroperitoneal or mesenteric\nlymphadenopathy.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Large stool ball in the rectum causing massive rectal distension with\nimaging findings concerning for stercoral proctitis.  Disimpaction is\nrecommended.\n2. Moderate amount of fecal loading throughout the remainder of the colon.\n3. Findings concerning for small airways disease within the lung bases,\npotentially secondary to aspiration given the presence of a small hiatal\nhernia.\n4. Nonspecific haziness of the mesenteric fat, can be seen with mesenteric\npanniculitis.\n5. Extensive atherosclerotic calcifications and coronary artery\ncalcifications."
        },
        {
            "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 on\ncontrast scan (normal >100HU) evidence of steatosis:  70 ___ on non-contrast\nscan (normal 60-70 ___ is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.\nThe gallbladder is surgically absent.\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.  Several stones are seen in the\nlower pole of the right kidney, with no interval change since the previous\nPET-CT of ___.  No cyst or solid mass seen.\nThere is no perinephric abnormality.\nGASTROINTESTINAL:\nThe stomach is not distended.  There is no abnormality in the duodenum.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..\nAppendix is not visualized.\nRETROPERITONEUM & 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 minimal calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nReproductive ___ are normal\n\nSKELETAL:\nNo worrisome for metastasis bony lytic or blastic lesions",
            "output": "1. Multiple renal stones in the lower pole of the right kidney\n2. Considering the limitations of noncontrast scans and low-dose technique\nthere are no other abnormalities in the abdomen 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:\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 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 up to 19.6 cm, unchanged compared to ___.  No splenic lesions are identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Kidneys are symmetrically atrophic, unchanged compared to prior exam.\nNo evidence of focal renal lesions 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.\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: Borderline right porta hepatic lymph node measures up to 1.0 cm\nin short axis, unchanged compared to ___ (3:63).  No other enlarged\nretroperitoneal or mesenteric lymph nodes are identified.  There is no pelvic\nor inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.  Soft tissue attenuation, likely fibrosis, surrounding the\nright internal iliac artery appears similar to ___ (3:114).\n\nBONES: Again demonstrated is cortical erosion and sclerosis involving the\nright pubic symphysis and right inferior pubic ramus measuring up to 1.8 cm,\nunchanged compared to ___ (3:126).  No new suspicious osseous lesions\nare identified.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  Soft tissue\ndensities overlying the anterior abdominal wall are unchanged compared to\nmultiple prior examinations (3:103).",
            "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Stable cortical erosion and sclerosis involving the right pubic symphysis\nand right inferior pubic ramus compared to ___.  No new suspicious\nosseous lesions are identified.\n3. Stable splenomegaly.\n4. Cholelithiasis.\n5. Please refer to separately reported CT chest performed concurrently for\ndescription"
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 is status post partial left nephrectomy, with expected\npostsurgical changes.  There is no evidence of disease recurrence along the\nsurgical margin.  No perinephric stranding.  No concerning mass lesions are\nseen within either kidney.  No evidence of stones or hydronephrosis. \nIncidental note is made of a right-sided extrarenal pelvis.  The ureters are\nnormal in caliber along their visualized course to the bladder.\n\nGASTROINTESTINAL: The stomach 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 thickening of the endometrium.  The right ovary\nappears enlarged (4:67), due to the presence of a dominant, probably\nhemorrhagic (48HU), cyst.  The left ovary is normal in appearance.\n\nLYMPH NODES: Numerous small retroperitoneal lymph nodes are present.  There is\nno mesenteric, 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 intramuscular lipoma within the proximal\nquadriceps muscle wad on the left, which is incompletely imaged.  There is a\nsmall umbilical hernia containing omental fat.",
            "output": "1. Status post partial left nephrectomy, with expected postoperative changes. \nNo evidence of disease recurrence along the surgical margin.  No evidence of\nmetastatic disease within the abdomen or pelvis.\n2. Multiple prominent retroperitoneal lymph nodes, for which attention on\nfollow-up is recommended.\n3. Thickened endometrium, likely due to timing of the menstrual cycle.\n\nRECOMMENDATION(S):\nMultiple prominent retroperitoneal lymph nodes, for which attention on\nfollow-up is recommended."
        },
        {
            "input": "CHEST:   Left breast lesion is not fully included in CT abdomen. Interval\nincrease lung base nodule since ___, for example postero-basilar\nsegment nodules is 8 mm was 4 mm; second adjacent nodule is 9 mm was 6 mm\n(04:43).  Please refer to concurrent chest CT for further description of\nthoracic findings.\n\nABDOMEN:  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 within normal limits,\nwithout stones or gallbladder wall thickening.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation. The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. The adrenals glands\nare unremarkable bilaterally.\n\nThe kidneys are of normal and symmetric size with normal nephrogram. There is\nno evidence of stones, focal renal lesions or hydronephrosis.  There is food\ngastric distention. Small and large bowels are unremarkable, except for\nmoderate colon fecal load. There is no evidence of retroperitoneal and\nmesenteric lymphadenopathy.\n\nPELVIS:  The urinary bladder is almost empty, but normal. Distal ureters are\nunremarkable. There is no evidence of pelvic or inguinal lymphadenopathy.\nUterus and adnexa are unremarkable, apart from an IUD.  There is no free fluid\nor air in the abdomen.\n\nBONES AND SOFT TISSUES:  There are no bone lesions suspicious for malignancy\nor infection. Anasarca.",
            "output": "1. No definitive evidence of intra-abdominal metastasis in patient with known\nleft breast lesion.\n2. Interval increase of the lung bases nodule since ___, please refer\nto concurrent CT chest for detailed description of thoracic findings"
        },
        {
            "input": "CHEST:\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings including left breast lesions and\npulmonary nodules.\n\nABDOMEN:\n\nThe liver enhances homogeneously without focal lesion or intrahepatic biliary\ndilatation. The gallbladder is unremarkable and the portal vein is patent. The\npancreas, spleen and adrenal glands are unremarkable. The kidneys present\nsymmetric nephrograms and excretion of contrast with no focal lesions, stones\nor hydronephrosis.\n\nThe stomach remains very distended.  The small and large bowel are normal in\ncaliber without evidence of obstruction.  There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. No ascites, free air or\nabdominal hernia.\n\nPELVIS:\n\nThe urinary bladder is unremarkable.  There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nBONES AND SOFT TISSUES:\n\nNo lytic or sclerotic lesion suspicious for malignancy is present in the\nabdomen or pelvis.  Diffuse body wall edema is again noted.",
            "output": "1. No definite evidence of intra-abdominal metastasis\n2. For details regarding the chest including pulmonary nodules and left breast\nlesions please see dedicated chest CT report"
        },
        {
            "input": "CHEST:\n\nThere is a small left pleural effusion with associated atelectasis. Extensive\npulmonary metastases in the lung bases have dramatically increased in size and\nnumber compared to the prior study.  There is a new moderate pericardial\neffusion.\n\nABDOMEN:\n\nEvaluation of the intra-abdominal soft tissues limited by lack of\nintra-abdominal fat. There are numerous new hypodensities within the liver\nconcerning for metastases, the largest of which in segment 6 of the liver\nmeasures approximately 3.1 x 3.9 cm.  The gallbladder is unremarkable and the\nportal vein is patent. The pancreas, spleen and adrenal glands are\nunremarkable. The kidneys present symmetric nephrograms and excretion of\ncontrast with no focal lesions, stones or hydronephrosis.\n\nThe small and large bowel are normal in caliber without evidence of\nobstruction.  There is no retroperitoneal or mesenteric lymphadenopathy by CT\nsize criteria. No ascites, free air or abdominal hernia.\n\nPELVIS:\n\nThe urinary bladder is unremarkable. There is no evidence of pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.  An\nintrauterine device seen within the uterus.\n\nBONES AND SOFT TISSUES:\n\nLytic lesion in the sternum appears larger than prior.   No evidence of lytic\nor sclerotic lesions in the pelvis. Masses in the left breast have increased\nin size compared to the prior study.",
            "output": "1. Increase in size and number of innumerable pulmonary metastases visualized\nin the lung bases.\n2. New moderate pericardial effusion\n3. Increase in size of left breast masses.\n4. New numerous liver metastases.\n5. No definite metastases identified in the pelvis to explain symptoms.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 9:07 ___"
        },
        {
            "input": "LUNG BASES:  A calcific density at the left lung base is likely a calcified\ngranuloma.  Otherwise, streaky opacities in the dependent portions of the lung\nbases is likely reflective of subsegmental atelectasis.  Otherwise, the lung\nbases are clear.  There is no pleural or pericardial effusion.  There is no\nhiatal hernia.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence focal lesion.  Mild\ndominance of the extrahepatic bile ducts is within post cholecystectomy\nlimits.  The portal vein is patent.  Coarse calcifications in the spleen\nlikely reflect sequela of prior granulomatous disease.  Otherwise, the spleen\nis unremarkable without evidence of splenomegaly.  The adrenal glands are\nnormal bilaterally.  The pancreas enhances homogeneously.  There is no\nperipancreatic stranding or ductal dilation.  A linear, 5 mm area of\nhypodensity along the medial left renal cortex is generally unchanged since\n___, too small to characterize.  Smaller bilateral vague renal\ncortical hypodensities are too small to characterize.  Otherwise, there is\nnormal symmetric renal enhancement.  There is no hydronephrosis.\n\nThe stomach and duodenum are unremarkable.  Nondilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening or\nobstruction.  The colon is unremarkable.  The appendix is not directly\nvisualized, however there are no secondary signs of appendicitis.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm are\ndilated.  There is mild calcification scattered throughout the abdominal\naorta.  Major proximal tributaries are patent.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy by CT size criteria.\nThere is no free intraperitoneal air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs including the bladder and terminal ureters, are\nunremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nThere is diffuse osteopenia. There is mild degenerative change of the imaged\nthoracolumbar spine.  There is grade 1 L5-S1 anterolisthesis, new since ___,\nbut likely degenerative.  There is no evidence of concerning focal lytic or\nsclerotic osseous lesion.",
            "output": "1. No evidence of intra-abdominal or intrapelvic malignancy or other\nabnormality correlating to reported history of lower abdominal pain and early\nsatiety.\n2. Chronic findings including osteopenia, thoracolumbar spine degenerative\nchange, and coarse calcifications in the spleen likely reflective of prior\ngranulomatous infection."
        },
        {
            "input": "HEPATOBILIARY:  There is increased intrahepatic biliary dilatation with\nmassively increased extrahepatic biliary dilatation up to 2.3 cm, which\nabruptly ends in the pancreatic head.  No soft tissue mass is definitively\nidentified.  A PTC is essentially unchanged in position, coiled in the second\nand third portions of the duodenum.  Some apparent fat stranding of the\nperihepatic fat adjacent to the anterolateral edge of the liver is\nnonspecific, but could conceivably represent peritoneal malignant disease. \nThere is unchanged hyperemia adjacent to the PTC where it enters the liver\nwith a small amount of adjacent fluid.  The liver otherwise demonstrates\nhomogenous attenuation throughout without focal lesions. The gallbladder is\ncontains stones, without evidence of gallbladder wall thickening or\npericholecystic fluid.\n\nPANCREAS:  There is unchanged, massive pancreatic ductal dilation up to 2.9 cm\nbeginning in the pancreatic head.  No soft tissue mass is definitively\nidentified.  There are numerous calcifications in the atrophic pancreatic\nparenchyma reflecting chronic pancreatitis in addition to rounded\ncalcifications within the massively dilated pancreatic duct which likely\nreflect stones.\n\nVASCULAR:\n\nThe celiac trunk trifurcates into the right hepatic, left hepatic, and splenic\narteries, none of which pass within close proximity to the abrupt cut off of\nthe common bile and pancreatic ducts.  The SMA, hepatic portal vein, and\nsplenic vein similarly do not pass within close proximity to the abrupt cut\noff of the common bile and pancreatic ducts.  The first branch of the SMV\nappears chronically occluded without an adjacent mass or soft tissue invasion,\nlikely sequela of chronic pancreatitis. There is no abdominal aortic aneurysm.\nThere is no calcium burden in the abdominal aorta and great abdominal\narteries.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 has normal caliber without fat stranding. 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\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThe medial portion the right L3 transverse process is absent, possibly from\nprior trauma.  There is no bony or soft tissue mass.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No soft tissue mass is definitively identified. However, there is increased\nintrahepatic and extrahepatic biliary dilatation with persistent massive\npancreatic ductal dilatation as described above.  Celiac trunk and SMA\nbranches and the hepatic portal and splenic veins are widely patent as\ndescribed above.\n2. Apparent stranding of the perihepatic fat adjacent to the anterolateral\nedge the liver is nonspecific, but could conceivably represent peritoneal\ndisease.\n3. Pancreatic calcifications and SMV branch occlusion are likely sequela of\nchronic pancreatitis.\n4. Cholelithiasis without cholecystitis."
        },
        {
            "input": "VASCULAR:\n\nThere is an accessory left hepatic artery the celiac axis, SMA, ___ are\npatent.  Bilateral renal arteries are patent.  The aorta is normal in caliber\nwithout aneurysmal dilatation, dissection, or intramural hematoma.  Mild\natherosclerotic disease is noted within the abdominal aorta and great\nabdominal arteries.  Patent hepatic veins.  The right posterior, right\nanterior and left portal veins are patent.  Possible thrombosis of a segmental\nright anterior portal vein and segmental left portal vein branch with\nassociated perfusion abnormalities of the liver.  The SMV and splenic vein are\npatent.\n\nLOWER CHEST: Limited assessment of the lung bases demonstrates minimal left\nlower lobe atelectasis.  The heart is normal in size.  No pericardial or\npleural effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Again seen is ill-defined slightly atrophic hypodensity\nspanning an area of 6.1 x 2.8 cm in the right hepatic lobe which has slightly\nincreased in distribution since prior examination and may be related to\nsegmental portal vein thrombosis.  Pneumobilia primarily within the left\nhepatic lobe is unchanged since prior examination.  There is progression of an\nill-defined hypodensity within segment 4 a (04:18) with associated atrophy. \nNo evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is decompressed.\n\nPANCREAS: Patient is status post Whipple procedure.  There are coarse\ncalcifications within the remaining portion of the pancreas as demonstrated\npreviously.  No pancreatic ductal dilatation.  Again seen is hazy density in\nthe fat surrounding the pancreas.  Multiple peripancreatic fluid collections\nare again noted.  There is a 2 x 1.9 cm (04:43) peripherally enhancing\ncollection anterior to the body of the pancreas which has increased in size\n(previously 1.6 x 0.9 cm) and demonstrates internal locules of gas. \nSuperiorly is an additional 4.6 x 4.9 cm (04:29) (previously 5 x 4.8 cm)\nperipherally enhancing irregular collection with locules of gas which is\nstable if not mildly decreased in size.  There is an additional ring-enhancing\ncollection anterior to the third portion of the duodenum measuring 1.9 x 1.8\ncm (04:55) (previously 2.1 x 1.8 cm) which is unchanged in size given\ndifferences in slice selection.  There is a fiducial marker within the\nuncinate process with a second fiducial within the pancreatic head/body,\nunchanged in location since 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 0.7 cm right upper pole renal hypodensity is stable and too small to\ncharacterize.  There is no evidence of stones, worrisome renal lesions, or\nhydronephrosis.  Mild prominence of the left ureter is stable since ___\nand likely within normal limits.  There are no urothelial lesions in the\nkidneys or ureters. There is no perinephric abnormality.  A persistent linear\nradiopacity adjacent to the right collecting system (4:60) may represent a\nCyberKnife fiducial.\n\nGASTROINTESTINAL:  Status post Whipple procedure with intact anastomosis.  No\nevidence of obstruction.  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 no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS:  Limited evaluation due to beam hardening artifact from right total\nhip replacement.  The visualized urinary bladder and distal left ureter are\nunremarkable.  The distal right ureter is not visualized due to beam hardening\nartifact.  There is no evidence of left pelvic or bilateral inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and adnexa are not visualized.\n\nBONES:  Subacute right lateral eleventh rib fracture again noted.  There is no\nevidence of worrisome osseous lesions or acute fracture.  Moderate\ndegenerative changes of the thoracolumbar spine are noted with anterior\nosteophytes, endplate sclerosis and disc space narrowing.\n\nSOFT TISSUES:  Small fat containing ventral hernia is again noted (4:78).  \nThe abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. Status post Whipple procedure with multiple peripancreatic fluid\ncollections as described above, many of which contain locules of gas and are\nslightly increased in size.  Differential includes walled off necrosis however\nsuperimposed infection cannot be excluded. Assessment for superimposed\nmalignancy is difficult extensive laboratory response.\n2. Interval progression of ill defined slightly atrophic right and left\nhepatic lobe hypodensities may be related to segmental portal vein thrombosis\nhowever a developing hepatic abscess would be similar in appearance.\n\nRECOMMENDATION(S):  Clinical correlation for infection is recommended.  If no\nconcern for infection recommend short interval followup CT in 3 months to\nassess for interval change of above described peripancreatic collections and\nirregular hepatic hypodensities.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:33 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider after\npaging was unsuccessful."
        },
        {
            "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 interval development of multiple irregular hypodense lesions concerning for\nmetastases throughout the the liver, primarily in the right lobe. In segment\n___, the largest lesion measures 1.4 x 2.6 x 2.2 cm (3; 134). In segment ___\nthere are also three smaller nearly confluent hypodense lesions measuring\n1.3-1.6 cm (3; 133).   In segment ___, the two largest lesions measure 2.6 x\n1.5 x 2.1 cm (3; 51) and 2.6 x 1.4 x 2.7 cm (3; 142); 2 smaller lesions\nmeasure 1.4 cm (3; 145) and 1.1 cm (3; 140).  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  Pneumobilia in the left\nhepatic lobe is unchanged.  The gallbladder is is not visualized and patient\nhas history of hepaticojejunostomy.\n\nAgain, there is an accessory left hepatic artery arising from the left\ngastric.  The celiac axis, SMA, ___, and bilateral renal arteries are patent. \nHepatic veins are also patent.  The left and right portal veins as well as the\nmain portal vein, SMV, and splenic vein are patent .\n\nPANCREAS:  Patient is status post aborted Whipple with preserved duodenum and\npancreatic head.  There are coarse calcifications throughout the pancreas\nconsistent with chronic pancreatitis, similar to ___.  There is\nincreased pancreatic ductal dilation in the pancreatic body/tail up to 0.3 cm\n(3; 135), which has increased since ___ with a stone is noted in\npancreatic duct. The 2 small pancreatic pseudocysts previously seen in ___ are no longer visualized. Peripancreatic stranding is primarily noted\nadjacent to the pancreatic head and uncinate process.   Fiducial markers in\nthe uncinate process and in the pancreatic head/body are 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.\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.  Radiopaque density likely a fiducial marker seen anterior to the\nright kidney (3; 168) is unchanged since ___.\n\nGASTROINTESTINAL: Hepaticojejunostomy and gastrojejunostomy are again\nvisualized.  Small bowel loops demonstrate normal caliber, wall thickness and\nenhancement throughout. Colon and rectum are within normal limits.  Appendix\ncontains air, has normal caliber without evidence of fat stranding. Prominent\nmesenteric lymph nodes measuring up to 0.7 cm in short axis (601 B; 51) do not\nmeet CT size criteria for pathologically enlarged lymph nodes.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nPeriaortic and aortocaval lymph nodes measuring up to 0.6 cm in short axis are\nnot pathologically enlarged (601 B; 58).\n\nPELVIS:  Limited evaluation of the pelvis from metallic artifact from right\nhip prosthesis.  The urinary bladder is unremarkable.  Mild prominence of the\nleft ureter is unchanged since ___.  There is no evidence of pelvic or\ninguinal lymphadenopathy. There is no free fluid in the pelvis.\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. \nDegenerative changes in the lumbar spine is most severe in L4-L5 and L5-S1. \nRight hip prosthesis.\n\nSOFT TISSUES: Small umbilical hernia containing wall of large bowel (3; 185)\nwithout evidence of obstruction.  There is diastasis recti superior to the\nlevel of the umbilicus.",
            "output": "1. Interval development of multiple hepatic lesions concerning for metastases\nmeasuring up to 2.7 cm.\n2. Slight increase in pancreatic duct dilation up to 0.3 cm in the body/tail\nwith a stone noted within the duct.\n3. Interval resolution of the two previously seen pancreatic pseudocysts.\n4. Small umbilical hernia containing large bowel without evidence of\nobstruction."
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  The abdominal aorta and its major\nbranches are patent.  A pseudoaneurysm arising from the left superficial\nfemoral artery is noted just inferior to the bifurcation of the left common\nfemoral artery.  The pseudoaneurysm neck measures approximately 5 mm (series\n4a:image 80), and the pseudoaneurysm is lobulated, irregular and measures at\nleast 2.1 x 2.8 cm.  A small groin hematoma is noted just medial to the\npseudoaneurysm.  Increased density of the hematoma on delayed imaging is\nconcerning for active bleeding.  The stent is noted within the distal right\nsuperficial femoral artery, which is patent.\n\nOn delayed phase imaging, the right femoral veins are well opacified and\npatent.\n\nABDOMEN:\n\nGASTROINTESTINAL:\nThe visualized small bowel loops are normal in caliber without wall thickening\nor obstruction.  The appendix is normal.  Colonic diverticulosis is noted\nwithout evidence of diverticulitis.  No intra-abdominal free air free fluid is\nseen There is no evidence of mesenteric lymphadenopathy.\n\nThe visualized aspects of the kidney, liver and pancreas are within normal\nlimits.\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 normal in size.\n\nBONES AND SOFT TISSUES:There is no evidence of worrisome lesions.",
            "output": "1. Irregular and lobulated pseudoaneurysm arising from the left superficial\nfemoral artery as described above just distal to the common femoral artery\nbifurcation.  Adjacent small medial hematoma noted in the groin consistent\nwith active bleeding.\n2. Asymmetric non-opacification of the left femoral vein on delayed imaging\ndue to edema and the a left groin and partial compression.  No evidence for\nthrombosis.\n\nNOTIFICATION:  The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 8:10 ___, 5 minutes after discovery of the\nfindings."
        },
        {
            "input": "LOWER ABDOMEN:  The visualized lower abdominal organs are unremarkable.\n\nPELVIS:  The left groin hematoma measures 5.7 x 5.0 x 9.3 cm (previously 2.8 x\n2.1 cm).  The hematoma that extends superiorly through the subcutaneous\ntissues to a greater extent than seen on prior exam.  No site of active\nextravasation is seen. No adjacent fat stranding is seen to suggest infection,\nbut cannot completely exclude superinfection biopsy.\n\nThe urinary bladder and distal ureters are unremarkable. There is no evidence\nof pelvic or inguinal lymphadenopathy. There is trace 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.",
            "output": "Interval increase in size left groin hematoma, which now measures 5.7 x 5.0 x\n9.3 cm and extends superiorly through the subcutaneous tissues to a greater\nextent than seen on prior exam.  No site of active extravasation is seen. No\nadjacent fat stranding is seen to suggest infection, but cannot completely\nexclude superinfection by imaging."
        },
        {
            "input": "Please refer to separate chest CT report for thoracic details.\n\nStudy is limited by lack of IV contrast.\n\nPatient is post resection of high-grade right retroperitoneal liposarcoma\nincluding partial hepatectomy, cholecystectomy, right nephrectomy and\nadrenalectomy. A small amount of fluid is noted within the right pericolic\ngutter. Remaining liver parenchyma is grossly unremarkable with surgical clips\nand fiducial markers along the resection margin. The patient's anatomy appears\nreoriented compared to prior exam secondary to lack of mass effect from the\nlarge right retroperitoneal mass. Soft tissue density anterior to the second\nduodenal segment is presumed to be solely pancreatic head and uncinate, or is\nlimited by the lack of IV contrast. No obvious pancreatic or peripancreatic\nmass. Normal appearance of the spleen, left adrenal. No nephrolithiasis or\nhydronephrosis of the left kidney. Multiple renal cysts are again\ndemonstrated.\n\nContrast within stomach. The second portion of the duodenum demonstrates\nsignificant mural thickening. Medially projecting second segment duodenal\ndiverticulum is noted. A markedly redundant sigmoid colon is demonstrated. No\ndiscrete colonic wall thickening. Aside from the duodenum, no other thickening\nof small bowel loops is noted is.\n\nMarked atherosclerosis of normal caliber abdominal aorta. Marked\natherosclerosis of iliac and common femoral arteries. The stranding is\ndemonstrated adjacent to the celiac artery and IVC, anterior to the descending\nduodenum. No obvious nodularity is demonstrated within this region. Stranding\nof the omentum is noted.\n\nDecompressed bladder. Small amount of free pelvic fluid in pelvic stranding is\nnoted. Indirect fat containing right inguinal hernia. Post prostatectomy.\n\nDegenerative changes of the spine. T12 superior endplate compression fracture\nis similar to prior.",
            "output": "-Study is limited by lack of IV contrast.\n-Thickening of the second duodenal segment. This may represent postoperative\nor post treatment change, however duodenitis should be considered.\n-Small amount of fluid within the right pericolic gutter. Stranding adjacent\nto the celiac artery and mid IVC, in addition to mild diffuse omental\nstranding and small amount of ascites. While these may represent\npostoperative/ posttreatment changes, attention on followup is warranted.\n-Soft tissue anterior to the second duodenal segment is presumed to be\nentirely pancreatic head and uncinate, however is limited due to lack of IV\ncontrast.\n-Marked atherosclerosis of abdominal aorta."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  Atelectasis is present at the\nlung bases.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  A\n2.1 x 1.6 cm hypoattenuating lesion in segment 4A as well as a smaller one at\nthe dome are incompletely characterized.  There is no evidence of 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.  There is no suspicious\nrenal 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 throughout.  Faint mesenteric fat stranding of jejunal loops in\nthe left mid abdomen with possible wall thickening (series 601:27) raises the\npossibility of enteritis.  There is a trace  amount of fluid versus fascial\nthickening in the right lower quadrant adjacent to the ileum, which itself\nappears without wall thickening.  The appendix appears normal.  Diverticulosis\nof the sigmoid colon is noted, without evidence of wall thickening or fat\nstranding.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Penile prosthesis with left pelvis reservoir appears\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.\nTransitional vertebrae is noted at the lumbosacral junction.\n\nSOFT TISSUES: There is an umbilical hernia containing fat and partially\ncontaining a non-dilated loop of bowel.",
            "output": "1. Long segment mild concentric wall thickening of jejunal loops associated\nwith mild mesenteric fat stranding in the left mid abdomen (series 601:27)\nraises the possibility of enteritis, either infectious or inflammatory, less\nlikely ischemic given the absence of significant atherosclerotic disease.  No\nintra-abdominal or pelvic fluid collections, pneumatosis or free\nintraperitoneal air noted.  Normal appendix.\n2. Sigmoid diverticulosis without evidence of acute diverticulitis.\n3. Hypoattenuating hepatic lesions are incompletely characterized.  In the\nabsence of malignancy, follow up liver ultrasound is recommended.  If there is\na history of malignancy, MRI liver is recommended.\n\nRECOMMENDATION(S):  If no history of malignancy, follow up liver ultrasound\nfor better characterization of multiple hypoattenuating lesions.  If there is\na history of malignancy, recommend follow-up with liver MRI.\n\nNOTIFICATION:  The updated recommendations were emailed to the ED QA nurses by\n___ MD at ___ 09:12."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Left hepatic hypodensities, largest measuring 1.4 cm are\nlargely unchanged from prior, likely represent cysts or biliary hamartomas\n(series 2, image 12).  Otherwise, the liver demonstrates homogenous\nattenuation throughout.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  There is a small stone near the neck of the gallbladder. \nThere is no gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: There is mild diffuse atrophy of the pancreas.  There is\nheterogeneous attenuation of the pancreatic head and peripancreatic stranding,\ncompatible with acute interstitial edematous pancreatitis.  There is no\nevidence of pancreatic necrosis.  There is also stranding around the second\nand third segments of the duodenum, which demonstrates mucosal hyperemia,\nlikely reactive inflammation.  There is no focal fluid collection.  There is\nno main 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: There is cortical thinning/scarring of the upper pole of the right\nkidney.  The kidneys otherwise demonstrate normal nephrograms.  There is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Other than inflammatory\nchanges of the duodenum described above, small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. 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 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: Multilevel degenerative changes of the thoracolumbar spine.  There is\ndepression of the superior endplates of L1, L2 and L3.  There is no evidence\nof worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postoperative changes are noted in the subcutaneous tissues of\nthe mid anterior abdominal wall.",
            "output": "-Acute interstitial edematous pancreatitis, without focal fluid collection.\n-Cholelithiasis without evidence of cholecystitis."
        },
        {
            "input": "Findings are limited by the lack of IV contrast.\n\nLower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nPeritoneal Cavity: There is no free air, free fluid or focal fluid collection.\n\nLiver: There is a 1.4 cm hypodense lesion in segment II that is not well\ncharacterized without contrast but likely represents a cyst ( ___:13 ).\n\nGallbladder and Biliary System: The gallbladder is not distended and there are\nno calcified gallstones.There is no significant intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The left kidney has been removed with surgical clips in\nthe left renal fossa (___:26 ).  On the right, there is marked hydronephrosis\nand hydroureter extending to the level of the ureterovesical junction. There\nis fat stranding within the perinephric fat that was not present on the recent\nMRI (03:25, 03:40). There is no obvious obstructing mass lesion or stone.The\nadrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are grossly normal with no\nevidence of bowel obstruction.\n\nPelvis:  The urinary bladder demonstrates diffuse wall thickening with\nadjacent perivesical fat stranding. Anteriorly, there is tethering and a soft\ntissue nodule that measures approximately 2.0 cm,  grossly stable compared to\nthe MRI, allowing for differences in technique and measurement. The uterus and\novaries are unremarkable with no adnexal mass.\n\nLymph Nodes: There are multiple prominent retroperitoneal lymph nodes\nmeasuring 11 mm a retrocaval location (03:24 ) and 10 mm in the paraaortic\nregion (03:36), which appear increased in size and are likely reactive.\n\nThere is atheromatous calcification involving the abdominal aorta with no\naneurysm.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1.  Right perinephric fat stranding is new since the MR examination from ___ and may reflect pyelonephritis. Multiple adjacent enlarged\nretroperitoneal lymph nodes are likely reactive.\n2.  Severe right hydronephrosis and hydroureter extending to the\nureterovesical junction is unchanged since the previous MRI, with no stone or\nobvious obstructing mass.\n3.  Diffuse mild bladder wall thickening with a stable known anterior wall\nmass.\n4."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 right peripheral stable hypodensity too small to characterize\n(02:14).  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 are stable bilateral cortical hypodensities representing simple cysts. \nOtherwise, there is no evidence of focal renal lesions or 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 colon is noted, without evidence of wall thickening and\nfat stranding. The appendix is normal (601:18).\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 a right hip arthroplasty.  There is no evidence of worrisome\nosseous lesions or acute fracture. Stable multilevel degenerative changes of\nthe visualized thoracolumbar spine are noted, including mild anterolisthesis\nof L3 on L4 and L4 and L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1.   No evidence of acute abdominopelvic process.\n2. Diverticulosis without evidence of acute diverticulitis.\n3. Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrates mild bibasilar atelectasis. \nThere is no evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is minimal periportal edema.  There is a stable 1.3 x 3.2 cm hypodense\nlesion in segment II (601; 22), stable since ___.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.\n\nPANCREAS: There is incidental note of pancreas divisum.  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.  There is a\n0.8 cm hypodense lesion in the splenic hilum, similar to prior, statistically\nlikely a hemangioma or 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 are redemonstration of bilateral renal cysts measuring up to 2.7 cm in\nthe right upper pole (601; 31) and measuring up to 1.2 cm in the left lower\npole, similar to prior.  Additional subcentimeter hypodensities in bilateral\nkidneys are too small to characterize but likely represents renal cysts. \nThere is no evidence of solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Moderate hiatal hernia with stable mild wall thickening of\nthe gastroesophageal junction.  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. The\nappendix is normal.\n\nPELVIS: Evaluation of the pelvis limited by streak artifact from right hip\nhardware.  The urinary bladder and distal ureters are unremarkable.  There is\nno 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: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right hip arthroplasty.  There is stable grade 1\nanterolisthesis of L3 on L4 and L4 on L5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nInjection granuloma is incidentally noted in the right buttock subcutaneous\ntissues.",
            "output": "1. No acute intra-abdominal process to explain patient's abdominal pain.\n2. Moderate hiatal hernia.\n3. Diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "Mild bibasilar atelectasis. Retained contrast within the intrathoracic stomach\nwith organoaxial gastric volvulus is again demonstrated. Tiny peripheral\nhepatic hypodensity within segment 8 is demonstrated, similar to prior, too\nsmall characterize, possible cyst. Decompressed gallbladder. Patent portal\nveins. Unremarkable pancreas without pain ductal dilatation.\n\nNormal spleen and adrenals. Upper pole and lower pole right renal cysts\nappears similar. Other subcentimeter scattered bilateral renal hypodensities\nare too small characterize, possible cysts.\n\nModerate colonic diverticulosis. Normal TI. No small bowel dilatation.\n\nModerate atherosclerosis of normal caliber abdominal aorta. No retroperitoneal\nor mesenteric adenopathy.\n\nRight total hip arthroplasty and cerclage wire results in beam hardening and\nstreak artifact, obscuring the pelvis. No appreciable free pelvic fluid.\nAbsent uterus.\n\nOsteitis pubis. Degenerative changes of the left hip joint with significant\nthinning of the medial bony acetabulum with overlying intact cortex.\nDegenerative changes of the spine. Grade 1 anterolisthesis of L4 on L5.",
            "output": "-No abdominopelvic lymphadenopathy.\n-Intrathoracic stomach with organoaxial gastric volvulus is again\ndemonstrated.\n- Other findings as detailed above."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. Patient is status post infrarenal aorto\nbifemoral bypass grafting.  At this level the native aorta is nearly entirely\noccluded.\n\nThere is an extensive amount of both calcified and noncalcified\natherosclerotic plaque throughout the visualized abdominal aorta.\n\nThe origin of the celiac trunk is markedly attenuated secondary to both\ncalcified and noncalcified atherosclerotic plaque.  Just distal to the origin\nthere is a 6 mm segment of near complete occlusion of the celiac trunk prior\nto the branch point (3:69, 602:77).\n\nThere is severe calcified atherosclerotic plaque at the origin of the SMA. \nJust distal to the origin there is a filling defect which extends\napproximately to the level of the first branch points where only trace flow is\nseen distally (3:77-90, 602:76).  There is no appreciable stranding\nsurrounding this thrombus.\n\nOrigins of the renal arteries are markedly attenuated bilaterally but appear\npatent.\n\nThe ___ appears patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating raising suspicion for\nhepatic steatosis.  There is no evidence of suspicious focal lesions. \nScattered transient hepatic attenuation differences are noted. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\ncontains stones, without evidence of gallbladder wall thickening or\npericholecystic fluid.  No portal venous gas.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal 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 morphology.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of obstructing stones, focal renal lesions, or\nhydronephrosis. There are no urothelial lesions in the kidneys or ureters. \nScarring is noted in the upper pole of the left kidney, likely the sequelae of\nprior infraction.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Stomach is markedly distended with fluid.  Loops of small\nbowel in the abdomen are mildly distended and fluid-filled.  There is apparent\nrelative hypoattenuation of the wall in numerous loops of small bowel\nincluding in the deep pelvis where there is small volume free fluid. There is\nfatty hypertrophy of the cecum which may reflect the sequelae of prior insult.\nThe appendix is not seen.\n\nRETROPERITONEUM: There is no retroperitoneal lymphadenopathy.\n\nPELVIS:  The urinary bladder contains air and iodinated contrast media as well\nas a Foley catheter balloon.  Distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multilevel moderate to severe degenerative changes.  Calcification\nof the posterior longitudinal ligament at L1-L2 causes mild-to-moderate canal\nnarrowing (02:36).\n\nSOFT TISSUES: There is bilateral gynecomastia.  Otherwise, the abdominal and\npelvic wall is within normal limits.",
            "output": "1. Severe calcification causes severe attenuation at the origin of the SMA.\nJust distal to the origin there is a filling defect with extends approximately\nto the first vessel branch points where only trace flow seen distally.\n2. There are numerous loops of small bowel in the abdomen which are mildly\ndistended, fluid-filled with hypoattending walls with a mild amount of free\nfluid in the pelvis raising suspicion for ischemic small bowel.\n3. The origin of the celiac trunk is markedly attenuated secondary to both\ncalcified and noncalcified atherosclerotic plaque. Just distal to the origin\nthere is a 6 mm segment of near complete occlusion of the celiac trunk prior\nto the branch point.\n4. Cholelithiasis without cholecystitis.\n5. Findings consistent with hepatic steatosis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 4:56 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. \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,.  There is a 4 mm\ncystic lesion in the pancreatic tail (5:43).  Addition, they are small areas\nof focal fat (5:38 and 40).  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. \nHypodensities in bilateral kidneys are too small to characterize.  There is no\nevidence of solid 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: Normal CT appearance of the uterus.  Left adnexa measures\n3.1 x 1.8 cm, right adnexa 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSclerotic focus in the left greater trochanter (8:122) likely a bone island. \nDegenerative changes of the thoracolumbar spine\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  Fat\ncontaining umbilical hernia.",
            "output": "1. No finding to explain the patient's symptoms.\n2. 4 mm cystic pancreatic lesion.  Further characterization with a MRI with\ncontrast recommended.\n3. Right adnexa is not well visualized on this exam.  If there is concern for\na gynecological abnormality, further assessment with a pelvic ultrasound is\nrecommended.\n\nRECOMMENDATION(S):  MRI and MRCP with and without contrast of the pancreas\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": "LOWER CHEST: There is no pericardial effusion or pleural effusion.  There is\nleft lung base partially visualized consolidation likely secondary to\natelectasis.  However superimposed pneumonia can not be excluded.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is significantly enlarged measuring 22.5 cm\ncraniocaudally.  There is a 1.1 cm low-attenuation lesion in hepatic segment 8\ngrossly unchanged from ___.  There are also subcentimeter low-attenuation\nlesions in hepatic segment 6 and left hepatic lobe stable from previous study\nand too small to characterized.  There is mild intrahepatic biliary ductal\ndilation.  The common bile duct is also dilated measuring up to 1 cm.  There\nis no distal ductal stricture or stone.  There is no ampullary region mass\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: There is mild bilateral hydronephrosis and hydroureter.  There is a\nFoley catheter visualized in the urinary bladder.  However the urinary bladder\nis due distended with significant wall thickening and enhancement suggestive\nof mal functioning Foley catheter and cystitis.  There is no evidence of solid\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\nsignificant thickening of the rectum with extension to the sigmoid colon which\nmay represent proctosigmoiditis.  There is also thickening and enhancement of\nthe gluteal fold skin.  The appendix is not visualized.\n\nThere is small free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and bilateral 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.  No atherosclerotic disease\nis noted.\n\nBONES AND SOFT TISSUE: There are chronic deformity of the left anterolateral\nsixth and seventh ribs.  There is chronic nonunion fracture of the left femur\nwith posterolateral dislocation of the distal fragment.  There is soft tissue\ndensity surrounding the fracture with fragment.  There is significant\ncompression deformity of the L5 vertebral body new from previous MRI study in\n___.  There is an open wound underneath the sacrum with air trapping anterior\nto the distal sacrum.  The wound track extending 1.6 cm superiorly, 3.9 cm\ninferiorly and 2.4 cm anteriorly to the soft tissue.  There is no discrete\nfluid collection visualized. There is distal sacrum destructive change.\nOsteomyelitis can not be excluded.",
            "output": "1. Distended urinary bladder with bilateral mild hydronephrosis and\nhydroureter.\n2. Urinary bladder wall thickening and enhancement concerning for cystitis.\n3. Large sacral wound with wound track extending 1.6 cm superiorly, 3.9 cm\ninferiorly and 2.4 cm anteriorly to the soft tissue.  Destructive change of\nthe distal sacrum.  Osteomyelitis could not be excluded.\n4. Significant wall thickening of the rectum with extension to the sigmoid\ncolon consistent with proctosigmoiditis.\n5. L5 compression deformity new from ___.\n6. Left femur chronic nonunion fracture with distal fragment dislocate\nposterolaterally.\n7. Significant hepatomegaly.\n8. Other chronic/incidental findings described as in above."
        },
        {
            "input": "LOWER CHEST: Lung bases are clear without pleural effusions.  Please refer to\nthe CTA chest from 2 days prior for complete 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 nondistended gallbladder is\nunremarkable in appearance.\n\nPANCREAS: Pancreas demonstrates moderate fatty infiltration, as seen on the\nstudy from ___.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: A 0.9 x 0.9 cm left adrenal gland nodule has been previously\ndescribed as an adenoma, and is unchanged in size since at least ___.\nThe 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 lesion or hydronephrosis.\n\nGASTROINTESTINAL: The visualized distal esophagus is unchanged in appearance\nsince ___, and unremarkable.  The stomach demonstrates intramural\nfat, as seen in ___.  The colon and rectum are within normal limits. \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: Large heterogeneously enhancing and partially calcified\nmasses in the uterus, compatible fibroids, are similar in appearance to the\nstudy from ___.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions. \nModerate degenerative changes of the lumbar spine are again seen, and most\npronounced at L4-L5 and L5-S1. Mild soft tissue stranding and foci of air in\nthe right anterior abdominal wall are likely due to recent subcutaneous\ninjections (4:31, 36).",
            "output": "1.  No evidence of intra-abdominal or intrapelvic malignancy or metastatic\ndisease.  Visualized esophagus is unchanged appearance since ___.\n\n2.  Please refer to the CTA chest from 2 days prior for intrathoracic\nfindings."
        },
        {
            "input": "Thorax: The lung bases are clear bilaterally. The visualized heart and\npericardium are normal.\n\nIn the absence of IV contrast, the liver is normal appearing with no intra or\nextrahepatic biliary ductal dilatation. The gallbladder, spleen, right adrenal\ngland and kidneys are unremarkable. A nodule within the left adrenal gland is\nunchanged in size from the prior examination and is consistent with an\nadenoma. The pancreas is normal. Again seen is moderate circumferential wall\nthickening involving the lower aspect of the esophagus, similar in appearance\nto the prior examination. The stomach, small bowel and colon are unremarkable.\nThere is no free fluid or free air in the abdomen. There are no pathologically\nenlarged retroperitoneal or mesenteric lymph nodes by CT size criteria. The\nabdominal aorta is not aneurysmal.\n\nPelvis: The bladder is unremarkable. An enlarged, fibroid uterus is again seen\nunchanged in size or character from the prior study. Note is made of\ncalcifications within 2 large fundal fibroids.  There is no free fluid in the\npelvis. The rectum and sigmoid colon are unremarkable.  There is no pelvic\nsidewall lymphadenopathy.\n\nOsseous Structures/ Soft Tissues: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures.",
            "output": "1. No evidence of intra-abdominal or pelvic metastasis.\n2. Wall thickening of the distal esophagus is stable from the prior\nexamination.\n3. Left adrenal adenomas and fibroid uterus are unchanged."
        },
        {
            "input": "LOWER CHEST: No suspicious pulmonary nodules or masses.  Emphysematous changes\nwith associated bronchial wall thickening in keeping with inflammation appear\nsimilar compared to prior.  Mild pleural thickening and scarring in the left\nlower lobe is similar compared 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.  Hyperdense material in the gallbladder most likely in keeping\nwith 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.\n\nADRENALS: Lipid rich left adrenal adenoma is unchanged.\n\nURINARY: Hyperdense and hypotrophic appearance of the renal cortices in\nkeeping with chronic renal disease and suspected delay in contrast excretion. \nSimple right renal cortical cyst is unchanged.  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. Appendix is\npoorly identified.\n\nPELVIS: Foley's catheter in situ in the bladder with intra bladder air most\nlikely secondary to instrumentation.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Prostatic calcifications are noted.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Tortuous abdominal aorta.  Infrarenal abdominal aortic aneurysm\nmeasuring up to 72 x 95 mm in the axial plane as previously described in\ndetail on recent CTA done yesterday appear similar compared to prior imaging. \nThere is no periaortic stranding nor free fluid to suggest active\nextravasation.  The lobulated left anterior out pouching in the lower aspect\nof the aneurysm appear similar compared to prior, suggesting impending\nrupture.  Involvement of the common iliac arteries are also stable.  There is\nno retroperitoneal hematoma.  Mild relative hypodensity of the blood pool\nsuggests anemia.\n\nBONES: Degenerative changes of the thoracolumbar spine with degenerative\nnarrowing of the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Stable imaging findings of the large infrarenal abdominal aortic aneurysm\ncompared to CTA done yesterday.\n2. No features of abdominal aortic rupture/acute extravasation.  Focal out\npouching in the anterior left lower aspect of the aneurysm suggest impending\nrupture appear similar compared to prior CTA done yesterday.  No evidence of\nhyperdense crescent/intramural hematoma.  The flow channel is suboptimally\nassessed due to the lack of IV contrast and reference is made to CTA report of\nEstrace.\n3. No acute abdominopelvic findings of note.\n4. Incidental findings as described above."
        },
        {
            "input": "Intrathoracic findings are reported separately.\n\nCT ABDOMEN:  No focal liver lesion is identified.  Common bile duct stents are\nin place with unchanged pneumobilia in the left hepatic lobe. Mild central\nintrahepatic bile duct dilation is similar to the prior study.  No discrete\nmass or discrete hilar tumor is identified. Increased soft tissue and\nstranding adjacent to the gallbladder since ___ with hyperemia in\nthe adjacent liver is concerning for gallbladder perforation (6:88, 14:35). \nThe inflammation extends to the colonic hepatic flexure (___).  Tumor\ninvolvement is felt to be less likely.  The spleen, pancreas and right adrenal\ngland are normal. A 3.1 x 2.5 cm left adrenal mass is a biopsy proven adenoma\n(biopsied ___.  The kidneys enhance symmetrically and excrete\ncontrast promptly without hydronephrosis. Multiple renal cysts measuring up to\n7.0 x 6.0 cm in the left renal lower pole are unchanged. Other renal\nhypodensities are too small to characterize but are most likely cysts.\n\nThe small and large bowel are normal in course and caliber without\nobstruction. The abdominal aorta is of normal caliber throughout with mild\natherosclerotic calcifications. The main portal vein, splenic vein and SMV are\npatent. Porta hepatic lymph nodes measuring up to 1 cm (6:85, 86) are\nunchanged. There is no free fluid and no free air.\n\nCT PELVIS: The rectum and sigmoid colon are unremarkable. The bladder is\nunderdistended. The uterus is absent. There is no free fluid no pelvic or\ninguinal lymphadenopathy.\n\nBONE WINDOWS:  No bone finding suspicious for infection or malignancy is seen.",
            "output": "1.  Increased soft tissue density and stranding at the gallbladder, concerning\nfor gallbladder perforation.  Tumor involvement is less likely. Involvement of\nthe adjacent colonic hepatic flexure by inflammation cannot be excluded.\n\n2.  No discrete mass identified.  No evidence of distant metastatic disease. \nMild intrahepatic bile duct dilation with CBD stent and pneumobilia unchanged\nfrom ___.\n\n3.  Stable biopsy proven left adrenal adenoma.\n\nNOTIFICATION:  Findings discussed with Dr. ___ by phone at 4:16pm\non ___.  Time of discovery:  4:10pm."
        },
        {
            "input": "Lungs and Heart: There is very minimal bibasilar atelectasis.  There is no\npleural or pericardial effusion.\n\nLiver, Gallbladder: There is intrahepatic biliary ductal dilatation, which is\nminimally increased from the prior exam. Pneumobilia is seen and is similar to\nthe prior exam. New from the prior exam are numerous hypodensities throughout\nthe liver predominantly in the right lobe at the dome, which may represent\nbile lakes or infection (microabscesses not excluded) vs ___ of disease(less\nlikely).  A biliary stent is again seen in unchanged position.  Again seen is\nincreased fat stranding and soft tissue density adjacent to the gallbladder\nconsistent with a history of a contained gallbladder perforation.  A 3.1 x 1.6\ncm loculated fluid collection just inferior to the gallbladder appears\nincreased from the prior exam done on ___.\n\nSpleen: The spleen is normal in size and enhancement.\n\nPancreas: The pancreas is normal with no masses or pancreatic ductal\ndilatation seen.\n\nKidneys, Adrenals: Multiple hypodensities are seen in the kidneys bilaterally\nconsistent with renal cysts and are unchanged.  Other subcentimeter\nhypodensities are too small to characterize 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\nBowel: The small bowel is unremarkable.  The large bowel is grossly normal.\n\nVessels: There is moderate atherosclerosis of the abdominal aorta.  There is\nno aneurysmal dilatation of the aorta and its major branches are patent.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes by CT size criteria.\n\nPelvis: The bladder is unremarkable.  The sigmoid colon and rectum are normal\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. Multiple new small hypodensities seen in the liver predominantly in the\nright lobe, not previously seen on the prior examination may represent bile\nlakes or infection, spread of cholangiocarcinoma felt less likely. Consider\nMRI for further characterization.\n2. Intrahepatic biliary ductal dilatation is minimally increased from the\nprior exam.\n3. Discontinuity of the gallbladder wall and adjacent soft tissue and fat\nstranding consistent with gallbladder perforation again seen with a small\nincrease in loculated fluid inferior to the gallbladder compared to the prior\nstudy.\n\nNOTIFICATION:  Updated findings including new hypodensities possibly\nrepresenting infection/microabscesses discussed by Dr. ___ with Dr.\n___ at approximately 4:15 pm on ___ in person."
        },
        {
            "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:\nAn approximately 3 cm ill-identified mass in the porta hepatis again seen with\nno significant change to the previous exam, 2 stents are present in the common\nbile duct extending from the right and left common hepatic duct into the\nduodenum.  There is mild upstream intrahepatic bile duct dilatation and\npneumobilia. The previously seen the scattered hypodensities in the both lobes\nof the liver, likely abscesses, have resolved.  A single 1 cm hypodensity is\nseen in segment 7.\nThe gallbladder is slightly distended with mild wall thickening.\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:\nThere is a stable 2.5 cm mass in the left exam, the previously characterized\nas an adenoma (16 ___ in non contrast scan)\nThe right adrenal glands is 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 solid lesions or hydronephrosis.  Bilateral\nrenal cysts seen, unchanged:  2 large on the left measuring 6.9 cm and 5.9 cm\nand the smaller on the right measuring 1.7 cm\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 and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & 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.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder and distal ureters are unremarkable.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nUterus is not seen, likely post hysterectomy\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions",
            "output": "1. Stable ill-defined mass in porta hepatis, known Klatskin tumor with stool\nCBD stents in good position.\n2. Resolution of the hepatic small abscesses.\n3. Stable left adrenal adenoma and bilateral renal cysts"
        },
        {
            "input": "ABDOMEN: There are small bilateral pleural effusions with bibasilar\natelectasis, right greater than left.  Again seen are two biliary stents\nwithin the right and left biliary systems in appropriate position terminating\nwithin the duodenum.  Pneumobilia in the left biliary system and right\nanterior biliary system suggest that the stents are draining does area as an\nare patent. There is no pneumobilia within the right posterior system similar\nto the previous study. Mild intrahepatic biliary dilatation dilation in\nunchanged from the prior exam.   Enhancement of the liver somewhat\nheterogeneous but the previously noted multiple hypodensities have resolved. \nA 6 mm segment 7 hypodensity smaller than on the prior exam when it measured 9\nmm.  There are no other discrete focal lesions. The portal vein is patent\nalthough attenuated by the soft tissue mass (4, 42). The left portal vein is\nalso attenuated but unchanged since the prior study. The ill-defined soft\ntissue density tumor within the porta hepatis is difficult to measure but\noverall unchanged from prior exams. The appearance of the gallbladder is\nunremarkable with soft tissue density along the hepatic and age compatible\nwith prior contained perforation. The pancreas and spleen are unremarkable.\nThe body of the right adrenal gland is thickened but unchanged since ___. Adrenal gland are unremarkable. A 3.0 x 2.6 cm left adrenal metastases\nis minimally greater than the prior study when it measured. 2.8 x 2.7 cm. The\nkidneys enhance excrete contrast symmetrically without any hydronephrosis. A\nmultiple bilateral cysts are unchanged. The stomach, small and visualized\nintra-abdominal large bowel are unremarkable. Mild mesenteric stranding and\nstranding in the soft tissues is likely due to volume overload. The aorta is\nof normal caliber without evidence of aneurysm. There is mild atherosclerotic\ndisease with calcification at the origins of the left renal artery celiac\nartery. There is no free air within the abdomen.\n\nPELVIS: There is a small amount of simple free fluid in the pelvis. The\nbladder rectum and sigmoid colon are unremarkable. There is no free air\nlymphadenopathy.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome lesions.",
            "output": "1. Biliary stents in appropriate position stable mild intrahepatic biliary\ndilation. Expected pneumobilia is present in the left in the anterior right\nbiliary systems confirming patency. No pneumobilia on the left posterior\nbiliary system, although this is stable from the prior study.\n2. No new focal liver lesions or abscesses. Segment 7 hypodensity has\ndecreased in size since the prior study.\n3. Ill-defined mass in the porta hepatis is unchanged.\n4. Minimal increase of left adrenal metastases and stable right adrenal\nthickening.\n5. Mesenteric stranding, soft tissue stranding and small amount of free fluid\nin the pelvis likely due to volume overload."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.\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.  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. \nSubcutaneous bruising is seen over the lateral right upper thigh (2:172).",
            "output": "Subcutaneous bruising over the lateral right upper thigh.  Otherwise normal CT\nof the abdomen/pelvis.."
        },
        {
            "input": "There is a mildly enlarged right epicardial lymph node measuring 13 mm in\ndiameter (02:21).\n\nThis monophasic contrast enhanced CT protocol is not suitable to evaluate for\nfocal liver lesions in the setting of cirrhosis, although no suspicious\nlesions are identified on this examination.  Liver has a cirrhotic appearance\nwith nodularity and volume redistribution.  Intrahepatic biliary ducts arm\nvery mildly prominent.  Extrahepatic ducts are mildly dilated, although\nprobably not out of proportion to the prior cholecystectomy.  Common bile duct\nmeasures at most 9 to 10 mm in diameter.  Extrahepatic biliary ducts have been\nmildly dilated since at least ___, however, without any increase here. \nIncidental note is made of pancreatitis divisum.  Given under distension of\nthe duodenum, the ampulla is not well visualized but no sizable mass is\nidentified at the expected site.  The spleen is again moderately enlarged\nmeasuring up to 16.1 cm in length.  Adrenals are unremarkable.  Kidneys appear\nnormal without evidence for stones, solid masses or hydro nephrosis on either\nside.  Hypoattenuating focus along the mid to lower left kidney measuring 10\nmm is too small to optimally characterize, although doubtful in significance.\n\nStomach and small bowel are unremarkable.  Sigmoid diverticulosis is severe.\n\nBladder is underdistended but appears normal.  Uterus and adnexa are\nunremarkable.\n\nAtherosclerotic disease is of moderate severity.  Aorta is nondilated.  A\nreplaced left hepatic artery arising from the left gastric is a normal\nvariant.\n\nA TIPS shunt extending from the right posterior portal vein to the right\nhepatic vein shows minimal mural thrombus at the distal margin, but narrowing\nis mild.  Branches distal to the right posterior may be thrombosed, which\nwould probably be postprocedural although although branching hypodensities\nscattered in the liver are probably in general due to the slightly dilated\nintrahepatic biliary ducts.  No widespread biliary dilatation, however. \nSplenic and main portal veins are markedly enlarged.  The umbilical vein is\npatent but even more striking are large esophageal mucosal varices. Numerous\ncollaterals are found along the anterior abdominal wall in addition to\ngastroomental collaterals and there are even small possible collaterals along\nthe bladder wall and left adnexa.  Small suspected rectal varices including\nlower anal hemorrhoids.\n\nQuantity of low-attenuation ascites is large.\n\nAlong the visualized lower chest are several paraspinal masses (2:4, 14, 23\nand 33).  The largest is a left lateral mass measuring up to 26 x 10 mm in\naxial ___ (02:24).\n\nThere are also several mildly prominent periaortic nodes although generally\nthese are not enlarged by size criteria.  An enlarged right lower periaortic\nlymph node (2:104) measures up to 25 x 15 mm in axial ___.\n\nThere are no suspicious bone lesions.  The L5-S1 interspace is\nmild-to-moderately narrowed.  Facet arthropathy is fairly severe at L4-L5,\nprobably explaining mild spondylolisthesis at that level.",
            "output": "1.  Cirrhosis with portal hypertension.  Patent TIPS shunt with mild distal\nnarrowing due to mural thrombus..  Large quantity of ascites.  Although no\nfocal liver lesions are identified, this protocol is not suitable to evaluate\nfor focal liver lesions in the setting of cirrhosis.\n\n2.  Indeterminant but suspicious paraspinal masses along the lower chest as\nwell as mildly enlarged right epicardial and periaortic lymph nodes. \nDifferential may include lymphoproliferative disorder or metastatic disease. \nLess common possibilities may include multiple neurogenic tumors, although\nthey might be potentially explained by extramedullary hematopoiesis in the\nappropriate setting.\n\n3.  No evidence for biliary masses or significant biliary dilatation in the\nsetting of prior cholecystectomy.\n\nRECOMMENDATION(S):  MR may potentially shed some light on the findings if\nneeded clinically and could also be helpful to assess for focal liver lesions\nin the setting of cirrhosis if needed clinically.  Otherwise imaging\nsurveillance of paraspinal masses and/or biopsy should be considered.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:47 pm, 17 minutes after\ndiscovery of the findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is severe calcium burden in the\nabdominal aorta and great abdominal arteries.  Hepatic arterial anatomy is\nconventional.\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.  A\n1.4 x 1.3 cm hypodense lesion in the hepatic dome (03:16) and two\nsubcentimeter hypodensities more medially in the hepatic dome and at the\nborder of segments V and VI (03:14 and 39, respectively) remain unchanged and\nwere previously characterized as hemangiomas on MRCP from ___. \nThere is no suspicious hepatic lesion.  The gallbladder is resected.  There is\na hepaticojejunostomy, without evidence of intrahepatic biliary ductal\ndilatation.\n\nPANCREAS: There are postsurgical changes of Whipple procedure.  The remnant\npancreatic body and tail has normal attenuation throughout, without evidence\nof focal lesions.  Mild prominence of the main pancreatic duct is unchanged. \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 multiple bilateral simple renal cortical cysts, the largest\nmeasuring 5.3 cm off of the interpolar region of the right kidney.  Bilateral\nmillimetric hypodensities compatible with simple cysts based on prior MRCP\nfrom ___.  The kidneys are of normal and symmetric size with\nnormal nephrogram. There is no evidence of stones or hydronephrosis. There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. Colon and rectum are within normal limits. \nAppendix is not visualized.  There are prominent mesenteric nodes measuring up\nto 9 mm short axis (3:64).\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 and the seminal vesicles are\nunremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nRight iliac crest and L5 vertebral body sclerotic foci are likely bone islands\nand unchanged since ___.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  There\nare small bilateral fat containing inguinal hernias.  There is also a small\namount of fluid in the right inguinal hernia.",
            "output": "1. Postsurgical changes of Whipple procedure.  No evidence of local tumor\nrecurrence.\n2. Prominent mesenteric lymph nodes, measuring up to 9 mm short axis,\nnonspecific.  Attention on follow-up is recommended.\n3. Otherwise no evidence of metastatic disease in the abdomen or pelvis.\n4. Stable hepatic hemangiomas."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 scattered hypodense lesions throughout the liver, too small to\ncharacterize but compatible with hepatic cysts or biliary hamartomas.  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 a 3\nmm stone at the Left ureterovesicular junction with mild upstream\nhydroureteronephrosis (2:84).  There is no right renal stones.  There is\nredemonstration of mild Left perinephric stranding, unchanged from prior study\ndated ___.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is colonic\ndiverticulosis without evidence of wall thickening or pericolonic stranding. \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.\n\nSOFT TISSUES: There is a small right fat containing inguinal hernia.",
            "output": "1. 3 mm obstructing stone at the left ureterovesicular junction with mild\nupstream hydroureteronephrosis.\n2. Diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "CHEST:\nCoarse calcification in the inferior left thyroid lobe.  There are no\nsupraclavicular adenopathy.\n\nLarge heterogeneous, peripherally enhancing solid mass in the right axilla,\nmeasures 12.2 x 8.8 x 12 cm and extends to the subpectoral region.  In the\ninferior aspect of the mass there is a 3.3 x 4.1 x  4.7 cm peripherally\ncalcified component (201:39).  The mass is inferior to and abuts the right\nsubclavian and brachial artery.  The subclavian and brachial veins are not\nwell assessed given the timing of the study.  The mass is in close contact\nwith the chest wall, however there are no changes in the ribs to suggest\ninvasion.\n\nA 4.4 x 2 cm mass seen the right breast is noted.  Additionally, there is\ndiffuse skin thickening in the right breast.\n\nNo left axillary adenopathy.\n\nThere are no mediastinal adenopathy.  Calcified lymph nodes in the subcarinal\nnodal station may be related to exposure to granulomatous disease.\n\nRight hilar adenopathy centrally necrotic, measure 0.6 cm (201:38).\n\nThe heart is normal in size.  Severe coronary artery calcifications, aortic\nvalve and mitral annulus are noted.\n\nThere is no pericardial effusion.  Trace bilateral pleural effusions.\n\nThere are multiple bilateral pulmonary metastases, the largest being a 2.8 x\n2.6 cm right lower lobe.  Adjacent to this, a more hypodense 2.7 x 2.6 cm\nnodule, although difficult to evaluate in single-phase however, seems to\ncourse towards the pulmonary artery/vein.\n\nSmall epiphrenic diverticulum versus hiatal hernia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nMultiple hypodense lesions are seen for instance a 1.7 cm segment VI and 1.8\ncm segment VIII and 2.2 cm at the hepatic dome are peripherally enhancing in\nkeeping with hepatic metastasis.  Mild prominence of the central intrahepatic\nducts without clear dilation may be related to cholecystectomy.\n\nPANCREAS: The pancreas is atrophic.  A 0.4 cm hypodensity in the pancreatic\ntail is noted, likely a side branch IPMN.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout.  Peripheral\nwedge-shaped hypodensities in the spleen, the morphology favors infarcts over\nmetastatic disease.\n\nADRENALS: Right adrenal gland is normal.  A 0.6 cm hypodense lesion in the\nleft adrenal gland is incompletely evaluated on this study.\n\nURINARY: Atrophic kidneys.  There is no evidence of solid renal lesions or\nhydronephrosis.  Simple appearing exophytic cortical cyst on the right.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Colon is\nunremarkable.  Fecal impaction in the rectum and rectosigmoid.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus contains a coarse calcification, likely a\ndegenerated fibroid.  No adnexal masses.\n\nLYMPH NODES/OMENTUM/MESENTERY: 2.7 x 2 cm omental implant in the right lower\nquadrant (201:126).  There is no 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: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is severe degenerative changes including anterior wedge compression\nfracture of L1 vertebral body.  Patient is status post bilateral femoral neck\nfixation with intramedullary rod and nail.  Patient is status post nail\nplacement in the right proximal humerus which is incompletely evaluated.\n\nSOFT TISSUES: 1.4 cm hyperdense soft tissue nodule in the right anterior chest\nwall is likely metastatic (series 201, image 29).  Few hyperdense soft tissue\nnodules in the subcutaneous tissues for example 8 mm (201: 36) and 5 mm (201,\n87) are nonspecific.  1.3 cm round soft tissue nodule between the with his\nmaximus and medius on the left is indeterminate.  Small fat containing\numbilical hernia.",
            "output": "1. 4.4 x 2 cm right breast mass is suboptimally characterized with CT however\nwith associated diffuse skin thickening of the right breast is concerning for\nprimary breast malignancy.  Correlation with mammography if advised.\n2. Large right axillary mass extending into the subpectoral region measures\n12.2 x 0.8 x 12 cm in about the right subclavian and brachial arteries is\nlikely metastatic adenopathy related to the right breast mass.\n3. Multiple metastases in both lungs, right hilum, liver and omentum.  A \nright lower lobe hypodense mass seems to course towards the pulmonary\nartery/vein, but is incompletely evaluated on single phase.\n4. Indeterminate soft tissue nodules could also be related to the metastatic\nprocess.\n5. Peripheral wedge-shaped hypodensities in the spleen could represent\ninfarcts however the differential diagnosis also includes metastases.\n6. Severe coronary calcifications, aortic stenosis and mitral annulus\ncalcification.\n7. Marked fecal impaction in the rectum and sigmoid.\n\nRECOMMENDATION(S):  Mammography"
        },
        {
            "input": "LOWER CHEST: There are trace bilateral pleural effusions and adjacent minimal\natelectasis at 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 is no evidence of focal renal lesions 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, however there are 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: 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 are multilevel degenerative changes and dextroscoliosis of the\nlumbar spine.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: There are few small foci of air along the lower anterior\nabdominal wall, likely injection sites.",
            "output": "1. No acute abdominopelvic process.  No CT findings correlating to the\nreported history of elevated WBC and abdominal tenderness.\n2. Diverticulosis with no evidence of acute diverticulitis.\n3. Trace bilateral pleural effusions."
        },
        {
            "input": "LUNG BASES:\nRespiratory motion somewhat limits interpretation of the lung bases. Within\nthis limitation, there is minimal bibasilar atelectasis. Otherwise the lung\nbases are clear. There is no evidence of pleural effusion.\n\nCT ABDOMEN:\n\nLack of administration of IV contrast limits interpretation of the\nintra-abdominal solid and hollow viscous organs.\n\nThe liver is of homogeneous attenuation throughout without evidence of focal\nlesion. There is no evidence of intrahepatic biliary ductal dilatation.\nCholecystectomy clips are seen in the gallbladder fossa.  Air is seen within\nthe common duct, as well as the left greater than right intrahepatic biliary\ntree, a normal finding status post ERCP. The spleen mildly enlarged, with a\ncraniocaudal diameter of 13.5 cm. There is no evidence of focal splenic\nlesion.\n\nThe pancreas is of homogeneous attenuation without evidence of ductal\ndilatation or peripancreatic stranding. The adrenal glands are within normal\nlimits. There are normal, symmetric nephrograms. There is no hydronephrosis.\n\nNon-dilated loops of small bowel are normal in course and caliber. A duodenal\ndiverticulum is noted.  There is no evidence of obstruction.  Oral contrast\nfills the colon. There is distal colonic diverticulosis without evidence of\ndiverticulitis. The colon was otherwise unremarkable. The appendix is not well\nvisualized. There is no evidence of mesenteric or retroperitoneal\nlymphadenopathy by CT size criteria.\n\nThere are scattered atherosclerotic mural calcifications of the abdominal\naorta.  There is no evidence of dilation or aneurysm. There is no\nintra-abdominal free air or fluid.\n\nCT PELVIS:\nThe imaged pelvic organs, including the bladder and terminal ureters, are\nnormal. There is no evidence of pelvic or inguinal lymphadenopathy by CT size\ncriteria.\n\nBONES AND SOFT TISSUES:\nThere is a large fat containing paraumbilical hernia, unchanged from prior\nexam. There is mild to moderate degenerative joint disease of the imaged\nthoracolumbar spine.  Alignment is normal.  There are no suspicious osteolytic\nor osteosclerotic lesions identified.",
            "output": "1. Pneumobilia, a normal finding after ERCP.\n2. No evidence of acute intra-abdominal or intrapelvic process.\n3. Large unchanged paraumbilical hernia.\n4. Mild splenomegaly.\n5. Diverticulosis.\n6. Status post cholecystectomy."
        },
        {
            "input": "Lung Bases:  Minimal dependent atelectasis is noted at the lung bases. The\nimaged portion of the heart is unremarkable.  The distal esophagus appears\nmildly thickened.\n\nAbdomen: The liver enhances normally without focal lesion. A subtle\nmicronodular contour of the liver especially along the inferior extent is\ncompatible with known cirrhosis. The gallbladder is surgically absent. The\nspleen is enlarged and measures up to 13.1 cm in length. Adrenal glands,\npancreas, and kidneys appear normal. The kidneys enhance symmetrically and\nexcrete contrast promptly without hydronephrosis or focal renal lesion. There\nare portosystemic varices in the upper abdomen notably along the proximal\nstomach. The abdominal aorta is normal in course and caliber with extensive\natherosclerotic calcification noted and without aneurysmal dilation. There is\nno retroperitoneal lymphadenopathy seen. There is no free air or free fluid.\nThe stomach is decompressed. The duodenum appears normal.\n\nPelvis: Loops of small and large bowel demonstrate no signs of ileus or\nobstruction. The appendix is normal.  The colon contains a mild fecal load\nwithout bowel wall thickening or obstruction. There is no free pelvic fluid.\nUrinary bladder is partially distended appearing normal. No pelvic or inguinal\nlymphadenopathy is seen.\n\nBones: Old rib deformities are noted bilaterally involving the ninth and tenth\nribs. No acute bony injury or worrisome bony lesion.",
            "output": "1.  Cirrhotic liver with splenomegaly and varices. No ascites.\n2.  Mildly thickened distal esophagus for which clinical correlation is\nadvised for possible esophagitis.\n3.  Atherosclerosis of the abdominal aorta without aneurysm."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Part of the liver dome is not included in the study.  The\nvisualized 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 within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 1.9 cm exophytic cyst arising from the upper pole of the left\nkidney measuring 1.9 cm.  A subcentimeter hypodense lesion in the lower pole\nthe right Kidney is too small to characterize.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout.  There\nis a segment of sigmoid colon containing multiple diverticula demonstrating\nbowel wall thickening, adjacent soft tissue stranding, and fascial thickening,\ncompatible with diverticulitis.  There is no evidence of extraluminal air or\nfocal fluid collection.  The appendix is not visualized.\n\nPELVIS: There is a small amount of air within the bladder, likely in the\nsecond recent catheterization.  No evidence of bladder injury.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.  There is\nadjacent soft tissue stranding and fascial thickening with a edema and free\nair within the vaginal wall, expected in the immediate postoperative setting\n(2:71, 2:76).  Additionally, there is a small amount of non organized free\nfluid within the vaginal vault (2:61), again expected in the postoperative\nsetting.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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 sigmoid diverticulitis.  No evidence of drainable fluid collection or\nextraluminal air.\n2. Status post hysterectomy with expected postoperative changes at the vaginal\nvault 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 hypoattenuation throughout,\nunchanged and compatible with steatosis.  There is a 2.6 cm hepatic cyst in\nthe left hepatic lobe.  Additional subcentimeter hypodensities in the liver\nare stable and previously characterized as cysts or biliary hamartomas on MRI.\nTwo hyperenhancing lesions in segments III and VII, the larger measuring up to\n1.7 cm in segment VII, are stable from priors and previously characterized as\nhemangiomas on MRI.  No new focal liver 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.  There is a tiny 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 (05:58).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is not significantly changed in size with no focal\nfibroid seen.  The bilateral 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.  The portal vein, splenic vein and SMV are patent.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is stable fatty atrophy of the bilateral gluteal muscles. \nThe abdominal and pelvic wall is otherwise within normal limits.",
            "output": "1. No acute process in the abdomen or pelvis.\n2. Stable hepatic steatosis and hepatic hemangiomas."
        },
        {
            "input": "LOWER CHEST: A 6 mm calcified granuloma is again seen within the right middle\nlobe.  Otherwise, visualized lung fields are within normal limits.  There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout.  Few\nscattered subcentimeter hypodensities throughout the liver appears similar to\nprior and are incompletely characterized but likely represent cysts or biliary\nhamartomas.  No evidence of new focal lesion within the limitations of an\nunenhanced scan.  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, wall thickness, and enhancement throughout. The colon and\nrectum are unremarkable.  The appendix is normal.  Hazy increased attenuation\nof the mesentery about the root with multiple subcentimeter lymph nodes appear\nsimilar to prior, compatible with mesenteric panniculitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy.  Multiple surgical clips are\nagain seen about the left common iliac chain and left pelvic sidewall.  No\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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are again seen about the lower midline\nabdomen and pelvis.",
            "output": "1. Redemonstration of mesenteric haziness, similar in appearance and\nsuggestive of mesenteric panniculitis.\n2. Otherwise, no acute findings within the abdomen or pelvis explain the\npatient's symptoms.  Specifically, no evidence of acute diverticulitis or\nurinary stones."
        },
        {
            "input": "LOWER CHEST: There is no evidence of pleural or pericardial effusion.  A 6 mm\ncalcified granuloma the right lung base is unchanged (series 2:9).\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis.  There are multiple phleboliths\nwithin the pelvis but no definite ureteral stones.  No hydroureter.  There is\nno perinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber and wall thickness throughout. Few scattered colonic\ndiverticula without evidence of acute diverticulitis.  The appendix is normal\n(series 2:64).  Again seen is haziness within the mesentery with multiple\nsubcentimeter mesenteric lymph nodes, similar to prior and compatible with\nmesenteric panniculitis.\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, status post hysterectomy. \nNo adnexal abnormality is seen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy by 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: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Redemonstration of mesenteric haziness, similar in appearance to the prior\nstudy and suggestive of mesenteric panniculitis.\n2. Otherwise, no other acute process within the abdomen or pelvis. \nSpecifically, no nephrolithiasis or definite ureterolithiasis.\n3. Few scattered colonic diverticula without evidence of acute diverticulitis.\n4. 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. \nThere is a 2.2 cm heterogeneous hypodensity within the right hepatic lobe near\nsegment VIII which demonstrates nodular opacification around the periphery\n(series 2, image 20) compatible with a hemangioma.  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 a 3 mm right renal collecting system stone (series 2, image 40). \nBilateral cortical hypodensities measure up to 0.8 cm on the right are too\nsmall to characterize by CT but likely represent simple cysts.  There is mild\nfullness in the right renal collecting system relative to the left.  There is\nno 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 surgically absent.\n\nPELVIS: The urinary bladder is normal.  The right distal ureter appears mildly\nthickened with minimal surrounding stranding.  A 2 mm hyperdensity was found\nto be superior to the ureter on thin reformats and is likely a phlebolith. \nThe left distal ureter is normal.  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.  Moderate atherosclerotic\ndisease is noted, including an eccentric atherosclerotic plaque at the distal\nabdominal aorta near the bifurcation (series 2, image 45).\n\nBONES: There 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 distal right ureteric stranding and minimal fullness of the right\nrenal collecting system is nonspecific, and could possibly reflect a recently\npassed stone or focal mild ureteritis of unclear etiology.  Symmetric\nnephrogram bilaterally.  Recommend correlation with urinalysis.\n2. Nonobstructing 4 mm stone within the inferior right renal collecting\nsystem.\n3. 2.2 cm hypodensity in the right hepatic lobe with nodular peripheral\nenhancement in segment VIII is consistent with a hemangioma.\n4. No bowel obstruction.\n\nNOTIFICATION:\n1. The updated findings were discussed with ___ MD by ___ MD on\nthe phone on ___ at 22:40."
        },
        {
            "input": "VASCULAR:\nThe patient is status post TIPS from the right hepatic vein to the portal\nconfluence and the TIPS appears patent.  Again seen, there is nonocclusive\nclot in the distal main portal vein at the confluence and just distal to the\nTIPS (9; 51).  There continues to be in occlusive thrombosis in the distal\nbranches of the SMV (15b; 44).  The splenic vein is small but patent.  The\nleft and right portal veins in the liver are not filled during th portovenous\nphase or with 3-minute delay, consistent with occlusive thrombosis.\n\nThere is no abdominal aortic aneurysm.  The aorta, celiac artery, SMA, and ___\nare patent. There is minimal calcium burden in the abdominal aorta and great\nabdominal 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 heterogeneous enhancement in the\narterial phase likely reflecting perfusion abnormality similar to ___\n(6; 24). There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is contains\nstones, without evidence of gallbladder wall thickening or pericholecystic\nfluid.  Minimal ascites in the abdomen.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\npancreatic ductal dilatation. There is no peripancreatic stranding.   Stable\n0.9 cm hypodense lesion in the pancreatic neck likely a side branch IPMN (9;\n44).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 1.0 cm hypodense lesion in the posterior interpolar region\nwith ___ of 23 (6; 65) stable since ___ likely representing a simple\ncyst.  There is no evidence of stones, or hydronephrosis. There are no\nurothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  Small duodenal diverticulum is again noted.  Small bowel\nloops demonstrate normal caliber, wall thickness and enhancement throughout. \nColonic diverticulosis without evidence of fat stranding or wall thickening. \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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is ascites in the\npelvis with ___ of 5 (9; 144).\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and contains coarse\ncalcifications and the seminal vesicles are unremarkable.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nDegenerative disc disease most severe in L2-L3 and L3-L4.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. Patent TIPS with similar clot burden compared to ___ with\nnonocclusive clot at the portal confluence and in the distal branches of the\nSMV.  Splenic vein is small but appears patent.\n2. Simple ascitic fluid noted in the pelvis.\n3. Gallstones without evidence of acute cholecystitis.\n4. Stable 0.9 cm pancreatic lesion, likely side branch 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 with\nlow attenuation consistent with steatosis.  There are a few liver\nhypodensities, which are too small to the characterized (for example series 2;\nimage 13), which likely represent cysts versus biliary hamartomas.  No\nconcerning liver lesions are identified.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is essentially within\nnormal limits, cannot exclude punctate 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 multiple\ndiverticula surrounding the sigmoid colon.  1 of these diverticula (series\n601; image 38) appears to represent the epicenter of a mild area of\nsurrounding inflammation (series 2; image 75, series 601; image 35),\nconsistent with uncomplicated, acute diverticulitis.  There is no evidence of\nsurrounding abscess or free intraperitoneal air.  The appendix is normal.\n\nPartially visualized is ventriculoperitoneal shunt with tip terminating in the\narea of the right lobe of the liver.\n\nPELVIS: The bladder is largely decompressed, but overall appears within normal\nlimits.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus and adnexae are within normal limits.  2.8 cm cyst\nin the right adnexa 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. \nThere is moderate degenerative change in the visualized thoracolumbar spine,\nmost notable at L5-S1 with endplate sclerosis and vacuum disc phenomenon.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Multiple diverticula in the sigmoid colon with surrounding inflammation\nwithout evidence abscess or free intraperitoneal air, consistent with\nuncomplicated, acute diverticulitis.\n2. Partially imaged VP shunt with tip terminating in the right upper quadrant\nwithout evidence of discontinuity or kinking.\n3. Borderline fatty 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. \nMultiple hyperattenuating lesions are noted throughout the liver, including a\n1.0 cm lesion within the left hepatic lobe (04:49), a 1.1 cm lesion within the\nleft hepatic lobe (04:46), a 1.0 cm lesion within the posterior right hepatic\nlobe (04:58), and a 0.7 cm lesion within the posterior right hepatic lobe\n(04:56).  Findings are nonspecific and difficult to evaluate on single phase\ncontrast enhanced CT, however given the presence of other findings could\nrepresent metastases.  Further evaluation with dedicated MRI is recommended\nfor characterization.  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 appear atrophic bilaterally, likely secondary to\natherosclerotic disease.  There is mild left hydronephrosis and proximal\nhydroureter (series 7, image 36).  There is a simple renal cyst in the right\nlower pole measuring 1.2 cm (07:32).  Few additional subcentimeter\nhypodensities within the bilateral kidneys are too small to characterize,\nthough likely compatible with simple renal 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.  Small amount\nof free fluid in the pelvis is likely physiologic.\n\nREPRODUCTIVE ORGANS: There is a small fibroid uterus.  There is a\nheterogeneous solid mass in the left lower quadrant measuring 7.2 x 6.7 x 4.8\ncm (7:27, 4:95), which demonstrates small focal areas of calcification and\nheterogeneous tissue density, and appears contiguous with a dilated left\ngonadal vein, findings which are highly concerning for a primary malignant\novarian neoplasm.  The left ureters encased by this mass, resulting in mild\nupstream obstruction.\n\nLYMPH NODES: Multiple enlarged, necrotic-appearing left periaortic lymph nodes\nare noted, with the largest measuring up to 1.9 cm in short axis (4:75) and\n1.4 cm in short axis (4:68).  There is no 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: A tiny umbilical hernia containing fat is noted.",
            "output": "1. 7.2 cm mass, likely of adnexal origin, with necrotic-appearing left\npara-aortic lymphadenopathy, highly concerning for primary ovarian neoplasm. \nGerm-cell tumors should be considered.  Gyn-Onc consultation should be\nconsidered.  Left periaortic lymph nodes may be amenable to percutaneous\nbiopsy.\n2. Mild left hydroureteronephrosis secondary to compression from the mass.\n3. Multiple hyperattenuating lesions are noted throughout the liver, findings\nwhich are nonspecific on this single-phase CT protocol, but metastases are a\nconsideration and further evaluation with MRI is recommended.\n4. For complete description of intrathoracic findings, please see dedicated\nreport of CT chest performed concurrently the same day.\n\nRECOMMENDATION(S):\n1. Gyn-oncology consultation.\n2. Further evaluation with dedicated MRI is recommended for characterization\nof multiple hyperattenuating lesions in the liver.\n\nNOTIFICATION:  The findings and recommendations were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 4:42\npm, approximately ___ minutes after discovery of the findings."
        },
        {
            "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 liver demonstrates homogenous attenuation throughout. \nPreviously noted foci of hyperenhancement seen on prior CT are less\nconspicuous compared with prior and were previously characterized on MRI as\ntransient hepatic intensity differences.  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 a 1.3 cm simple cyst in the right lower pole.  Previously seen left\nhydroureteronephrosis has resolved.  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 bladder is collapsed.  The distal ureters are unremarkable.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is within normal limits.  No right adnexal\nabnormality.  A left ovarian mass containing calcification is decreased in\nsize, currently spanning 4.0 x 2.7 x 4.0 cm compared with 7.2 x 4.8 x 6.7 cm\npreviously (5:94; 09:20).\n\nLYMPH NODES: Left periaortic lymphadenopathy is improved from prior.  For\nreference, the largest left periaortic lymph node currently measures up to 11\nmm in the short axis compared with 19 mm previously (5:74).  An additional\nleft periaortic lymph node measures up to 7 mm in the short axis compared with\n14 mm previously (5:67).  There is no mesenteric lymphadenopathy.  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: A tiny umbilical hernia containing fat is noted.",
            "output": "1. Interval decrease in size of a left ovarian mass and improvement in left\nperiaortic lymphadenopathy.\n2. Interval resolution of left hydroureteronephrosis.\n3. No evidence of new 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: There is mild bibasilar atelectasis.  There is no pleural or\npericardial effusion.  The imaged portion of the heart is unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.There is a small amount of periportal\nedema.  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 solid renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Positive oral contrast limits mucosal assessment.\n\nThe stomach and duodenum appear normal.  Proximal small bowel loops appear\nnormal in course and caliber.  Contrast is seen through the level of the\ntransverse colon.  There is an long segment of abnormally thickened small\nbowel in the right lower quadrant involving distal ileum extending to the\nterminal ileum.  Notable fat stranding is seen at the ileocecal junction. \nAdjacent prominent lymph nodes are likely reactive.  No free air or\nextraluminal fluid collection.  No resultant bowel obstruction.  Adjacent\nareas of mesenteric fibrofatty proliferation suggest prior inflammation in the\nright lower quadrant.  This area of focal thickening persists for about 12 cm.\nThe appendix is normal.  Cecum appears minimally thickened though the\nremainder of the colon 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.  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": "Acute on chronic Crohn's disease with long segment acute distal/terminal\nileitis.  No resultant bowel obstruction."
        },
        {
            "input": "VASCULAR:\n\nThere is a large 13.5 x 15.5 x 20.9 cm retroperitoneal hematoma (305:99,\n606:47), which is intimately associated with an asymmetrically enlarged and\nheterogeneous appearing iliopsoas muscle, likely representing intramuscular\nhematoma (606:66).  Multiphasic imaging reveals no evidence of active\nextravasation.  This large collection exerts mass effect with anterior\ndisplacement of the right kidney and right lobe of the liver.  The major\naortic branches are patent.  Incidental note is made of a replaced right\nhepatic artery arising from the SMA.  There is no abdominal aortic aneurysm. \nThere is extensive calcium burden in the abdominal aorta and great abdominal\narteries.\n\nLOWER CHEST: Atelectasis is noted in the right lung base.  The heart is\nmoderately enlarged with partially imaged dense mitral calcifications.  These\nfindings are better evaluated on same-day chest CT.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.1\ncm hypodense lesion in the right lobe of the liver (305:60) likely represents\na hepatic cyst.  There is mild central intrahepatic biliary ductal dilatation\nwith prominence of the common bile duct measuring up to 1.1 cm (305:71).  The\ngallbladder contains stones, without evidence of gallbladder wall thickening\nor pericholecystic fluid.\n\nPANCREAS: The pancreas is normal attenuation throughout without evidence of\nfocal lesions.  There is mild pancreatic ductal dilatation up to 4 mm. \nPunctate 3 mm hyperdense focus is noted at the ampulla which may represent a\npartially obstructive stone.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: Slightly nodular appearance of the left adrenal gland measuring up\nto 1.2 x 0.8 cm (305:53.  The right adrenal gland is normal in size and\nshape.)\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis.  1.3 cm hypodense lesion in\nthe upper pole of the left kidney with intermediate density may represent a\ncyst with proteinaceous or hemorrhagic contents.  Multiple additional\nbilateral subcentimeter hypodense lesions seen throughout the kidneys are too\nsmall to characterize but likely represent additional renal cysts.  There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\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.\nThere is borderline thickening of the appendix measuring up to 0.8 cm\n(305:130).  No adjacent mesenteric fat stranding is noted.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy. \nLarge retroperitoneal hematoma as described above.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is a small volume of\nsimple free fluid within the pelvis (305:148).\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  There is no adnexal\nabnormality.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere is mild grade 1 retrolisthesis of L2 on L3 and L3 on L4 as well as mild\ngrade 1 retrolisthesis of L4 on L5.  There is a compression deformity of the\nT12 vertebral body, which appears chronic.  Moderate multilevel degenerative\nchanges are seen in the lumbar spine, most pronounced at L5-S1 and L2-L3.\n\nSOFT TISSUES: There is diffuse body wall edema.  There is small fat containing\nbilateral inguinal hernias.",
            "output": "1. Large retroperitoneal hematoma measuring up to 20.9 cm with no evidence of\nactive extravasation.\n2. Mild central intrahepatic, extrahepatic, and pancreatic ductal dilatation\nwith a 3 mm stone visualized at the ampulla.\n3. 1.2 cm left adrenal gland nodule.\n4. Borderline thickening of the appendix measuring up to 0.8 cm with no\nadditional secondary signs of appendicitis present.\n5. Small volume of simple free pelvic fluid.\n6. 1.3 cm hypodense lesion in the upper pole of the left kidney contains\nintermediate density fluid and may represent a cyst with proteinaceous or\nhemorrhagic content.  Follow-up ultrasound in 6 months is recommended to\nensure stability.\n7. Diffuse body wall edema.\n\nNOTIFICATION:   The findings were discussed with ___, N.P. by\n___, M.D. on the telephone on ___ at 7:57 am, 10 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Small right pleural effusion.  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. \nAgain seen is a 1.1 cm hypodense lesion within the right lobe of liver (series\n2, image 67).  Minimal intra and extrahepatic biliary ductal dilatation. \nThere is interval enlargement of the gallbladder with pericholecystic\nstranding. There has been interval increase in fat stranding in the right\nupper quadrant including the perihepatic fat, ___ fat, pericolonic\nfat in addition to the gallbladder fossa.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Again seen is mild pancreatic ductal dilatation measuring up\nto 4 mm in diameter.  Again seen is a punctate hyperdensity within the distal\nCBD at the level of the ampulla (2:71) which could represent a partially\nobstructive stone (series 2, image 71).\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is slight nodular appearance of the left adrenal gland.  The\nright adrenal gland remains normal.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of solid renal lesions or hydronephrosis.  Again seen is\na 1.3 cm hypodense lesion in the upper pole of left kidney (measuring up to 40\nHounsfield units) which could represent a proteinaceous or hemorrhagic cyst. \nThere are multiple additional subcentimeter cystic lesions are too small to\ncharacterize but likely represent simple cysts.  There are no suspicious\nmasses or lesions within the kidneys.  Again seen is mass effect on the right\nkidney secondary to the retroperitoneal hematoma.\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 measures 0.7 cm, without evidence of inflammatory changes.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is a\nmoderate amount of free fluid within the pelvis, increased from ___.\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: The previously noted retroperitoneal hematoma measures approximately\n17.3 x 13.3 x 21.4 cm, similar in size to 16.6 x 14.5 x 21.6 cm on ___.  This lesion remains intimately associated with the heterogeneous ileus\npsoas muscle which has an intramuscular hematoma which appears grossly\nsimilar.  There continues to be anterior mass effect on the right kidney and\nright lobe of the liver.  There is no abdominal aortic aneurysm.  Moderate\natherosclerotic disease is noted.\n\nBONES: Again seen are multilevel degenerative changes of the thoracolumbar\nspine with mild multilevel retrolisthesis as well as compression deformity of\nthe T12 vertebral body.  There are no acute or suspicious findings.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Interval enlargement of the gallbladder with development of pericholecystic\nstranding, concerning for acute cholecystitis.  Cholelithiasis.\n2. Unchanged mild central intrahepatic, extrahepatic and pancreatic ductal\ndilatation with unchanged position of the 3 mm stone in the distal CBD, at the\nlevel of the ampulla.\n3. Stable right retroperitoneal hematoma.\n4. 1.3 cm indeterminate left upper pole renal lesion, possibly a\nhemorrhagic/proteinaceous cyst, amenable to 6 month follow-up ultrasound.\n\nNOTIFICATION:  The findings were discussed with ___, M.D.  By ___\n___, M.D. on the telephone on ___ at 4:26 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: A moderate right pleural effusion and atelectasis at the right\nlung base are not significantly changed.  Small amount of atelectasis is at\nthe left lung base is not significantly changed.  The heart is markedly\nenlarged.  Status post mitral valve replacement.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a stable 1.1 cm likely hepatic cyst in the liver.  Mass effect on the\nright lobe of the liver by the retroperitoneal hematoma is not significantly\nchanged.  Mild central biliary duct dilatation is not significantly changed. \nA punctate hyperdensity in the distal common bile duct at the ampulla is not\nsignificantly changed, representing a common bile duct stone (5:43).\n\nCompared with ___, patient has undergone interval percutaneous\ncholecystostomy, with the tip of the tube terminating in the gallbladder lumen\nwhich is now decompressed containing gallstones.  Adjacent to the fundus of\nthe gallbladder, there is a new 5.7 x 4.9 x 7.0 cm fluid collection and\ninferior to that there is an additional 2.9 x 2.7 x 2.7 cm fluid collection\n(5:53; 62).  These are concerning for gallbladder perforation.  Small\nperihepatic ascites is not significantly changed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  Previously noted pancreatic duct dilatation is no longer seen.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  Minimal perisplenic free fluid is new\n\nADRENALS: The 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 hypodense lesion in left upper pole which contained hyperintense\nmaterial on prior CT on ___ is not significantly changed, likely\ncyst containing hemorrhagic or proteinaceous material.  Additional\nsubcentimeter cortical hypodensities bilaterally are too small to\ncharacterize, however not significantly changed from prior likely represent\ncysts.  There is no hydronephrosis.  Mass effect on the right kidney but the\nright retroperitoneal hematoma is not significantly changed.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout. Mild dilatation of\nsmall-bowel loops in the left lower quadrant is nonspecific.  The colon and\nrectum are within normal limits.  The appendix is normal (5:69).\n\nA large right retroperitoneal hematoma measuring up to 19 cm in SI direction\nand associated mass-effect is not significantly changed.  Right psoas hematoma\nis not significantly changed.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Pelvic free\nfluid is slightly increased compared to prior\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 diffuse subcutaneous edema, not significantly changed.  There\nare multilevel degenerative changes in the lumbar spine, not significantly\nchanged.  Compression deformity T12 is not significantly changed.  Mild\nanterolisthesis of L4 on L5 is not significantly changed.  Median sternotomy\nwires are partially visualized.",
            "output": "1. Interval placement of a percutaneous cholecystostomy tube which terminates\nin the gallbladder lumen which is decompressed and contains gallstones. \nAdjacent to the fundus of the gallbladder there are 2 new fluid collections\nwhich appear to be separate from the gallbladder lumen (gallbladder is\ndecompressed), the larger measuring up to 7 cm in the SI direction, likely\nrepresenting walled-off perforation.\n2. 3 mm distal CBD stone with mild associated extra and intrahepatic bile\ndilation is again noted.  Bile duct dilation as well as pancreatic duct\ndilatation appears slightly improved compared to prior.\n3. Small perihepatic ascites not significantly changed.  Interval increase in\namount pelvic free fluid and a small perisplenic fluid is new.\n4. Large right retroperitoneal hematoma is not significantly changed.\n5. No significant change in a 1.3 cm left upper pole renal lesion which\ncontained hyperintensity on prior noncontrast CT, likely a cyst containing\nhemorrhagic or proteinaceous material, however for which six-month follow-up\nrenal ultrasound is recommended.\n6. Small right pleural effusion with bibasal atelectasis (right more than\nleft).\n7. Marked cardiomegaly.\n\nRECOMMENDATION(S):  Follow-up renal ultrasound in 6 months."
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion and a trace left pleural\neffusion.  There is bibasilar atelectasis.  Significant calcifications\ninvolving the coronary arteries, ascending aorta and aortic valve.  There is a\nprosthetic mitral valve.  The heart is markedly enlarged. There is no\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.0\ncm hypodensity in the right lobe the liver is redemonstrated and likely\nrepresents a cyst (series 2, image 45).  There is significant mass effect on\nthe right lobe of the liver by the retroperitoneal hematoma, not significantly\nchanged.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.\n\nPatient is status post percutaneous cholecystostomy, with tip of tube\nterminating in the gallbladder lumen, as on prior.  There is redemonstration\nof cholelithiasis. There is redistribution of the stones within the\ndecompressed gallbladder.\n\nAdjacent to the fundus of the gallbladder, there is a fluid collection\nmeasuring 5.5 x 4.9 cm, not significantly changed in size compared to prior\n(series 2, image 55).  New additional hyperdense material in the inferior\nregion of the collection may represent hemorrhage.\n\nThe inferior extraluminal collection has decreased in size and measures 1.5 x\n1.5 cm (series 2, image 64), previously 2.9 x 2.7 cm.\n\nPerihepatic ascites and stranding in the gallbladder fossa is redemonstrated. \nThere is loss of the fat plane between the gallbladder and the transverse\ncolon and second portion of the duodenum.  An underlying fistula cannot be\nexcluded.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 lesion in the upper pole of the left kidney is unchanged.  Additional\nhypodensities bilaterally are too small to characterize however likely\nrepresent cysts.  Redemonstrated mass-effect on the right kidney from the\nretroperitoneal hematoma.  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\nRedemonstrated large right retroperitoneal hematoma measures 19.5 cm in\nmaximal coronal diameter (series 601, image 27) and is not significantly\nchanged compared to prior.  Right psoas muscle hematoma is also unchanged.\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.\n\nLYMPH NODES: There is no abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes of the lumbar spine redemonstrated. \nCompression deformity at T12 is unchanged compared to prior.  Redemonstrated\nmild anterolisthesis of L4-L5 and mild retrolisthesis of L3 on L4.\n\nSOFT TISSUES: Moderate subcutaneous edema/anasarca is unchanged.",
            "output": "1. Fluid collection inferior to the gallbladder is not significantly changed\nin size, but now contains new hyperdense material, which is concerning for\nhemorrhage.\n2. Additional smaller extraluminal collection has decreased in size.\n3. Percutaneous cholecystostomy tube terminates within the gallbladder lumen. \nRedistribution of cholelithiasis within the decompressed gallbladder lumen.\n4. Loss of the fat plane between the gallbladder and the transverse colon as\nwell second portion of the duodenum, secondary to inflammatory changes.  A\ndeveloping fistula cannot be excluded.\n5. Large right retroperitoneal hematoma which is not significantly changed.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:59 pm, 30 minutes\nafter discovery of the findings."
        },
        {
            "input": "LOWER CHEST: There is a small right pleural effusion, not substantially\nchanged from prior study.  There is mild bibasilar atelectasis.  Otherwise,\nvisualized lung fields are within normal limits.  There are extensive\ncalcifications involving the coronary arteries and aortic valve.  The patient\nis status post mitral valve replacement.  The heart is severely enlarged. \nThere is no pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is redemonstration of a 10 mm hypodense lesion in hepatic segment 4B,\nunchanged from prior study and compatible with a hepatic cyst.  Otherwise,\nthere is no evidence of focal lesions within the limitations of an unenhanced\nscan.  There is interval resolution of the previously noted perihepatic\nascites.\n\nThe percutaneous cholecystostomy tube tip terminates in the gallbladder lumen.\nInjected contrast material from prior study is noted within the gallbladder\nlumen with intraperitoneal extravasation through a defect within the\npreviously noted contained collection communicating with the inferior\naspect/fundus of the gallbladder (2:46), compatible with perforation.  There\nis resultant decompression of the gallbladder and of the previously seen\nadjacent collection compatible with a contained perforation, now decompressed.\nThe extravasated contrast appears extends inferior to the gallbladder adjacent\nto the transverse colon measuring up to 3.0 x 2.3 cm (2:49).  No contrast\nmaterial is noted within the common bile duct.\n\nPANCREAS: The pancreas has normal attenuation throughout, without 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 stable\nsubcentimeter hypodense lesions, too small to characterize.  High-density\nmaterial in the region of the renal pelves ureter and bladder is likely\nexcreted contrast.  Otherwise, there is no suspicious 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.  There is extensive colonic\ndiverticulosis without evidence of diverticulitis.  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 a\nsmall amount of free fluid in the pelvis with multiple small dependent\ncalcified densities, compatible with gallstones (2:75).\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: Multilevel degenerative changes of the lumbar spine are not\nsubstantially changed from prior study.  Compression deformity of the T12\nvertebral body is unchanged.  There is mild ___ of L4 relative to\nL5 and mild relative ___ of L3 relative to L4, unchanged.  There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is redemonstration of a large right retroperitoneal\nhematoma measuring 10.1 x 8.4 x 18.8 cm, mildly decreased from prior study\n(2:46 and 602:26).  The right psoas hematoma appears slightly decreased from\nprior study measuring up to 7.7 cm, previously measuring up to 8.5 cm\n(601:42).  Otherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post percutaneous cholecystostomy with intraperitoneal extravasation\nof contrast material, compatible with perforation and resultant decompression\nof the previously noted contained collection communicating with the\ngallbladder fundus.\n2. Small amount of free fluid within the pelvis containing multiple\ngallstones.\n3. Redemonstration of a large right retroperitoneal hematoma and right psoas\nhematoma, mildly decreased from prior study.\n4. Extensive diverticulosis without evidence of diverticulitis."
        },
        {
            "input": "LOWER CHEST: Marked cardiomegaly is again seen with mitral valve replacement\nand notable biatrial chamber enlargement.  No pericardial effusion.  There is\na small partially visualized right pleural effusion with associated\ncompressive lower lobe and middle lobe atelectasis.  Mild left basal\natelectasis is also seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally.  There is a small cyst in segment\n4 B unchanged.  The gallbladder contains hyperdense material likely\nrepresenting a combination of stones and injected contrast.  The previously\nnoted cholecystostomy tube has been removed.  There is a fluid collection\nwhich communicates with the gallbladder fundus and extends inferomedially\nwhich measures approximately\n6.7 x 5.8 x 5.9  cm (series 2, image 51).  This collection may represent\nabscess versus contained biloma.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Multiple\nsubcentimeter hypodensities are too small to characterize.  The urinary\nbladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening and fat stranding. The\nappendix is normal.\n\nPELVIS:  Small volume pelvic free fluid with enhancement along the right\nperitoneal wall concerning for peritonitis (series 2, image 71).\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the lumbar spine are demonstrated.  T12\ncompression deformity is unchanged in appearance.  Grade 1 retrolisthesis L3\nover L4 and anterolisthesis L4 over L5 is stable\n\nSOFT TISSUES: Redemonstrated is the large right psoas hematoma that measures\n19.0 x 10.2 x 8.5 cm, overall unchanged in size compared to prior.",
            "output": "1. Interval removal of the cholecystostomy tube with perforated gallbladder\nand increased fluid collection extending inferomedially from the gallbladder\nfundus, which may represent a biloma versus abscess.\n2. Small volume pelvic free fluid with thickening and hyperenhancement of the\nperitoneum in the deep pelvis raises concern for peritonitis.\n3. Similar appearance of a large organized right-sided psoas hematoma\n4. Marked cardiomegaly.  Partially visualized right pleural effusion with\ncompressive atelectasis in the right lower lung.\n\nNOTIFICATION:  The updated findings were discussed with ___, m.D.\nby ___, M.D. on the telephone on ___ at 9:59 pm, 5 minutes after\ndiscovery of the findings."
        },
        {
            "input": "A small right-sided pleural effusion appears unchanged and is accompanied by\npartial right middle and lower lobe atelectasis as before.  Lesser atelectasis\nis also unchanged at the left lung base without pleural effusion.  Heart is\nagain moderate to severely enlarged cava, especially each atrium and the right\nventricle.  Left ventricular thinning is suspected.  Patient is status post\nmitral valve replacement.  Coronary artery calcification is visible.\n\nThere is hyperenhancement along the anterior capsule of the lower right lobe\n(2:43) suggesting peritoneal inflammation along the liver surface.  A small\nhepatic cyst is unchanged in the fourth segment.  Gallbladder catheter was\nremoved.  The gallbladder itself still appears decompressed with mild wall\nthickening and many small to medium calcified stones.  Emanating from the\ngallbladder is a rim enhancing collection (2:47) which measures up to 64 x 47\nmm in axial ___.  On the recent prior CT it measured up to 62 x 71 mm\nin diameter so mildly reduced in size.\n\nThere is still slight surrounding fat stranding.  Although there is still no\nbiliary dilatation, a new finding is the presence of a group of small stones\n(each measuring less than 3 mm) layering dependently in the distal common bile\nduct.\n\nThe pancreas is again mildly atrophic without inflammatory change.  Spleen is\nnormal in size and appearance.  Adrenals are unremarkable.  There are few sub\n5 mm hypodense foci in the right kidney there are too small to characterize\nbut unchanged and doubtful in clinical significance.  A small simple cyst\nalong the upper pole of the left kidney measures 14 mm in diameter.  No hydro\nnephrosis.  Tiny stone along the right lower pole measures 3 mm in diameter. \nVery small cortical calcification along the left inferior pole measures 2 mm.\n\nHyperdense pill fragments within the stomach, which is nondistended.  Small\nbowel appears normal.  Sigmoid diverticulosis is moderate.  Although there is\nfat stranding in the deep pelvis and trace ascites, these findings appear\nreduced and probably are not related directly to the sigmoid colon.  It is\nnoted that tiny calcifications in the pelvic cul de sac are probably\nassociated with dropped gallstones (2:70 and 68).  Dependent peritoneal\nthickening and possibly debris with trace hemorrhage appear very similar\nalthough there is less inflammatory change about the cul-de-sac overall.\n\nA large evolving hematoma in the right retroperitoneum measures up to 106 x 84\nmm in axial ___ (as measured on 2:47) is stable.  Atherosclerotic\nchanges are moderately severe.  Major vascular structures appear patent,\nhowever, without indication of any severely stenotic vessels although still\nsome degree of right renal artery stenosis is possible.  Inferior vena cava\nand hepatic veins are enlarged in keeping with suspected right-sided cardiac\ninsufficiency.  Mild diffuse anasarca similar to prior study.\n\nNo uterus is found. No adnexal mass. Bladder is unremarkable. No\nlymphadenopathy.\n\nThere are no suspicious bone lesions.  Moderate degenerative changes affect\nlower lumbar facet joints.  There are no suspicious bone lesions.  Bones are\nprobably demineralized.  Mild loss in height of the T12 vertebral body is\nstable.",
            "output": "1.  Decrease in organized pericholecystic collection.  The collection contains\na number of very small gallstones, as does the residual mostly collapsed\ngallbladder.\n\n2.  Decreased ascites and inflammation in the pelvic cul de sac.  Dropped\ngallstones in the cul de sac as seen previously.\n\n3.  Group of new very small distal common duct stones compared to the recent\nprior CT but without upstream biliary dilatation.  Correlation with clinical\ncircumstances and laboratory data is recommended."
        },
        {
            "input": "LOWER CHEST: Stable cardiomegaly.  Unchanged small right pleural effusion with\ncompressive atelectasis of the middle and right lower lobe.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nUnchanged cyst/biliary hamartoma in segment 4 B (5:36) measuring 1.0 cm. \nThere is no evidence of focal suspicious lesions.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is again\nnoted to be perforated connecting to an abscess formed in the mesentery\nmeasuring approximately 4.2 x 1.6 cm (5:48), previously measuring 6.3 x 4.6\ncm.  A drain has been placed in the gallbladder lumen and it is appropriately\nplaced.  Small gallstones are noted within this mesenteric abscess. The\ngallbladder itself remains decompressed with several gallstones noted in the\ninfundibulum (5:38).  Gallstones are again identified in the stent common bile\nduct (5:38).\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 simple cyst in the left kidney (5:26) measuring 1.4 cm.  Subcentimeter\nhypodense lesion in the right kidney is stable however too small to\ncharacterize.  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. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The rectum is unremarkable.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nagain small amount of free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  No grossly large adnexal\nmasses bilaterally.\n\nLYMPH NODES: Stable hematoma in the right retroperitoneal space measuring\napproximately 10.5 x 8.1 cm (5:50).  There is no retroperitoneal or mesenteric\nlymphadenopathy.  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.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Re-demonstration of a mesenteric abscess in communication with a perforated\ngallbladder fundus, with recent placement of a draining pigtail catheter.  The\ncatheter is in appropriate position and the mesenteric abscess is smaller\ncompared to prior study of ___.  No hepatic abscesses are\nidentified.\n2. Right retroperitoneal hematoma, stable."
        },
        {
            "input": "The visualized lung bases are clear. The heart is normal in size and there is\nno evidence of pericardial effusion.\nABDOMEN: Redemonstrated are multiple liver hypodensities, unchanged since ___, with the largest measuring 2.1 x 1.4 cm within segment ___ (2:10).  The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder, pancreas, spleen, and\nbilateral adrenal glands are normal.  Multiple accessory splenules are noted,\nunchanged from prior. The patient is status post left nephrectomy, and there\nis no evidence of local recurrence. The right kidney enhances symmetrically\nand is without suspicious solid mass.\nThe stomach is grossly unremarkable in appearance. The small and large bowel\nare grossly normal in caliber and without evidence of wall thickening. There\nis a large degree of colonic fecal loading. The appendix is normal. There is\nno retroperitoneal lymphadenopathy by CT size criteria. There is no free\nabdominal fluid or pneumoperitoneum. The aorta and iliac branches are normal\nin course and caliber. The celiac trunk and SMA are grossly patent.\nPELVIS:  The bladder, sigmoid colon, and rectum are grossly unremarkable.\nThere is no pelvic side-wall or inguinal lymphadenopathy by CT size criteria.\nNo free pelvic fluid is identified.\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No evidence of acute intra-abdominal process.\n2. Status post left nephrectomy without evidence of recurrent disease."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable.  The\nappendix is normal.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No atherosclerotic disease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Extending from the perianal region to the distal rectum, there\nis a 4.0 x 3.6 x 7.0 cm area of inflammatory change or phlegmon.  Within this\narea of inflammation, there is a 2.2 x 2.0 x 3.0 cm irregular rim enhancing\nfluid collection, compatible with a perianal abscess.",
            "output": "1. 2.2 x 2.0 x 3.0 cm irregular perianal abscess with a large amount of\nsurrounding inflammation and phlegmon extending cranially to the distal\nrectum."
        },
        {
            "input": "LOWER 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.\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 adrenal is normal. Both arms of the left adrenal are\nmildly enlarged likely due to hyperplasia.\n\nURINARY: There is a hypodensity in the left kidney which measures 1.7 cm in\ndiameter and likely represents a renal cyst. There is a subcentimeter\nhypodensity in the inferior pole the right kidney which is likely a renal\ncyst. There are two hypodensities involving the midpole of the right kidney\n(series 9, image 22) measuring 1.1 and 1.4 cm in diameter and likely\nrepresenting renal cysts.\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:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.  The main portal vein,\nsplenic vein and SMV are patent.\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. Uterus is of normal size and enhancement. No evidence of adnexal\nabnormality.\n\nBONES AND SOFT TISSUES: No bone finding suspicious for infection or malignancy\nis seen.  Patient status post left mastectomy.",
            "output": "1.  There is no evidence of metastasis within the abdomen and pelvis.\n2.   There are multiple hypodensities in the kidneys bilaterally which are\nlikely renal cysts."
        },
        {
            "input": "PELVIS:  Previous small-bowel anastomosis is seen.  Diverticulosis is seen\nthroughout the large bowel.  Stranding around the anterior bladder is\nconsistent with trauma.  Air seen the bladder secondary to Foley catheter\nplacement.  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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Extensive atherosclerotic disease is noted.\n\nBONES: Displaced and comminuted fractures are seen of the superior and\ninferior left pubic rami.  There is an additional left sacral fracture at the\nmid sacroiliac joint.  A 4.0 x 2.5 cm hematoma is seen medially adjacent to\nthe fracture (301, 61).  Additionally, high density material consistent with\nhematoma is seen lateral to the left greater trochanter consistent with\nhematoma (304, 40).  There is severe osteopenia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Comminuted fractures of the left superior and inferior pubic rami.  Mildly\ndisplaced left sacral fracture along the left mid sacroiliac joint.\n2. Adjacent hematomas are seen just superior to the left pubic symphysis and\nlateral to the left greater trochanter."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 not visualized.  The CBD is dilated to\n1.2 cm and tapers down smoothly at the level of the ampulla.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 extrarenal pelvises are noted.  A 2 cm simple renal cyst arising\nfrom the lower pole of the left kidney is noted.  Additional hypodensities in\nthe kidneys bilaterally too small to characterize but statistically cysts. \nPunctate nonobstructing right renal calculus is noted.  Alternatively, this\ncould represent a vascular calcification.  Cortical thinning compatible scar\nnoted at the upper pole the right kidney.  There is no evidence of focal\nsuspicious renal lesions or hydronephrosis.  There is 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.  No bowel obstruction.  Oral contrast seen up to the distal\ntransverse colon, distal to the a ventral hernia containing loops of\nnonobstructed transverse colon.  There are two additional small bowel\ncontaining hernias inferior to this hernia without secondary obstruction. \nLarge amount of stool is noted in the distal transverse colon, descending\ncolon, sigmoid and rectum.  Colonic diverticulosis without diverticulitis. \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 not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES/MESENTERY/OMENTUM: No abdominal or pelvic lymphadenopathy.  Again\nseen 2.3 cm omental infarct is noted in the right lower quadrant, similar to\n___.\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: Ventral hernia containing loops of the small bowel and\ntransverse colon without causing bowel obstruction.",
            "output": "1. Three nonobstructing bowel containing hernias along the anterior abdominal\nwall, the superior most hernia contains transverse colon.  Two more inferior\nmidline abdominal hernias contain nonobstructed small bowel.\n2. Large amount of stool from the distal transverse colon to the rectum.  No\nobstruction.\n3. Diverticulosis without diverticulitis."
        },
        {
            "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: Liver is normal in contour and attenuation.  No focal\nparenchymal lesions identified.  As noted on the study performed in ___, there is mild to moderate intrahepatic bile duct dilatation, as well as\nmarked dilatation of the CBD (up to 14 mm), with normal tapering towards the\nampulla.  Patient is status-post cholecystectomy.  The ductal dilatation is\nlikely related to the post-cholecystectomy status.  The CBD dilatation has\nmildly progressed from the study performed in ___, previously\nmeasuring up to 12 mm in diameter.  The intrahepatic bile duct dilatation is\nsimilarly slightly more pronounced.\n\nPANCREAS: Pancreatic parenchyma is normal in bulk and attenuation.  No focal\nparenchymal lesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (10 cm).  There are multifocal plaque-like,\nalmost nodular implants studding the splenic capsule, hypodense relative to\nthe splenic parenchyma on the post-contrast scan.  Some of these implants are\nlarger and more conspicuous than they were on the study performed ___ (series 6, image 53 and series 6, image 51).  There is an additional\nimplant which is seemingly new (series 6, image 47).  These implants appear to\nscallop the splenic parenchyma.  Implants have an intermediate attenuation\n45-50 Ho___ units on the portal venous phase.  The attenuation is more\ndifficult to measure on the non-contrast scan, as these are relatively\nobscured.\n\nADRENALS: The right adrenal gland is normal.  There is mild diffuse nodularity\nof the left adrenal gland, without a single discrete adrenal nodule. \nAppearance is unchanged from the study performed in ___.\n\nURINARY: There is mild diffuse thinning of the renal cortex bilaterally.  Note\nis made of bilateral renal cortical cysts.  There is a 3 mm non-obstructing\ncalculus at the interpolar region of the right kidney.  No nephrolithiasis\notherwise.  An extrarenal pelvis is noted in both kidneys.  No hydronephrosis.\n\nGASTROINTESTINAL: Moderately large hiatus hernia.  Stomach otherwise\nunremarkable.  No structural abnormality of the small bowel.  Significant but\nuncomplicated sigmoid diverticulosis with additional scattered uncomplicated\ndiverticula in the descending colon.  As on the prior study, there is a\nmoderately large paraumbilical hernia with a neck measuring approximately 6.2\ncm, previously 5.3 cm in ___.  Fat and transverse colon are seen\nherniating through this defect.  There are no signs to suggest presence of\nstrangulation.  Upstream bowel is not dilated.  There is no fluid in the\nhernia sac.  No hernia sac fat stranding.  Appendix is not identified.\n\nPERITONEUM: No intra-abdominal free air or free fluid.  There is a small\nomental infarct along the right hemiabdomen (series 6, image 84).  A second\nsmall omental infarct is noted more superiorly in the right hemiabdomen\n(series 6, image 65).  These are both visualized on the prior CT.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Patient is status-post hysterectomy.  The vaginal vault\nis unremarkable.  No adnexal abnormality.  There is an element of pelvic\ndescent.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, or mesenteric\nlymphadenopathy.\n\nVASCULAR: There is severe aortoiliac and general intra-abdominal vascular\ncalcification.  The abdominal aorta and iliac vessels are not aneurysmal. \nVisualized aorta, common iliac, external iliac, and visualized internal iliac\narteries demonstrate opacification.  There is marked atherosclerotic plaque at\nthe origins of multiple aortic branch vessels.  Portal vein, portal\nconfluence, SMV, and splenic vein patent.  IVC patent.\n\nBONES: There is degenerative facet arthropathy in the lower lumbar spine.  No\nacute or focal destructive osseous lesions are seen.\n\nSOFT TISSUES: Aside for the abdominal wall hernia described above, there is\nscarring from prior midline laparotomy.  Abdominal and pelvic wall otherwise\nunremarkable.",
            "output": "1. Multifocal plaque like, almost nodular implants studding the splenic\ncapsule.  Some of these are larger and more conspicuous than they were in\n___.  There is at least one implant that appears new from this prior\nstudy.  The nature of these findings is indeterminate.  Whether this is\nrelated to known lung malignancy is unclear.  This is not a common observation\nwith lung cancer, but can be seen with other malignancies such as appendiceal\nmucinous tumors or ovarian tumors.  Note that we seen no evidence of such\npathology on today's scan.  This requires further characterization with MRI,\nprimarily to determine whether the implants truly represent enhancing soft\ntissue.  Biopsy under ultrasound guidance or CT guidance would be technically\nchallenging given the location of these findings and the proximity to the lung\nand pleura.  The necessity and the feasibility of biopsy can be discussed once\nthe MRI is performed.\n2. There is no evidence of intra-abdominal or pelvic malignancy otherwise.\n\nRECOMMENDATION(S):  An MRI with and without contrast is recommended to further\nassess the plaque-like implants studding the splenic capsule."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 suspicious focal lesion.  Diffuse intra and extrahepatic biliary\ndilation is 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: Redemonstration of numerous implants along the splenic capsule,\nmeasuring up to 1.3 cm, unchanged.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Bilateral renal scarring and cortical thinning is noted.  A left\ninferior pole renal cyst is redemonstrated.  No hydronephrosis.  Numerous\nsubcentimeter cortical hypodensities are too small to characterize.  Mild\nbilateral perinephric stranding is nonspecific.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  There are small bowel loops\nin a ventral hernia which not appear obstructed.  There is colonic\ndiverticulosis without evidence of diverticulitis.  The colon is distended\nwith predominantly fat density fecal material.  A large ventral hernia\ncontains a loop of transverse colon that does not appear obstructed.  There is\ncolonic diverticulosis without evidence of diverticulitis.  The appendix is\nnot visualized.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is extensive atherosclerotic disease. There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.  No aggressive\nosseous lesion or acute fracture.\n\nSOFT TISSUES: Numerous nodular densities are seen along the anterior abdominal\nwall, possibly related to subcutaneous injection.  See above for a description\nof ventral hernias.",
            "output": "1. Ventral hernias containing a loop of transverse colon and inferiorly a\nventral hernia containing a loop of small bowel, without convincing evidence\nof obstruction.  Compared to ___, there is increased small bowel\nwithin the inferior ventral hernia.\n2. The colon is distended with large volume predominantly fatty fecal material\nthroughout.\n3. Multiple nodular foci along the posterior margin of the spleen are\nunchanged compared to ___."
        },
        {
            "input": "THORAX: Multiple pulmonary nodules are seen at the lung bases, the largest\nmeasuring 5 mm at the base of the left lung (series 2, image 14 an additional\n4 mm nodule is seen more superiorly (series 2, image 9). The visualized heart\nand pericardium are normal.\n\nLIVER: Innumerable hypodense lesions seen throughout the liver are consistent\nwith known hepatic metastases, characterized on prior MRI from ___.  The\nhepatic and portal veins appear patent.  There is mild periportal edema,\npresumably related to fluid resuscitation.  There is no evidence of intra or\nextrahepatic biliary ductal dilatation.\n\nGALLBLADDER: The gallbladder is normal.\n\nSPLEEN: The spleen is normal in size and enhancement. There are multiple\nperisplenic venous collaterals noted.\n\nPANCREAS: A 3.9 cm low-density mass centered within the pancreatic tail is\nagain demonstrated and is better characterized on the prior MRI.  There is no\npancreatic ductal dilatation or peripancreatic fat stranding.\n\nADRENALS: The adrenal glands are unremarkable bilaterally.\n\nKIDNEYS: A subcentimeter hypodense lesion within the left kidney is too small\nto characterize.  The kidneys display symmetric nephrograms and show no\nevidence of hydronephrosis.\n\nBOWEL: The small bowel is normal appearing with no evidence of obstruction.\nThe large bowel is filled with stool and is normal.  There is no free air or\nfree fluid in the abdomen or pelvis.\n\nVESSELS: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLYMPH NODES: Multifocal lymphadenopathy is again demonstrated involving the\nporta hepatis, gastrohepatic ligament and retroperitoneal nodes, unchanged\nfrom the prior MRI.\n\nPELVIS: The bladder is unremarkable.  The sigmoid colon and rectum are normal\nappearing.  There is no pelvic sidewall lymphadenopathy\n\nOSSEOUS STRUCTURES/ SOFT TISSUES: There are no suspicious lytic or blastic\nlesions seen in the visualized osseous structures. Moderate degenerative\nchanges noted throughout the spine.",
            "output": "1. 3.9 cm mass within the pancreatic tail is again demonstrated and better\ncharacterized on recent MRI.\n2. Extensive necrotic hepatic metastases are again demonstrated. Mild\nperiportal edema is seen and is likely related to fluid resuscitation.\n3. Normal gallbladder.\n4. Multifocal lymphadenopathy is unchanged from the prior MRI.\n5. Multiple pulmonary nodules, predominantly at the base of the left lung are\nnoted and likely represent metastatic lesions."
        },
        {
            "input": "CT ABDOMEN:  For detailed description of the chest, including multiple\nmetastatic lesions in the lungs, refer to separately reported chest CT.\n\nExtensive metastatic disease in the liver is significantly worsened compared\nwith ___, with increase in number and size of metastasis.  Nearly\nthe totality of the volume of the liver is affected by metastasis.  The left\nportal vein is patent. The anterior and posterior branches of the right portal\nvein are newly occluded, likely due to tumor thrombosis by an enlarging\nmetastasis at the bifurcation of the right portal vein (series 6, image 27). \nThere is no significant intrahepatic biliary duct dilatation. The gallbladder\nis decompressed.  The common bile duct is not dilated.\n\nThe uncinate process and body of the pancreas are unremarkable. The large mass\nabutting the pancreatic tail measuring 6.0 x 5.5 cm is significantly increased\nin size compared with the previous exam when it measured are 3.8 x 3.8 cm. \nThe spleen is mildly enlarged, measuring 14 cm of the superoinferior\ndimension, not significantly changed from prior.  The splenic vein is\nthrombosed, with significant perisplenic varices.  Extensive for\nretroperitoneal and porta hepatis lymphadenopathy is also worsened from ___, with increase in number and size of the numerous enlarged nodal masses.\n\nThe right adrenal gland is unremarkable. The left adrenal gland is thickened\nand nodular, and inseparable from the pancreatic tail mass. This nodularity is\nmore conspicuous than in the prior exam and concerning for metastasis versus\ntumor invasion from pancreatic tail neoplasm. The kidneys demonstrate\nsymmetric nephrograms.  A 1.1 cm cyst in the interpolar region of the left\nkidney is unchanged.\n\nThe small and large bowel are grossly unremarkable.  There is no mesenteric\nlymphadenopathy.  There is perihepatic fluid with scalloping of the liver\nalong the inferior portion of the right liver lobe, concerning for mass effect\nin the setting of peritoneal carcinomatosis..  There is no free air.  The\naorta is non aneurysmal. The main intra-abdominal arteries are grossly patent.\n\nCT PELVIS:  The urinary bladder and uterus are unremarkable. There is no\npelvic wall or inguinal lymphadenopathy.  Moderate amount of pelvic free fluid\nis present, likely tracking from the peritoneum.\n\nOSSEOUS STRUCTURES: There is no lytic or blastic lesion worrisome for\nmalignancy.",
            "output": "1. Significant interval worsening of extensive metastatic disease to the\nliver, retroperitoneal nodes and porta hepatis nodes, noteworthy given short\nfollowup interval.  There is also significant interval increase of pancreatic\ntail mass.\n\n2. Loss of the fat planes between the mass and the thickened and nodular left\nadrenal gland may represent tumoral invasion versus metastatic disease.\n\n3.  Interval occlusion of the anterior and posterior branches of the right\nportal vein, likely due to tumor thrombosis from an enlarging mass at the\nbifurcation of the right portal vein.  Unchanged thrombosis of the splenic\nvein with numerous perisplenic varices and moderate splenomegaly.\n\n4. Perihepatic fluid resulting in scalloping of the liver surface raises\nconcern for peritoneal carcinomatosis."
        },
        {
            "input": "The bases of the lungs are clear.  Aside from mild periportal edema, the liver\nis normal without evidence of focal lesions, or intrahepatic biliary ductal\ndilatation the gallbladder is normal.  The spleen is homogeneous, and normal\nin size.  The adrenal glands bilaterally are unremarkable.  The kidneys\nbilaterally are normal.  The pancreas is normal without evidence of focal\nlesions, or pancreatic ductal dilatation.\n\nThe stomach is mildly prominent.  The duodenum, and small bowel are otherwise\nunremarkable.  The colon is unremarkable.  The patient is status post\nappendectomy.\n\nCT pelvis:  The urinary bladder is significantly distended.  There is no\npelvic wall, or inguinal lymphadenopathy.  There is no pelvic free fluid.\n\nOsseous structures:  No lytic or blastic lesions concerning for malignancy\nidentified.",
            "output": "No acute intra-abdominal abnormalities identified.  Note is made of a\ndistended stomach, however there is no evidence of esophageal distention. The\nduodenum is normal in caliber.\n\nSignificantly distended bladder."
        },
        {
            "input": "LOWER 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.  6 mm\nhypodensity in segment IV B is too small to characterize, and was not well\nevaluated on prior MRI.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is fatty infiltration and atrophy of the pancreatic gland\nwithout focal lesions.  The main pancreatic duct is not dilated.  There is no\nperipancreatic stranding.\n\nSPLEEN: Patient is status post splenectomy.\n\nADRENALS: Bilateral adrenal glands are normal.\n\nURINARY: Atrophic and scarred left kidney already present in ___ however\nprogressed, with again/persistent mild to moderate hydronephrosis and dilation\nof the proximal ureter.  A 2 x 1.6 x 1.5 cm heterogeneous lesion immediately\nposterior to or arising from the lower pole of the left kidney (5:65).  The\nretroperitoneal conglomerate adenopathy extends into the left perinephric\nspace toward the left renal pelvis, similarly to ___.  The right kidney\nappears normal with mild fullness of the caliceal system without frank\nhydronephrosis.  No focal lesions or lithiasis seen.\n\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.  Bilateral adnexa are not\nidentified.\n\nLYMPH NODES: Extensive retroperitoneal adenopathy extending from the\ndiaphragmatic crura to bilateral external iliac chains.  The largest/bulkiest\ncomponent measures 8.2 x 3.3 cm in axial plane (5:64) at the level of the\nrenal arteries.  The conglomerate attenuates bilateral renal arteries, and\nencases and elevates the aorta without narrowing the lumen.  On current study\nthe majority of the disease is in the central retroperitoneum extending\ntowards the left perinephric space, while in ___ there was majority of\ndisease on the left side of the retroperitoneum and perirenal space.  The\namount of disease in the left perirenal space is smaller than on prior.  The\nleft renal vein appears stretched out but patent.  The infrarenal IVC appears\ncollapsed.  There is thickening of the Gerota and Zuckerkandl fascia on the\nleft.\n\nPeriportal adenopathy measures 1.1 x 2.6 cm (short, long axis) (05:55).  Few\nmesenteric lymph nodes measure up to 1.4 x 1.4 cm (5:68).  Bilateral common\niliac chain adenopathy measure up to 1.1 x 1.2 cm on the left (5:87). \nBilateral external iliac chain adenopathy measure up to 1.9 x 1 cm on the left\n(5:101).\n\nFew nonenlarged bilateral inguinal lymph nodes show FDG avidity on PET-CT. \nPlease refer to the PET/CT report for more details.\n\nVASCULAR: 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 most prominent in the lumbar spine, worse at L4-L5\nlevel with grade 1 anterolisthesis of L4 on L5, vacuum phenomenon within the\ndisc in subchondral sclerosis and anterior osteophyte.  Facet arthropathy is\nat least moderate in the lower lumbar spine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Extensive conglomerate adenopathy involving mainly the retroperitoneum, but\nalso the left perirenal space, mesentery and bilateral common iliac and\nexternal iliac chains.  The bulkiest component is at the level of the renal\narteries, causing attenuation of bilateral renal arteries and veins.\n2. 2 x 1.5 x 1.6 cm lesion likely arising from the lower pole of the left\nkidney could represent lymphomatous involvement but could also be secondary to\na separate malignant renal lesion such as RCC.\n3. Progressed atrophy of the left kidney since ___.\n4. Please refer to separately reported chest CT performed the same day and ___\nFDG PET-CT performed on the same day for further evaluation of disease."
        },
        {
            "input": "Partly imaged heart appears mildly enlarged.  Trace barely detectable pleural\neffusions with minimal atelectasis at each lung base.\n\nThere is no biliary dilatation.  No focal liver lesions are identified.  The\ngallbladder appears normal.  Pancreas is unremarkable.  Spleen is absent. \nRight kidney appears normal.  Left is again markedly atrophic with multifocal\nareas of cortical thinning.  Infiltration of the left renal hilum by a\nretroperitoneal mass appears very similar.  Along the posterior inferior\nmargin of the left kidney, a hyperenhancing mass measuring up to 22 x 18 mm in\naxial ___ (05:38) is unchanged.\n\nStomach and small bowel are unremarkable.  Quantity of stool throughout the\ncolon is mildly prominent but there is no evidence of inflammatory change.\n\nThere is mild fat stranding around the bladder but markedly decreased\nsuggesting resolving cystitis.  Small residual atrophic uterus or uterine\nstump.  No adnexal mass is found.\n\nExtensive infiltrate of heterogeneous but predominantly hyperenhancing\nretroperitoneal mass is consistent with lymphoma.  In maximum axial ___\nthis recently measured 82 x 33 mm in maximum axial ___ on the prior CT\nfrom ___ at the same level it now measures up to 70 x 26 mm, somewhat\ndecreased.  Although infiltrated, arterial structures remain patent.  Venous\nstructures are difficult to assess.  At the aortic bifurcation decrease in\ntumor is even more striking.  Left iliac lymphadenopathy is similar to mildly\ndecreased.  A right external iliac node that previously measured 29 x 17 mm\nnow measures only 19 x 13 mm (5:67).\n\nBones appear demineralized.  Sclerotic bone lesion along the medial left iliac\nwing appears stable.  Os acetabulum all along each hip with mild degenerative\nchanges.  Degenerative changes of the lumbar spine include mild unchanged\nspondylolisthesis of L4 on L5 with associated degenerative changes.  The L1-L2\ninterspace is also again moderately narrowed with anterior osteophytes.",
            "output": "1.  Decreasing inflammation about the bladder.\n\n2.  No evidence of new acute process in the abdomen or pelvis.\n\n3.  On the whole, significant decrease in lymphoma."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields show 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 or\nextrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout with mild fatty\nreplacement.  There is no evidence of focal lesions or pancreatic ductal\ndilatation.  No peripancreatic stranding.\n\nSPLEEN: Absent.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Right kidneys are of normal and symmetric size with normal\nnephrogram.  Left kidney is again noted atrophic with hilum infiltration by\nthe adjacent retroperitoneal mass.  Stable appearance of the perirenal\nhyperenhancing 14 x 23 mm mass when compared to the most recent prior however\ndecreased in size since ___.  There is no hydronephrosis or\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout, no evidence of\nactive inflammatory process.  There is edematous wall thickening and hyperemia\ninvolving the descending colon through the rectum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Residual atrophic uterus is re-demonstrated.\n\nLYMPH NODES: Unchanged appearance of hyperenhancing retroperitoneal mass\ncompared to prior study and consistent with lymphoma.  The bulk of the mass is\nhowever decreased when compared to ___ and measures up to 6.3 x 1.9\ncm (04:37) and on the CT scan from ___, it measured up to 8.2 x 3.3 cm. \nThe soft tissue infiltration extends into the left renal hilum and inferiorly\nalong the common iliac chains.  There is no pelvic or inguinal\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Again noted the medial as well as with the sclerotic lesion in the\nmedial left iliac wing.  Increased tracer uptake seen on the prior PET in the\nright acetabulum and sacrum are not visualized on this CT.  No suspicious\nosseous lesions visualized.  Degenerative changes in hip joints and lumbar\nspine are unchanged as well.  Grade 1 anterolisthesis of L4 on L5..\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Acute colitis extending from the descending colon through the rectum,\nlikely infectious in etiology.\n2. Since ___, interval decrease in tumor bulk in the retroperitoneum,\nleft renal hilum and along the iliac chains.\n3. Trace bilateral pleural effusions.\n\nNOTIFICATION:  Updated impression was communicated to and acknowledged by Dr.\n___ by Dr. ___ at 17h05 on ___"
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The parenchyma enhances homogeneously.  There is an unchanged\n3 mm cyst at the dome in segment VIII (05:41).  No new focal hepatic lesions\nidentified.  The portal vein and its branches, the hepatic veins are patent.\nNo intra or extrahepatic biliary ductal dilation noted.\nThe gallbladder is partially distended with no radiopaque calculi within it.\nPANCREAS: The pancreatic parenchyma appears normal with no main duct dilation.\nNo focal pancreatic parenchymal lesions identified..\nSPLEEN:  The spleen is atrophic, as before and demonstrates tiny hypodensities\nwithin it, unchanged.\nADRENALS:  There are no adrenal nodules.\nURINARY: The left kidney is chronically atrophic with scarring.  No\nhydronephrosis seen on either side.  The right kidney has a normal appearance.\nAgain visualized is retroperitoneal soft tissue, described below.\nThere is interval decrease in size of left perinephric soft tissue now\nmeasuring 1.8 x 1.1 cm (series 5, image 64) previously 1.4 x 2.3 cm.\nGASTROINTESTINAL: There is no bowel obstruction.  A moderate amount of stool\nis noted throughout the colon.\n\nLYMPH NODES: Again visualized is soft tissue encasement of the abdominal aorta\nas well as bilateral renal arteries and the left renal vein with extension of\nthe soft tissue up to the aortic bifurcation.  Compared to the prior exam\ndated ___, there is interval decrease in size of this\nretroperitoneal soft tissue; for example a representative area measured in the\nleft para-aortic region at the left renal hilum now measures 3.3 x 2.1 cm\n(series 5, image 62); previously 3.6 x 2.8 cm respectively.\nContinued decrease in size of left external iliac lymph nodes (5:94) now\nmeasuring 7 mm in short axis compared to a prior of 1.3 cm.\nVASCULAR: Mild calcified atherosclerotic plaque is noted throughout the\nabdominal aorta and its branches.\n\nPELVIS:\nThe bladder is moderately distended and appears normal.  The uterus is\nunremarkable.  No adnexal masses.  No free fluid in the pelvis..\n\nBONES AND SOFT TISSUES:\nThere is no evidence of worrisome lesions.  Degenerative changes of both hip\njoints noted.  Multilevel facetal arthropathy is also seen in the lumbar\nregion.  Degenerative disc disease is noted at L4-5 level, as before.",
            "output": "1. Interval decrease in size of retroperitoneal lymph nodal soft tissue\nencasing the aorta, bilateral renal artery origins and left renal vein as\ndescribed in detail above.  Decrease in size of left posterior perinephric\nsoft tissue and left external iliac lymph nodes also noted.\n2. No new lymphadenopathy seen in the abdomen and pelvis.\n3. Chronic atrophy of the left kidney with renal cortical scarring is\nunchanged.  Normal appearance of the right kidney with compensatory\nhypertrophy and no hydronephrosis.\n4. The spleen is atrophic with unchanged subtle hypodensities within it."
        },
        {
            "input": "LOWER 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.  An\nunchanged 3 mm hypoattenuating lesion is demonstrated within segment VIII\nlikely demonstrates no increased enhancement on delayed imaging and likely\nrepresents a hepatic cyst.  No intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder demonstrates no radiopaque stones.  There is\nnodular thickening of the gallbladder fundus which may represent\nadenomyomatosis (series 2, image 55).\n\nPANCREAS: The pancreas has is slightly atrophic and there is fatty replacement\nof the pancreatic head.  No focal pancreatic lesions are demonstrated.  There\nis no peripancreatic stranding.\n\nSPLEEN: The spleen is severely atrophic and demonstrates two\nwell-circumscribed hypoattenuating lesions which may reflect hemangiomas.\n\n\nADRENALS: The left adrenal gland is diffusely nodular without discrete lesion.\nThe right adrenal gland is normal in size and shape.\n\nURINARY: Redemonstration of a chronically atrophic and scarred left kidney.\nWithin the left renal pelvis is a hypoattenuating soft tissue lesion that\nmeasures 3.1 x 2.1 cm, previously 3.0 x 2.1 cm, (series 2, image 63),\nunchanged in morphology and size from prior.  There is soft tissue that\nencases the bilateral renal artery origins and abuts the left renal vein\ncausing mild attenuation of the left renal artery .  Additionally inferior and\nlateral to the left kidney, is hypoattenuating soft tissue lesion which\nmeasures 1.1 x 1.4 cm, previously 1.1 x 1.8 cm, not significantly changed in\nsize and morphology, (series 2, image 65) compared to most recent prior,\naccounting for differences in measurement technique.\n The right kidney is normal in size and demonstrates a normal nephrogram.\n\n\n\nGASTROINTESTINAL: The stomach 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 is unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nLYMPH NODES:\nThere is no significant change in appearance of soft tissue within the\nretroperitoneum which encases the aorta and abuts the IVC.  No interval change\nin size of a 1.0 cm left internal iliac lymph node.  No new lymphadenopathy is\ndemonstrated within 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. \nMultilevel facet joint arthropathy is again demonstrated.  Mild to moderate\nmultilevel degenerative changes of the lower thoracic and lumbar spine include\nintervertebral disc space narrowing osteophytosis and endplate sclerosis. \nGrade 1 anterolisthesis of L4 on L5 is again demonstrated.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No interval change in appearance of retroperitoneal soft tissue which\nencases the aorta, bilateral renal origins and left renal vein as described.\n2. No interval change in morphology and size of a left perinephric\nhypoattenuating soft tissue.\n3. No evidence of new lymphadenopathy in the abdomen and pelvis.\n4. Please refer to same-day CT chest for detailed report 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: The liver demonstrates homogenous attenuation throughout. \nSubcentimeter hepatic dome hypodensity measuring 9 mm, too small to be\ncharacterize statistically likely reflecting a hepatic cyst.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: Redemonstrated slightly atrophic appearance of the pancreas.  No\nevidence of focal lesions or pancreatic ductal dilatation.  There is no\nperipancreatic stranding.\n\nSPLEEN: Redemonstrated appearance of atrophic spleen, with similar appearance\nof splenic hypodensities, may reflect splenic hemangiomas.\n\nADRENALS: Unchanged bilaterally.\n\nURINARY: The right kidney is normal in size and shape.  Redemonstrated\nchronically atrophic and scarred left kidney.  No significant interval change\nin the previously noted hypoattenuating soft tissue density along the left\nrenal pelvis, measuring 3.3 x 2.0 cm, previously measuring 3.1 x 2.1 cm.  No\nsignificant interval change in the hypoattenuating soft tissue density along\nthe inferior aspect of the left kidney, measuring up to 1.2 cm.  No\nsignificant interval change in the hypoattenuating soft tissue density encases\nthe origin of bilateral renal arteries and the left renal vein, with similar\nmild attenuation of the left renal artery.  There is no evidence of solid\nrenal lesions or hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable.  No abnormally dilated loops\nbowel.  The appendix is not visualized.\n\nPELVIS: Partially decompressed urinary bladder, limiting evaluation.  There is\nno 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.  No\nsignificant interval change in the left internal iliac lymph node measuring to\n9 mm in short axis.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Redemonstrated retroperitoneal soft tissue density encases the\naorta and abuts the IVC, without significant interval change.\n\nBONES: Multilevel degenerative changes of the thoracolumbar spine.  No\ndestructive osseous lesions.  Redemonstrated grade 1 anterolisthesis of L4 on\nL5.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No significant interval change of the previously noted retroperitoneal soft\ntissue density, encasing the aorta, bilateral proximal renal arteries, and\nleft renal vein.\n2. No significant interval change in the previously noted left perinephric\nsoft tissue density.\n3. No evident new lymphadenopathy 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: Please refer to the same-day chest CT report for thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is a 1.0 cm appendix dome hypodensity (2:39), which likely represents a\nhepatic cyst.  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 demonstrates stable mild atrophy has normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen appears atrophic, unchanged from previous.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The right kidney is normal in shape and size, showing a normal\nnephrogram.  The left kidney is shows stable atrophy and extensive cortical\nscarring.  Overall stable appearance of the soft tissue density adjacent to\nthe left renal pelvis measuring 3.4 x 2.3 cm (2:60), which previously measured\n3.3 x 2.2.  At the same level in the aorto caval region in the retrocaval\nregion there is ill-defined soft tissue density and haziness, which appears\nminimally improved from previous.  There is no evidence of solid 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 aside from a large colonic stool burden.\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 gross 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. \nMultilevel degenerative changes with mild anterolisthesis of L4 over L5 with\nintervertebral disc space narrowing and subchondral sclerosis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Overall stable appearance of the soft tissue density adjacent to the left\nrenal pelvis measuring 3.4 x 2.3 cm.  Minimal improvement of the ill-defined\nsoft tissue density in the aortocaval region at the same level.\n2. No new lymphadenopathy in the abdomen or pelvis.\n3. Chronic atrophy of the left kidney and the spleen.\n4. Please refer to the separate chest CT report for thoracic findings."
        },
        {
            "input": "LOWER CHEST: Partially imaged for 1.5 x 1 cm (AP by T) irregular soft tissue\nnodule in the deep lower left breast (2:61), unchanged compared to most recent\nprior.  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. \nUnchanged 1 cm cyst in the liver dome (2:73).  There is no evidence of\nsuspicious focal lesions. There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: There is fatty infiltration of the pancreas with mild atrophy,\nhowever with normal attenuation throughout, and no evidence of focal lesions\nor pancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: Markedly atrophic spleen, with central areas of hypoenhancement.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. \nSoft tissue stranding haziness posterior to the left adrenal gland in the\npara-aortic region is unchanged compared to prior (2:110), measures\napproximately 1.5 x 2.2 cm (AP by T).\n\nURINARY: There left kidney is atrophic unchanged ill-defined soft tissue\ndensity centered in the left renal pelvis, that measures 2.2 x 3.5 cm (AP by\nT).\nThe right kidney is of normal size with normal nephrogram.  There is no\nevidence of solid renal lesions or hydronephrosis.\n\nIll-defined soft tissue density and haziness in the aortocaval region is\nunchanged compared to prior, without discrete measurable lesion.\n\nGASTROINTESTINAL: There is thickening of the stomach is unremarkable.  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 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: Marked degenerative changes of the spine and bilateral hips.  Grade 1\nanterolisthesis of L4 on L5.  Bilateral acetabular osteophyte chronic\nfractures.  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 unchanged appearance of soft tissue density centered in the left\nrenal pelvis, measuring 2.2 x 3.5 cm, previously 2.3 x 3.4 cm.\n2. Ill-defined para-aortic soft tissue stranding posterior to the left adrenal\ngland, is unchanged and measures approximately 1.5 x 2.2 cm.\n3. Haziness and soft tissue density in the aortocaval region, is unchanged\ncompared to prior.\n4. Chronic atrophy of the left kidney and the spleen."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously.  There is an\nunchanged 9 mm cyst at the hepatic dome (2:74).  The hepatic veins, portal\nvein and its branches are patent.\nThe gallbladder is distended with no radiopaque calculi within it.\nPANCREAS: There is mild atrophy of the pancreatic parenchyma with fatty\nreplacement, no focal lesions or main duct dilation.\nSPLEEN:  The spleen is severely atrophic with similar appearance of a small\ncystic area within it as noted on the prior scan.\nADRENALS:  No adrenal nodules.  Previously described soft tissue posterior and\ninferior to the left adrenal gland, in the left para-aortic region (2:113) is\nunchanged and measures 2.2 x 1.5 cm.\nURINARY: The right kidney demonstrates a normal appearance.\nSevere atrophy of the left kidney with preserved cortical parenchymal\nenhancement.  No hydronephrosis.\nThere is interval decrease in soft tissue surrounding the left renal pelvis,\nnow measuring 3.0 x 1.3 cm in size (2:122), compared to a prior of 3.5 x 2.2\ncm.\n\nGASTROINTESTINAL: There is no bowel obstruction.  Moderate stool burden is\nnoted throughout the colon.  Normal appendix.\n\nLYMPH NODES: There are no new enlarged lymph nodes in the abdomen or pelvis. \nSoft tissue at the aortocaval region, posteroinferior to the left adrenal and\nencasing the left renal pelvis at described above..\nVASCULAR: Mild calcified atherosclerotic plaque is noted within the abdominal\naorta and its branches, no aneurysmal dilation.\nMild aortocaval region soft tissue stranding (2:122) is similar to prior.\n\nPELVIS:\nThe bladder is minimally distended and appears normal.  The uterus is\natrophic.  No adnexal masses or free fluid in the pelvis..\n\nBONES AND SOFT TISSUES:\nLevoconvex curvature of the lumbar spine noted.  No osteolytic or blastic bone\nlesions identified.  Mild compression deformity of the L3 vertebral body\nnoted.  Degenerative disc disease is seen at L4-5 level.  There is grade 1\nanterolisthesis of L4 over L5.  Facetal arthropathy is seen in the lumbar\nregion.\n1.4 cm deep left breast soft tissue nodule is unchanged.",
            "output": "1. Minimal interval decrease in size of the soft tissue encasing the left\nrenal pelvis now measuring 3.0 x 1.3 cm compared to a prior of 3.5 x 2.2 cm.\n2. Soft tissue stranding at the aortocaval region and an approximately 2.2 x\n1.5 cm soft tissue located posterior and inferior to the left adrenal gland in\nthe left para-aortic region are stable.\n3. No new lymphadenopathy in the abdomen or pelvis.\n4. Incidental findings including severe chronic atrophy of the left kidney;\natrophic spleen; and a left breast soft tissue nodule measuring 1.4 cm 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 suspicious focal lesion.  There is a 9 mm hypodense lesion at the\nhepatic dome (5:64), unchanged from priors, likely a simple cyst.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  The gallbladder\nis within normal limits.\n\nPANCREAS: The pancreas demonstrates fatty atrophy, without evidence of focal\nlesions.  There is no pancreatic ductal dilatation or peripancreatic\nstranding.\n\nSPLEEN: The spleen is severely atrophic, with stable small cystic area within\nit\n\nADRENALS: The right and left adrenal glands are normal in size and shape. \nThere is redemonstration of a soft tissue density posterior and inferior to\nthe left adrenal gland, in the left para-aortic region (5: 93) that measures\n1.5 x 2.1 cm, unchanged compared to prior\n\nURINARY: There is severe atrophy of the left kidney, with preserved cortical\nparenchyma enhancement as well as mild compensatory hypertrophy the right\nkidney no evidence of renal stones or hydronephrosis.  There is\nredemonstration of a soft tissue density surrounding the left renal pelvis,\nthat measures 3.2 x 1.4 cm (5:101), overall unchanged compared to most recent\nstudy.  The urinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin 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: There is no new abdominopelvic lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultilevel degenerative changes of the lumbar spine, more prominent at the\nlevel of L3-S1, with grade I anterolisthesis of L4 over L5 and stable\ncompression deformity of L2 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Unchanged soft tissue density encasing the left renal pelvis, as well as a\nsoft tissue density in the left para-aortic region just posterior and inferior\nto left adrenal gland.\n2. No new abdominopelvic lymphadenopathy.\n3. Redemonstration of severe chronic atrophy of the left kidney and splenic\natrophy.\n4. Please refer to separate report of CT chest for description of the thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Please refer to the separate chest CT report from same date for\nsupradiaphragmatic findings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nStable appearance of a subcentimeter hypodensity at the dome of the liver\n(6:27).  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is within\nnormal limits.  The common bile duct is mildly prominent at 11 mm, but tapers\nnormally at the level of the ampulla.\n\nPANCREAS: The pancreas demonstrates mild fatty atrophy and normal attenuation\nthroughout, without evidence of focal lesions or pancreatic ductal dilatation.\nThere is no peripancreatic stranding.\n\nSPLEEN: Stable diminutive appearance of the spleen with a cystic hypodensity\nin the medial portion measuring up to 6 mm (6:44), largely unchanged from\nprior.\n\nADRENALS: The right and left adrenal glands are normal in size and shape. \nSlightly less conspicuous appearance of soft tissue density inferior to the\nleft adrenal gland adjacent to the aorta measuring up to 1.6 x 1.2 cm (6:91).\n\nURINARY: The right kidney shows normal size and nephrogram.  There is no\nevidence of focal renal lesions or hydronephrosis.  There is no perinephric\nabnormality.  Stable appearance of a severely atrophic left kidney, likely\nrelated to the soft tissue mass encasing the renal pelvis, which is largely\nunchanged from prior measuring approximately 3.4 x 1.4 cm (6:70), previously\nmeasured approximately 3.0 x 1.3 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: The visualized reproductive organs are unremarkable.\n\nLYMPH NODES: Aside from the above described left periaortic soft tissue\ndensities and the left renal hilum soft tissue densities, there is no\nretroperitoneal or mesenteric lymphadenopathy.  There is mild, stable\nstranding in the retroperitoneum surrounding the aorta and the bifurcation. \nThere is 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 of the lumbar spine,\nincluding levoscoliosis, mild anterolisthesis of L3 over L4 and L4 over 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. Largely unchanged soft tissue density encasing the left renal pelvis and\nleft periaortic soft tissue density inferior to the left adrenal gland.\n2. Stable severe left renal atrophy, likely related to the encasing soft\ntissue density in the hilum.\n3. No new lymphadenopathy throughout the abdomen or pelvis.\n4.  Please refer to the"
        },
        {
            "input": "LOWER CHEST: Visualized lungs are within normal limits.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation particularly\ninvolving the left hepatic lobe and partially extending into the hepatic\nsegment 8, likely perfusional (05:15).  There is no evidence of focal lesions.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder demonstrates fundal adenomyomatosis.  The common bile duct is 9\nmm, which is mildly prominent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is diffuse cortical thinning bilaterally with more focal areas of\nthinning/defects which can be seen in medicorenal disease superimposed on\nsubsequent insults. Patient is status post left ureteral stenting with the\nproximal component seen coiling in the left renal pelvis and the distal\ncomponent seen coiling within the bladder, appropriately placed. 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. Extensive sigmoid\ndiverticulosis is noted without evidence of acute diverticulitis.  Otherwise,\nthe colon and rectum are within normal limits. The appendix is not seen.\n\nPELVIS: The urinary bladder contains small locules of gas, likely sequela of\nprior instrumentation.  There is a small amount of free pelvic fluid seen\nlayering along the right side of sigmoid colon (5:65 and 08:34).  There is\nfluid and ill-defined heterogeneous soft tissue posterior and slightly distal\nto left internal iliac artery origin, and extending to the level of the\nbladder, which is difficult to differentiate between residual tumor and\npostsurgical sequela (5: 61-68).\n\nREPRODUCTIVE ORGANS: Post total abdominal hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES: There is no mesenteric lymphadenopathy. Postsurgical changes from\npara-aortic debulking noted (5: 37).  Postsurgical changes are seen in the\npelvis following extensive lymph node debulking.  A 7 mm left pararenal lymph\nnode is seen posterior to the left renal vein (07:28).\n\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Note is made of a duplicated right renal artery.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Postsurgical changes are seen along the midline lower abdomen\nwith superficial surgical staples, fluid seen inferior to the incision site,\nsubcutaneous edema and subcutaneous emphysema.",
            "output": "1. Postsurgical changes from total abdominal hysterectomy, bilateral\nsalpingo-oophorectomy, and left retroperitoneal and pelvic lymph node\ndissection.\n2. Ill-defined heterogeneous soft tissue and fluid seen extending along the\nleft pelvic sidewall slightly distal to the left internal iliac artery origin\nand extending to the level of the bladder is difficult to differentiate\nbetween residual tumor versus postsurgical sequela.\n3. Mildly increased prominence of the CBD, measuring 9 mm, without evidence of\npancreatic ductal dilatation or central biliary dilatation, of uncertain\nclinical significance.  Recommend correlation with LFTs.\n4. Small locules of gas within the urinary bladder lumen likely represent\nsequela of prior instrumentation.\n5. Extensive sigmoid diverticulosis is seen without evidence of acute\ndiverticulitis."
        },
        {
            "input": "LOWER CHEST: There is a stable 4 mm calcified granuloma in the left lower\nlobe.  Otherwise, visualized lung fields are within normal limits.  There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffuse hypoattenuation throughout,\ncompatible with steatosis.  There are innumerable hypodense lesions throughout\nthe liver, several demonstrating peripheral rim enhancement measuring up to\n1.7 cm in hepatic segment 6 (2:27), significantly progressed from prior study\ndated ___.  There is no evidence of intrahepatic biliary\ndilatation.  The common bile duct is dilated measuring 10 mm, unchanged from\nprior study.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size 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 redemonstration of asymmetric atrophy of the left kidney. \nThere is new moderate left hydroureteronephrosis with delayed nephrogram\nsecondary below described pelvic sidewall mass.  Interval removal of a\nnephroureteral stent\n\nThe right kidney is grossly unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  There is\nincreased wall thickening, edema, and pericolonic stranding involving the\nascending and transverse colon.  Status post appendectomy\n\nPELVIS: There is a small amount of free fluid within the right hemipelvis.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy and bilateral\nsalpingo oophorectomy.\n\nLYMPH NODES: The previously seen necrotic left pelvic sidewall lymph node\nappears decreased in size measuring approximately 2.3 cm, previously measuring\n3.2 cm ___ and 3.7 cm in ___ (2:62).  Otherwise, there is no\nnew retroperitoneal or mesenteric lymphadenopathy.  There is no new 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.\n\nSOFT TISSUES: There is no abdominal wall hernia.  Subcutaneous foci of air\nlikely from injection.",
            "output": "1. Moderate left hydroureteronephrosis to the level of the known pelvic\nsidewall mass, new since the MRI from 5 weeks ago.  Delayed nephrogram and\nurothelial enhancement is concerning for superimposed infection.\n2. Innumerable new hypodense hepatic lesions with rim enhancing, new since MRI\nfrom 5 weeks ago.  Rapid onset favors hepatic abscesses over substantial\nmetastatic disease progression.\n3. Moderate colitis involving the ascending and transverse colon.  Findings\nare nonspecific and can be in the setting of ischemic, inflammatory, or\ninfectious etiologies.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:24 pm, 1\nminutes after discovery of the findings."
        },
        {
            "input": "LOWER CHEST: Focal density in the right lower lung likely represents\natelectasis (series 2, image 10).  Otherwise, the visualized lung fields are\nwithin 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 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\nsignificant stool burden within the colon, otherwise 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 bilateral adnexae are within normal\nlimits.An IUD is present in the endometrium.\n\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": "Significant stool burden compatible with constipation."
        },
        {
            "input": "LOWER CHEST: There is minimal dependent atelectasis in the right lower lobe.\n\nABDOMEN:\n\nHEPATOBILIARY:\nThe liver demonstrates a nodular contour and a cirrhotic morphology.\nAgain visualized are geographic areas of decreased attenuation within the\ncaudate lobe extending to segment VI, and surrounding the gallbladder fossa in\nsegment IV B, unchanged dating back to ___, likely representing\nareas of focal fat deposition.  Please note, this study is not optimized for\nevaluation of HCC.  A punctate focus of calcification is noted in segment VII\n(2:55).  No intrahepatic biliary ductal dilation noted.  Gallbladder is\ndistended and demonstrates presence of hyperdense calculi within it.  There is\nsignificant gallbladder wall edema, likely related to third spacing.\nThe main portal vein and its branches are patent.  Hepatic veins are patent. \nRecanalized umbilical vein noted.  There are small mesenteric varices.\n\nPANCREAS: Homogeneous attenuation of the pancreatic parenchyma without main\nduct dilation or focal pancreatic lesions\n\nSPLEEN: The spleen is mildly enlarged measuring 14.3 cm in the craniocaudal\naxis.\n\nADRENALS: No adrenal nodules\n\nURINARY: No hydronephrosis seen on either side.  No solid enhancing renal\nmasses.  The urinary bladder is moderately distended and appears normal.\n\nGASTROINTESTINAL: The stomach is decompressed.  There are varices surrounding\nas well as within the wall of the distal esophagus and in the gastric fundus. \nNo bowel obstruction.  Colonic loops are unremarkable.\n\nPELVIS:  There is small volume ascites in the abdomen and pelvis.\n\n\nREPRODUCTIVE ORGANS: An IUD is noted in appropriate position within the\nendometrial cavity.  Again visualized is a partly exophytic right subserosal\nfibroid that demonstrates decreased enhancement compared to ___,\nfollowing interval uterine fibroid embolization procedure. The fibroid\nmeasures 2.9 x 2.5 cm in size, unchanged compared to the prior exam\nBoth ovaries appear normal for the age of the patient.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal aortic aneurysm.\nThere is a 1.2 x 0.8 cm pseudoaneurysm arising from the right common femoral\nartery (series 2, image 171) with surrounding soft tissue stranding and a\nsmall hematoma overlying it.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are subcutaneous varices within the ventral abdominal\nwall.  An umbilical hernia containing the recanalized umbilical vein noted.",
            "output": "1. No source of infection noted in the abdomen or pelvis on this exam.\n2. 1.2 x 0.8 cm pseudoaneurysm arising from the right common femoral artery\nwith surrounding soft tissue stranding and a small hematoma overlying it\nwithin the right groin.\n3. Cirrhotic morphology of the liver with geographic areas of focal fat\ndeposition within the caudate lobe as well as segment VI and segment IV B,\nunchanged dating back to ___.  Please note, this is a single phase\nexam, not optimized for evaluation for ___.  Patent portal vein and its\n___"
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal lesions. The gallbladder is\nnormal with no radio-opaque gallstones.  The pancreas is normal with no\nperipancreatic fat stranding or fluid collections.  The spleen is normal in\nsize and homogeneous in attenuation.  The adrenal glands are normal in size\nand morphology. The kidneys enhance symmetrically and display prompt contrast\nexcretion with no focal lesions, hydronephrosis, or radio-opaque stones.\n\nThe distal esophagus and stomach are normal. The small and large bowel are\nnormal in caliber with no wall thickening. The appendix isnonvisualized.\nPartially necrotic aortocaval lymph node conglomerate (5:76 - 82) is not\nsignificantly changed since ___, and again extends to the level of the\naortic bifurcation. No new or enlarged lymph nodes are appreciated. There is\nno intraabdominal free air or free fluid.  Fat containing umbilical hernia\nwith surrounding increased soft tissue density is unchanged since ___.\n\nPELVIS: The distal ureters and urinary bladder are normal.  The uterus and\novaries are not seen. There is no pelvic side-wall or inguinal lymphadenopathy\nby CT size criteria. No free pelvic fluid is identified.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "Unchanged partially necrotic aortocaval lymph node conglomerate, as compared\nto ___.  No new or enlarged lymph nodes or evidence of solid organ\nmetastasis."
        },
        {
            "input": "Please see separately submitted report of Chest CT for full description of the\nlungs.\n\nLIVER: The liver enhances homogeneously without focal lesion or intrahepatic\nbiliary duct dilation.The portal and hepatic veins are patent.The nondistended\ngallbladder is within normal limits, without wall thickening or\npericholecystic fluid.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nPANCREAS: The pancreas is without focal lesion, peripancreatic stranding, or\nfluid collection.\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: The stomach is distended without obvious intraluminal mass or wall\nthickening.  A partially calcified soft tissue density immediately inferior to\nthe umbilicus is likely related to prior laparoscopic surgery. The small and\nlarge bowel are within normal limits, without wall thickening or evidence of\nobstruction. The appendix is not definitively visualized, but there are no\nsecondary signs to suggest acute appendicitis. There is colonic diverticulosis\nwithout evidence of diverticulitis. A small soft tissue density in the\ninferior right paracolic gutter has increased in size compared with ___, now measuring 8 x 8 mm compared with 4 x 5 mm (6:44).\n\nRETROPERITONEUM: The partially necrotic aortocaval lymph node conglomerate has\nalso increased in size, now measuring 2.4 x 2.0 cm, increased from 2.3 x 2.0\n(06:42). Several additional periaortic lymph nodes at the level of the renal\narteries have also increased compared with the prior studies (06:33,\n06:40).The aorta is normal in caliber, with scattered atherosclerotic\ncalcifications. There is no retroperitonealormesenteric lymph node enlargement\nby CT size criteria.\n\nCT PELVIS: The urinary bladder appears normal.No pelvic wall or inguinal lymph\nnode enlargement by CT size criteria is seen.There is no pelvic free fluid.\n\nOSSEOUS STRUCTURES: No focal lesion suspicious for malignancy present.",
            "output": "1. Interval increase in size of periaortic and aortocaval lymphadenopathy.\n2. Enlarging soft tissue density in the inferior right paracolic gutter is\nconcerning for a drop metastasis."
        },
        {
            "input": "LOWER CHEST: There is a 7 mm wide pulmonary nodule in the left lung base\n(02:14), not significantly changed from the prior chest CT on ___.  No\npleural effusions.  Heart size is normal, without a pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits. \nPortal venous system 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.  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.  There is a 6 x 8 mm enhancing nodule in the left\nhemipelvis posterior to the bladder (2:130), not definitely identified on the\nprior study.\n\nREPRODUCTIVE ORGANS: Status post hysterectomy and bilateral\nsalpingo-oophorectomy.\n\nLYMPH NODES:  There are innumerable retroperitoneal lymph nodes along the\naortocaval chain, the largest measuring up to 12 mm in short axis (2:66).  A\ndominant preaortic node measures 10 mm (2:64), also similar to the prior\nstudy.  Some lymph nodes have increased in size in the interim.  For example,\nthere are two contiguous left para-aortic lymph nodes just inferior to the\norigin of the left renal vein that measure 9 mm each (2:62, 63), previously\nmeasuring 6 mm.  Notably, there is a 18 x 14 mm necrotic aortocaval node\n(2:82) that anteriorly abuts causing compression of the inferior IVC, near the\niliac bifurcation, and may explain patient's symptoms of venous obstruction. \nIVC however remains patent through this level.\n\nPelvic sidewall nodes have also enlarged.  For example, there is a 12 mm right\npelvic sidewall node (2:133), previously 8 mm.  Additional right pelvic\nsidewall node has increased from 5 mm to 9 mm (2:141).  A right external iliac\nnode has increased from 8 mm to 12 mm (2:133).\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. 18 x 14 mm necrotic aortocaval node causing anterior compression on the\ninferior IVC, without associated occlusion/ thrombosis.\n2. Worsening intra-abdominal/pelvic lymphadenopathy in the short 3 weeks\ninterval.\n3. New 8 x 6mm enhancing nodule in the left inferior hemipelvis, may represent\nan additional metastatic focus.  Recommend attention on follow-up studies.\n4. Unchanged 7 mm left lower lobe pulmonary nodule.  Short interval follow-up\nin 3 months is advised, as previously recommended."
        },
        {
            "input": "Lungs and Heart: The lung bases are clear bilaterally. The visualized heart\nand pericardium are normal.\n\nLiver, Gallbladder: There is a subcentimeter tiny hypodensity in segment 2 of\nthe liver, too small to fully characterize. Otherwise, the liver is normal.\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\nKidneys, Adrenals: The kidneys display symmetric nephrograms with no evidence\nof hydronephrosis or mass lesion in either kidney.  The ureters are\nsymmetrical in their course to the bladder. The adrenal glands are\nunremarkable bilaterally.\n\nStomach, Bowel: There is diffuse circumferential wall thickening and adjacent\nstranding involving the ascending and transverse colon as well as a small\nsegment of the terminal ileum.  The descending colon is decompressed as is\nmost of the sigmoid colon, but the structures appear grossly unremarkable. The\nremainder of the small bowel is normal appearing. The appendix is\nnormal-appearing.\n\nVessels: There is no aneurysmal dilatation of the abdominal aorta. The aorta\nand its major branches are patent.\n\nLymph Nodes: There is shotty lymphadenopathy in the right lower quadrant\nhowever there are no pathologically enlarged lymph nodes by CT size criteria.\n\nPelvis: There is small amount of free fluid in the pelvis.  There is mild wall\nthickening of the rectum. The bladder is unremarkable.\n\nOsseous Structures: There are no suspicious lytic or blastic lesions seen in\nthe visualized osseous structures. There is a small left inguinal hernia\ncontaining fat.",
            "output": "1. Diffuse wall thickening involving the ascending and transverse colon as\nwell as the rectum consistent with proctocolitis. Additionally, there is mild\nthickening of the terminal ileum consistent with mild terminal ileitis. \nFindings are likely due to an inflammatory or infectious etiology.\n2. Trace free fluid in the pelvis.\n3. Normal appendix."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits. There is no\nevidence of pleural or pericardial effusion.  Mild dependent atelectasis is\nseen.\n\nABDOMEN:\n\nHEPATOBILIARY: There is no focal liver lesion.  The portal vein and hepatic\nveins are patent.  The gallbladder is distended with a thickened wall\nmeasuring up to 9 mm with hyperemia of the adjacent liver consistent with\nacute cholecystitis.  There is no evidence of perforation or adjacent free\nfluid.\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 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:\n\nThere is no evidence of worrisome lesions.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Acute uncomplicated cholecystitis.\n2. No evidence of bowel obstruction."
        },
        {
            "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: There are a few subpleural opacities within the left lung base. \nNo pleural or pericardial effusions.  There is a prominent 0.8 cm epicardial\nlymph node.  Please refer to dedicated CT chest for complete report.\n\nABDOMEN:\n\nHEPATOBILIARY: There is heterogeneous attenuation of the liver.  Multifocal\nareas arterial enhancement are seen predominantly within the periphery of the\nleft hepatic lobe as well as segments 4A, 4B, and 6.  These incompletely\ncharacterize, but likely represent perfusion anomalies.  A small hypodensity\nis also noted in segment 8, too small to characterize, but statistically\nrepresenting a cyst.  There is diffuse dilatation of the intrahepatic biliary\nducts as well as the CBD which measures up to 1.7 cm to there is abrupt cut\noff of the CBD at the level of the ampullary mass.  The gallbladder and cystic\nduct are dilated.  No secondary signs of cholecystitis.\n\nPANCREAS: Large ill-defined ampullary mass with involvement of the pancreatic\nhead and uncinate process roughly measuring 1.7 x 3.2 cm.  The mass results in\nobstruction of the main pancreatic duct as well as the CBD.  The main\npancreatic duct measures up to 1.1 cm, and contains soft tissue at the level\nof the and biliary mass at (5:138).  The distal pancreatic body and tail are\natrophic.  Multiple dilated side branches are also seen in the pancreatic head\nand uncinate process.  Assessment for vascular involvement is difficult due to\nthe paucity of intra-abdominal fat in this patient.\n\nAllowing for these limitations, there is no obvious involvement of the celiac\naxis.  There is mild narrowing of the celiac axis at the ostium favored to be\nsecondary to atherosclerosis.  There is infiltrative hazy stranding\nsurrounding the left gastric artery.  There is incidental note of an accessory\nleft hepatic artery arising from the left gastric artery.  The SMA is free of\ndisease.  There is infiltrative soft tissue stranding encasing the first\nposterior branch of the SMA however (5:129).  The common hepatic and splenic\nartery root not involved.  A posterior branch of the GDA is involved and\noccluded by the mass.\n\nThe main portal vein is patent and free of disease.  The SMV is incompletely\nopacified with contrast, but is mildly compressed by normal pancreatic\nparenchyma.  No obvious disease involvement is appreciated.  The splenic vein\nis also free of disease.  No significant venous collaterals are appreciated.\n\nThere is some infiltrative hazy fat stranding within the retroperitoneum,\nabutting the IVC and aorta less than 180 degrees with no associated\ndistortion.  Multiple borderline retroperitoneal lymph nodes are appreciated\nwith some enlarged lymph nodes, largest measuring 1.5 x 1.6 cm (5:117).\n\nSmall volume ascites is seen within the pelvis.  No definite peritoneal or\nomental nodules are appreciated, though study is limited by paucity of\nintra-abdominal fat.\n\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.4 x 1.8 cm nodule within the lateral limb of the left\nadrenal gland not which is hypodense on the noncontrast images, likely an\nadenoma.  In the medial limb of the adrenal gland, there is a 0.9 cm nodule\nwhich is not hypodense on noncontrast images, which is concerning.  Normal\nappearance of the right adrenal gland.\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 no evidence of gastric outlet obstruction.  Small\nbowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.  There is some serpiginous hyperdensity within the anterior wall\nof the rectum, near the colorectal junction.\n\nRETROPERITONEUM: Multiple retroperitoneal lymph nodes as described above.\n\nBONES: No worrisome osseous findings.  There is mild vertebral body\ncompression along the superior endplate of L2.  Small enostosis in the right\nfemoral head.  At least 2 lipoma as in the anterior subcutaneous soft tissues\nare appreciated.",
            "output": "1. Large ampullary mass with involvement of the pancreatic head and uncinate\nprocess resulting in pancreatic atrophy and dilatation of the main pancreatic\nduct as well as CBD and central intrahepatic biliary ducts.  As described\nabove, there is hazy infiltration surrounding the left gastric artery which\nsupplies an accessory left hepatic artery.  Hazy infiltrative soft tissue is\nalso seen extending towards the retroperitoneum with abutment of the IVC and\naorta less than 180 degrees.  Mass effect on the SMV favored to be from the\ncompressed adjacent normal pancreatic parenchyma rather than tumor.\n2. Multiple retroperitoneal enlarged lymph nodes, which is concerning for\ntumoral involvement.\n3. Multiple arterially enhancing lesions within the liver, which are\nincompletely characterized on this study.  Liver MRI is recommended.\n4. Small nodule within the medial limb of the left adrenal gland which is\nconcerning for possible metastasis.  Left lateral adrenal limb nodule likely\nrepresents an adenoma.\n5. Serpiginous hyperdensity within the colorectal junction may represent an\nunderlying vascular lesion.  Sigmoidoscopy is recommended."
        },
        {
            "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: There has been interval increase in size in some of the\nmultiple enhancing hepatic lesions consistent with metastases.  For example, a\n2.4 x 1.8 cm lesion in segment 2 (7:92), has increased from 1.3 x 0.9 cm. \nAnother example includes a 4.7 x 4.1 cm lesion in segment 8 (7:88), increased\nfrom 3.6 x 3.2 cm.  Few lesions are slightly decreased in size compared to\nprior, including a 2.3 x 2.0 cm lesion in segment 6 (7:104), decreased from\n2.7 x 2.6 cm.  A  2.1 x 2.1 cm lesion in segment 6 (07:00 13) is also milldy\ndecreased compared to prior when it measured 1.3 x 1.8 cm.  PTBD is again\nnoted to traverse the left lobe of the liver, passing through the CBD stent\nand terminating in the third portion of the duodenum.  Again noted is expected\npneumobilia.  Mild intrahepatic biliary ductal dilatation is slightly more\nprominent compared to prior.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS:  A 2.5 x 2.2 cm heterogeneous infiltrative ampullar mass appears\nmildly decreased in size compared to prior when it measure 3.4 x 2.8 cm,\nhowever direct comparison is limited given the differences in contrast timing.\nThe pancreas is again noted to be diffusely atrophic with marked dilatation of\nthe main pancreatic duct, measuring up to 1.5 cm.  Diffuse soft tissue\nstranding surrounding the vessels of the upper abdomen is redemonstrated.  \nAgain noted is narrowing of the left renal vein, however it remains patent. \nThe celiac axis, common hepatic artery, SMA and renal arteries are patent.\n\nVASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nSPLEEN: There are new and increased peripheral hypodense lesions within the\nsuperior aspect of the spleen, measuring up to 9 mm (10:46).\n\nADRENALS: No significant interval change in a 1.7 x 1.4 cm left adrenal gland\nnodule.  The right adrenal gland is normal 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.  No\nsignificant interval change is an upper abdominal lymph nodes.  A 3.2 x 1.2 cm\naortocaval node (07:00 10) is not significantly changed compared prior.\n\nRETROPERITONEUM: Ill-defined retroperitoneal lymph nodes are difficult to\naccurately measure, however some of them appear mildly decreased  compared to\nprior, including a 1.3 x 0.8 cm left para-aortic node (07:00 32), decreased\nfrom 1.3 x 1.0 cm.\n\nPELVIS: The bladder is decompressed.  There is no evidence of pelvic or\ninguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: There is a new compression fracture of the superior endplate of L3\nvertebral body.  Similar appearance of the compression fracture of the\nsuperior endplate of L2 vertebral body.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mixed tumor response as evidenced by mild interval decrease size in some of\nthe hepatic metastases while others have increased size.\n2. The ampullary mass appears mildly decreased in size accounting for\ndifferences in technique.\n3. New and increased peripheral hypodense splenic lesions likely represent \nperisplenic peritoneal implants.\n4. New compression fracture at the superior endplate of L3 vertebral body and\nsimilar appearance of the compression fracture of the superior endplate of L2\nvertebral body."
        },
        {
            "input": "LOWER CHEST: Multiple pulmonary nodules are again noted in both lung bases. \nThe largest is noted in the left lung base measuring 0.9 x 0.7 cm (9:86).\nPlease refer to separate report of CT chest performed the same day for\ndescription of the thoracic findings.\n\nABDOMEN:\n\nLimited evaluation given paucity and hazy increased density of the\nintraperitoneal fat.\n\nHEPATOBILIARY: The liver demonstrates innumerable heterogeneous hypodense\nlesions within the liver, consistent with metastatic disease.  There has been\ninterval worsening compared to the exam of ___.  For example, the\nindex lesion within the right lobe of the liver in segment 8 measures 6.3 x\n4.6 cm, previously measuring 4.7 x 4.1 cm (9:84).  Index lesion within segment\n2 measures 3.5 x 2.7 cm, previously measuring 2.4 x 1.8 cm (9:90).  No\ndefinite new lesions.  A percutaneous internal external biliary drain is again\nnoted through the left lobe of the liver passing through a biliary stent with\ntip in the third portion of the duodenum, unchanged in position.  Intrahepatic\nbiliary duct dilatation with pneumobilia is unchanged.  The gallbladder is\nwithin normal limits, without stones or gallbladder wall thickening.\n\nPANCREAS: The infiltrative ampullary tumor is difficult to delineate but is\nnot significantly changed measuring 2.1 x 2.0 cm.  There is marked pancreatic\nduct dilatation measuring up to 2.1 cm, previously 1 1.7 cm.  Associated\npancreatic atrophy.  A hypodense lesion within the head of the pancreas\nmeasures 0.6 x 0.8 cm, unchanged (9:123).\n\nCeliac axis, SMA an common hepatic artery are patent.  Splenic vein and SMV\nare patent.  As demonstrated previously, there is narrowing of the left renal\nvein but it remains patent.\n\nA portacaval lymph node measures 2.3 x 1.7 cm, unchanged.\n\nSPLEEN: Peripheral hypodensities within the peripheral aspect of the superior\nspleen are not significantly changed.  Spleen is normal size.\n\nADRENALS: The left adrenal gland measures 2.0 x 1.5 cm, previously measuring\n1.8 x 1.6 cm.  Right adrenal gland is mildly thickened but no discrete nodule\nis identified.\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 0.5\ncm hypodense lesion is noted in the interpolar region of the left kidney, too\nsmall to definitively characterize.  There are no urothelial lesions in the\nkidneys or ureters. 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.\n\nRETROPERITONEUM: Hazy increased density within the retroperitoneum makes\nevaluation of retroperitoneal lymphadenopathy difficult.  A is left\npara-aortic lymph node is unchanged measuring 1.3 x 0.8 cm (9:119).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  A right\ncommon iliac lymph node measures 0.8 cm unchanged (9:148).  There is no free\nfluid in the pelvis.\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: Compression deformity of the superior endplate of the L3 vertebral body\nwith approximately 50% height loss is unchanged.  Mild compression deformity\nof the L2 vertebral body is unchanged.\n\nSOFT TISSUES: A small lipoma in the subcutaneous soft tissues of the left\nanterior abdominal wall measures 0.8 cm and is unchanged.",
            "output": "1. Interval progression of multiple hepatic metastases.\n2. The patient's primary ampullary mass is difficult to measure but is not\nsignificantly changed compared to the prior exam.\n3. Stable peripheral hypodensities within the spleen, likely peritoneal\nimplants.\n4. Compression fractures of L2 and L3 are unchanged."
        },
        {
            "input": "LOWER CHEST: No suspicious pulmonary nodules or masses.  No confluent airspace\nconsolidation.  No pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: Cirrhotic morphology of the liver with a multinodular\nappearance.  There is no abnormally enhancing arterial lesions or early\nwashout to suggest HCC.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder contains multiple gallstones but no\nfeatures of cholecystitis.\nLiver volume: 1549.425 CM3\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Marked splenomegaly.  A few small arterially hyperenhancing lesions\n(series 301 image 56, 57, 22, 54) are nonspecific, most likely represent\nsplenic 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. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  ___ jejunal tube terminates\nin the proximal jejunum.  Visualized small and large bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.\n\nLYMPH NODES: No adenopathy\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Extensive portosystemic collaterals extending towards the\ngastroesophageal junction and into the posterior mediastinum via the\ndiaphragmatic hiatus. Suspected nonocclusive/partial portal vein thrombosis at\nthe portal confluence (series 303, image 55).\n\nA central line terminates in the right atrium.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nOld right lateral seventh and left ninth rib fractures.\n\nSOFT TISSUES: Moderate ascites.  Marked skin thickening and interstitial edema\ninvolving the left breast (asymmetric compared to the right) but this may be\npositional in nature and clinical correlation is advised.  Few locules of air\nin the left abdominal wall (series 301, image 9) is nonspecific",
            "output": "1. Cirrhotic morphology of the liver with sequela of portal hypertension in\nthe form of extensive portosystemic collaterals also extending into the\nposterior mediastinum, splenomegaly and moderate ascites.  No focal lesions\nconcerning for HCC.\n2. Anasarca.  Few locules of air in the left abdominal wall (series 301, image\n9) is nonspecific though may be iatrogenic.\n3. Asymmetrical left breast skin thickening and interstitial edema (may be\npositional in nature) but clinical correlation is advised.\n4. Cholelithiasis without evidence of cholecystitis.\n5. ___ jejunal feeding tube in place."
        },
        {
            "input": "VASCULAR:\n\nThere is preserved flow in the major celiac and SMA branches.  The ___ is also\ncontrast opacified. There is minimal atherosclerotic plaque and no abdominal\naortic aneurysm.  There is stable nonocclusive thrombus in the proximal main\nportal vein and there are markedly extensive portosystemic varices,\nparticularly in the paraesophageal region.  The splenic vein, SMV and left and\nright portal veins are patent.\n\nLOWER CHEST: Mild bibasal atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates advanced cirrhotic morphology with areas\nof extensive fibrosis, similar to prior.  No focal liver lesions worrisome for\nHCC are identified.  Cholelithiasis is again noted.  There is no biliary\ndilation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged at 18 cm in greatest coronal dimension, similar\nto prior.  There is a new peripheral wedge-shaped a hypoattenuating focus in\nthe superior aspect, consistent with infarct.  There are a few additional\nill-defined areas of hypodensity which could represent additional small\ninfarcts.\n\nADRENALS: The 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 stones are demonstrated and there is no hydronephrosis.\n\nGASTROINTESTINAL: There is a nasointestinal tube with the tip in the proximal\njejunum.  There is intraluminal contrast throughout much of the small bowel,\nlimiting evaluation of the bowel wall.  However, allowing for this no obvious\nhypoenhancing bowel is seen and there is no significant mural thickening. \nThere is no pneumatosis or free air.  The colon is underdistended but grossly\nunremarkable.  A rectal catheter is present.  There is no evidence of\nmesenteric lymphadenopathy.\n\nThere is large volume ascites, increased from prior.  There are no organized\ncollections.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: The bladder is nondistended.  There is no evidence of pelvic or\ninguinal lymphadenopathy.\n\nREPRODUCTIVE ORGANS: The patient is status post hysterectomy.  Adnexal\nstructures are unremarkable.\n\nBONES: There is no acute fracture seen.  5 level degenerative changes of the\nvisualized thoracic and lumbar spine.  DXA includes Schmorl's nodes at\nmultiple levels.  There is mild irregularity of the endplates of L5 and S1\nwith blurring of the cortex.\n\nSOFT TISSUES: There is diffuse body wall edema, with more extensive\nsubcutaneous edema/fluid along the left flank.  There is again noted to be\nskin thickening and edema in the left breast, for which clinical correlation\nhas been suggested.",
            "output": "1. No evidence of ischemic bowel or intra-abdominal abscess.\n2. Increased ascites compared with ___.\n3. New small splenic infarcts.\n4. Findings of advanced cirrhosis and portal hypertension with extensive\nportosystemic varices again demonstrated.  Nonocclusive main portal vein\nthrombus is unchanged.\n5. Nonspecific irregularity of the endplates of L5-S1, with blurring of the\ncortex may relate to osteolysis if there is impaired renal function, or\ndegenerative change.  Recommend clinical correlation.  However, if there is\nclinical concern for possible discitis osteomyelitis consider lumbar MRI for\nfurther evaluation.\n\nRECOMMENDATION(S):  If there is clinical concern for possible discitis\nosteomyelitis consider lumbar MRI for further evaluation."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm. There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  There are extensive\nparaesophageal, gastrohepatic, perisplenic and upper abdominal varices.  There\nis a splenorenal shunt.  There is redemonstration of the focal narrowing of\nthe main portal vein and enlargement of the splenic and superior mesenteric\nveins.  There is mild multifocal narrowing of the left hepatic artery near its\norigin.  The hepatic veins appear patent.\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: There is heterogeneous attenuation in the right lobe of the\ntransplant liver (304:47-61).  Air within the biliary system is likely related\nto biliary stent placement.  The gallbladder is surgically absent.\n\nPANCREAS: The pancreas is atrophic.  There is no pancreatic ductal dilatation.\n\nSPLEEN: The spleen is enlarged.  No focal splenic lesion is identified.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic.  The transplant kidney in the right\nlower quadrant also enhances normally.  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. Colon and rectum are within normal limits.  The\nappendix is not visualized.  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 free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not well visualized.  No adnexal lesion is\nidentified.\n\nBONES: No suspicious osseous lesions are identified.  There is a partially\nvisualized deformity through the lateral aspect of the right seventh rib. \nHealed left rib fractures are noted.  Degenerative changes are present in the\nspine.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of acute bleeding in the abdomen or pelvis.\n2. Heterogeneous attenuation in the right lobe of the liver is nonspecific,\nbut could represent perfusional differences, cholangitis, or known transplant\nrejection.\n3. Mild multifocal narrowing of the left hepatic artery near its origin.  The\nright hepatic artery is patent.  Unchanged narrowing of the main portal vein\nwith enlargement of the splenic and superior mesenteric veins.\n4. Splenomegaly and extensive paraesophageal and upper abdominal varices\nconsistent with portal hypertension.\n5. A biliary stent remains in place.  Air within the biliary system is likely\nrelated to this stent."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.  There is no evidence of\npleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The transplant liver demonstrates subtle wedge-shaped\nhypoattenuation in the right hepatic lobe (02:20).  There is no evidence of\nfocal lesions within the limitations of an unenhanced scan.  Re-demonstrated\nis mild pneumobilia likely secondary to biliary stent placement.  There is no\nintrahepatic biliary ductal dilation.  Cholecystectomy clips are noted.  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 measuring 17.1 cm\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The native kidneys are atrophic.  The transplant kidney in the right\nlower quadrant appears unremarkable within the limits of a noncontrast study. \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: 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 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 varices are again noted.  There is no abdominal aortic\naneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: Chronic left-sided rib fractures 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. There is subtle peripheral wedge-shaped hypoattenuation areas in the right\nhepatic lobe. Findings may represent transplant rejection. Correlation with\nliver function tests recommended.\n2. Mild pneumobilia compatible with biliary stenting.\n3. Moderate splenomegaly.\n4. Small hiatal hernia."
        },
        {
            "input": "There is a tiny walled off leak again along the left aspect of the bladder,\nanterolateral to the ___ flap site (series 4, image 18 and 19) measuring\napproximately 1.3 x 0.3 cm.  This walled-off leak is seen at a site of inward\nconvexity/distortion of the bladder related to the flap construction.  This is\nsimilar in configuration to the prior examination.  No free leakage of\ncontrast is demonstrated.\n\nThere is a small amount of gas in the bladder that dissipated on the delayed\nphase imaging.  The patient is status post total abdominal hysterectomy. There\nare multiple surgical clips noted in the pelvis, and embolization coils are\nnoted in the left pelvis.\n\nThere is no hydronephrosis involving either kidney. There is appropriate\nexcretion of contrast from both kidneys.\n\nNo hepatic lesion is demonstrated. The portal vein is patent. There is no\nintra or extrahepatic biliary dilatation. The spleen is normal size measuring\n11.8 cm. The adrenal glands are unremarkable. IVC stent is again noted.\n\nThe previously demonstrated right pelvic hematoma has undergone expected\nevolution now lower in attenuation measuring 5.6 x 2.5 cm.\n\nNo small or large bowel dilatation is present. There is no abdominal or pelvic\nlymphadenopathy.\n\nThe lung bases are clear.  The bones are unremarkable.",
            "output": "1. Small walled off leak is again demonstrated involving the bladder,\nanterolateral to the ___ flap site, similar in configuration to the prior\nexam.  No free leak demonstrated.\n2. Right pelvic hematoma measuring 2.5 x 5.6 cm stable from the prior exam."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis..  There is no\nevidence of pleural or pericardial effusion.  There are no solid pulmonary\nnodules.\n\nABDOMEN:\n\nHEPATOBILIARY: There are innumerable hypoattenuating variable-sized rounded\nlesions scattered throughout the liver measuring up to 4.6 x 5.4 x 4.6 cm. \nThere is no evidence of intrahepatic or extrahepatic biliary dilatation.  The\npatient is status post cholecystectomy.\n\nPANCREAS: There is a hypoattenuating mass within the tail the pancreas\nmeasuring approximately 3.4 x 1.7 x 2.3 cm (series 12, image 44).  There is no\nassociated pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  The splenic vein is thrombosed.\n\nADRENALS: There is a hypoattenuating lesion within the left adrenal gland\nmeasuring 1.5 by 1.2 by 1.5 cm (series 12, image 43).  The right adrenal gland\nis unremarkable.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a subcentimeter hypoattenuating cystic lesion within the left kidney\nwhich is too small to characterize.  There is no hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: No bowel obstruction.  Extensive perigastric varices are\nnoted, likely related to splenic vein thrombosis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is\nsmall volume free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus and both ovaries appear unremarkable.\n\nLYMPH NODES: There are subcentimeter short axis porta hepaticus lymph nodes. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is thrombosis of the splenic vein.  There is no abdominal\naortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: There are chronic degenerative changes of the thoracolumbar spine. \nFacetal arthropathy is noted in 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. Hypoattenuating mass within the pancreatic tail measuring up to 3.4 cm in\nsize with associated adjacent splenic vein thrombosis is concerning for a\nprimary pancreatic tail malignancy.  No main pancreatic duct dilation.\n2. There are innumerable hypoattenuating lesions throughout the liver\ncompatible with metastases.  Left adrenal nodule measuring 1.5 cm is also\nconcerning for a metastatic lesion.\n\nRECOMMENDATION(S):  Targeted liver biopsy for histopathologic confirmation."
        },
        {
            "input": "CHEST: Please see a separate report discussing findings within the thorax.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal hepatic lesions. There is\nmild central intrahepatic biliary dilatation. The portal vein is patent. The\ncommon bile duct is dilated with a stent in the common bile duct in the region\nof the pancreatic head. The stent terminates in the duodenum. The\nbiopsy-proven adenocarcinoma of the pancreatic head is not readily\nidentifiable on this study. There is no pancreatic duct dilatation or\nsurrounding inflammatory change. The spleen is normal in attenuation with no\nfocal lesion. The adrenal glands are morphologically normal bilaterally. The\nkidneys enhance symmetrically with no hydronephrosis. Tiny cortical\nhypodensity at the midpole of the right kidney is too small to characterize.\nThere is a fat containing paraesophageal hernia. Stomach and small bowel are\nnormal in caliber. The appendix is air-filled and large bowel does not\ndemonstrate surrounding inflammation. There are no pathologically enlarged\nmesenteric or retroperitoneal lymph nodes. The omentum and peritoneal surface\nis normal without nodularity. No free air or free fluid.\n\nPELVIS: The urinary bladder, prostate, and seminal vesicles are normal. There\nis no pelvic lymphadenopathy or free fluid.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent. The\nceliac axis is widely patent. There is a replaced right hepatic artery off the\nSMA (10:91). There is a single renal artery supplying each kidney. The ___ is\npatent. The SMA, SMV, portal vein, and splenic vein are widely patent with no\nevidence of increased soft tissue surrounding these vessels.\n\nOSSEOUS STRUCTURES: There is considerable kyphosis of the thoracic spine and\nmild degenerative changes of the lower lumbar spine with pars defects at L5-S1\nbilaterally.",
            "output": "1. No identifiable mass in the pancreatic head, despite the biopsy-proven\ndiagnosis of adenocarcinoma. Mesenteric arterial and venous vasculature is\nnormal with no evidence of tumoral involvement.  Note is made of a replaced\nright hepatic artery off the SMA.\n2. No enlarged porta hepatis, peripancreatic, or mesenteric lymph nodes. No\nevidence of distant metastasis in the abdomen or pelvis.\n3.  Please see a separate report discussing findings within the chest."
        },
        {
            "input": "CHEST: The imaged lung bases demonstrate moderate to large bilateral pleural\neffusions.  There is considerable consolidation of the right middle and lower\nlobes, with air bronchograms.  Additionally, there is mild consolidation at\nthe left lung base.  Given the clinical history of recent aspiration events,\nthis likely represents pneumonia.  The heart is moderately enlarged but there\nis no pericardial effusion.  Nasogastric tube terminates in the stomach.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast.  The liver is normal in attenuation.  There is no\nintrahepatic biliary dilatation the patient is status post ___ procedure\nwith cholecystectomy.  The remainder the pancreas appears atrophic but\nunremarkable.  Surgical sutures noted in the small bowel and near the distal\nand of the remnant pancreas.  The spleen is normal in size and attenuation. \nThe adrenal glands are morphologically normal bilaterally.  The kidneys are\nnormal in size and shape with no hydronephrosis.  There is a nonobstructive\nstone at the lower pole of the left kidney measuring 4 mm.\nNasogastric tube terminates in the stomach.  Surgical drain enters the abdomen\nin the right lower quadrant, terminating in the ___ the lower abdomen. \nThe stomach and small bowel are nondistended.  Oral contrast extends to the\nlevel of the colon, without obstruction.  There is no evidence of oral\ncontrast extravasation into the abdomen to suggest anastomotic leak.  Moderate\namount of simple ascites is seen in the abdomen, around the liver, stomach,\nand spleen.  Mesenteric congestion and body wall edema are indicative of\nanasarca.  No mesenteric or retroperitoneal lymph nodes are pathologically\nenlarged.  There is a small amount of free air collecting non-dependently\nanterior to the left lobe liver as well as small locules of air in the\nretroperitoneum (4:34).\n\nPELVIS: The urinary bladder is decompressed, containing a Foley catheter.  The\nrectum contains a rectal tube.  No pelvic lymphadenopathy or significant\npelvic free fluid.\n\nVESSELS: The aorta is normal in caliber with no significant calcium burden.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Status post Whipple procedure with no evidence of oral contrast\nextravasation from the small bowel anastomoses.  Small amount of\npneumoperitoneum anterior to the left lobe liver, as well as new locules of\nair in the retroperitoneum, which are new since the prior study.  This raises\nthe concern that the anastamoses, while not leaking enteric contents, may not\nbe air-tight.  Alternatively, the abdominal wall closure could not be entirely\nentact, allowing small amount of air to enter the abdomen.\n2.  Consolidation at the lung bases bilaterally, right greater than left,\nrepresenting pneumonia in the setting of recent aspiration events.\n3.  Anasarca as characterized by simple bilateral pleural effusions, moderate\nsimple abdominal ascites, body wall edema, and mesenteric congestion.\n4.  Nasogastric tube tip barely terminates in the gastric cardia and could be\nadvanced for better positioning.\n\nNOTIFICATION:   The findings were discussed by Dr. ___ with Dr. ___ in\nperson on ___ at 1:41 ___, 5 minutes after discovery of the findings."
        },
        {
            "input": "LUNG BASES:  Please see dictation for separately reported CT Chest\nexamination.\n\nCT ABDOMEN:\nThe liver enhances homogeneously without evidence of focal lesion.  There is\nno intrahepatic biliary ductal dilation.  The portal vein is patent.  The\ngallbladder surgically absent.  Postsurgical changes are seen throughout the\nupper abdomen status post Whipple procedure.  The remaining pancreatic body\nand tail enhance homogeneously without peripancreatic stranding or ductal\ndilation.  There is no splenomegaly or focal splenic lesion.\n\nAn irregularly-shaped relatively simple fluid collection is seen in the\nintraperitoneal cavity anterior to the stomach and extending superiorly and\nlayering along the anterior splenic capsular surface.  This collection appears\ncontinuous at its inferior extent within an additional rim enhancing more\nfocal fluid collection with surrounding fat stranding and\ninflammatory/phlegmonous change in the left mid hemi-abdomen (series 2, image\n66).  The adjacent transverse colon is mildly narrowed without pre-stenotic\ndilatation.  The collection demonstrates a relatively thin but enhancing wall.\nWhile overall the amount fluid is decreased in comparison to most recent CT,\nthe collections appear more loculated with more apparent surrounding\ninflammatory change.  Superimposed infection cannot be excluded by CT.  An\nadditional 3.5 x 1.7 cm (series 2, image 74) simple appearing fluid collection\nanterior to the biliary limb with nearby surgical clips in the mid right\nhemiabdomen may represent a small lymphocele.\n\nThe adrenal glands are unremarkable.  Small renal cortical hypodensities are\ntoo small to characterize; otherwise, there is normal symmetric renal\nenhancement bilaterally.  There is no hydronephrosis.\n\nAn enteric tube extends to the distal stomach/pylorus.  The GJ junction is\npatent.  The JJ anastomosis is not definitively visualized, however there is\nno evidence of small bowel dilation, wall thickening, or obstruction.  There\nis mild colonic diverticulosis without evidence of diverticulitis.  The colon\nis otherwise unremarkable.  The appendix is normal.\n\nThe abdominal aorta is normal in caliber without evidence of aneurysm or\ndilation.  Proximal tributaries appear patent.  There is no mesenteric or\nretroperitoneal lymphadenopathy by CT size criteria.  There is no free\nintraperitoneal air.\n\nCT PELVIS:\nThe imaged pelvic organs including the bladder and terminal ureters, are\nunremarkable.  There is no pelvic sidewall, iliac chain, or inguinal\nlymphadenopathy.  There is no free pelvic fluid.\n\nMUSCULOSKELETAL:\nDiffuse generalized subcutaneous soft tissue edema is compatible with a\ngeneralized edematous state.  There is mild degenerative change of the imaged\nthoracolumbar spine.  Alignment is normal.  No concerning focal lytic or\nsclerotic osseous lesions are identified.",
            "output": "1. Irregular intraperitoneal fluid collection primarily seen anterior to the\nstomach and spleen, and layering dependently just superior to the transverse\ncolon.  While there has been an overall decrease in the amount of\nintraperitoneal fluid, the collections now appear more loculated, with more\napparent surrounding inflammatory change, a thin but enhancing wall, and an\narea of more focal possible phlegmonous change adjacent to the transverse\ncolon.  Superimposed infection cannot be excluded by CT.\n2. Small fluid collection anterior to the biliary limb may represent a small\nlymphocele.\n3. Status post Whipple procedure.  Normal biliary limb.  No evidence of\nobstruction.  Normal pancreatic remnant.\n4. Diffuse mild mesenteric haziness and subcutaneous soft tissue edema,\ncompatible with a generalized edematous state.\n5. Please see separate report for intrathoracic findings from same-day CT\nchest.\n\nNOTIFICATION:     The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 2:45 ___, 45 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 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.  Overall, small bowel loops\ndemonstrate normal caliber and wall enhancement.  The colon and rectum are\nwithin normal limits.  The appendix is normal.  Mild inflammation is seen\nsurrounding the tip of the appendix, which is likely reactive secondary to\ninflammatory changes seen by the main pelvic mass.\n\nPELVIS:\n\nThe uterus is retroverted, demonstrating at least 2 intramural hypodense\nlesions, likely fibroids, measuring up to 15 mm (series 602b, image 31, 30). \nArising from the fundus is an exophytic 3.6 x 5.4 x 3.9 cm lesion with a\nhypodense center and calcified wall (series 2, image 55, series 602b, image\n37), likely a calcified fibroid.  There is extensive stranding surrounding\nthis area (series 2, image 54), extending inferiorly, with obliteration of the\nmid plane against the bladder dome (series 602b, image 36), where there is a\nheterogeneous enhancing nodule measuring approximately 3.0 x 2.8 cm axially\n(series 2, image 62), immediately below the calcified fibroid.  There is\nobliteration of the fat between this process with several loops of distal\nileum (series 2, image 52).  There is no bowel obstruction.  No drainable\nfluid components are seen.  The ovaries appears separate from this process\n(series 2, image 56, 61).\n\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. Ill-defined pelvic mass contiguous with both the uterine fundus and a\ncalcified exophytic fibroid, with an infiltrative soft tissue component\nappearing contiguous with the dome of the bladder and possibly loops of distal\nileum.  This is associated with extensive stranding but no drainable\ncollections or bowel obstruction.  An adenocarcinoma arising from a urachal\nremnant should be considered given the soft tissue component contiguous with\nthe bladder dome.  Other considerations include a primary uterine neoplasm\nsuch as a leiomyosarcoma or an atypical primary bladder mass such as a\nplasmacytoid-variant urothelial carcinoma.  Atypical infection is less likely.\nCorrelate with results from reported OSH biopsy.\n2. No acute appendicitis or appendiceal mass.  Mild periappendiceal stranding\nat the tip adjacent to the pelvic mass is likely reactive."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions measuring 10 mm in thickness on the\nright and 32 mm on the left.  There is passive atelectatic changes in both\nlung bases.  There is fluid within the distal esophagus.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver parenchyma demonstrates homogeneous attenuation.  In\nthe hepatic hilum, there are three fluid collections measuring 4.3 x 2.6 cm,\n3.5 x 1.9 cm, and 1 x 0.8 cm, likely representing biliomas or seromas.\nAdditionally, there is a stable 15 mm cyst in the right lobe of the liver, as\nwell as a few other scattered subcentimeter hypodensities which are too small\nto characterize.\n\nThe gallbladder is is resected.  There is no intrahepatic biliary ductal\ndilatation.\n\nPANCREAS: Patient is status post Whipple procedure.  The body and tail of the\npancreas are atrophic and the main pancreatic duct is nondilated.  The\npreviously noted a 3 mm hypodensity in the pancreatic tail is not readily\napparent on today's examination.  There is no peripancreatic stranding.  A\nfiducial marker is noted anterior to the IVC.\n\nTwo right anterolateral approach surgical drains are seen terminating\nanteriorly to the pancreaticojejunostomy anastomosis, and anterior to the\njunction of the vena cava and left renal vein.\n\nSPLEEN: The spleen is normal in size and homogeneous in attenuation.\n\nADRENALS: The right adrenal gland is normal in size and shape.  The left\nadrenal gland is slightly nodular with a question of a 6 mm nodule in the\nmedial limb.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no hydronephrosis.  Multiple bilateral renal cysts are demonstrated\nmeasuring up to 2.2 cm in the lower pole of the right kidney.  Multiple\nadditional subcentimeter cortical renal hypodensities are too small to\ncharacterize, but also likely represent cysts.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Marked dilatation of the stomach is noted, likely due to\ngastric outlet obstruction.  Small bowel loops demonstrate normal caliber,\nwall thickness and enhancement throughout.  There is subtle fat stranding\nsurrounding the right colonic hepatic flexure with suggestion of mural edema,\nlikely reactive/inflammatory changes.  The remainder of the colon is\nunremarkable.  There is no evidence of mesenteric lymphadenopathy.\n\nTrace pneumoperitoneum beneath the right hemidiaphragm is presumably\npostoperative in nature.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm.  There are minimal\natherosclerotic calcifications.  The IVC and the hepatic veins are patent. The\nportal vein is patent.  There is thrombosis of a small mesenteric vessel\ncoursing alongside a branch of the SMV (series 3, image 76).\n\nPELVIS: The urinary bladder contains gas, presumably secondary to recent Foley\ncatheter; correlate clinically.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.\n\nBONES: A 6 mm sclerotic lesion in the posterior left ilium adjacent to the\nsacroiliac joint (series 3, image 132) is unchanged, with no remote prior\nimaging available for comparison.  There is multilevel degenerative disc\ndisease involving the visualized lower thoracic and lumbar spine.  There is\nmild lumbar levocurvature.\n\nSOFT TISSUES: There is a left inguinal hernia containing a portion of the\nbladder.  There is subcutaneous edema of the lower abdominal and pelvic wall,\nlikely due to third spacing.  There are incisional changes and skin staples\nalong the anterior upper abdominal wall.",
            "output": "1.  Postsurgical changes of Whipple procedure. Three fluid collections in the\nhepatic hilum, likely biliomas or seromas.\n2.  Markedly dilated stomach, likely due to gastric outlet obstruction.\n3.  Subtle fat stranding surrounding the right colonic hepatic flexure with\nsuggestion of mural edema, likely reactive/inflammatory changes.\n4.  Small bilateral pleural effusions, left greater than right."
        },
        {
            "input": "LOWER CHEST: Small right pleural effusion has resolved. Moderate size left\npleural effusion has improved with a small left pleural effusion remaining. \nThere is interval improvement of subsegmental left lower lobe atelectasis with\nfew areas focal hypoenhancing noted.  4 mm right middle lobe pulmonary nodule\n(series 2, image 3), unchanged.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout.  1.5\ncm right hepatic lobe cyst is unchanged.  There is a 0.7 cm low-density lesion\nin the hepatic dome (series 2, image 7) has increased in size from prior exam\nwhich measured 0.5 cm.  There is no new evidence of focal lesions.  Patient is\nstatus post hepaticojejunostomy.  Postoperative fluid collections in hepatic\nhilum have improved with no ring-enhancing collection is seen to suggest\nabscess.  There is no evidence of intrahepatic biliary dilatation.  The\ngallbladder is surgically absent.\n\nPANCREAS: Patient is status post Whipple procedure. There is atrophy of the\nremaining body and tail of pancreas similar to prior exam.  There is no\npancreatic ductal dilatation.  There is no peripancreatic stranding.  A\nFiducial marker is seen anterior to the IVC.\n\nSPLEEN: The spleen shows normal size, without evidence of focal lesions.\n\nADRENALS: The right adrenal gland is normal in size and shape.  There is\nnodular thickening of left adrenal gland, unchanged.\n\nURINARY: The kidney is unremarkable except for multiple bilateral simple\ncysts..\n\nGASTROINTESTINAL: Patient is status post pylorus sparing Whipple Procedure. \nThere is a gastrojejunostomy tube in place.  The remaining bowel is normal in\nappearance with no evidence obstruction\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. Small low-density lesion in the hepatic dome seem slightly larger measures\n0.7 cm, previously 0.5 cm. This is incompletely characterized on this exam.\n2. Interval improvement of subsegmental left lower lobe atelectasis with few\nareas focal hypoenhancing which could be due to retained secretions or small\nareas of infection.\n3. Interval resolution of small right pleural effusion.\n\nRECOMMENDATION(S):  Recommend further evaluation with liver MR after\nimprovement in ___ condition, preferably in no more than 1 month."
        },
        {
            "input": "CHEST:  Limited assessment of lung bases demonstrates minimal bibasilar\natelectasis.  No pleural effusion. The visualized heart is normal in size\nwithout pericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous in enhancement. No focal lesion identified.Persistent\nmild intrahepatic biliary duct dilatation is noted. A 4.8 x 2.3 cm (02:43)\nfluid-filled lesion is again seen within the gallbladder fossa with new 3 and\n2 mm calcified stones in a patient who is status post cholecystectomy most\nconsistent with a dilated cystic duct remnant or remnant gallbladder. Stable\nmild prominence of the common bile duct measuring 0.8 cm and is expected in a\npatient who is status post cholecystectomy. The portal vein, SMV, and splenic\nvein are patent.\n\nThe spleen is normal. The pancreas enhances homogenously and is without focal\nlesions, peripancreatic fat stranding, or focal fluid collection. The adrenal\nglands are unremarkable.\n\nThe kidneys display symmetric nephrograms and excretion of contrast.  No focal\nrenal lesions. No hydronephrosis or hydroureter identified.\n\nThe distal esophagus is normal without hiatal hernia.  Small amount of oral\ncontrast is seen within the distal esophagus. Patient is status post Roux-en-Y\ngastric bypass surgery.  Excluded stomach and duodenum are unremarkable.  At\nthe jejunojejunostomy in the mid abdomen, there is a focally dilated, patulous\nappearing loop of bowel measuring up to 5.2 cm in maximal diameter with\nfecalization of luminal contents and mild adjacent stranding and fluid. In\ncomparison to the previous examination, the morphology of this anastamosed\njejunal bowel loop appears similarly dilated, though the adjacent mild\nstranding and fluid is new as well as the fecalized material.  The upstream\nsmall bowel leading into the anastomosis is mildly dilated to 4.2-cm, however,\noral contrast is seen passing distally beyond this prominent loop of bowel and\ntransits through a second jejunojejunostomy in the left upper quadrant.  No\ndefinite wall thickening or hyperemia is noted about this prominent loop of\nsmall bowel.  The large bowel is normal in caliber without wall thickening,\nfat stranding, or focal mass lesion. The appendix is normal without evidence\nof acute appendicitis.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  The\nceliac axis, SMA, and ___ are patent .  Small amount of atherosclerotic\ncalcification noted. The iliac arteries are normal in course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo abdominal wall hernia or pneumoperitoneum.\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria.  No free pelvic fluid\nseen. The uterus and ovaries are unremarkable.\n\nOSSEOUS STRUCTURES: Multilevel, multifactorial degenerative changes are seen\nwithin the visualized thoracolumbar spine.  A densely sclerotic lesion is\nagain seen within the left sacrum measuring 1.4 cm (2:112) consistent with a\nbone island. An additional 1.9 x 1.7 cm (02:10 3) lucent lesion is seen within\nthe left ilium adjacent to the SI joint, unchanged from previous examination,\nand again may reflect an intraosseous lipoma. No focal lytic or sclerotic\nlesion concerning for malignancy.",
            "output": "1.   Patulous, focally dilated loop of bowel at the jejunojejunostomy in the\nmid abdomen appears similar in morphology compared to the prior CT, but there\nis a new small amount of stranding and fluid about the anastomosis, perhaps\ndue to non-specific inflammation. Fecalization of contents within the\njejunojejunostomy with mild dilatation of the small bowel upstream of the\nanastomosis is also new, suggesting stasis and perhaps partial obstruction,\nhowever, there is no evidence of high grade small bowel obstruction with oral\ncontrast transiting beyond this anastomosis in the mid abdomen, and passing\ndistal to a second jejunojejunostomy in the left upper abdomen.\n2.  4.8 cm fluid-filled structure within the gallbladder fossa with calcified\nstones in a patient who is status post cholecystectomy may reflect a remnant\ngallbladder or dilated cystic duct."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Postoperative changes consistent with Roux-en-Y gastric\nbypass noted.  No contrast is seen within the excluded stomach.  However,\nthere is thickening noted focally at the proximal Roux limb just beyond the\ngastrojejunostomy concerning for inflammation possibly in the setting of\nmarginal ulcer.  No adjacent free air.  There is adjacent mild free fluid. \nDistal to this, small bowel is unremarkable.  2 levels of jejunojejunostomy\nappear uncomplicated.  The appendix is normal.  The colon 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: Multiple subcutaneous surgical clips are seen along the lower\nabdominal wall.  The abdominal and pelvic wall is within normal limits.",
            "output": "Status post Roux-en-Y gastric bypass with bowel wall thickening at the\nproximal Roux limb just beyond the gastrojejunostomy is concerning for\nenteritis possibly due to marginal ulceration, no free air though there is\ntrace free fluid.  No 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: Patient is status post TACE procedure and hepatic segments 8\nand 5 are stained with high-attenuation lipiodol.  The previously seen segment\n8 lesion is difficult to distinguish.  The lesion in segment 7 posterior to\nthe IVC is again seen now measuring 3.3 x 3.2 cm, previously 2.8 x 2.2 cm\nthere is no evidence of new focal lesions within the limitations of an\nunenhanced scan.  Caudate hypertrophy and nodular contour suggestive of\ncirrhosis.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  There is a ring of attenuating material in the gallbladder\nsurrounding a large gallstone previously seen on CT chest ___ prior to\ntace, likely due to porcelain 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 is mildly enlarged and has 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 suspicious\nrenal 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.\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 no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.  There are paraesophageal varices\n\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Again seen is a moderate-sized ventral abdominal wall hernia\ncontaining fat and mesenteric vessels.",
            "output": "1. Redemonstration of segment 7 lesion now measuring 3.3 cm, previously 2.8\ncm.\n2. Patient is status post TACE procedure with treatment of segments 8 and 5.\n3. There is a ring of attenuating material in the gallbladder surrounding a\nlarge gallstone previously seen on CT chest ___ prior to tace, likely\ndue to porcelain gallbladder.\n4. Stigmata of cirrhosis such as splenomegaly, paraesophageal varices, nodular\ncontour of the liver, and caudate lobe hypertrophy.\n5. Cholelithiasis without evidence of 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 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 a few cysts in bilateral kidneys, the largest is a 3.1 cm cyst in\nthe lower pole of the left kidney.  There is no evidence of focal renal\nlesions or hydronephrosis.  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.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is a cortical step off at anterior aspect of S2 (9:41) best seen\non sagittal view, new since prior study, with subtle heterogeneity of\nunderlying bone.  Chronic moderate T11 compression deformity and schmorl's\nnode.  4 mm sclerotic foci on L2 and T12, unchanged from prior, likely bone\nislands.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1.  Cortical step off anteriorly along the S2 vertebral body with subtle\nheterogeneity of underlying bone.  Correlation with trauma history and\nattention on follow-up recommended.\n2. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):   The impression and recommendation above was entered by\nDr. ___ on ___ at 11:24 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 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 hydronephrosis but bilateral extrarenal pelves are\nnoted.  Redemonstration of multiple bilateral renal cysts measuring up to 3.1\ncm in the midpole 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.\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 grossly within\nnormal limits. Gas is noted in the 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 redemonstration of a cortical step-off anteriorly to S1, with\ninterval increase in sclerotic changes, due to a healing fracture.  There is\ndegenerative bony changes.  There is a Schmorl nodule in the upper endplate of\nT11.\n\nSOFT TISSUES: There is a rectus abdominis diastasis.",
            "output": "1. There is no significant abdominopelvic changes when compared with prior\nstudy, no evidence of lymphoma in the abdomen."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY: The liver parenchyma enhances homogeneously.  No focal liver\nlesions identified.\nThe gallbladder is distended with no radiopaque calculi within it..\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 seen on either side.  Bilateral simple appearing\nrenal cortical cysts noted.  No solid enhancing renal masses identified.\nGASTROINTESTINAL: There is no bowel obstruction.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Moderate calcified atherosclerotic plaque is noted within the\ntortuous abdominal aorta, no aneurysmal dilation.\n\nPELVIS:\nThe bladder is partially distended and appears normal.  The uterus and adnexae\nare unremarkable..\n\nBONES AND SOFT TISSUES:\nFat containing umbilical hernia noted.\n5 mm densely sclerotic focus within the L3 vertebral body is unchanged, likely\na bone island.  Chronic compression deformity of the T11 vertebral body\nremains unchanged.  No new worrisome osseous lesions identified.",
            "output": "1. No splenomegaly or abdominal/pelvic lymphadenopathy.\n2. Incidental findings including a fat containing umbilical hernia, bilateral\nrenal cortical cysts are unchanged compared to the 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: There is focal fat density adjacent to the falciform ligament.\nThe liver otherwise demonstrates homogenous 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.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right 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 hypoattenuating cysts within the kidneys which more likely represent\nsimple cysts.  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. 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: Stable chronic compression deformity of T11 vertebral body.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a fat containing umbilical hernia. The abdominal and\npelvic wall is within normal limits.",
            "output": "1. No lymphadenopathy or splenomegaly.\n2. Please refer to dedicated CT chest for further 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: The liver, spleen, pancreas and adrenal glands are unremarkable.  The\ngallbladder is within normal limits.  No biliary ductal dilatation.  Bilateral\nrenal cysts are stable.  There is a hypodense 1.5 cm right renal lesion on\nseries 4, image 62 that is slightly more prominent, however measured water\ndensity on prior CT, possibly interval mild hemorrhage within a cyst.  No\nhydronephrosis.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.  The previous\nascending colonic finding is no longer visualized and represented mixing of\noral contrast with fecal material.\n\nPELVIS: The uterus and adnexa are unremarkable for age.  No pelvic free fluid.\n\nLYMPH NODES: There is new right deep inguinal, obturator and external iliac\nadenopathy.  For example, a 2.1 right deep inguinal, 2.1 cm right deep\ninguinal, 2.1 cm right external obturator, 1.5 cm right external iliac and 0.8\ncm right common iliac inguinal lymph nodes are new, previously all\nsubcentimeter.\n\nVASCULAR: There is no abdominal aortic aneurysm.  The hepatic vasculature is\npatent.\n\nBONES: No worrisome osseous lesions are visualized.  Unchanged in T11\ncompression fracture and multiple sclerotic lesions in the spine and pelvis.\n\nSOFT TISSUES: Fat containing paraumbilical and supraumbilical hernias are\nagain noted.",
            "output": "New right inguinal, obturator and external iliac adenopathy concerning for\ndisease recurrence."
        },
        {
            "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\ndecompressed, and appears normal.  No radiopaque ductal stones are detected.\n\nThe pancreas demonstrates normal density and bulk, without duct dilation or\nfocal lesion.\n\nThe spleen size within normal limits.  There are no focal splenic lesions.\n\nThe adrenal glands are normal size and shape.\n\nThe kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.  There are multiple well-circumscribed hypodense lesions\nthroughout both kidneys, the majority demonstrating fluid density, compatible\nwith simple cysts.  Intermediate density 1.4 x 1.4 cm right interpolar lesion\nis unchanged from prior examinations (series 2, image 60), but does not\ndemonstrate FDG avidity on the PET-CT from ___, also most\ncompatible with a cyst.  No concerning renal masses are detected.\n\nThe stomach and intra-abdominal and intrapelvic loops of small and large bowel\nare normal in caliber.  There is no focal gastrointestinal lesion.  There is\nmild fibrofatty deposition along the terminal ileum wall, likely the sequela\nof prior inflammation (series 2, image 90).\n\nThere is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.  Previously-seen enlarged right inguinal and\nexternal iliac lymphadenopathy on the ___ examination is no longer\nvisualized.  No newly enlarged nodes are detected.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries, ___, and iliac\nbranches are patent and normal in caliber, demonstrating minimal\natherosclerotic calcifications.  There is no dissection.\n\nThere is a moderate fat containing umbilical hernia, unchanged from prior\n(series 2, image 75).",
            "output": "1. Interval resolution of previously-seen right inguinal and external iliac\nlymphadenopathy.  No new abdominopelvic lymphadenopathy.\n2. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings.\n3. Unchanged moderate fat containing umbilical 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 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 solid focal renal lesions or hydronephrosis.  Again\nseen are bilateral well-circumscribed low-attenuation lesions in both kidneys.\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 visualized reproductive organs are unremarkable.\n\nLYMPH NODES: There is no retroperitoneal, periaortic 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: Apart from the protruding peritoneal fat due to diastasis of the\nrectus sheath, the abdominal and pelvic wall is within normal limits.",
            "output": "1. No inguinal, mesenteric, deep pelvic or periaortic lymphadenopathy is\npresent.\n2. Stable renal cysts and diastasis of rectus sheath in anterior abdominal\nwall"
        },
        {
            "input": "VASCULAR:\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Median sternotomy are noted.  Please refer to dedicated CT chest\nreport same day for intrathoracic 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. There is no peripancreatic\nstranding.\n\nSPLEEN: Heterogeneous enhancement the spleen is likely related to the arterial\nphase of the 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 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.  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. An addendum will be made to this report with regard to the vasculature\nafter 3D reconstruction images are fully processed.\n2. No acute abnormality in the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: Moderate bilateral pleural effusions with associated compressive\natelectasis similar to prior CT.\n\nABDOMEN:\n\nMild ascites.\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 moderately 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 no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Enteric tube terminates within\nthe duodenum.  Small bowel loops demonstrate normal caliber and wall thickness\nthroughout.  The colon and rectum are within normal limits. The appendix is\nnormal.\n\nPELVIS: Foley catheter within the bladder which is incompletely distended. \nMild free fluid within the pelvis in the setting of ascites.\n\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 change of the visualized spine most severe at the L3-L4\nand L5-S1 levels.  No fracture or suspicious osseous lesion.\n\nSOFT TISSUES: Diffuse body wall edema compatible with anasarca.",
            "output": "1. Moderate bilateral pleural effusions, mild ascites, and anasarca compatible\nwith third spacing.  No drainable fluid collection/abscess identified.\n2. Moderately distended gall bladder without focal inflammatory change appears\nless prominent when compared to patient's prior outside CT examination and is\npresumably related to fasting state.\n3. Additional chronic changes as above."
        },
        {
            "input": "LOWER CHEST: Evaluation of the lung bases is limited due to motion artifact. \nNo significant abnormalities are identified.\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.  Calcifications are seen\ncoursing along the pancreas, which are likely vascular nature.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right 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 parapelvic 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.  There is\nsignificant diverticulosis without acute diverticulitis.\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.  No adnexal\nmasses 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.  There is aneurysmal\ndilatation of the bilateral common iliac arteries, measuring the maximal\ndiameter of 1.6 cm on the left and 1.6 cm on the right.  Extensive\natherosclerotic disease is noted, though the celiac artery, SMA, and ___ are\npatent at their origins.\n\nBONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions or\nacute fracture.  Minimal degenerative changes are seen in the thoracolumbar\nspine and bilateral hips.  There is straightening of the normal lumbar\nlordosis.  The abdominal and pelvic wall is within normal limits.",
            "output": "1. No CT evidence of ovarian mass.\n2. Minimal degenerative changes of the hips.\n3. Common iliac artery aneurysms bilaterally."
        },
        {
            "input": "LOWER 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: A 1.0 cm hypodensity in the pancreatic tail is unchanged since the\nprior study, and likely representative of a side branch IPMN (5:60).  No\nductal dilatation or peripancreatic stranding.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 amount of\nstool, fluid, and air throughout the colon.  The appendix is normal (5:81).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Patient is post hysterectomy.\n\nLYMPH NODES: A 1.9 x 1.4 cm gastrohepatic lymph node is smaller, previously\nmeasuring 2.7 x 2.7 cm (5:52).  A 0.9 x 0.6 cm right retroperitoneal node is\nsmaller, previously measuring 1.5 x 1.3 cm (05:58).  A 1.4 x 0.9 cm aortocaval\nnode is also smaller, previously measuring approximately 2.7 x 1.5 cm (5:64). \nThere is 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.  Multilevel\ndegenerative changes of the thoracolumbar spine again noted.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias are unchanged.",
            "output": "1.  No acute intra-abdominal or intrapelvic process to correlate with the\npatient's pain.  Specifically, no colitis or appendicitis.\n2.  Multiple previously described enlarged mesenteric and retroperitoneal\nlymph nodes have decreased in size since ___, as described above.\n3.  Please refer to the CT chest from the same date for the intrathoracic\nfindings."
        },
        {
            "input": "LOWER CHEST:\nAortic root stent noted in place.  Bilateral lower lobe and the same a and\nhoneycombing are partially imaged.  No pleural effusions.\n\nABDOMEN:\n\nGENERAL: There is no intra-abdominal free air or free fluid.\nHEPATOBILIARY:  The liver parenchyma enhances homogeneously with no focal\nlesions.  No intrahepatic biliary ductal dilation.  The portal vein and its\nbranches are patent.\nThe gallbladder is partially distended with no radiopaque calculi within it.\nPANCREAS: There is diffuse atrophy of the pancreatic parenchyma without main\nduct dilation.  Again visualized is a cystic lesion measuring 9 mm in the\ndistal pancreatic body (series 3, image 26) that is unchanged dating back to\n___ and likely a branch duct IPMN.\nSPLEEN:  No splenomegaly or focal splenic lesions.\nADRENALS:  No adrenal nodules.\nURINARY: No hydronephrosis on either side.  3 mm left renal lower pole\ncortical hypodensity is likely a cyst.\nGASTROINTESTINAL: There is a small hiatus hernia.  No bowel obstruction. \nDiffuse colonic diverticulosis without acute diverticulitis.  No small or\nlarge bowel wall thickening noted.\n\nLYMPH NODES: There are no enlarged lymph nodes in the abdomen or pelvis..\nVASCULAR: Extensive atherosclerotic calcification of the abdominal aorta and\nits branches noted.  No aneurysmal dilation.  The abdominal aorta also appears\ntortuous.\n\nPELVIS:\nThe bladder is moderately distended and unremarkable.  The uterus and both\novaries are not visualized..\n\nBONES AND SOFT TISSUES:\nMultilevel degenerative changes of the thoracolumbar spine noted.  There is\nmild compression deformity of the lower thoracic vertebrae, as before.\nBilateral small fat containing inguinal hernia noted.",
            "output": "1. No solid organ abnormalities or abdominal/pelvic lymphadenopathy.\n2. Large stool burden throughout the colon without bowel obstruction.  No\nsmall or large bowel wall thickening noted.  Extensive atherosclerotic\ncalcification of the tortuous abdominal aorta and its branches without\naneurysmal dilation.\n3. Diffuse pancreatic parenchymal atrophy without main duct dilation with an\nunchanged 9 mm cystic lesion in the distal body/tail, likely a side branch\nIPMN."
        },
        {
            "input": "CHEST: The lungs demonstrate moderate bibasilar atelectasis and subpleural\nscarring.  The heart is moderately enlarged with diffuse coronary artery\ncalcifications and a prosthetic aortic valve. There is no pericardial or\npleural effusion.  Right hilar and pericardial lymphadenopathy is incompletely\nassessed.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal hepatic lesions. The\ngallbladder is decompressed, with no stones. The pancreas demonstrates\nconsiderable fatty atrophy, and there is stable 1.3 x 0.9 cm\nwell-circumscribed hypodensity in the tail of the pancreas, likely\nrepresenting an IPMN, stable since ___. The spleen is normal in\nsize and attenuation. The adrenal glands are normal bilaterally. The kidneys\nenhance and excrete contrast normally. There is no hydronephrosis.\n\nThe stomach and small bowel are decompressed. The appendix is normal. In the\nmid sigmoid colon, in the region of several diverticula, there is\ncircumferential wall thickening of the sigmoid colon, with surrounding\nhyperemia and stranding of the mesentery.  There is likely a small intramural\nabscess, but no drainable fluid collection. No evidence of macro perforation.\nOther scattered diverticula are seen, without evidence of other foci of\ndiverticulitis.\n\nThere are numerous pathologic retroperitoneal, periportal, and portacaval\nlymph nodes (2:22, 24, 28, 31, 37), the largest measuring up to 3.4 cm. There\nis no free air or free fluid.\n\nPELVIS: The urinary bladder is normal.  Inflammation from the sigmoid colon\nextends to left adnexa, and the uterus is either atrophic or surgically absent\nvia a supracervical hysterectomy, however correlation with surgical history is\nrecommended. There is no pelvic sidewall or inguinal lymphadenopathy. \nBilateral fat containing inguinal hernias as noted.\n\nVESSELS: The aorta demonstrates moderate atherosclerotic calcification without\naneurysmal dilatation. There is moderate atherosclerotic calcification of the\nSMA and celiac axis.\n\nOSSEOUS STRUCTURES: No concerning osseous lesions are seen.",
            "output": "1. Sigmoid diverticulitis in the mid sigmoid colon with moderate surrounding\ninflammatory change and a small intramural abscess, but no drainable fluid\ncollection. Recommend endoscopic evaluation after resolution of acute\nsymptoms.\n2.  New, significant retroperitoneal, periportal, and portacaval\nlymphadenopathy is indeterminate although potentially concerning for\nlymphoproliferative disease or other malignancy, versus inflammatory change. \nComplete imaging of the chest is recommended to fully evaluate the partially\nimaged thoracic lymphadenopathy.\n\nFindings discussed with Dr. ___ by Dr. ___ discovery at 315AM on\n___.\n\nRECOMMENDATION  Complete imaging of the chest is recommended to fully evaluate\nthe partially imaged thoracic lymphadenopathy. Recommend endoscopic evaluation\nafter resolution of acute symptoms of diverticulitis, to exclude underlying\ncolonic malignancy.  Further evaluation or follow up of abdominal\nlymphadenopathy can be directed in part based upon findings at dedicated chest\nCT, but if biopsy is not performed or alternate etiology determined, a short\ninterval follow up is required to assess resolution (suggest within 3 months).\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 17:57 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: There is a trace left pleural effusion.  Dense coronary artery\ncalcifications are noted.  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.  There is a stable calcification posterior to the\nliver which may represent a calcified chronic hematoma (2; 25).  Small\ncalcifications are seen posterior to the CBD, unchanged compared to prior.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions within the limitations of an unenhanced scan. A calcification is\nseen within the pancreas (2;29).  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: A 1.7 cm left adrenal adenoma is stable (2; 30).\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 3 mm nonobstructing stone is seen in the interpolar\nregion of the right kidney.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass.  There\nis diffuse small bowel distention beginning at the jejunal-jejunal anastomosis\nand extending to the neo-ileocolic junction without fecalization.  The patient\nis status post right hemi colectomy.  The neo ileocolic junction appears\nunremarkable.  There is no surrounding fluid.  There is sigmoid diverticulosis\nwithout wall thickening or surrounding inflammation.  There is a moderate\namount of pneumoperitoneum.  A calcified epiploic appendage is again seen in\nthe left lower quadrant.\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 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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are seen in the lumbar spine.  There is grade 1\nanterolisthesis of L4 on L5.\n\nSOFT TISSUES: A midline incision is seen with soft tissue stranding and\nsubcutaneous emphysema along midline and along the left flank.",
            "output": "1. Diffuse distention of small bowel without secondary findings of\nobstruction, suggest ileus in this postoperative setting. However a partial\nfunctional stenosis at the anastomosis cannot be completely excluded. \nRecommend continued follow-up with serial KUBs.\n2. Moderate volume pneumoperitoneum, small amount of free fluid in the pelvis\nand trace less pleural effusion, likely sequela from recent right\nhemicolectomy (POD#4).  The anastomosis appears intact.\n3. Stable left adrenal adenoma."
        },
        {
            "input": "LOWER CHEST: Right basilar opacity may represent aspiration.  Trace left\nbasilar pleural effusion noted.  There is cardiomegaly with atherosclerotic\ncalcifications of the coronary arteries and aortic valve.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is a 1.5 cm left adrenal nodule, unchanged since ___\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.  Punctate\nnonobstructive renal calculus seen in the right kidney.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The patient is status post Roux-en-Y gastric bypass.  The\npatient is also status post right hemicolectomy.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. Diverticulosis of\nthe sigmoid colon is noted, without evidence of wall thickening or fat\nstranding. The appendix is surgically absent.\n\nPELVIS:  There is a small amount of abdominopelvic free fluid.\n\nREPRODUCTIVE ORGANS: The visualized 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 extensive atherosclerotic disease.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: There is interval development of bilateral rectus sheath\nhematomas.",
            "output": "1. Bilateral small rectus sheath hematomas, with no evidence of active ongoing\nbleeding.\n2. Small amount of abdominopelvic free fluid.\n3. Punctate, nonobstructive renal calculus in the right kidney.\n4. Diverticulosis without evidence of diverticulitis.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. Right basilar nodular opacities may represent aspiration.\n\nNOTIFICATION:  Updated findings were communicated with ___,\nMD via telephone by ___, MD via telephone on ___ at\n09:28 a.m."
        },
        {
            "input": "Lung Bases:  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, spleen, gallbladder, adrenal glands, and pancreas appear\nnormal.  Kidneys appear unremarkable.  The abdominal aorta is normal in course\nand caliber.  No lymphadenopathy, free air or free fluid is seen.  The stomach\nand duodenum appear normal.\n\nPelvis: Small bowel loops demonstrate no signs of ileus or obstruction. The\nappendix is not clearly visualized though there are no secondary signs of\nappendicitis. There is diffuse hyperemia and thickening of the colonic wall\nwith mild adjacent fat stranding concerning for pan colitis. Additionally,\nthere is a long ahaustral segment of the transverse colon. Overall appearance\nraises concern for ulcerative colitis though an infectious etiology can't also\nbe considered. No bowel obstruction. No pneumatosis or evidence of\nperforation. No significant free fluid. The uterus and adnexal regions appear\ngrossly unremarkable. The urinary bladder is decompressed.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "Pancolitis with features suggestive of ulcerative colitis, though differential\nconsiderations include infectious colitis.\n\nNOTIFICATION:  Findings were discussed with Dr. ___ at the time of this\ndictation."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is mild\nleft basilar pleural thickening with adjacent surgical clips.  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 CBD is mildly enlarged measuring up\nto 1 cm in this patient status post cholecystectomy.  There is no evidence of\nintrahepatic 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 adrenal gland contains a 1.4 cm heterogeneously enhancing\nnodule in the left adrenal gland contains a 1.0 cm heterogeneously enhancing\nnodule.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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.  The distal rectum is thickened without significant\nstranding and likely reflects internal hemorrhoids.\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 grossly 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 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 bowel ischemia or colitis.\n2. Bilateral heterogeneously enhancing adrenal nodules for which nonemergent\nfollow-up imaging can be obtained, if not previously characterized."
        },
        {
            "input": "LOWER CHEST: Status post left lower lobectomy.  Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\ndilation.  The CBD is mildly enlarged, measuring up to 1 cm in this patient\nstatus post cholecystectomy, grossly unchanged 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: Re-demonstration of a 1.5 cm right adrenal gland heterogeneously\nenhancing nodule, and a 1.0 cm left adrenal gland heterogeneously enhancing\nnodule, grossly unchanged from prior CT.\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.\n\nGASTROINTESTINAL: The stomach is 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.  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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is an osseous sclerotic lesion within the right iliac bone\n(series 5, image 84), new since PET/CT dated ___, grossly unchanged\nfrom prior CT dated ___.  This finding is highly suspicious for an\nosseous metastasis.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Sclerotic lesion within the right iliac bone, new since PET/CT dated ___, and more conspicuous than on the CT from ___, highly\nsuspicious for a osseous metastasis.\n2. Stable right and left adrenal nodules.\n3. Same-day chest CT is reported separately\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 12:03 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "LOWER CHEST: Left left basal atelectasis is noted.  The imaged portion of the\nheart is unremarkable.  No pleural or pericardial effusions seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances normally without concerning focal liver\nlesion.  The main portal vein is patent.  No biliary ductal dilation.  The\ngallbladder appears unremarkable.  No CBD dilation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions.  There is diffuse pancreatic ductal dilatation up to 6 mm\n(series 601, image 20), previously 4 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: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is a millimetric right cortical hypodensity too small to characterize by\nCT but likely representing 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. There is a\nmoderate-sized stool ball within the rectum.  There is diverticulosis the\ndescending and sigmoid colon without diverticulitis.\n\nPELVIS: The there is mild thickening of the urinary bladder with urothelial\nhyperenhancement suggesting possible infection.  The distal ureters are not\nwell visualized.  Multifocal calcifications near the UVJ are likely\nphleboliths without evidence of hydroureter.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The the uterus appears within normal limits.  The adnexa\nare 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: Multiple healed fractures are noted involving the left lower ribs.  In\naddition, there is a chronic appearing deformity of the right posterior\ntwelfth rib.  Degenerative changes at the bilateral hips are similar in\nextent.  Dextroscoliosis of the lumbar spine is incompletely evaluated on\nthese non standing views but appears similar to the prior study.  Scoliosis is\nre-demonstrated with multilevel lumbar degeneration\n\nSOFT TISSUES: An oval opacity is partially in the left imaged in the left\nanterior breast, measuring 1.4 x 0.8 cm, not significantly changed from ___.",
            "output": "1. Mild bladder wall thickening, please correlate with UA as infection is \nsuspected.  No signs of pyelonephritis.\n2. Slightly increased pancreatic ductal dilation up to 6 mm, consider\nnonemergent MRCP to further assess.\n3. Chronic deformities of the lower left ribs.  Healed deformity of the right\nposterior twelfth rib.\n4. Partially visualized rounded density in the left breast can be correlated\nwith results from prior mammogram as this finding is unchanged from a prior CT\nfrom ___"
        },
        {
            "input": "Please see the dedicated chest CT report from the same day for further details\nregarding intrathoracic findings.\n\nABDOMEN:\n\nThe liver enhances homogenously without any focal lesions or intra-hepatic\nbiliary dilatation. The common bile duct is mildly dilated measuring 9 mm,\nwithin normal limits in this age group. The main portal vein is patent. The\ngallbladder, pancreas, spleen and adrenal glands are unremarkable. The kidneys\nenhance excrete contrast symmetrically without any hydronephrosis.  There are\nmultiple hypodensities in both kidneys. For example arising from the\ninterpolar region of the right kidney is a 2.3 x 1.8 cm lesion that is most\nlikely a cyst. Others are too small to characterize. The stomach and\nintra-abdominal small bowel are unremarkable.\n\nThere is a circumferential mass within the cecum spanning at least 5 cm and\ninvolving the ileocecal valve and terminal ileum. There is no evidence of\nbowel obstruction.\n\nThe aorta is of normal caliber without evidence of aneurysm. There is\natherosclerotic disease at the origins of the renal arteries bilaterally.\nDense atherosclerosis extends into the iliac vessels.\n\nThere is no free fluid, free air lymphadenopathy within the abdomen.\n\nPELVIS:\n\nThe bladder, rectum and sigmoid colon are unremarkable. A small 1.4 x 1.1 cm\nposterior uterine fibroid is present. There is no free fluid, free air\nlymphadenopathy within the pelvis.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  There is scoliosis involving the\nthoracolumbar spine and multilevel degenerate changes the lumbar spine with\ndisc space narrowing and vacuum phenomenon. Abdominal and pelvic wall is\nwithin normal limits.",
            "output": "1. Circumferential colonic wall mass within the cecum and involving the\nterminal ileum.  No evidence of intra-abdominal metastatic disease.\n2.  Bilateral probable renal cysts."
        },
        {
            "input": "LOWER CHEST: Bilateral pleural effusions, moderate on the right, and small on\nthe left.  Enhancing consolidation at the left lung bases compatible with\natelectasis.  There is also right middle lobe atelectasis.  However, there are\nadditional nodular opacities in the bilateral lower lobes, left greater than\nright, which are suspicious for aspiration or pneumonia.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates heterogeneous attenuation. \nSubcentimeter hypodensities most likely represent small cysts.  There is no\nevidence of intrahepatic or extrahepatic biliary dilatation.  Marked\ngallbladder wall edema is likely due to third spacing.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 linear cortical defect along the posterior interpolar region of the\nright kidney, likely extending to the renal sinus fat, which has an appearance\nsuggestive of a normal variant junctional parenchymal defect (___).  There\nis no evidence of focal renal lesions or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Enteric tube terminates in the body of the stomach.  Small\nbowel loops demonstrate normal caliber, wall thickness, and enhancement\nthroughout. The colon and rectum are within normal limits. There is small\nvolume ascites/mesenteric edema.  No pneumoperitoneum.\n\nPELVIS: There is a Foley catheter and post instrumentation air.  Trace free\nfluid 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 no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is a circumaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild degenerative changes are noted.  There is minimal retrolisthesis of L2-3,\nand L4-5.\n\nSOFT TISSUES: Evaluation of the soft tissues is notable for body wall edema,\nwhich is most pronounced in the pelvis and upper thighs.",
            "output": "1. Heterogeneous enhancement of the liver with no discrete lesions identified.\nOtherwise, no infectious source identified within the abdomen or pelvis. \nMarked circumferential gallbladder wall edema is likely due to third spacing\nin the setting of small volume ascites.  The hepatic findings could be\nsecondary to hepatitis for which further correlation and evaluation with LFTs\nand enhanced MRI of the liver are recommended.\n2. Nodular bibasilar parenchymal opacities, suspicious for aspiration or\npneumonia.\n3. Moderate right and small left pleural effusions with bibasilar atelectasis."
        },
        {
            "input": "CHEST:   Interval increase of right non hemorrhagic pleural effusion, now\nmoderate. Linear opacity at the left lung base are atelectasis. There is\nmoderate pericardial effusion.\n\nPlease refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nABDOMEN:  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 within normal limits,\nwithout stones or gallbladder wall thickening.\n\nThe pancreas has normal attenuation throughout, without evidence of focal\nlesions or pancreatic ductal dilatation.  The spleen shows normal size and\nattenuation throughout, without evidence of focal lesions. Lower pole\naccessory spleen is unchanged since ___.  Coronal and lesion next to\nthe upper pole of the spleen (series 5: Image 71) is 5 mm of was 7 mm in ___ allowing for differences in technique this is likely a second accessory\nspleen. The adrenals glands are unremarkable bilaterally. The kidneys are of\nnormal and symmetric size with normal nephrogram.  There is no evidence of\nstones, focal renal lesions or hydronephrosis.\n\nThere is no evidence of retroperitoneal and mesenteric lymphadenopathy.\n\nThe abdominal aorta demonstrates moderate atherosclerosis.\n\nPELVIS:  The urinary bladder and distal ureters are unremarkable.  Uterus and\nadnexa are not visualized.  There is no evidence of pelvic or inguinal\nlymphadenopathy.  There is no free fluid or air in the abdomen.\n\nBONES AND SOFT TISSUES:  There is no evidence of worrisome lesions. Previously\ndescribed FDG-avid L3 right posterior pedicle focus does not have any\nradiological correlate. Moderate degenerative changes of the spine.",
            "output": "1. No definite evidence of intra-abdominal metastatic disease from known right\nlung cancer.\n2. Previously described L3 right posterior pedicle bone metastatic lesion is\nnot identified.\n3. Please refer to report of concurrent CT chest for detailed description of\nthoracic findings"
        },
        {
            "input": "LOWER CHEST: There is minimal bibasilar subsegmental atelectasis. \nAdditionally, there is minimal basal scarring, (series 5, image 16).  There is\nno evidence of pleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: There are numerous peripherally enhancing irregular\nhypodensities of the liver.  The largest irregular hypodensity is located in\nsegment III and measures 44 x 34 mm with associated calcification, (series 5,\nimage 14).  The liver otherwise demonstrates homogenous attenuation\nthroughout.  There is evidence no evidence intrahepatic or extrahepatic\nbiliary dilatation.  There is mild periportal edema.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: At the upper pole of the right kidney the 14 mm well-circumscribed\nhypodensity which represents a simple renal cyst.  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 slightly decompressed. The wall of the distal\nstomach is thickened which may represent known gastric cancer or may be due to\nthe decompressed state of the stomach.  The stent extends from the pylorus to\nthe second part of the duodenum and is widely patent.  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: Mild prostatomegaly.  The seminal vesicles are\nunremarkable.\n\nLYMPH NODES: There are numerous centrally necrotic periportal and portacaval\nlymph nodes suggesting metastatic lymph node involvement, for example a 10 mm\ncentrally necrotic portacaval node, (series 5, image 24) and a 12 mm\nperiportal lymph node, (series 5, image 19).  In the peripancreatic superior\nto the distal pancreatic body is 21 x 10 mm soft tissue lesion with multiple\ncalcifications which likely represents a mesenteric lymph node, (series 5,\nimage 21).\nThere is retroperitoneal lymphadenopathy, for example centrally necrotic\nperiaortic lymph nodes than measure 14 x 12 mm, (series 5 image 25) and 20 x\n14 mm, (series 5 image 41).  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.\nThere is moderate multilevel degenerative changes of the lower thoracic and\nlumbar spine including mild retrolisthesis of T12 on L1 and L1 on L2, (series\n8, image 32), intervertebral disc space narrowing and vacuum phenomena.\n\n\nSOFT TISSUES: In the right upper anterior abdominal wall is a\nwell-circumscribed hyperdensity which may represent a fiducial, (series 5\nimage 36).  The abdominal and pelvic wall is within normal limits.",
            "output": "1. The walls of the antrum and pylorus of the stomach are thickened which may\nrepresent the known gastric cancer. The gastric stent extends from the distal\nstomach to the duodenum and is patent.  No evidence of gastric outlet\nobstruction or small-bowel obstruction.\n2. There are numerous enlarged centrally necrotic lymph nodes in the abdomen\nwhich represent metastatic involvement of lymph nodes.\n3. Numerous irregular hypodensities in the bilateral lobes of the liver, some\nwith calcifications representing hepatic metastasis."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis, otherwise the visualized lung fields\nare unremarkable.  Diffuse calcification of the coronary arteries. Mildly\nenlarged heart.  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 contains a large stone\nwithout evidence of gallbladder wall thickening or pericholecystic fluid.\n\nPANCREAS: The pancreas is atrophic 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, without\nevidence of focal lesions.\n\nADRENALS: The 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 hypodense lesions are compatible with cysts, not substantially\nchanged in the interval.  There is no evidence of solid renal lesions or\nhydronephrosis.  No urolithiasis.  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.  Large stool ball is seen within the rectum without wall thickening\nor stranding.  The appendix is not visualized.\n\nPELVIS: The urinary bladder is mildly decompressed and demonstrates mild wall\nthickening.  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 lymphadenopathy.  Bilateral prominent inguinal lymph nodes are\nredemonstrated, 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. \nModerate to severe multilevel degenerative changes of the lower thoracic and\nlumbar spine.  Grade 1 retrolisthesis of L3 on L4 and grade 1 anterolisthesis\nof L4 and L5 are unchanged.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits. \nRedemonstration of right ischial bursitis.",
            "output": "1. Mild wall thickening of the urinary bladder may be due to decompressed\nstate. However cystitis cannot be excluded and correlation with urinalysis\nrecommended.\n2. Cholelithiasis without evidence of acute cholecystitis.\n3. Scattered colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields demonstrates a stable 4 mm nodule in the\nright middle lobe.  There is bibasilar atelectasis.  There is no evidence of\npleural or pericardial effusion.  There are severe coronary artery\ncalcifications.  Heart size is moderately enlarged.\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 without\nwall thickening or surrounding inflammation.\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. \nAgain is redemonstration of multiple bilateral hypodense lesions, measuring up\nto 3.2 x 3.1 cm in the right interpolar region and measuring up to 2.7 x 2.5\ncm in the left upper pole, similar to prior, likely representing renal cysts. \nThere is no evidence of solid renal lesions or hydronephrosis.\n\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 or fat stranding. The appendix is not visualized.\n\nPELVIS: The wall of the urinary bladder appears thickened, greater than\nexpected for distension, with mucosal hyperenhancement and with adjacent fat\nstranding concerning for cystitis.  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.  Moderate atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nSevere multilevel degenerative changes are noted in the lumbar spine most\nnotable at L1-L2 through L5-S1.  There is grade 1 anterolisthesis of L4 on L5.\n\nSOFT TISSUES: There is mild diffuse anasarca.  There is a small fat containing\nright inguinal hernia.",
            "output": "1. Thickened bladder wall with adjacent fat stranding concerning for cystitis.\nCorrelation with urinalysis is recommended.\n2. No hydronephrosis or nephrolithiasis.\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. \nSubcentimeter hypodensity in segment 8 is too small to characterize, but\nlikely represents a simple cyst or biliary hamartoma.  This is unchanged\ncompared to prior 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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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.  Simple cysts measure up to 6.3 cm in the upper pole of the\nright kidney and up to 1.2 cm in the lower pole of the left kidney.  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: 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 at L5-S1 are noted.\n\nSOFT TISSUES: There is a lobulated fluid collection with mild peripheral\nenhancement centered in the low left anterior abdominal wall which extends\ninferiorly along the left rectus femoris muscle and into the left inguinal\nregion, measuring up to 3.5 x 9.3 cm (AP by CC, 602:56).  Surgical clips are\nseen posterior to this collection.",
            "output": "1. Fluid collection centered in the left inguinal region measures up to 9.3 cm\ncraniocaudally.  This demonstrates ring enhancement and is concerning for\nabscess\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. \nHypodensity in segment VIII is too small to fully characterize but likely\nrepresents a simple cyst or biliary hamartoma, unchanged from prior studies\n(2:70).  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is decompressed, somewhat limiting assessment,\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. \nSimple cysts are seen bilaterally.  Additional hypodensities that are too\nsmall to fully characterize likely represent additional simple cysts.  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. There is moderate\ncolonic fecal loading.  The cecum and portions of the ascending colon cross\nthe midline posteriorly and terminate in the left upper quadrant after passing\nposterior to the distal branches of the SMA and SMV, a new configuration when\ncompared with recent prior studies suggesting a mobile cecum.  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 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 are moderate multilevel degenerative changes of the lower lumbar spine,\nworst at L4-S1.\n\nSOFT TISSUES: There is a fat containing umbilical hernia.  The previously seen\nfluid collection involving the left inferior abdominal wall and extending into\nthe inguinal region is no longer present with minimal residual fat stranding\nin this area.  There is no drainable fluid collection.",
            "output": "1. Interval resolution of the previously seen left lower quadrant superficial\nabdominal wall collection with no residual drainable fluid.\n2. No evidence of acute process in the abdomen or pelvis.\n3. Mobile cecum and ascending colon, currently terminating in the left upper\nquadrant, which may predispose to cecal volvulus, although there is no\nvolvulus or obstruction at this time.\n4. Moderate colonic fecal loading."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis with small bilateral pleural\neffusions.\n\nVASCULAR:  The abdominal aorta and its major branches are patent.  There is no\nabdominal aortic aneurysm.  The portal vein is patent.  The proximal portion\nof the superior mesenteric vein appears patent.  No definite thrombus is seen\nalthough the distal superior mesenteric vein branches are not well seen.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver enhances homogeneously.  A sub cm hypodensity in\nsegment V is too small to characterize but unchanged from prior.  The\ngallbladder is unremarkable.  There is no intra or extrahepatic biliary duct\ndilation.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation. There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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 distal esophagus is normal.  Postsurgical changes from\nright colectomy are noted with a intact right mid abdominal anastomosis. \nPreviously seen long segment of dilated small bowel proximal to the\nanastomosis demonstrates persistent moderate wall thickening and edema, but to\na lesser degree than on ___.  Bowel loops are no longer dilated.  No\npneumatosis is seen.  Bowel wall now demonstrates submucosal enhancement. \nThere is intraloop free fluid as well as free fluid in the pelvis, as seen\npreviously.  The remainder of the small and large bowel are unremarkable. \nThere are prominent mesenteric lymph nodes, but none that are pathologically\nenlarged.\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 moderate volume\npelvic free fluid.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is air within the superficial soft tissues, likely from\ninjections.  Fiducial and stranding are noted along the anterior abdominal\nwall, unchanged from prior.",
            "output": "1. Overall improvement in appearance of small bowel loops proximal to the\nanastomosis, now non dilated and with improved enhancement although these\nloops continue to demonstrate moderate wall edema.  No pneumatosis or free\nair.\n2. Pelvic free fluid and mild interloop free fluid in the right lower\nquadrant, unchanged from prior.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11 p.m., 5 minutes after\ndiscovery 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 liver demonstrates homogenous attenuation throughout. There\nis no evidence of focal lesions. There is no evidence of intrahepatic biliary\ndilatation.  Common bile duct is top-normal in size measuring up to 8-9 mm. \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. \nNo hydronephrosis.  5.3 cm cyst arising from the interpolar region of the\nright kidney has faint calcifications of its outer wall, unchanged.  Few\nadditional subcentimeter hypodensities bilaterally are too small to\ncharacterize, but also likely reflect simple cysts.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout.  Pancolonic diverticulosis is worse in the\nascending and sigmoid colon.  Enhancing soft tissue nodule in the mid abdomen\nmeasures 1.3 x 1.3 cm, minimally increased in size compared to exam in ___, but stable to slightly decreased in size compared to exam in ___ (3:83), likely a reactive lymph node.\n\nRETROPERITONEUM: No 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: Uterus is not visualized.  No adnexal abnormalities.\n\nVASCULAR:  Aorta and its major branches are patent without significant\natherosclerotic disease.  Severe narrowing at the origin of the celiac axis is\nsimilar to prior.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nUnchanged grade 1 anterolisthesis of L4 on L5 and L5 on S1.\n\nSOFT TISSUES: There is a small fat containing umbilical hernia.",
            "output": "1. No acute intra-abdominal process.  Specifically, no evidence for ischemic\ncolitis.\n2. High-grade narrowing of the origin of the celiac artery, as seen\npreviously.\n3. Colonic diverticulosis without diverticulitis.\n4. Similar appearance of 1.3 cm enhancing soft tissue nodule in the mid\nabdomen, potentially a reactive 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: The liver demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic\nbiliary dilatation.  Prominence of the CBD is unchanged.  The gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: Large exophytic simple cyst arising from the lower pole the right\nkidney.  Additional subcentimeter hypodensities within kidneys bilaterally are\ntoo small to characterize, but also likely represent cysts.  Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram.  There is no\nevidence of enhancing 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.  Scattered colonic diverticula.  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: Central mesenteric nodule measuring 11 mm is unchanged compared\nto prior (series 6, image 86).  There is no new retroperitoneal or mesenteric\nlymphadenopathy.  There is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  Severe narrowing the celiac axis is unchanged, possibly due to\ncompression from the median arcuate ligament.\n\nBONES: Grade 1 anterolisthesis of L4 on L5 due to facet arthropathy.  There is\nno evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Small fat containing umbilical hernia.  Otherwise, the abdominal\nand pelvic wall is within normal limits.",
            "output": "1. No evidence of malignancy within the abdomen or pelvis.\n2. Unchanged 11 mm nodule within the central mesentery, which is indeterminate\nbut may represent a lymph node.\n3. Please refer to the chest CT with the same date for evaluation of the\nintrathoracic structures."
        },
        {
            "input": "LOWER CHEST: Mild 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 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 solid renal lesions or hydronephrosis.  Several\nlow-density lesions throughout the kidneys bilaterally, unchanged when\ncompared to CT from ___ and measuring up to 6.4 cm on the right are all\nlikely cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a percutaneous gastrostomy tube in situ which\nappears new when compared to the CT from ___.  This appears to be in\nappropriate positioning.  There is mild stranding of the fat surrounding the\ntract to the subcutaneous tissues, but this is felt to be within normal\nlimits.  There is diverticular disease affecting the distal ileum. \nDiverticulosis affecting the cecum, ascending: None sigmoid also with no\nevidence of diverticulitis.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  Trace pelvic\nfree fluid.\n\nREPRODUCTIVE ORGANS: Evidence of prior 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. \nGrade 1 anterolisthesis of L4 on L5 with mild degenerative change at this\nlevel.  Significant lower lumbar spine facet joint degenerative change..\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Percutaneous gastrostomy tube in situ with mild surrounding inflammatory\nchange that is within normal limits.\n2. No intra-abdominal or pelvic acute infectious process identified."
        },
        {
            "input": "LOWER CHEST: There is bibasilar 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 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 a few hypoattenuating cystic lesions within the kidneys, largest at\nthe inferior pole on the right measuring 5.5 x 5.7 cm.  There is no evidence\nof solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a PEG tube placement within the stomach.  The\nstomach is otherwise unremarkable.  Small bowel loops demonstrate normal\ncaliber, wall thickness, and enhancement throughout. There are few scattered\ndiverticula within large bowel without evidence diverticulitis.  There is a\nlarge amount of stool within the rectum with perirectal stranding and\npresacral fluid.\n\nPELVIS: There is a focus of air within the bladder, likely from recent\ninstrumentation.  The urinary bladder and distal ureters are unremarkable. \nThere is trace free 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.  There is mild narrowing of\nthe celiac artery at its origin.  Mild atherosclerotic disease is noted.\n\nBONES: There is anterolisthesis of L4 on L5.  There are chronic degenerative\nchanges of the lower lumbar 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": "1. Large amount of stool within the rectum with associated perirectal\nstranding and fluid.  Findings may reflect proctitis and possibly stercoral\ncolitis."
        },
        {
            "input": "VASCULAR:\n\nAbdominal aorta is non-aneurysmal major branch vessels of the abdominal aorta\nincluding the celiac axis, SMA, ___, and renal arteries are patent.\n\nLOWER CHEST: Dense parenchymal changes involving dependent portions of both\nlungs, consistent with atelectasis.  Small volume bilateral pleural fluid,\nmore pronounced on the right.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal in contour and attenuation.  There is mild\nfocal fat deposition at the falciform ligament.  Portal and hepatic veins are\npatent.  Normal gallbladder.  No intrahepatic or extrahepatic bile duct\ndilatation.\n\nPANCREAS: Pancreas is normal in bulk and attenuation.  No focal parenchymal\nlesions identified.  No main duct dilatation.\n\nSPLEEN: The spleen is small, measuring approximately 7 cm in diameter.  No\nfocal parenchymal lesions are seen.\n\nADRENALS: Adrenal glands are normal.\n\nURINARY: Bilateral renal cortical cysts.  The largest is seen at the lower\npole of the right kidney and measures approximately 6.2 cm in diameter.\n\nGASTROINTESTINAL: Due to the administration of positive oral contrast,\nassessment for lower GI bleed cannot be performed.Oral contrast has propagated\nto the level of the rectum, where note is made of a fecaloma.  This\nsurrounding rectal wall is thickened and there is furthermore significant\nperirectal fat stranding. Constellation of findings is consistent with\nstercoral colitis.  There is no evidence of free intra-abdominal air.  A\nG-tube is in situ.\n\nThere is no abnormality of the small bowel.\n\nOf note is pancolonic diverticulosis.  In the ascending colon, there is a\nfocal area of mural thickening, which does not fill with contrast (series 6,\nimage 81).  Although this may reflect a diverticulum that has not been filled\nwith oral contrast, this cannot be determined with certainty on today's CT.\n\nPERITONEUM: Small volume of free fluid is noted in the pelvis and in the right\nand left upper quadrants.\n\nLymph nodes: No inguinal, pelvic, retroperitoneal, or periportal\nlymphadenopathy.\n\nPELVIS: The urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: The uterus is not seen.  There is no adnexal mass.\n\nBONES: Mild degenerative anterolisthesis of L4 on L5, and to lesser extent L5\non S1 (grade 1).  No acute or focal destructive osseous lesions.\n\nSOFT TISSUES: There is mild subcutaneous soft tissue edema along the abdominal\nand pelvic wall and into the proximal thighs.  Abdominal and pelvic wall\notherwise unremarkable.",
            "output": "1. Due to the administration of positive oral contrast, assessment for lower\nGI bleed cannot be performed.\n2. There is a large fecaloma in the rectum.  Surrounding the fecaloma is\nrectal wall is thickened and significant perirectal fat stranding and edema. \nConstellation of findings is suggestive of stercoral colitis.\n3. Pancolonic diverticulosis.  There is a focal area of mural thickening at\nthe level of the ascending colon, as above. Although this may reflect a\ndiverticulum that has not been filled with oral contrast, this cannot be\ndetermined with certainty on today's CT.  If clinically indicated, direct\nvisualization with scope may be considered.\n4. Small bilateral pleural effusions with passive atelectasis."
        },
        {
            "input": "Chest is reported separately.\n\nThere is no biliary dilatation.  No focal liver lesions are identified.  The\ngallbladder appears normal.  Pancreas is also on remarkable.  Spleen is normal\nin size.  There has been short-term appearance of many new subcentimeter\nhypoattenuating nodules in the spleen measuring up to 5 mm in diameter.  These\nare suggestive of micro abscesses due to atypical infectious process such as\ncandidiasis in the setting of febrile neutropenia.  Adrenals are unremarkable.\nNo evidence for stones, solid masses or hydro nephrosis involving either\nkidney.  A few very small hypoattenuating foci in each kidney are probably\nunchanged and doubtful in significance, likely cysts.  In addition a sizable\ninterpolar cyst measures up to 57 mm has before.\n\nA gastro jejunostomy tube is in place.  It terminates in the mid jejunum. \nThere is persistent dense presacral fat stranding and mild and borderline\nrectal wall thickening, still with a sizable, but somewhat smaller, stool\nball.  Mild thickening of the wall of the descending and sigmoid portions of\nthe colon is perhaps slightly improved.  Moderate diverticulosis along the\ncecum and sigmoid colon.\n\nUterus is apparently absent.  There is no adnexal mass.  Bladder appears\nnormal.  There is no ascites or lymphadenopathy.  Major vascular structures\nappear widely patent.\n\nThere are no suspicious bone lesions.  Sacroiliac joints are partly fused. \nBones appear demineralized.  Moderate degenerative severe degenerative changes\naffect lumbosacral facet joints.  Similar sclerotic appearance of the L2\nvertebral body.",
            "output": "1.  Many small developing hypodense lesions which are suggesting of which that\nsuggest micro abscesses associated with atypical infectious process such as\ncandidiasis.\n\n2.   Persistent but slightly improved wall thickening of the colon. \nPersistent sizable but somewhat decreased stool ball in the rectum with\ninflammatory changes suggestive of stercoral proctitis.\n\n\nNOTIFICATION:  Findings discussed with 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 demonstrate heterogeneous enhancement.  However, no\ndiscrete 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 demonstrates numerous hypoattenuating lesions, which\noverall appear increased in size and number, with more confluent lesions\nwithin the inferior pole (for example, 04:56).\n\nADRENALS: The 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 cyst of the lower pole of the right kidney measures 5.1 cm.  Other,\nsmaller, subcentimeter renal hypodensities are too small to characterize. \nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: A gastrojejunostomy tube is in place, with the tip\nterminating within jejunal loops within the low left pelvis.  Small bowel\nloops demonstrate normal caliber, wall thickness, and enhancement throughout.\nThere has been interval evacuation of the large stool ball within the rectum. \nMild rectal mucosal hyperenhancement.  Mild rectal wall thickening and\npresacral edema have not substantially changed.  Surgical clips are seen at\nthe left lateral aspect of the rectum, from prior ulcer repair.  Colonic\ndiverticulosis, without evidence of acute diverticulitis.  Trace fluid is seen\nalong the bilateral paracolic gutters.\n\nPELVIS: The bladder appears unremarkable.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  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.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMild anterolisthesis of L4 on L5 is likely degenerative.  Multilevel\ndegenerative changes of the thoracolumbar spine are moderate.\n\nSOFT TISSUES: Small, fat containing umbilical hernia.  Subcutaneous edema\nalong the lateral abdominal walls.",
            "output": "1. Interval increase in number and size of numerous hypodense splenic lesions,\nwith more confluent lesions within the inferior pole, concerning for splenic\nmicroabscesses.\n2. Interval evacuation of the rectal stool ball, with mild mucosal\nhyperenhancement and no substantial change in mild wall thickening and\npresacral edema, likely reflecting residual proctitis.\n3. Please refer to the separate report of the chest CT performed on the same\nday for intrathoracic characterization."
        },
        {
            "input": "LOWER CHEST: A left pleural effusion demonstrates increased density with\nadjacent relaxation atelectasis.  Cardiac size is mildly enlarged.  No\nevidence of pericardial effusion.  Interval resolution of trace right pleural\neffusion.  Mild right 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\nbiliary dilatation.  The common hepatic duct measures up to 8 mm, (series 2,\nimage 38) unchanged 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 again demonstrates innumerable hypodensities.  Some of\nwhich have demonstrated interval decrease in size.  No evidence of\nsplenomegaly.\n\nADRENALS: The 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 well-circumscribed hypoattenuating lesions are demonstrated\nthroughout the bilateral renal cortices some too small to fully characterize\non CT but statistically likely renal cysts.  The largest renal cyst is\ndemonstrated within the inferior pole of left kidney is a well-circumscribed\nrenal cyst which measures up to 5.6 cm, unchanged.  No hydronephrosis.  There\nis no perinephric abnormality.\n\nGASTROINTESTINAL: A percutaneous gastrojejunostomy tube is again demonstrated\nwhich terminates within the jejunal loops in the left lower quadrant.  No\nbowel obstruction is seen.  Few scattered colonic diverticulosis without\nevidence of wall thickening or adjacent fat stranding to suggest acute\ndiverticulitis.  A surgical clip is demonstrated within the left lateral\naspect of the rectum, from prior ulcer repair.\n\nPELVIS: The urinary bladder is unremarkable.  There is no 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.  Minimal flecks of\ncalcification are demonstrated within the bilateral common iliac arteries.\n\nBONES: Redemonstration of anterolisthesis of L4 on L5 without evidence of\nspondylolisthesis which is likely secondary to degenerative changes.  The\npatient is status post partial laminectomy changes of L4 on L5.\n\nSOFT TISSUES: A small umbilical hernia containing fat is noted.  Improved\npresacral stranding when compared to most recent prior.",
            "output": "1. Moderate left pleural effusion.\n2. No acute abdominopelvic pathology to explain patient's symptoms.\n3. Again seen innumerable splenic hypodensities, some of which have\ndemonstrated interval decrease in size.\n4. Few scattered colonic diverticulosis without evidence of acute\ndiverticulitis."
        },
        {
            "input": "CHEST:\n\nThere is no abnormality in the imaged portion of the lower chest.\n\nABDOMEN:\n\n The liver is markedly hypoattenuated diffusely.  There are no concerning\nfocal liver lesions. The gallbladder and biliary tree are normal. The pancreas\nis normal, without focal lesion or duct dilation.  There are no inflammatory\nchanges associated with the pancreas. The spleen is normal in size, without\nfocal lesion. The adrenal glands are normal. There is severe right renal\ncortical atrophy secondary to chronic hydroureteronephrosis from an\nobstruction of the distal ureter at the ureterovesicular junction, likely\nsecondary to a diverticulum.  The left kidney enhances and excretes contrast\nnormally. The stomach and duodenum are normal. The small bowel and large bowel\nare normal in caliber, without wall thickening or mass.  There is sigmoid\ndiverticulosis without evidence of diverticulitis.\n\nThere is no intra- or retroperitoneal lymphadenopathy. There is no ascites,\nfluid collection, or pneumoperitoneum. The abdominal aorta is normal caliber,\nwith patent main branches.  The portal vein and IVC are patent.  A retroaortic\nleft renal vein is incidentally noted.\n\nPELVIS:\n\nThe bladder is collapsed around a Foley catheter balloon. The rectum is\nunremarkable. There is no pelvic mass. There is no free fluid. There is no\npelvic or inguinal lymphadenopathy.\n\nBONES AND SOFT TISSUES:\n\nThere is no acute fracture. There are no destructive osseous lesions\nconcerning for malignancy or infection. There are no soft tissue masses.",
            "output": "1. Diffuse hypoattenuation of the liver, consistent with hepatic steatosis,\nbut hepatitis can present similarly.\n2. There is no biliary obstruction or cholecystitis.\n3. Normal CT appearance 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: There is heterogeneous enhancement pattern of the liver, most\npronounced in the right hepatic lobe and segment 2 and 3.  Mild periportal\nedema.  There is no evidence of focal lesions. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder appears\ndistended without definite wall thickening or adjacent 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 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.  Fluid within the\ncolonic lumen is consistent with ongoing diarrheal illness.  No colonic wall\nthickening or adjacent 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 left adnexa are unremarkable.  There is a\n4.4 x 4.5 cm hypodense cystic lesion in the right 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.  No atherosclerotic disease\nis noted.  Portal vein is patent.  The hepatic veins are not well opacified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Right adnexal cystic lesion measures 4.4 x 4.5 cm and may be a functional\ncyst.  If there is clinical concern for ovarian torsion, pelvic ultrasound\nshould be considered.\n2. Heterogeneous enhancement of the liver is nonspecific but can be seen with\nBudd-Chiari or anecdotally with oral contraceptive use.  Other etiologies such\nas hepatic congestion related to heart disease or ___ disease\nconsidered unlikely given lack of suggestive clinical history.  Correlate with\nLFTs and any history of OCP use.  Consider ultrasound to confirm hepatic vein\npatency.\n3. The gallbladder appears mildly distended, however, without specific CT\nfindings to suggest acute cholecystitis.\n4. Fluid in the colon is consistent with ongoing diarrheal illness.\n\nRECOMMENDATION(S):  1.  Consider pelvic ultrasound if there is concern for\nright ovarian origin.\n2.  Heterogeneous enhancement of the liver is nonspecific but can be seen with\nBudd-Chiari or anecdotally with oral contraceptive use.  Other etiologies such\nas hepatic congestion related to heart disease or ___ disease\nconsidered unlikely given lack of suggestive clinical history.  Correlate with\nLFTs and any history of OCP use. Consider ultrasound to confirm hepatic vein\npatency.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:52 pm."
        },
        {
            "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 a 1.5 cm hypodense lesion in hepatic segment ___, also seen on prior\nCT.  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 or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: There is re-demonstration of a cystic lesion in the right\nadnexa now measuring up to 6.0 cm and previously 4 cm with layering density. \nThere is a new 2.6 cm cystic lesion in the left adnexa also with layering\ndensity.  These are likely endometriomas.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: No significant atherosclerotic disease is noted.  There is no\nabdominal 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. Likely endometriomas bilaterally.  Gynecology referral and follow up pelvic\nMRI or ultrasound in ___ weeks is recommended.\n2. No evidence of acute appendicitis as clinically questioned.\n3. Incompletely characterized 1.5 cm hypodense lesion in hepatic segment ___,\nlikely a hemangioma.  No further workup is recommended if there are no risk\nfactors for HCC.  If there are risk factors for HCC, then MRI liver without\nand with contrast in 3 months is recommended.\n\n\nRECOMMENDATION(S):  Gynecology referral and follow up pelvic MRI or ultrasound\nin ___ weeks is recommended.\nIf there are risk factors for HCC, then MRI liver without and with contrast in\n3 months is recommended.\n\nNOTIFICATION:  These findings were communicated to the ED QA nurses via ___\non ___ at 10:02 to provide appropriate patient follow-up."
        },
        {
            "input": "LOWER CHEST: Minimal 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 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: Spleen remains upper limits of normal in size, measuring 13.0 cm,\nunchanged to previous.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There remain simple parapelvic renal cysts bilaterally.\n\nGASTROINTESTINAL: The patient is status post omental dissection,  colectomy\nwith ileal anal reconstruction, again with apparent narrowing/collapse at the\nileal anastomosis with a slightly nodular appearance, with distal\nreconstitution, which is similar in appearance to prior.  There is some fecal\nmaterial within the ileal pouch, but no secondary findings of pouchitis. \nThere is no evidence of small-bowel obstruction.\n\nPELVIS: Allowing for metal artifact from total hip arthroplasty bilaterally,\nremains a partially visualized perianal ___.  The perirectal region is\nincompletely evaluated due to streak artifact, however no drainable fluid\ncollections are identified.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are not well visualized\ndue to streak artifact.\n\nLYMPH NODES: No enlarged lymph nodes.\n\nVASCULAR: There is no abdominal aortic aneurysm.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nBilateral hip prostheses are again seen with no evidence of hardware failure.\n\nSOFT TISSUES: Fat containing ventral abdominal wall diastasis/hernia (series\n2, image 32).  Prior stoma changes in the right lower quadrant.",
            "output": "1. Status post colectomy with ileoanal reconstruction.  There is some fecal\nmaterial within the pouch, but no evidence of pouchitis, or bowel obstruction.\n2. No acute intra-abdominal abnormality to explain patient's symptoms."
        },
        {
            "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 demonstrates homogenous attenuation throughout. \nThere is no evidence of focal lesions. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation.  Redemonstration of probable fundal\nadenomyomatosis, unchanged compared to prior.  Otherwise, the gallbladder is\nwithin normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Multiple subcentimeter hypodense\nlesions, too small to further characterize but statistically cysts. \nAdditionally, there peripelvic cysts seen in the left kidney.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: The wall of the distal esophagus appears thickened, which\nmay represent esophagitis from recent episodes of emesis.  Small hiatal\nhernia.  Patient is status post total colectomy with ileoanal anastomosis. \nThe remaining small bowel is normal in caliber and without evidence of\nobstruction.  ___ in the anal region is partially imaged.  No fluid\ncollections identified.\n\nPELVIS: Evaluation is partially limited due to streak artifact from bilateral\nhip arthroplasties.  Within these limitations, the urinary bladder and 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: 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: Bilateral total hip replacements without hardware complications.  There\nis no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Multiple small fat containing ventral wall hernias noted.",
            "output": "1. Status post total colectomy and ileal anal anastomosis.  No evidence of\nsmall-bowel obstruction.  No acute findings in the abdomen or pelvis to\nexplain patient's symptoms.\n2. Distal esophageal wall thickening may represent esophagitis from recent\nemesis.\n3. Small hiatal hernia."
        },
        {
            "input": "LOWER CHEST: There are diffuse centrilobular nodules, which can be seen in\npatient with smoking history.  There is mild dependent atelectasis in\nbilateral lower lobes.  There 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: There is moderate fatty atrophy of the pancreas.  There is mild\nfatty stranding abutting the pancreatic tail.  There is no ductal dilatation\nor focal lesion.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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.  There is a duodenal diverticulum.  Otherwise, small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement throughout. There\nis colonic diverticulosis without evidence of diverticulitis.  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 is not enlarged.\n\nLYMPH NODES: Presumed VP shunt terminates in the right mid abdomen.  There are\nsub-centimeter paraesophageal lymph nodes, not pathologically enlarged by CT\nsize criteria.  There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.  There is no evidence of 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. Adjacent fatty stranding abutting the pancreatic tail, compatible with\nacute interstitial pancreatitis.  No evidence of fluid collection,\npseudoaneurysm, or other complication from pancreatitis.\n2. Colonic diverticulosis without evidence of diverticulitis. No evidence of\nobstruction.\n3. Diffuse centrilobular nodules in the lung bases, a nonspecific finding\nwhich can sometimes be seen in smokers."
        },
        {
            "input": "LOWER CHEST: There is a moderately sized nonhemorrhagic left pleural effusion,\nsimilar from prior with associated compressive atelectasis.  Trace atelectasis\nis noted at the right lung base. There is cardiomegaly. Note is made of aortic\nvalve calcifications\n\nABDOMEN:\n\nHEPATOBILIARY: There is a somewhat mottled attenuation pattern of the hepatic\nparenchyma which is most likely secondary to contrast phase.  There are no\ndefinite suspicious focal liver lesions.  There is no intra or extrahepatic\nbiliary ductal 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: There is nonspecific thickening of the lateral limb of the left\nadrenal gland.  The right adrenal gland is unremarkable.\n\nURINARY: Bilateral kidneys are moderately atrophic.  There is no evidence of\nhydronephrosis or obstructing renal stone.  No definite perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is grossly unremarkable, not well assessed on\nCT.  There is no evidence of bowel obstruction.  There are several loops of\nfluid filled small bowel which are not distended.  A loop of small bowel in\nthe left lower quadrant contains some fecalized material. There is a prominent\nfecal load in the colon.  The appendix is not definitively visualized however\nthere 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: 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 extensive calcified atherosclerotic disease about the\nintra-abdominal aorta and its great branches.  There is significant calcium\nburden at the origin of the celiac trunk and SMA.  There is no abdominal\naortic aneurysm.\n\nBONES: There is unchanged bilateral L5 spondylolysis and grade 2, 13 mm\nanterolisthesis of L5 on S1.  There are extensive degenerative changes about\nthe thoracolumbar spine including prominent anterior osteophytes.\n\nSOFT TISSUES: Incidental note is made of bilateral gynecomastia.  There is\nmild anasarca.  The soft tissues of the abdominopelvic wall are otherwise\nwithin normal limits.",
            "output": "1. No acute process in the abdomen pelvis to explain the patient's symptoms.\n2. Stable appearance of a moderately sized left pleural effusion with\nassociated compressive atelectasis.\n3. Prominent fecal load in the colon.\n4. Extensive vascular calcifications about the abdominal aorta including at\nthe origins of the celiac trunk and SMA."
        },
        {
            "input": "LOWER CHEST: There is a small left pleural effusion with associated\ncompressive atelectasis, unchanged from prior study.  There is mild right\nbasilar atelectasis.  Otherwise, visualized lung fields are within normal\nlimits.  There are extensive coronary artery and aortic valve atherosclerotic\ncalcifications.  There 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 within normal limits.  There is a small amount\nof 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.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: There is thickening of the lateral limb of the left adrenal gland\nwithout discrete nodule.  Otherwise, the right adrenal gland is normal in size\nand 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 moderate fecal loading\nthroughout 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 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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: There is a small, minimally displaced acute fracture through the\nanterior inferior base of the L4 vertebral body (602:images 39-43).  There is\nmoderate to severe multilevel degenerative changes of the thoracolumbar spine,\nunchanged.  There is grade 2 anterolisthesis at L5-S1, unchanged from prior\nstudy (602:39).  There is no evidence of fracture dislocation of the bilateral\nfemoroacetabular joints.  Within the limitations of a noncontrast enhanced\nstudy, there is no radiographic evidence of osteomyelitis or osteonecrosis.\n\nSOFT TISSUES: There are small bilateral inguinal hernias, unchanged. \nGynecomastia is again noted.",
            "output": "1. Acute fracture through the anterior, inferior base of the L4 vertebral\nbody.\n2. Small amount of perihepatic and pelvic ascites.  In the presence of\ngynecomastia, Findings may represent underlying liver disease.  Correlation\nwith liver function tests is recommended.\n3. No fracture of the left hip identified.\n\nNOTIFICATION:  The updated wet read was discussed with ___ MD on ___ at 14:40 by at ___ MD."
        },
        {
            "input": "CHEST:  There is a moderate simple appearing left pleural effusion with\nadjacent atelectasis, which appears unchanged from multiple prior radiographs\npost recent CABG.  Mild atelectasis at the right lung base. Heart size is\nmildly enlarged, with a small nonhemorrhagic pericardial effusion.\n\nABDOMEN: The liver enhances heterogeneously in a pattern suggestive of passive\nhepatic congestion.  Allowing for this, no discrete focal lesion is seen\nwithin the liver. There is no biliary ductal dilation. Main portal vein is\npatent. The gallbladder, adrenal glands, spleen and bilateral kidneys are\nnormal. There is no perinephric fat stranding or hydronephrosis. Incidental\nnote is made of a duplicated right ureter.\n\nThe small and large bowel are normal in caliber, without evidence of\nobstruction.  No evidence of bowel ischemia.\n\nAtherosclerotic calcifications are noted throughout the abdominal aorta and\niliac branches, which are normal in course and caliber. Dense calcification at\nthe origin of the SMA is noted.\n\nPELVIS:  The bladder is moderately distended. Prostate is unremarkable. A\nsmall amount of free fluid is noted within the abdominal cavity, may reflect\nvolume status. No pneumoperitoneum. The appendix is not visualized.\n\nMUSCULOSKELETAL:  Multilevel degenerative changes and noted throughout the\nthoracolumbar spine. There is grade II anterolisthesis of L5 on S1 with\nbilateral pars defects noted at this level.  These findings are grossly\nunchanged since the prior study ___. No lytic or sclerotic lesions\nconcerning for malignancy.",
            "output": "1.  No acute intra-abdominal process.\n2. Stable appearing left pleural effusion, left greater than right basilar\natelectasis.\n3.  Heterogeneous enhancement of the liver likely due to passive hepatic\ncongestion.\n4.  Severe atherosclerosis.\n5.  Severe degenerative disease at the lumbosacral junction with grade 2\nanterolisthesis and bilateral pars defects."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  Visualized lung fields are 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 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.  Splenic granuloma 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 4 mm nonobstructing renal calculi in the left upper pole.  There is\nno evidence of solid renal lesions or hydronephrosis.  There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Large 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 or fat stranding.\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: There is no evidence of worrisome osseous lesions or acute fracture. \nPatient is status post right hip arthroplasty.  Postsurgical changes are seen\nto the lumbar spine.\n\nSOFT TISSUES: There is a new well-circumscribed high-density collection\nmeasuring approximately 2.3 x 5.7 x 6.7 cm concerning for an right rectus\nsheath hematoma.  (Series 2, image 48 and series 601, image 19).  There is a\nfat containing ventral wall hernia with a neck measuring 2.9 cm.",
            "output": "1. Findings concerning for a right rectus sheath hematoma measuring 2.3 x 5.7\nx 6.7 cm.\n2. Nonobstructing 4 mm left upper pole renal calculi\n3. Diverticulosis without evidence of diverticulitis.\n\nNOTIFICATION:  The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 12:55 am, 2 minutes after discovery\nof the findings."
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes and\nunchanged 4 mm left lower lobe subpleural pulmonary nodule (2:8).. Mitral\nannular calcification is noted.  No pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  A subcentimeter calcified granuloma in\nthe right lobe of the liver is unchanged (series 2: Image 29).  Mild\nintrahepatic and moderate extrahepatic biliary dilatation, with the common\nbile duct measuring up to 11 mm, likely secondary to prior cholecystectomy,\nsimilar to prior.  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: Multiple punctate splenic granulomas are again noted.  Spleen is\notherwise 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 solid renal lesions.   There is no perinephric\nabnormality.  There is no hydronephrosis or hydroureter.  The urinary bladder\nis unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. There is extensive fecal\nloading of the large bowel without evidence of obstruction.  There is\ndiverticulosis without evidence of diverticulitis of the sigmoid colon.  There\nis mild peripheral calcification within the distal appendix, which may\nrepresent an appendicolith (series 2: Image 92). There is no surrounding\ninflammation.\n\nPELVIS:  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 2.1 cm simple cyst in the left ovary, previously 1.5 cm. \nFibroid uterus is noted.  Suspected tubal ligation clips are noted\nbilaterally.\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 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 and pelvis.\n2. Extensive fecal loading of the large bowel without evidence of obstruction.\n3. Diverticulosis without evidence of diverticulitis.\n4. Status post cholecystectomy with unchanged mild intrahepatic and moderate\nextrahepatic biliary ductal dilatation."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm):  At least 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.  Duct dilated up to 1.0 cm.\nBiliary tree abrupt cutoff with or without upstream dilatation:  Absent, but\nmetal stent in place\n\nArterial Evaluation\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nVariant anatomy: none\n\nVenous Evaluation\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:  The inferior mesenteric vein is the first\ndraining vein and there is contact with the IMV.  The gastrocolic trunk is the\nsecond draining vein and has hazy soft tissue abutting.  The first jejunal\nvein is the third draining vein and has the soft tissue abutting it.\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: Present, no significant change from the prior study. \nSmall peripancreatic nodes are noted to the left of the uncinate process. \nAlso noted are common hepatic artery lymph nodes and periportal lymph nodes\nwhich measure under 1.0 cm in short axis.\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\n\nLOWER CHEST: Minimal atelectasis is noted in the lung bases. There is no\npleural or pericardial effusion.\n\nABDOMEN:\nHEPATOBILIARY: The liver demonstrates homogenous low attenuation throughout,\nnew from prior, consistent with fatty liver.  Again seen are 2 simple cysts. \nThere is pneumobilia.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is within normal limits, without stones\nor gallbladder wall thickening.\n\nPANCREAS: Interval resolution of the cystic lesion within the head of the\npancreas, likely a pseudocyst.  There is slightly less stranding around the\npancreatic head and uncinate process, likely from resolving 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.\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.  Enhancement of the anus\nconsistent with hemorrhoids, unchanged.\n\nVASCULAR: There is no abdominal aortic aneurysm.  There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\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: Status post hysterectomy and bilateral salpingo\noophorectomy\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nThere are multiple osseous hemangiomas within the vertebral bodies.  Bilateral\nhip osteoarthritis.\n\nSOFT TISSUES: Small fat containing umbilical hernia .",
            "output": "Again seen is the hypoattenuating mass within the pancreatic head which\nmeasures at least 2.3 cm, slightly smaller.  Persistent dilation of the main\npancreatic duct up to 1.0 cm.  Interval resolution of a cystic lesion within\nthe pancreatic head consistent with resolving pseudocyst and pancreatitis. \nConcern for vascular involvement as detailed above, not significantly changed;\nwhat is pancreatitis versus subtle tumor extension is not completely clear."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\n\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating\nSize (maximal axial dimension in cm): 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.  The pancreatic duct is dilated up to 9 mm.\nBiliary tree abrupt cutoff with or without upstream dilatation: Absent.  A\nmetallic stent is in place.\n\nArterial evaluation\n\nSMA involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nVariant anatomy: none\n\nVenous evaluation\n\nMPV involvement: absent\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: Small peripancreatic lymph nodes are again seen, not\nsignificantly changed compared to previous\nOther extrapancreatic disease (invasion of adjacent structures): absent\n\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 low attenuation throughout. \n2 simple cysts are again seen in the right lobe, unchanged compared to\nprevious.  There are no new focal hepatic lesions.  There is re- demonstration\nof pneumobilia secondary to a CBD stent.  There is no intra or extrahepatic\nbiliary ductal dilatation.  The gallbladder is within normal limits, without\nstones or gallbladder wall thickening.\n\nPANCREAS: See above.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The 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 cortical hypodensities are seen in the left kidney, too small to\ncharacterize but likely represent cysts and are unchanged compared to\nprevious.  There is no evidence of stones or hydronephrosis.  There is no\nperinephric abnormality.\n\nGASTROINTESTINAL: Small bowel loops demonstrate normal caliber, wall thickness\nand enhancement throughout. There is mild sigmoid diverticulosis without\ndiverticulitis.  The appendix is unremarkable.  There is no evidence of\nmesenteric lymphadenopathy.  Nodular hyper enhancement within the anus is\nagain suggestive of hemorrhoids, unchanged.\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: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nMultiple hemangiomas are again seen within the vertebral bodies.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Hypoattenuating mass within the pancreatic head which measures 2.3 cm, not\nsignificantly changed compared to previous.  There is persisting concern for\nvascular involvement as detailed above."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild l calcium burden in the\nabdominal aorta and great abdominal arteries.  The superior mesenteric artery\nis patent.  Bilateral renal arteries and inferior mesenteric artery are\npatent.\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 is diffusely low in attenuation consistent with\nhepatic steatosis.  Well-circumscribed hypodensities within segment VIII of\nthe liver measure 0.7 cm and 1.1 cm, previously characterized as cysts or\nbiliary hamartomas by MR dated ___.  There is no new or worrisome\nhepatic lesion.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  The gallbladder is is resected.\n\nPANCREAS: Patient is status post Whipple procedure.  There has been interval\nremoval of surgical drains.  The remaining pancreas is atrophic with\npancreatic duct dilation measuring 4 mm.  Fiducial markers are present in the\nregion of the resected pancreatic head.  Overall area of abnormality within\nthe resection site is decreased.  There is soft tissue about the superior\nmesenteric vein just proximal to its confluence with the portal vein with\nfocal occlusion of the superior mesenteric vein, previously just narrowed\n(4:112).  The portal vein appears patent and 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 kidneys are of normal and symmetric size with normal nephrogram.\nThere is no evidence of stones or hydronephrosis.  Cortical hypodensities\nwithin the left kidney are stable, characterized as renal cysts by MR. ___\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: Post Whipple procedure anatomy is present.  The stomach is\notherwise unremarkable.  Loops of small and large bowel are nondilated. \nSigmoid diverticulosis is without evidence of diverticulitis.  Appendix is not\nvisualized.  There is no evidence of mesenteric lymphadenopathy.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Locule of air within the may reflect recent catheterization.  There is\nno evidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in\nthe pelvis.\n\nREPRODUCTIVE ORGANS: The uterus is not visualized. No adnexal abnormality is\nseen.\n\nBONES: Multiple hemangiomas throughout the imaged spine are stable.  There are\nnot new worrisome osseous lesions.  No acute fracture.\n\nSOFT TISSUES: The small umbilical hernia contains minimal fluid.Post\nprocedural changes involve the left lateral abdominal wall in this patient\nwith gastrostomy tube removal.",
            "output": "1. Post Whipple procedure anatomy with fiducial markers within the surgical\nbed.  While overall area of abnormality within the surgical bed surrounding\nthe superior mesenteric vein is decreased, soft tissue is present with focal\nocclusion of the superior mesenteric vein, previously only narrowed.  This may\nreflect scar tissue for which attention on follow up is warranted.\n\n2. No evidence of metastatic disease within the abdomen or pelvis.\n\n3. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is minimal calcium burden in the\nabdominal aorta and great abdominal arteries.  An IVC filter is in appropriate\nposition.\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: Mild inhomogeneity of the liver parenchyma on CTA may be due to\nperfusional differences.  No masslike enhancement is identified.  Diffusely\ndecreased attenuation is likely related to mild hepatic steatosis, unchanged. \nThere are hypodensities in segment 8 which are too small to characterize but\nlikely represent simple hepatic cysts or biliary hamartomas, unchanged\ncompared to multiple prior exams.  There is no evidence of intra or\nextrahepatic biliary duct dilation.  The gallbladder is surgically absent.\n\nPANCREAS: The patient is status post Whipple procedure with the expected\npostsurgical anatomy and fiducial seeds in the region of the pancreatic head. \nThere is again mild distal ductal dilation and parenchymal atrophy.  Soft\ntissue density surrounding the celiac axis and proximal hepatic and splenic\narteries is similar in appearance, as is mild soft tissue stranding\nsurrounding the proximal SMA.  These are likely related to post treatment\nchanges and fibrosis.  Soft tissue surrounding the proximal SMV is also\nsimilar in appearance, with short-segment occlusion, also unchanged.\n\nSPLEEN: The spleen is homogeneous and normal in size.\n\nADRENALS: The adrenal glands are normal in caliber and configuration\nbilaterally.\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 are normal in caliber, without wall\nthickening or evidence of obstruction.  There is sigmoid diverticulosis.  A\nnormal appendix is visualized.  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: The uterus is not visualized.  No adnexal mass is\nidentified.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nStable hemangiomas in L4, L1 and at T10 vertebra\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post Whipple procedure with expected postsurgical anatomy. \nPersistent stable mild soft tissue in the surgical bed potentially related to\npost treatment change, with focal occlusion of the superior mesenteric vein,\nunchanged compared to ___.\n2. No evidence of metastatic disease in the abdomen or pelvis.\n This preliminary report was reviewed with Dr. ___ radiologist."
        },
        {
            "input": "VASCULAR:\n\nThere is no abdominal aortic aneurysm.  There is mild calcium burden in the\nabdominal aorta and great abdominal arteries.  IVC filter is in unchanged\nposition.  Hazy soft tissue surrounding the celiac trunk and proximal SMA is\nunchanged, within postoperative limits following Whipple.  The celiac artery\nand SMA are otherwise patent.  The portal vein, splenic vein, and portal\nconfluence are patent.  Short-segment occlusion of the SMV when series 304,\nimage 42) is similar to ___.\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 demonstrate normal morphology with decreased\nattenuation throughout.  Scattered hypoattenuating lesion measuring up to 1.0\ncm in the right lobe most likely representing cysts are unchanged.  There is\nno biliary ductal dilatation.  There is interval increased pneumobilia.  The\ngallbladder is is resected.\n\nPANCREAS: Patient is status post Whipple procedure without evidence of mass in\nthe surgical bed.  Soft tissue at the surgical bed is within postoperative\nlimits.  The remnant pancreas demonstrate normal morphology without focal\nlesions 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 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 Whipple procedure.  There is no\nobstruction.  There is diverticulosis of the sigmoid colon without\ndiverticulitis.  The remaining colon and rectum are unremarkable.  The\nappendix is unremarkable.  There 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.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The uterus is surgically absent.  No adnexal masses.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nHemangiomas in L4, L1, and T10 are stable.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Post Whipple procedure without evidence of recurrent mass in the surgical\nbed or distal abdominopelvic metastasis.\n2. Postsurgical changes in the surgical bed and surround the celiac artery and\nproximal SMA are stable since the prior examination.\n3. Unchanged short-segment occlusion of the SMV.\n4. Please see separate report performed on the same day for detailed\nevaluation of the chest."
        },
        {
            "input": "PANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): hypoattenuating/cystic\nSize (maximal axial dimension in cm):  Unknown because of cystic degeneration\nand pancreatitis\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, but\nstent in place\n\nArterial evaluation\n___ involvement: absent\nCeliac Axis involvement: absent\nCommon hepatic artery involvement: absent\nFocal vessel narrowing or contour irregularity:  absent\nExtension to celiac axis: absent\nExtension to bifurcation of right/left hepatic artery: absent\nVariant anatomy: none\nVariant vessel contact:  absent\nFocal vessel narrowing or contour irregularity:  absent\n\nVenous evaluation\nMPV involvement: absent\nFocal vessel narrowing or contour irregularity (tethering or tear drop):\nabsent\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: absent\nOther extrapancreatic disease (invasion of adjacent structures): absent\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. \nMultiple hypodensities during up to 1.0 cm likely hepatic cysts.  There is no\nevidence of intrahepatic or extrahepatic biliary dilation.  The gallbladder is\nwithin normal limits, without stones or gallbladder wall thickening.  There is\nslight thickening of the bile duct wall and enhancement without dilation\nlikely secondary to stenting.  The plastic biliary stent is in the expected\nlocation with upstream component in the CHD.\n\nPANCREAS:  A cyst has developed within the pancreatic head mass and adjacent\nto it which could be cystic degeneration or possibly a small pseudocyst.  It\nmeasures 2.5 cm in maximal dimension and has a thin wall.  The mass margins\nare less well defined today within the head and neck of the pancreas The soft\ntissue component of the mass extends medially and appears to contact the SMV\n(6:107). A more hazy second point of apparent contact with the SMV distally\ncould be from tumor or possibly from pancreatitis (6:112). The pancreatic duct\nis dilated to 9 mm now just upstream from the mass with an abrupt transition\nat the mass.  It is almost cystic at this point but more upstream it is only\nmildly dilated.  There is mild stranding around the pancreatic head, neck, and\nuncinate process from 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. \nSubcentimeter hypodensities within the kidneys too small to characterize,\nlikely renal cysts. There is no evidence of stones or hydronephrosis. There\nare no urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL:  The stomach is unremarkable.  Suprampullary and\ninframpullary duodenal diverticula are noted.   Small bowel loops demonstrate\nnormal caliber, wall thickness and enhancement throughout.  Diverticulosis of\nthe sigmoid colon without evidence of fat stranding or wall thickening. \nAppendix contains air, has normal caliber without evidence of fat stranding.\nIncreased enhancement within the anus may represent hemorrhoids.   There is no\nevidence of mesenteric lymphadenopathy.\n\nVASCULAR:  There is no abdominal aortic aneurysm. There is minimal calcium\nburden in the abdominal aorta and great abdominal arteries.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Foci of air along the anterior bladder wall is noted.  There is no\nevidence of pelvic or inguinal lymphadenopathy.  There is no free fluid in the\npelvis.\n\nREPRODUCTIVE ORGANS: The patient is post hysterectomy and bilateral\noophorectomy.\n\nBONES:  Hemangiomas seen in L1 and L4 vertebral bodies.  Degenerative changes\nmoderate in right hip and mild in left hip.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Pancreatic mass in the head and neck is less well defined and has developed\na cystic lesion that my be cystic degeneration or a small pseudocyst. \nApparent contact with the SMV at two points, both well less than 180 degrees,\nthough one may be from pancreatitis, which is present to a mild degree. \nIncreased pancreatic duct dilation with abrupt transition; CBD stent in place.\nNo suspicious lymph nodes or evidence of metastasis.\n2. Suprampullary and inframpullary duodenal diverticula noted.\n3. Increased enhancement within the anus likely represents hemorrhoids. \nCorrelation with physical exam recommended."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  A subcentimeter hypodensity in the left hepatic lobe is too\nsmall to characterize (06:46). Superior to the gallbladder, there are 2\nadjacent hepatic simple cysts, which measure approximately 3.0 x 2.2 cm\n(09:26), and 2.5 x 2.5 cm respectively (09:28). Otherwise, the liver\ndemonstrates homogenous attenuation throughout.  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 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 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.\n\n\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions.  A right total hip arthroplasty is\nnoted. Abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Simple hepatic 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.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is no evidence of focal renal lesions 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 unremarkable.  The appendix is surgically absent.\n\nThere are 2 drains in place, 1 terminating in the right lower quadrant, an\nanother terminating in the right rectal vesicular space.  No fluid collections\nare seen in these 2 regions.  A previously seen fluid collection in the left\nanterior abdomen is no longer present.  No new fluid collection is seen in the\nabdomen or 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: 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. Resolution of multiple intrapelvic abscesses ; drains were removed\nfollowing this study.  No new fluid collection identified."
        },
        {
            "input": "LOWER CHEST: Note that findings pertaining to the chest will be reported\nseparately.\n\nABDOMEN:\n\nHEPATOBILIARY: Liver is normal contour and attenuation.  No focal parenchymal\nlesions identified.  Portal and hepatic veins patent.  Normal gallbladder.  No\nintrahepatic or extrahepatic bile duct dilatation.\n\nPANCREAS: Pancreatic parenchyma is mildly atrophic.  There are tiny foci of\nhypoattenuation within the distal body of the pancreas (series 7, image 59). \nThese measure up to 4 mm in diameter.  This is unchanged from the prior study.\nThese are likely reflective of small pancreatic cysts.  There is no evidence\nof main duct dilatation.\n\nSPLEEN: The spleen is not enlarged (9 cm).  Tiny punctate lesions are\nredemonstrated in the spleen.  These are likely present on a remote CT of the\nchest performed in ___.\n\nADRENALS: The right adrenal gland is normal.  The medial limb of the left\nadrenal gland remains slightly thickened, but no discrete adrenal nodule is\nseen.\n\nURINARY: Bilateral renal cortical cysts.  At the interpolar region of the\nright kidney, there is a mildly hyperdense lesion which measures approximately\n13 mm in diameter, and has an internal attenuation of approximately 24\nHounsfield units (series 7, image 69).  It is unchanged in size and appearance\nfrom the prior study.  An extrarenal pelvis is noted in both kidneys.  Is no\nevidence of hydronephrosis or nephrolithiasis.\n\nGASTROINTESTINAL: Stomach is normal in appearance.  Small bowel is similarly\nnormal.  Scattered uncomplicated sigmoid diverticula.  Large bowel otherwise\nunremarkable.  Appendix in the right lower quadrant normal.\n\nPERITONEUM: No intra-abdominal free air or free fluid.  No peritoneal\nnodularity.\n\nPELVIS: Urinary bladder is unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus is normal.\n\nLYMPH NODES: No inguinal, pelvic, retroperitoneal, periportal, mesenteric\nlymphadenopathy.\n\nVASCULAR: Moderate aortoiliac atherosclerosis.  No aneurysmal dilatation.\n\nBONES: No acute or focal destructive osseous lesions.  Prior instrumentation\nof the left hip.  No gross hardware related complications.\n\nSOFT TISSUES: Abdominal and pelvic wall unremarkable.",
            "output": "1. No evidence of metastatic disease to the abdomen or pelvis.\n2. The median limb of the left adrenal gland is unchanged in appearance, and\nremains mildly thickened.  No discrete measurable nodule is identified.  The\nright adrenal gland is normal.\n3. Redemonstrated tiny foci of hypoattenuation in the distal body of the\npancreas, likely reflecting small side-branch IPMNs.  The main pancreatic duct\nis not involved.\n4. 13 mm hyperdense lesion at the interpolar region of the right kidney, with\nan internal attenuation of 24 Hounsfield units.  This lesion can not be\ncharacterized on this study.  Given the density, this should be assessed with\nadditional imaging, starting with a renal ultrasound.\n5. Note that findings pertaining to the chest will be reported separately.\n\nRECOMMENDATION(S):  Renal ultrasound to evaluate mildly hyperdense 13 mm\nlesion at the interpolar region of the right kidney."
        },
        {
            "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\nGENERAL: There is no intra-abdominal free air or free fluid.\n\nHEPATOBILIARY:  Extensive postsurgical changes from prior pylorus-sparing\nWhipple procedure are noted, with mild central biliary ductal dilatation and\npneumobilia (05:49). The right hepatic lobe, adjacent to the gallbladder\nfossa, there is an ill-defined area of hypodensity, possibly related to\npost-operative change(05:59).  The gallbladder is surgically absent.  No\nenhancing focal liver lesion is identified.\n\nA 9 mm hepatic hypodensity adjacent to the intrahepatic IVC, at the level of\nthe superior caudate lobe (05:48) is new since the prior study, as is an\nadjacent 6mm hypodensity (5:49).  Additionally, there has been enlargement of\na celiac axis node since the prior study, now measuring 21 x 25mm, previously\n14 x 21mm.  Prominent periportal lymph nodes measure up to 8 mm in short axis\ndiameter (05:55), similar compared to prior.\nPANCREAS: The distal pancreas is unremarkable, with no focal lesion or\nperipancreatic abnormality detected.  The pancreatic head, neck, and proximal\nbody are surgically absent.\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: Bilateral simple renal cysts are numerous, but unchanged compared to\nthe prior study. Otherwise, kidneys present symmetric nephrograms with no\nevidence of hydronephrosis, stones, or solid renal masses bilaterally. \nIncidental note is made of prominent distal ureters bilaterally, measuring 11\nmm on the right, and 12 mm on the left in axial diameter (5:97), with no\nperiureteral abnormality or enhancing urothelial lesion identified.\nGASTROINTESTINAL:  There is a small hiatal hernia. There is no intraperitoneal\nfree air or free fluid. Enteric contrast material passes to the level of the\nhepatic flexure of the colon. Remaining loops of intra-abdominal large and\nsmall bowel demonstrate normal course and caliber with no evidence of wall\nthickening or obstruction.. Appendix contains air, has normal caliber without\nevidence of fat stranding.\nRETROPERITONEUM AND MESENTERY: As described previously, there is slight\ninduration of the fat about the mesenteric root, with some slightly prominent\nmesenteric lymph nodes, including either a bilobed node, or 2 adjacent smaller\nnodes, which measure 8 x 23 mm in overall dimension (5:64), not significantly\nchanged. An additional prominent mesenteric node measures 9 x 14 mm (5:72). No\nretroperitoneal lymphadenopathy is noted .\nVASCULAR:  There is no abdominal aortic aneurysm.  There is no calcium burden\nin the abdominal aorta and great abdominal arteries.\n\nPELVIS:\n\nThere is re- demonstration of a small fat-containing left inguinal hernia,\nwith no evidence of obstruction or bowel herniation. There is no evidence of\npelvic or inguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Multiple hypodensities within the median lobe of the\nprostate (05:10 7) are less conspicuous compared to the prior study, likely\nrelated to prior TURP defect.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of osseous lesion suspicious for malignancy. Extensive\ndegenerative changes are present in the lumbar spine, including grade 2\nanterolisthesis of L5 on S1, multilevel osteophytosis and disc space\nnarrowing, including near complete disc height loss at the L1-2 level.\nAbdominal and pelvic wall is within normal limits.",
            "output": "1. Enlargement of celiac lymph node and newly appeared small hypodense liver\nlesions are concerning for metastasis, but are too small to completely\ncharacterize on this single-phase CT.  Irregular hepatic hypodensity in the\ngallbladder fossa could be due to post-operative change.  MRI of the abdomen\nis recommended for further assessment.\n2. Expected postoperative changes following Whipple procedure, with persistent\nmild central biliary dilatation and pneumobilia.  Prominent periportal and\nmesenteric lymph nodes, as described above, for which attention on follow-up\nimaging is recommended.\nINCIDENTAL FINDINGS:\n\n\n\n1. Hypodensities in the median lobe of the prostate, likely related to TURP\ndefect.\n2. Lumbar spine degenerative changes and spondylolisthesis, as described\nabove.\n3. Small fat-containing left inguinal hernia.\n4. Small hiatal hernia.\n\nNOTIFICATION:   The impression above was entered by Dr. ___ on\n___ at 11:52 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider."
        },
        {
            "input": "Please refer to separate chest CT report for thoracic details.\n\nPreviously demonstrated peripherally enhancing segment 8 liver lesions on MRI\nare slightly enlarged allowing for differences in modality, the larger 1.6 x\n1.3 cm and smaller 1.2 x 1 cm (5, 50 and 5, 51). A 9 mm lesion in the hepatic\ndome (5, 45) is noted, not well seen on MRI, suspicious for new metastasis.\nPatent portal veins.  Post cholecystectomy.\n\nPatient is post Roux-en-Y hepaticojejunostomy.  Postoperative changes are\ndemonstrated with grossly unremarkable appearance of the pancreaticobiliary\nlimb.  No intrahepatic ductal dilatation.  The remaining pancreatic body and\ntail is grossly unremarkable without mass or main ductal dilatation. A 2.7 x\n1.9 cm periportal lymph node is noted.\n\nNormal spleen and adrenals.\n\nNo hydronephrosis.  Bilateral left greater than right renal cortical atrophy. \nBilateral extrarenal pelvis. Numerous bilateral renal cysts are again noted,\nsimilar to recent MRI.\n\nRetained esophageal contrast, suggestive of reflux or dysmotility. Contrast\nwithin stomach. Chronic diverticulosis. No small bowel dilation.\n\nModerate atherosclerosis of normal caliber abdominal aorta. Bilateral renal\nostial arterial calcifications. Mesenteric adenopathy with surrounding fat\nstranding and edema, suggestive of mesenteric panniculitis.\n\nNo focal bladder wall thickening. No free pelvic fluid. No pelvic adenopathy.\n\nDegenerate changes of bilateral hip joints. Osteitis pubis. Degenerative\nchanges of bilateral SI joints and multi level facet joints. Grade 2\nanterolisthesis of L5 on S1 with bilateral pars defects, similar to prior.",
            "output": "-Slight interval increase in size of 2 previously demonstrated segment 8 liver\nlesions. An additional subtle subcentimeter hepatic dome hypodensity is noted,\nsuspicious for new metastasis.\n-Postoperative changes of hepaticojejunostomy. Enlarged 1.9 cm periportal\nlymph node, similar to prior.\n-Findings suggestive of probable mesenteric panniculitis, demonstrated on\nprior MRI, as opposed to nodal mesenteric metastases.\n-Grade 2 anterolisthesis of L5 on S1 with bilateral pars defects.\n- Other findings as detailed above."
        },
        {
            "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:\nThe liver demonstrates homogenous attenuation throughout.  There is no\nevidence of steatosis:  68 ___ on contrast scan (normal >100HU).\nThe 2 hypoenhancing liver lesions seen segment 8 have decreased in size\ncompared to the previous scan:\n11.1 mm (series 7, image 49) compared to 12.7 x 15.7 mm\n5.5 mm (series 7, image 50) compared to 10.4 x 11.6 mm\nThe dome lesion is hardly appreciated.\nThere is no evidence of intrahepatic or extrahepatic biliary dilatation. \nPneumobilia again seen from previous Whipple\nThe gallbladder is surgically absent.\nPANCREAS:\nStatus post Whipple with no signs of local recurrence or used lesion in the\nremaining body and tail of pancreas which are mildly atrophic.\nA hepatic artery/porta hepatis node (series 7, image 54) and is again seen\nappears slightly smaller measuring 16 x 20.2 mm, compared to 19.3 x 26.6 mm .\nThere is no evidence of bowel dilatation of to the pancreatic or biliary limb\nof\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.  Multiple cysts\nagain seen with no interval change from the previous scans.\nThere are no urothelial lesions in the kidneys or ureters. There is no\nperinephric abnormality.\nGASTROINTESTINAL:\nThe stomach is not distended.  Status post Whipple with no signs of\nobstruction of bowel dilatation.\nSmall bowel loops demonstrate normal caliber, wall thickness and enhancement\nthroughout.\nColon and rectum are within normal limits with no obstructing lesion..  There\nare several diverticula in the sigmoid colon with no signs of diverticulitis.\nAppendix is normal in caliber.\nRETROPERITONEUM & MESENTERY:\nThere is no evidence of retroperitoneal, mesenteric and omental lymph node\nenlargement.  No solid or cystic mass. Mild mesenteric stranding with no signs\nof lymph node enlargement\nVASCULAR:\nThere is no abdominal aortic aneurysm.  There is no calcium burden in the\nabdominal aorta and great abdominal arteries.\nABDOMINAL WALL AND SOFT TISSUES:\nThere is no abdominal wall hernias or subcutaneous solid or cystic mass.\nThere is no inguinal hernia or lymph node enlargement.\n\nPELVIS:\nThe urinary bladder is distended with a slightly thick wall due to enlarged\nprostate.\nThere is no evidence of pelvic or inguinal lymph node enlargement.  No solid\nor cystic pelvic mass seen. There is no free fluid in the pelvis.\nProstate is enlarged with signs of previous TURP.\n\nSKELETAL:\nThere is no evidence of worrisome lesions.  No worrisome for metastasis bony\nlytic or blastic lesions.  Grade 2 anterolisthesis of L5-S1 with bilateral\npars defects again seen",
            "output": "1. Interval decrease the size of the liver lesions\n2. Status post Whipple with no evidence of local recurrence\n3. Stable lymph node in the region of the celiac axis/hepatic artery origin\n4. L5-S1 anterolisthesis as previous"
        },
        {
            "input": "LOWER CHEST:\nThere is an 8 mm pleural-based pulmonary nodule at the right lung base (5:7),\nwhich appears to have enlarged compared to ___ where it measured 4 mm\n(2:39, prior study). There is no pleural effusion. The heart size is normal,\nand there is no pericardial effusion\n\nABDOMEN:\n\nHEPATOBILIARY: There is a 3 mm heterogeneous focus along the anterior lateral\naspect of segment segment VI (5:32), compatible with the lesion that was\nsuspicious for ___ as seen on the recent MRI dated ___.  Other hepatic\nlesions described on that MRI, including the suspicious segment III lesion,\nare not well visualized on this single phase study. There is no evidence of\nintrahepatic or extrahepatic biliary dilatation. A stone is visualized within\nthe gallbladder, but there is no 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 and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and 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 34 x 29 mm simple cyst in the lower pole of the left kidney. There\nis no evidence of stones, suspicious renal masses or hydronephrosis. There are\nno urothelial lesions in the kidneys or ureters. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderately large hiatal hernia. Small bowel loops\ndemonstrate normal caliber, wall thickness and enhancement throughout.  The\ncolon and rectum are unremarkable, without evidence of wall thickening or\ndiverticulitis. Appendix contains air, has normal caliber without evidence of\nfat stranding. However, there is mild non-specific fat stranding inferior to\nthe cecum and posterior the appendix (6b:32), which may be a sign of early\ncolitis.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal and mesenteric\nlymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic\ncalcifications are noted in the abdominal aorta and right common iliac artery.\nIncidental note is made of a patent umbilical vein, splenic varices, a\nsplenorenal shunt (6b:33) with resulting downstream left renal vein dilation\n(5:29), compatible with underlying portal hypertension.\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.\n\nREPRODUCTIVE ORGANS: The uterus is slightly heterogeneous in appearance, but\nno discrete masses are identified.\n\nBONES AND SOFT TISSUES:\n\nThere is no evidence of worrisome lesions. Abdominal and pelvic wall is within\nnormal limits.",
            "output": "1.  Mild non-specific fat stranding in the right lower quadrant inferior to\nthe cecum, without evidence of colonic wall thickening, may be seen in\nmild/early cecal colitis. No appendicitis or diverticulitis.\n2. 3 mm heterogeneous focus along the lateral aspect of segment VI,\ncorresponding to the ___ better evaluated on recent MRI dated ___. \nPreviously described suspicious segment III lesion is not well visualized on\nthis single-phase study.\n3. Sequela of portal hypertension including patent umbilical vein, splenic\nvarices, and a splenorenal shunt with resulting downstream left renal vein\ndilation.\n4. Large hiatal hernia.\n5. Cholelithiasis without evidence of cholecystitis.\n6. Interval enlargement of an 8 mm, likely pleural based, pulmonary nodule at\nthe right lung base.\n\nRECOMMENDATION(S):  CT Chest for further evaluation of lung nodule.\n\nNOTIFICATION:  Final results telephoned to Dr. ___ by Dr. ___ at 11:42AM."
        },
        {
            "input": "LOWER 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.  Incidental note is made of multiple accessory\nspleens.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: The stomach is 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.  A tubular right adnexal\ncystic structure measures 4.7 x 3.2 x 3.1 cm, decreased in size from ___ (5:101, 8:43).  A left adnexal cystic structure measures 3.0 x 1.7 x 1.7\ncm, previously 3.5 x 2.2 x 1.8 cm (5:103, 8:36).\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no 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. Bilateral tubular cystic adnexal lesions, previously characterized as\nhydrosalpinx, are decreased in size when compared to ___.  Patient is\nstatus post ultrasound-guided drainage of the right hydrosalpinx on ___.\n2. No evidence of intra abdominal or intra pelvic lymphadenopathy."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis.  Otherwise, the\nremaining visualized lung 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 distended but within\nnormal limits.a  There is small volume abdominopelvic 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.  Incidental note is made of small accessory\nspleens.\n\nADRENALS: The right and left adrenal glands 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.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  Otherwise, the stomach is\nunremarkable.  There is small volume interloop ascites and mild wall\nthickening of several small bowel loops, likely reactive, as expected post\nlaparotomy.  There is mild distension of several central small bowel loops,\nrepresenting postoperative ileus.  No evidence of significant enteritis or\nsmall bowel obstruction.  There is mild colonic diverticulosis.  No evidence\nof diverticulitis.  The rectum is within normal limits.  The appendix is\nnormal.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nThere is a 4.6 x 5.6 x 5.8 cm intermediate density fluid collection in the\nrectouterine pouch with faint thin peripheral hyperenhancement and mild\nsurrounding inflammatory changes/stranding (2:77, 601:48). In addition, there\nappears to be a small locule of air dependently within the superior aspect of\nthe collection (2:69, 601:48).  This collection abuts the superior posterior\naspect of the vaginal cuff.  Of note, this appears to be in the same location\nof the prior adnexal cystic lesions/hydrosalpinx on CT from ___,\nand has been removed per operative report on ___.\n\nThere is trace free fluid in the pelvis.  There is a tiny locule of free air\nin the right hemipelvis, likely representing trace residual pneumoperitoneum,\nas expected postoperatively (2:65).\n\nREPRODUCTIVE ORGANS: The uterus is not visualized.  Status post 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There are postsurgical changes of the anterior abdominal wall. \nThere is mild subcutaneous edema of the bilateral flanks.  There are small\nlocules of free intraperitoneal air in the anterior upper abdomen,\nrepresenting trace residual pneumoperitoneum, as expected postoperatively\n(2:22).  Otherwise, the abdominal and pelvic wall is within normal limits.",
            "output": "1. 4.6 x 5.6 cm hyperdense fluid collection noted in the right hemipelvis\nlocated anterior to the rectum.  This collection is at the site of location of\nthe right ovary that was recently resected.  Differentials include a\npostoperative hematoma or a complex postoperative seroma, with less concern\nfor an abscess.  The tiny locule of air abutting this collection is at the\ncranial margin rather than within the collection and is likely postsurgical,\nsimilar to other scattered locules of free intraperitoneal air as described\nabove.\n2. Small volume abdominopelvic ascites and trace residual pneumoperitoneum, as\nexpected postoperatively.  There are scattered mildly dilated loops of\nfluid-filled small bowel with small volume interloop free fluid, without a\ntransition point, suggesting ileus rather than obstruction.\n3. Small hiatus hernia."
        },
        {
            "input": "CT abdomen: The liver enhances homogeneously without concerning focal lesions\nor biliary dilatation. Gallbladder, spleen, pancreas, and adrenal glands are\nwithin normal limits. The kidneys enhance and excrete symmetrically.  A 1 cm\nrounded hypodensity in the interpolar region of the left kidney is most\nconsistent with a simple cyst. Additional sub cm hypodensities in bilateral\nkidneys are too small to characterize but statistically likely represent\ncysts. There is no hydronephrosis.\n\nThe stomach is partially distended with oral contrast. Loops of small and\nlarge bowel are normal in course and caliber. There is no obstruction.\nAppendix is normal. Abdominal aorta demonstrates diffuse atherosclerotic\ndisease without aneurysmal dilatation. There is no lymphadenopathy, free air\nor free fluid.\n\nCT pelvis: The bladder, seminal vesicles, and prostate gland are unremarkable.\nThere is no pelvic or inguinal lymphadenopathy. There is no pelvic free fluid.\n\nBone window: No suspicious lytic or sclerotic osseous lesion is identified.\nMultilevel degenerative changes in the spine are noted. A fat containing\numbilical hernia is present.",
            "output": "1.  No abdominal or pelvic metastasis detected.\n2.  Please refer to separately dictated CT chest report from the same day for\nfull description 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 predominantly central mild\nintrahepatic biliary dilation and extrahepatic biliary dilation with the CBD\nmeasuring up to 1.5 cm to bring down smoothly to the level of the ampulla\n(601:27), 1.3 cm on prior study from ___.  The gallbladder is surgically\nremoved.\n\nPANCREAS: There is fatty infiltration of the pancreatic gland without\npancreatic duct dilation or 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 are of normal and symmetric size 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 bowel obstruction or\nascites.  Small bowel loops demonstrate normal caliber, wall thickness, and\nenhancement throughout.  Few scattered diverticular noted.  The colon and\nrectum are within normal limits.\n\nPELVIS: The urinary bladder is markedly distended.  Distal ureters are\nunremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: 1.8 cm mildly calcified fibroid is seen in the posterior\nlower uterine segment.  Remainder uterus and adnexa are unremarkable.\n\nLYMPH NODES/MESENTERY/OMENTUM/RETROPERITONEUM: Mesenteric fat stranding with\nfew not enlarged lymph nodes are again seen, consistent with mesenteric\npanniculitis.  There is no retroperitoneal or mesenteric lymphadenopathy. \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Minimal atherosclerotic\ndisease is noted.\n\nBONES: Degenerative changes are most pronounced in the lower thoracic and\nlumbar spine with anterior spondylosis.  No suspicious bone lesions or\nfractures.  Patient is status post left femur intramedullary rod and screws\nplacement.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Mild intrahepatic biliary dilation and slightly increased CBD diameters are\nnew since ___.  No evidence of stones on CT however choledocholithiasis\ncannot be excluded.  Correlation with hepatic function is recommended.\n2. No bowel obstruction or 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 a 7 mm simple cyst in the left lobe the liver.  There is an 8 mm\nhypodense lesion in segment 8 (series 2, image 16) which is too small to\ncharacterize by CT and was not present on ___.  This could be\nfurther assessed with an ultrasound.  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 hydronephrosis.  There are bilateral subcentimeter renal\nhypodensities, too small to characterize but likely small cysts. Changes of\npartial right nephrectomy are noted and are associated with a 10 mm rounded\narea of perinephric edema.\n\nGASTROINTESTINAL: The stomach is 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.  Bilateral renal veins are patent.  The main portal vein, the\nhepatic veins and splenic vein 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. Patient is status post right partial nephrectomy, without evidence of local\nrecurrence or distant metastasis.\n2. Hypodense lesion within segment 8 of the liver, new since ___.  This could\nbe further assessed with ultrasound.\n\nRECOMMENDATION(S):  Ultrasound of the liver is recommended for further\nassessment of a small lesion involving segment 8.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___ on ___ at 15:27 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.  The\nliver density measures 65 ___ compared to 169 of the spleen consistent with\nfatty deposition.  There are areas of normal density along the gallbladder\nconsistent with focal fatty sparing.  There is no evidence of focal lesions. \nThe previously identified hypodense lesion in segment 8 is not as well seen\ntoday.  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 is a\n1.4 cm enhancing lesion in the anterior tip of the spleen on series 3 ___ 21. \nThis is not definitely identified on prior examination of ___ or ___ it is in retrospect seen on ___ and is unchanged in\nsize.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. \nThere is fat stranding adjacent to the lower pole of the right kidney\nconsistent with postsurgical change.  There is a subcentimeter hypodense\nlesion in the interpolar region on series 3 ___ 40 which is too small to\ncharacterize but likely represents a cyst and is also unchanged.  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.\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. 1.5 cm enhancing lesion in the spleen unchanged compared to ___\nbut not definitely seen on prior contrast enhanced study of ___\nas well as older studies.  This is indeterminate, however may represent a\nhemangioma, or ___, metastatic disease is considered unlikely.  Further\nevaluation with MRI is recommended\n2. Status post partial right nephrectomy.  No evidence of tumor recurrence. \nNo definite evidence of metastatic disease.\n3. Hepatic steatosis with focal fatty sparing along the gallbladder fossa\n\nRECOMMENDATION(S):  MRI of the abdomen for further evaluation of new,\nindeterminate splenic lesion\n\nNOTIFICATION:  The impression and recommendation above was entered by Dr.\n___ on ___ at 09:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider."
        },
        {
            "input": "BONES: The expansile mass centered around the right sacrum involving the right\nsacroiliac joint is slightly increased in size compared to the prior pelvic\nMRI, now measuring approximately 6.6 x 6.5 x 5.7 cm (TR x AP x CC) (3:40,\n7:78).  This mass is again noted to involve the first right sacral foramen\n(3:34).\nA linear fracture is identified in the right sacral ala (3:27).  Additional\nlinear fractures in the right sacral also extend into the sacral canal and\nright S1 neural foramen.  There is no significant displacement of the above\nfractures.  Additionally, linear fractures are identified in both transverse\nprocesses of L5 (3:19, 24), also not significantly displaced.\n\nPELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nSOFT TISSUES: Small subcentimeter soft tissue nodules noted in the anterior\nabdominal wall (3:52, 65 and 67) are nonspecific, but may represent\nsubcutaneous injections.",
            "output": "1. Nondisplaced fractures through the right sacral ala with extension into the\nsacral canal and right S1 neural foramen.\n2. Nondisplaced bilateral L5 transverse process fractures.\n3. Slight interval increase in the soft tissue mass centered in the right\nsacroiliac joint, now measuring up to 6.6 x 6.5 x 5.7 cm."
        },
        {
            "input": "PELVIS:  The partially visualized small and large bowel are unremarkable. The\nurinary bladder and 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 pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Moderate atherosclerotic disease is noted.\n\nBONES: The patient is status post screw fixation of the sacroiliac joints,\nwhich limits evaluation.  Nondisplaced fractures of the bilateral transverse\nprocesses of L5 are unchanged.  There is bony destruction of the right sacral\nala, as before, with extension of soft tissue anteriorly measuring\napproximately 4.9 x 2.0 x 4.9 cm, previously 5.4 x 2.4 cm x 4.9 cm  when\nmeasured with similar technique.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Status post screw fixation of the sacroiliac joints, with streak artifact\nlimiting evaluation.\n2. Similar size of soft tissue mass extending from the right sacroiliac joint\nwhen measured with similar technique, allowing for limitations from streak\nartifact.\n3. Unchanged nondisplaced fractures of the bilateral transverse processes of\nL5."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions, less pronounced\ncompared to the prior study.  Bibasilar subsegmental atelectatic changes as\nwell as mild interlobular septal thickening, unchanged.  No pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is dysmorphic with nodular contour, in keeping with\ncirrhosis.  Stable small focal course calcification within the right hepatic\nlobe (03:43), likely a calcified granuloma.  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 contains\ngallstones without wall thickening or evidence of inflammation.  Mild amount\nof perihepatic fluid.\n\nPANCREAS: The pancreas is atrophic without focal lesions ductal dilatation. \nThere is no peripancreatic stranding.\n\nSPLEEN: The spleen is at upper limits of normal size measuring 13.3 cm in\ncraniocaudal dimension.\n\nADRENALS: There is a 1.5 cm indeterminate right adrenal nodule which is stable\ncompared to the CT of ___ statistically most likely to represent an\nadenoma.  Another stable 0.9 cm right adrenal nodule is noted with low density\nsuggestive of a small adenoma.  No discrete left adrenal nodules.\n\nURINARY: The kidneys are of normal and symmetric size.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis.\n\nGASTROINTESTINAL: An NG tube is noted terminating in the stomach.  Small bowel\nloops demonstrate normal caliber and wall thickness throughout. There is\nmoderate fecal loading throughout the colon with fecal content distending the\nrectum.  Stable mild perirectal/pre sacral fat stranding.\n\nPELVIS: The urinary bladder has mildly thickened wall with multiple\ndiverticula, in keeping with chronic outlet obstruction.  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.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Redemonstration of left hip hardware.  The appearance of the left hip\nis unchanged.  No acute fractures.  Multilevel degenerative changes of the\nspine.  No aggressive bone lesions.\n\nSOFT TISSUES: Uncomplicated fat containing small left inguinal hernia.",
            "output": "1. Moderate fecal loading throughout the colon down to the level of the\nrectum.  Mild stable nonspecific perirectal/pre sacral fat stranding.\n2. Cirrhotic liver with mild ascites and borderline enlarged size of the\nspleen.\n3. Redemonstration of 1.5 cm right adrenal nodule, stable compared to the CT\nof ___ statistically most likely an adenoma.  Additional stable 0.9\ncm right adrenal adenoma.\n\nNOTIFICATION:  A Wet Read was provided by the on-call resident immediately\nafter the scan."
        },
        {
            "input": "LOWER CHEST: Refer to chest CT performed today\n\nABDOMEN:\nHEPATOBILIARY:  Interval placement of a PTBD.  There is moderate right and\nleft intrahepatic biliary duct dilation with some foci of pneumobilia.  At the\nposterior aspect of hepatic segment 5 there is a 9 x 32 mm hypoenhancing\nregion (6:76) as well as a 24 x 40 mm hypoenhancing region with rim\nenhancement and foci of air (6:  84).  After discussion with the ___ team\nconsidering PTBD placement on ___ these are likely due to sequela\nof that placement and less likely to represent infected collections at this\ntime.\n\nAdditional hypoenhancing lesions include a 13 x 25 mm area with foci of air at\nthe bifurcation of the right portal vein into the anterior and posterior\nportal branches (6:75), a 23 x 18 mm area with foci of air just anterior to\nthe right anterior portal vein branch (6:68), and a 14 x 5 mm region with a\nfocus of air within hepatic segment 8 (6:67).  These are also likely due to\nsequela of ___ BD placement and less likely to represent infected collections\nat this time.\n\nThese are all new when compared to MRI performed on ___\n\nThere is no calcified gallstone.  There is gallbladder wall thickening without\npericholecystic fluid.  This could be further evaluated with ultrasound if\nindicated.\n\nPANCREAS: There is a poorly defined hypoenhancing 3.0 x 2.5 cm mass in the\nhead of the pancreas consistent with pancreatic adenocarcinoma.  There is\nupstream atrophy with a dilated main pancreatic duct.  This mass cannot be\nseparately identified from the second portion of the duodenum with spiculated\nsoft tissue at the lateral aspect of the duodenum.  Findings are concerning\nfor infiltration of the second portion of the duodenum.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.  There is a small splenule 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 or hydronephrosis. There is no perinephric\nabnormality.\n\nThere is a 6 mm left lower pole, a 5 mm posterior left interpolar, and a 6 mm\nright posterior interpolar hypodensity which are too small to characterize but\nmay represent cysts.\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 is decompressed. There is no evidence of pelvic or\ninguinal lymphadenopathy.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  Left ovary is unremarkable. \nThere is an 8 mm simple appearing cyst within the right ovary.\n\nBONES: Punctate 4 mm focus of sclerosis within L3 may represent a bone island.\nPunctate 3 mm focus of sclerosis within L2 may also represent a bone island.\n\nThere is no lytic lesion.\n\nThere is mild right lumbar dextroscoliosis.  There are degenerative changes of\nof the spine most advanced in the lumbar region.  There is osteopenia.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\n\nPANCREATIC CANCER STAGING:\nMorphologic Evaluation\nAppearance (in the pancreatic parenchymal phase): Hypoenhancing\nSize (maximal axial dimension in cm): 2.5 x 3.0 cm\nLocation (head right of SMV, body left of SMV): Head\nPancreatic duct narrowing/abrupt cutoff with or without upstream dilatation:\nPresent\nBiliary tree abrupt cutoff with or without upstream dilatation: PTBD is in\nplace, cannot be well assessed.\n\nArterial evaluation\nSMA involvement: absent\nSolid soft-tissue contact: NA\nIncreased hazy attenuation/stranding contact: NA\nFocal vessel narrowing or contour irregularity: NA\nExtension to first SMA branch: NA\n\nCeliac Axis involvement: absent\nSolid soft-tissue contact: NA\nIncreased hazy attenuation/stranding contact: NA\nFocal vessel narrowing or contour irregularity: NA\n\nCommon hepatic artery involvement: absent\nSolid soft-tissue contact:  None\nIncreased hazy attenuation/stranding contact:  <=180\u00b0\nFocal vessel narrowing or contour irregularity:  None\nExtension to celiac axis: None\n\nProper hepatic artery involvement: Present\nSolid soft tissue contact:  Over 180 degree\nIncreased hazy attenuation/stranding contact: Over 180 degree\nFocal vascular narrowing or contour irregularity: Present (6:79)\nExtension to bifurcation of right/left hepatic artery: Present\n\nGastroduodenal artery is completely encased with soft tissue and narrowed.\n\nVariant anatomy: Replaced left hepatic artery off the left gastric artery\nVariant vessel contact:  absent\nDegree of solid soft-tissue contact:  NA\nDegree of increased hazy attenuation/stranding contact:  NA\nFocal vessel narrowing or contour irregularity:  NA\n\nVenous evaluation\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: Present\nDegree of solid soft-tissue contact:  <=180\u00b0\nDegree of increased hazy attenuation/stranding contact: Over 180 degree\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: Multiple new hypoenhancing liver lesions as described above\nwhich are most likely due to somewhat difficult placement of a ___ BD.\nPeritoneal or omental nodules: absent\nAscites: absent\nSuspicious lymph nodes: Several prominent peripancreatic lymph nodes as well\nas aortocaval lymph nodes are noted (6:96, 81, 95)\nOther extrapancreatic disease (invasion of adjacent structures): Second\nportion of the duodenum is inseparable from the pancreatic head mass and is\nlikely involved.  .",
            "output": "1. There are several hypoattenuating lesions within the right hepatic lobe\nsome of which demonstrate internal foci of air and the largest demonstrates\nrim enhancement.  After discussion with the interventional radiology team, in\nlight of the somewhat difficult recent PTBD placement with gelfoam\nembolization  these are likely sequela of this procedure (hmeatoma/bilioma) .\n2. Ill defined hypoenhancing 3.0 x 2.5 cm pancreatic head mass is concerning\nfor pancreatic adenocarcinoma.  Arterial and venous invasion as well as\ninvasion of adjacent structures is described in detail above.  Specifically,\nthe main portal vein, SMV, gastroduodenal artery,  proper hepatic artery, and\nduodenum are affected by this lesion.\n3. There is no calcified gallstone or pericholecystic fluid, however, the\ngallbladder wall is thickened.   This could be further evaluated with\nultrasound if indicated.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:03 AM."
        },
        {
            "input": "LOWER CHEST: Mild bibasilar atelectasis is noted.  Coronary artery\ncalcifications and dense mitral annular calcifications noted.  Hypoattenuation\nof the blood pool relative to the myocardium is consistent anemia.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nThere is no evidence of overt 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: There is mild diffuse atrophy of the pancreas.  There is no main\nductal dilatation.  There is no peripancreatic stranding or fluid collection.\n\nSPLEEN: The spleen is mildly enlarged, measuring 13.7 cm in length, previously\n12.1 cm on MRI of the abdomen 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\n\nGASTROINTESTINAL: There is a moderate size hiatal hernia.  Small bowel loops\nare normal in caliber.  There is a small rim calcified sigmoid diverticulum. \nThe colon is otherwise unremarkable.  The appendix is not visualized however\nthere 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 unremarkable.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Extensive atherosclerotic\ndisease is noted.\n\nBONES: Known myelomatous osseous lesions are better evaluated on prior MR of\nthe thoracic and lumbar spine from ___.  There is no acute fracture. \nThere is mild anterolisthesis of L4 on L5.\n\nSOFT TISSUES: Bilateral fat containing inguinal hernias.",
            "output": "1. No acute intra-abdominal pathology to account for patient's symptoms,\nwithin the limitations of this unenhanced 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:\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  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 dilation.  There is no peripancreatic\nstranding.\n\nSPLEEN: Splenomegaly is mildly increased, measuring 14.4 cm in length, from\n13.7 cm on ___.\n\nADRENALS: The right and left adrenal glands 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.  Mild thickening of\nthe bladder wall is likely related to chronic bladder outlet obstruction, and\nunlikely to represent cystitis.\n\nGASTROINTESTINAL: There is a moderate-sized hiatal hernia.  Small bowel loops\ndemonstrate normal caliber, wall thickness, and enhancement. The colon and\nrectum are within normal limits. The appendix is not visualized.\n\nPELVIS:  There is no free fluid in the pelvis.  A 1.4 cm calcified epiploic\nappendage again seen in the pelvis (series 5, image 160).\n\nREPRODUCTIVE ORGANS: The prostate and seminal vesicles are grossly\nunremarkable.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  A\nround 1.3 cm left pelvic node (series 5, image 171) is likely benign.\n\nVASCULAR: There is extensive atherosclerotic disease.  There is no abdominal\naortic aneurysm.\n\nBONES: Numerous known myomatous osseous lesions involving multiple lumbar and\nvertebrae, right ilium, left ischium, bilateral femurs are again seen, and\nbetter characterized on prior PET-CT dated ___.  Radiation change\nof the lumbar spine is seen.  There is no evidence of acute fracture.\n\nSOFT TISSUES: There is a fat containing direct left inguinal hernia.  Soft\ntissue calcifications anterior to the right thigh are stable from multiple\nprior studies.",
            "output": "1.  No evidence of colitis, enteritis, or diverticulitis.\n2.  Mildly increased splenomegaly.\n3.  Redemonstration of numerous known myomatous osseous lesions involving the\nlumbar vertebrae, bony pelvis, and bilateral femurs.  No evidence of acute\nfracture.\n4.  Fat containing direct left inguinal hernia.\n5.  Please refer to separate report of CT chest performed on the same day for\ndescription of thoracic findings."
        },
        {
            "input": "LOWER CHEST: Bibasilar dependent atelectasis is noted in the lung bases. There\nis 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.  Portal venous system is\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. \nA 3.0 x 2.9 cm simple cyst arises from the upper pole of the right kidney.  No\nstones.  No nephrolithiasis. There are no urothelial lesions in the kidneys or\nureters. There is no perinephric abnormality.\n\nGASTROINTESTINAL:  Small bowel loops demonstrate normal caliber, wall\nthickness and enhancement throughout. Colon and rectum are within normal\nlimits.  Appendix is not definitely visualized, but there are no secondary\nsigns of acute appendicitis.  There is no evidence of mesenteric\nlymphadenopathy.\n\nThere is small volume perihepatic hemoperitoneum (4:215), that has not\nsignificantly changed compared to the outside CT performed on ___.\nHemorrhagic fluid is is also present within the left upper quadrant about the\nspleen, which is continuous with a more localized but ill-defined collection\nalong the greater curvature of the stomach that measures approximately 4.4 x\n3.8 cm; this closely abuts the wall of the stomach with no intervening fat\nplane, and an underlying lesion cannot be excluded.  There is mild surrounding\nfat stranding (4b:241).  There is a long hyperdense curvilinear structure\nwithin this collection that most likely represents a vessel rather than active\ncontrast extravasation given background collateralization within the left\nupper quadrant.  Additionally, the size of this perigastric collection has not\nsignificantly increased.  A small amount of hemorrhagic fluid continues to\ntrack inferiorly along the left abdomen.  The volume of hemorrhagic fluid\nwithin the pelvis is little changed or minimally increased.\n\nVESSELS:  Abdominal aorta is normal in caliber.  Celiac axis, common hepatic\nartery and its branches are patent.  Left gastric artery is patent.  Status\npost splenic artery embolization, with collateralization towards the splenic\nhilum.  Superior mesenteric artery and bilateral single renal arteries are\npatent.  Inferior mesenteric artery is patent.  Bilateral iliac branches are\nunremarkable in appearance.  No evidence of aneurysm or pseudoaneurysm.\n\nRETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.\n\nPELVIS: Urinary bladder is largely collapsed around a Foley catheter.  There\nis no evidence of pelvic or inguinal lymphadenopathy.  There is no free fluid\nin the pelvis.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable.  No adnexal masses are\nidentified.\n\nBONES: There 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 aneurysm, pseudoaneurysm or active extravasation.\n2. Small volume hemoperitoneum in the upper abdomen and pelvis, little changed\nfrom the outside hospital CT performed several hours earlier.\n3. More localized fluid with surrounding stranding along the greater curvature\nof the stomach, raising the possibility that the source of bleeding is from\nthe gastroepiploic territory.  However, an underlying lesion cannot be\nexcluded, and an MRI is recommended for further evaluation when clinically\nappropriate.\n\nRECOMMENDATION(S):  MRI Abdomen to exclude underlying lesion along the greater\ncurvature of the stomach.\n\nNOTIFICATION:  Recommendation for MRI was communicated by Dr. ___ with\nDr. ___ on the telephoneon ___ at 9:58 AM, 30 minutes after\nattending review."
        },
        {
            "input": "VASCULAR:\n\nEvaluation is limited due to artifact from splenic artery aneurysm coil. No\nnew aneurysm is identified.  There is no abdominal aortic aneurysm. There is\nminimal calcium burden in the abdominal aorta and great abdominal arteries.\n\nLOWER CHEST: Scattered, streaky opacities at the lung bases are consistent\nwith subsegmental atelectasis.  Otherwise, the partially imaged lung bases are\nclear.  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:  There is diffuse fatty pancreatic atrophy.  There is no\nperipancreatic stranding or 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 renal hypodensities, the largest measuring 2.9 cm and\narising from the upper pole of right kidney, are likely simple renal cysts. \nOtherwise, the kidneys are of normal symmetric size with normal nephrogram. \nThere is no evidence of stones 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. 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. 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: 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 coiling of splenic artery aneursym.  Limited evaluation due to\npresence of metallic artifact. No new aneurysm identified."
        },
        {
            "input": "LOWER CHEST: There is a new (since ___ 7.5 mm nodule in the left\nlower lobe (series 2, image 16).\n\nABDOMEN:\n\nHEPATOBILIARY: Unchanged 8 mm hypodensity in segment 4A  and a 6 mm\nhypodensity in segment 3 (series 2, images 22 and 38 respectively).  There is\nno evidence of other 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.  Again seen is a non obstructive calculus measuring 1.7 cm\nin the lower pole calices of the right kidney 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: Status post hysterectomy.  The ovaries are present with\nno adnexal masses.  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. \nDegenerative lower lumbar changes.\n\nSOFT TISSUES: Subcutaneous soft tissue nodules within the right lower anterior\nabdominal wall may be related to subcutaneous injections.",
            "output": "1. Nonobstructive 1.7 cm right renal inferior pole calculus.\n2. New indeterminate 7 mm left lower lobe pulmonary nodule.  A dedicated chest\nCT is recommended to evaluate for additional lung parenchymal nodules.\n\nRECOMMENDATION(S):  Dedicated chest CT to evaluate the entire thorax for\npresence of additional lung nodules."
        },
        {
            "input": "LOWER CHEST: There is left basilar atelectasis and suggestion of a prior\nresection given surgical chain sutures.  There is a new left pleural effusion,\nsmall.  The heart size is within normal limits.  There is no pericardial\neffusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered subcentimeter hypodensities throughout liver are too small to\ncharacterize by CT, though presumably cysts or biliary hamartomas, not\nsubstantially changed from prior exams.  There is no evidence of intrahepatic\nor extrahepatic biliary dilatation.  The gallbladder is within normal limits.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions 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 measures 15 mm (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. \nRight interpolar region scarring and staghorn calculus in the lower pole of\nthe right kidney are unchanged from prior exam.  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 (601:38).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The uterus has been removed.  The left ovary is\nunremarkable (02:59).  The right ovary is not definitively identified, though\nthe candidate is unremarkable (02:59).\n\nLYMPH NODES: There is no 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 circumaortic left renal vein.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.  Diastasis of the\nrectus abdominus is also noted.",
            "output": "1. No hydronephrosis.  Stable right lower pole staghorn calculus.\n2. Symmetric enhancement of the kidneys with stable scarring of the interpolar\nregion of the right kidney.\n3. New small left pleural effusion.  Evidence of interval left lower lobe\nresection given surgical chain sutures."
        },
        {
            "input": "LOWER CHEST: There is bibasilar atelectasis.  Otherwise, no abnormality in the\nlower chest.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nScattered hypodensities throughout the liver are too small to characterize\nhowever likely represent cysts or biliary hamartomas and are unchanged.  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. \nRedemonstrated staghorn calculus in the lower pole of the right kidney\nmeasuring up to 1.8 cm.  Interpolar region of cortical scarring of the right\nkidney is redemonstrated.  No hydronephrosis bilaterally.  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. No adnexal abnormality is\nseen.\n\nLYMPH NODES: There is no abdominopelvic lymphadenopathy.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild 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.",
            "output": "1. No acute intra-abdominal pathology.  Specifically, no evidence for bowel\nobstruction or diverticulitis.\n2. Unchanged nonobstructing right lower pole staghorn calculus.  No\nhydronephrosis.\n3. Stable scarring in the interpolar region of 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: Redemonstration of scattered subcentimeter hypodensities that\nare unchanged compared to prior study.  They likely represent cyst or\nhemangioma.  Otherwise, the liver demonstrates homogenous attenuation\nthroughout.  There is no suspicious focal lesion.  There is no evidence of\nintrahepatic or extrahepatic biliary dilatation.  The gallbladder is\ncontracted but otherwise unremarkable.\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.  Splenule noted.\n\nADRENALS: The right adrenal gland is normal in size and shape.  The left\nadrenal gland appears mildly thickened compared to ___.\n\nURINARY: Redemonstration right cortical scarring at the middle pole. \nUnchanged compared to prior study.  There is also staghorn calculus located at\nthe lower pole of the right kidney that is also unchanged compared to prior\nstudy.  Otherwise, the kidneys are of normal and symmetric size with normal\nnephrogram.  There is no evidence of solid renal lesions.   There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. The colon and rectum are\nwithin normal limits. The appendix is normal.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic aneurysm.\n\nBONES: Degenerative changes are seen in the lumbar spine.\n\nSOFT TISSUES: Tiny fat-containing umbilical hernia.  Otherwise, the abdominal\nand pelvic wall is within normal limits.",
            "output": "1. The left adrenal gland appears mildly thickened compared to prior study in\n___.  Otherwise, without suspicious features identified.\n2. No lymphadenopathy or suspicious lesions identified throughout the\nabdomen/pelvis.\n3. Unchanged staghorn calculus at the lower pole of the right kidney"
        },
        {
            "input": "LOWER CHEST: The lung bases are clear aside from mild dependent changes set. \nSuture material is seen along the left hemidiaphragm, similar compared to the\nprior.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. \nThere is no suspicious focal lesion.  Hypodense subcentimeter hepatic lesions\nare too small to be characterized, however likely represent simple hepatic\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 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.  Redemonstration of a staghorn\ncalculus within the lower pole of the right kidney, unchanged in size or\nlocation.  No renal calculi are identified in the left kidney.  There is no\nperinephric abnormality.  There is no hydronephrosis or hydroureter.  The\nurinary bladder is unremarkable.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement. Diverticulosis of the sigmoid\ncolon is noted, without evidence of wall thickening or fat stranding. The\nappendix is normal.\n\nPELVIS:  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.  \nThere is no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: Mild atherosclerotic disease is present.  There is no abdominal\naortic 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 abnormality.\n2.  Right lower pole staghorn renal calculus, unchanged in size or position."
        },
        {
            "input": "LOWER CHEST: Linear atelectasis in the right lung base.  There is no evidence\nof pleural or pericardial effusion.  Sternotomy wires 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 or\nextrahepatic biliary dilatation.  The gallbladder is mildly distended but not\ninflamed.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands 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.  Both kidneys contain simple cysts and\nmultiple subcentimeter hypodensities which are too small to characterize but\nsuggestive of cysts.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: A hiatal hernia is small.  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 not\nvisualized.  There are no secondary signs of appendicitis.\n\nPELVIS: The urinary bladder demonstrates mild circumferential wall thickening.\nThe distal ureters are unremarkable.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is enlarged and the seminal vesicles contain\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.  Mild atherosclerotic disease\nis noted.  Patent visualized abdominopelvic vasculature.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture. \nModerate to severe bilateral hip osteoarthritis and mild degenerative changes\nof the sacroiliac joints, right-greater-than-left.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No evidence of traumatic injury in the abdomen and pelvis.\n2. No acute fractures.  Moderate to severe bilateral hip osteoarthritis.\n3. Mild circumferential bladder wall thickening could be due to cystitis or\nchronic bladder outlet obstruction in the setting of mild prostatomegaly.\nCorrelation with urinalysis recommended. No hydronephrosis or CT evidence of\npyelonephritis.\n\nRECOMMENDATION(S):  Urinalysis"
        },
        {
            "input": "LOWER CHEST: Nonspecific 3 mm right subpleural nodule (3:15).  There is no\nevidence of pleural or pericardial effusion.1\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 suspicious\nrenal lesions within the limitations of an unenhanced scan.  There are left\nparapelvic cysts, as visualized on prior study of ___.  There is no\nhydronephrosis.  There is no nephrolithiasis. There is no perinephric\nabnormality.\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 or 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: Fibroid uterus overall unchanged in size compared to\nprior study measuring 9.8 x 7 3 cm.  There is an exophytic mass isodense to\nthe uterus, arising superior to the left adnexa, which represents an exophytic\nfibroid or ovarian fibroma, now measuring 8 x 5.4 cm (3:117), previously 6.6 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.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is a supraumbilical ventral hernia, localizing\napproximately 1.4 cm above the umbilical scar, with a peritoneal defect/neck\nthat measures 1.8 cm, and contains fat and small amount of fluid, there is\nmarked stranding of the fat within the hernia, as can be seen in fat necrosis.\nIn addition there is a very small fat containing umbilical hernia.",
            "output": "1. Fat containing supraumbilical ventral hernia demonstrates active\ninflammatory changes and likely fat necrosis.  There is no evidence of bowel\ninvolvement.\n2. Additional very small umbilical fat containing hernia.\n3. Stable fibroid uterus.  Exophytic lesion arising superior to the left\nfundus/left adnexa, is slightly increased compared to remote study of ___, and likely represents an exophytic fibroid or ovarian fibroma."
        },
        {
            "input": "VASCULAR: Again seen is focal ectasia of the infrarenal abdominal aorta\nmeasuring 2.5 cm in longest diameter, previously 2.5 cm.  No extraluminal\ncontrast demonstrated.  Conventional celiac branching.  The mesenteric\narterial vasculature is patent.  The portal vasculature is patent no\nretroperitoneal hematoma is visualized..\n\nLOWER CHEST: Minimal bibasilar atelectasis.\n\nABDOMEN: The liver, spleen, pancreas, left adrenal gland and kidneys are\nunremarkable except for a stable nonspecific hypodense splenic lesion.  A  2\ncm right adrenal nodule was previously characterized as an adenoma in ___\nwhere it measured 1.2 cm.  The gallbladder is within normal limits aside for\nsludge or vicarious excretion of contrast.\n\nGASTROINTESTINAL: There is no intestinal obstruction or ascites.  Changes of\n___ fundoplication are noted.  There is mild soft tissue stranding\nsurrounding the gastroesophageal junction and in the omentum, presumably\nrelated to recent intervention.  No free air demonstrated.\n\nRETROPERITONEUM: No enlarged retroperitoneal lymph nodes are visualized.\n\nPELVIS: There is no evidence of pelvic or inguinal lymphadenopathy.  There is\nno free fluid in the pelvis.\n\nBONES: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: Changes of ventral and left inguinal hernia repair are\nredemonstrated.  Sequela of injections are seen in the anterior abdominal\nsubcutaneous fat.",
            "output": "1. No retroperitoneal hematoma or active extravasation of contrast in the\nabdomen or pelvis.\n2. Soft tissue stranding in the omentum and gastroesophageal junction\npresumably related to recent revision of Nissen fundoplication.\n3. 2 cm right adrenal adenoma, mildly increased 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 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 adrenal gland is normal in size and shape.  There is mild\nthickening of the left adrenal gland without discrete nodule.\n\nURINARY: Patient is status post right nephroureterectomy.  No soft tissue\nabnormalities are demonstrated within the postsurgical resection bed.  The\nleft kidney demonstrates normal size and attenuation.  Multiple subcentimeter\nrenal cortical hypodensities are too small to fully characterize.  No\nhydronephrosis.  No perinephric abnormality is demonstrated.\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 is under distended.  No discrete masses are\nidentified.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Redemonstration of a multilobulated fibroid uterus.  No\nadnexal abnormalities are identified.\n\nLYMPH NODES: Small right retroperitoneal lymph nodes near the surgical\nresection bed are not pathologically enlarged and measure up to 6 mm in short\naxis, decreased in size compared to prior examination where they measured up\nto 7 mm in short axis (4:63).  There is no mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 of the thoracolumbar spine are mild.\n\nSOFT TISSUES: There is a small ventral hernia containing fat with the opening\nmeasuring up to 1.2 cm in AP and SI dimension (4: 60, 08:32).  Increased soft\ntissue stranding along the mid lower abdomen is likely related to patient's\nprior surgery.",
            "output": "1. Status post right nephroureterectomy without evidence of local tumor\nrecurrence or evidence of abdominopelvic metastatic disease.\n2. Small right-sided retroperitoneal lymph nodes near the surgical resection\nbed are not pathologically enlarged.  Continued attention on follow-up imaging\nis recommended.\n3. Stable mild thickening of the left adrenal gland without evidence of a\ndiscrete nodule.\n4. 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\n___ 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.\n\nPANCREAS: The pancreas has normal attenuation throughout pancreatic ductal\ndilatation.  There is a 6 mm calcification in the pancreatic tail which may\nrepresent sequela of prior pancreatitis.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and 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 without evidence of soft\ntissue nodules or fat stranding within the surgical bed.  There are small\ncortical defects within the left kidney which may represent sequela of prior\ninfection or infarction.  Left kidney demonstrates no evidence of focal renal\nlesions or hydronephrosis.  There is no perinephric abnormality.\n\nGASTROINTESTINAL: Small to moderate hiatal hernia is again seen.  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: There are small bilateral bladder wall diverticula, images 2:104 on\nthe right and 2:108 on the left.  The distal ureters are unremarkable.  There\nis no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Fibroid uterus is again noted.  The bilateral adnexa are\nunremarkable.\n\nLYMPH NODES: Multiple non enlarged right and left retroperitoneal lymph nodes\nare unchanged when compared to most recent prior.  No enlarged retroperitoneal\nlymph nodes.  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: There is no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: There is unchanged fat containing supraumbilical ventral\nabdominal wall hernia, (series 2, image 64)",
            "output": "1. The patient is status post right nephrectomy without evidence of local\ndisease recurrence.  No evidence of lymphadenopathy in the abdomen and pelvis.\nStable nonenlarged right and left retroperitoneal lymph nodes.\n2. Stable appearance of the left kidney with small cortical defects, likely\nsequela of prior infection or infarctions.\n3. Small bilateral bladder wall diverticula.\n4. Fibroid uterus.\n5. Stable fat containing supraumbilical ventral abdominal wall hernia.\n6. Please refer to same-day CT chest for a detailed report of thoracic\nfindings."
        },
        {
            "input": "LOWER CHEST: Visualized lung fields are within normal limits.  There is no\nevidence of pleural or pericardial effusion.  There is 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 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.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys 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 circumaortic left renal vein.  There are\ntwo renal veins on the right.\n\nGASTROINTESTINAL: The stomach is unremarkable, not well assessed on CT.  There\nis no small bowel obstruction.  There is prominent fat stranding surrounding a\ndiverticulum in the distal descending colon (2:62, 601:26).  There other\nscattered diverticula.  There is no evidence of abscess.  There is no free\nair.  The patient is status post appendectomy.  There is no ascites.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: Mild calcification is seen associated with the seminal\nvessels which can be seen in the setting of diabetes.\n\nLYMPH NODES: Scattered but prominent mesenteric lymph nodes are not enlarged\nby CT size criteria and are likely reactive in etiology.\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: There is no acute fracture.  An 8 mm sclerotic lesion in the T11\nvertebral body likely represents a bone island\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "Acute uncomplicated diverticulitis involving the distal descending 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 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 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. Scattered colonic\ndiverticulosis predominantly involving the descending and sigmoid colon is\nnoted, without evidence of wall thickening or fat stranding. 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 unremarkable.\n\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. \nSmall foci of air is seen in anterior to the left sacroiliac joint, likely\nrelated to the joint.  Small 7 mm sclerotic focus in the T11 vertebral body\n(602:75) with seen previously and likely represents a bone island.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. No acute abdominopelvic process.  No CT findings of acute traumatic injury\nin the abdomen or pelvis.\n2. Colonic diverticulosis without evidence of acute diverticulitis."
        },
        {
            "input": "Lower Thorax: There is a focus of atelectasis in the left lower lobe.There is\nno cardiomegaly.\n\nPeritoneal Cavity: There is a small amount of pneumoperitoneum likely related\nto recent procedure.  There is a mild to moderate amount of ascites with no\nfocal rim enhancing collection to suggest intra-abdominal abscess.\n\nLiver: The liver is mildly nodular in contour in keeping with known cirrhosis.\n\nGallbladder and Biliary System: There is mild pericholecystic fluid or\ngallbladder wall thickening with no gallbladder wall distention, likely\nrelated to known chronic liver disease.There is no significant intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in size with no focal lesion, ductal\ndilatation or calcifications.\n\nSpleen: There is splenomegaly up to 18.4 cm with no focal splenic lesion.\n\nKidneys and Adrenals: There is a 10 mm hypodensity in the upper pole of the\nright kidney that is too small to characterize but may represent a small\ncyst.The kidneys and adrenal glands are otherwise normal bilaterally.\n\nBowel: There is a gastrostomy tube in the antrum of the stomach with small\nadjacent foci of air and no contrast leakage. In the left lower quadrant there\nis a fistulous tract extending from small bowel towards a skin communication\nin the left lateral abdominal wall representing the known enterocutaneous\nfistula. There is colonic diverticulosis and no evidence of bowel obstruction.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: There are splenic varices and recanalization of the paraumbilical\nvein in keeping with known cirrhosis and portal hypertension.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.",
            "output": "1. Status post PEG tube insertion with expected minimal pneumoperitoneum and\nno focal collection or contrast leak.\n2.  Cirrhotic liver with splenomegaly and varices related to portal\nhypertension.\n3.  Known enterocutaneous fistula in the left lower quadrant.\n4. Atelectasis in the left lower lobe."
        },
        {
            "input": "LOWER CHEST: Interstitial changes at the peripheral basilar lung bases may be\nrelated atelectasis or early interstitial lung disease.  There is no evidence\nof pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. \nSeveral hypodensities up to a 1.3 cm sub hepatic hypodensity is stable since\n___ and likely represents a simple cyst or 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 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.  A\ncortical renal hypodensity measuring 0.7 cm (series 2, image 66) stable since\n___ and well too small to characterize by CT likely represents a simple cyst.\nThere 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.\n\nPELVIS: Numerous millimetric stones are seen layering along the anterior\nbladder, without evidence of obstruction (series 601, image 24a).  A\ncalcification along the posterior bladder wall which is distant from the\ninsertion of the ureters is noted (series 2, image 135).  The distal ureters\nare normal caliber.  No free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is notably 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. \nModerate to severe degenerative changes throughout the lumbar spine are noted,\nwithout significant interval change from ___.  Along the anterolateral right\ntenth rib there are 2 sclerotic foci which are stable from the prior study and\nlikely represent bone islands (series 602 image 19).  Significant degenerative\nchanges at the hips.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.",
            "output": "1. Numerous layering stones within the urinary bladder measuring up to 3 mm\nwithout signs of obstruction.  No hydronephrosis, no nephrolithiasis.\n2. No acute findings within the abdomen or pelvis."
        },
        {
            "input": "LOWER CHEST: There are small bilateral pleural effusions with subjacent\natelectasis.  Lingular and right middle lobe consolidations likely reflect\nadditional areas of atelectasis.  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 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.  Punctate\nhyperdensities within the spleen may represent a sequelae 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.  There is no suspicious\nrenal lesions within the limitations of an unenhanced scan. Trace simple free\nfluid is seen adjacent to the left kidney tracking down the retroperitoneum\ninto the pelvis.  There is no hydronephrosis.  There is no nephrolithiasis.\nThere is no perinephric abnormality.\n\nGASTROINTESTINAL: There is a small hiatal hernia.  An enteric tube is seen\nterminating in the stomach.  Small bowel loops demonstrate normal caliber and\nwall thickness 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\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.  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 posterior decompression and fusion extending\nfrom L1 to S1. An anterior screw in the L4-5 disc space is seen abutting the\nleft common iliac vessels without evidence of surrounding hematoma (2; 67). \nDegenerative changes are seen in the visualized thoracolumbar spine.  Anterior\nright fifth through eighth and left fourth through eighth rib fractures are\nseen.  Hyperdense material is seen layering along the right psoas, likely\nsecondary to recent procedure.\n\nSOFT TISSUES: A 12.4 x 2.6 x 15.3 cm fluid collection is seen along the left\nanterior abdominal wall likely representing a seroma.  An umbilical hernia\ncontaining fat is noted.",
            "output": "1. No evidence of retroperitoneal or intraperitoneal hematoma.  Trace free\nfluid within the retroperitoneum may be postsurgical.\n2. 15.3 cm anterior abdominal wall seroma.\n3. Bilateral small pleural effusions.\n4. Bilateral minimally displaced anterior rib fractures."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar dependent atelectasis.  No pleural\neffusions.  Mild cardiomegaly.  Partially imaged small pericardial effusion\nappears grossly similar to ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is diffusely hypoattenuating relative to the spleen,\nsuggestive of fatty infiltration (2:21).  There is no evidence of focal\nlesions.  There is no evidence of intrahepatic or extrahepatic biliary\ndilatation.  There is cholelithiasis.  Air within the gallbladder and CBD are\nlikely a result of recent sphincterotomy.  Portal venous system 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. \nNo hydronephrosis.  Tiny hypodensity in the interpolar region of the right\nkidney is too small to characterize, but statistically likely represents a\ncyst (2:41).  No parenchymal lesions are identified on the left.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  Apparent wall\nthickening of the descending and sigmoid colon are likely due to under\ndistention (2:46,77).  Colon and rectum are otherwise unremarkable.  The\nappendix is not visualized.\n\nSince the prior study performed on ___, there has been interval\nplacement of a pigtail catheter into a retroperitoneal fluid collection.  The\nsuperior aspect of the fluid collection located adjacent to the pancreatic\nhead/second part of the duodenum has decreased in size from 4.0 x 2.3 cm to\n3.4 x 2.1 cm on the current study (2:36).  More inferiorly shortly after the\ncatheter enters the peritoneal cavity, the collection has also decreased from\n5.8 x 2.6 cm to 4.3 x 1.4 cm (2:54).\n\nHowever, remainder of the multiloculated fluid collections in the right\nperirenal space are not significantly changed in size.  For instance, the\nfluid measures approximately 6.3 x 1.2 cm TV x AP anterior to the right kidney\n(2:40), and 3.8 x 1.9 cm posteriorly (2:42), which are similar to prior. \nDegree of surrounding rim enhancement is unchanged.\n\nFree fluid in the abdomen and pelvis that was noted on the prior study has\nessentially resolved.  There is a fluid collection adjacent to the left adnexa\nthat now appears newly organized, measuring 3.7 x 1.9 cm (2:73), may represent\nwalled-off ascites.  A crescent-shaped fluid collection abutting the posterior\nuterine wall is slightly smaller (2:74).\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.\n\nREPRODUCTIVE ORGANS: Uterus is unremarkable in appearance.  Hypodensity in the\nregion of the endometrial canal is nonspecific in a premenopausal woman, and\nmay represent hemorrhagic products.\n\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: Subcutaneous soft tissue nodule in the right gluteal region may\nrepresent an injection granuloma (2:86).  Abdominal and pelvic wall is\notherwise within normal limits.",
            "output": "1. Interval placement of a pigtail catheter, with resulting decrease in size\nof the retroperitoneal fluid collection along its course.\n2. However, remainder of the small multiloculated perirenal fluid collections\non the right are unchanged in size.\n3. Within the pelvis, a new 3.7 x 1.9 cm organized collection in the region of\nthe left adnexa could represent walled-off ascites.  Fluid collection along\nthe posterior uterine wall has decreased.\n4. Fatty infiltration of the liver.\n5. Trace pericardial effusion, grossly unchanged."
        },
        {
            "input": "LOWER CHEST: There is a focal area of bronchiectasis in the middle lobe of the\nright lung (series 2 image 1).  The remainder of the visualized lung fields\nare within normal limits.  There is no evidence of pleural or pericardial\neffusion.\nABDOMEN:\n\nHEPATOBILIARY: There are several hypoattenuating lesions in both lobes of the\nliver that have the appearance of cysts.  The largest is a segment 4A/4B cyst\nmeasuring 3.6 cm.  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 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.  There is\nextensive but uncomplicated sigmoid diverticulosis.  The remainder of the\ncolon and rectum are within normal limits.\n\nPELVIS: There are there are 2 bladder calculi.  There is mild generalized\nthickening of the bladder most likely secondary to chronic bladder outflow\nobstruction.  There is no free fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The prostate is markedly enlarged, measuring 6.5 cm in\ntransverse diameter..  There are prominent vascular structures along the\nspermatic cord most likely represent large varicoceles.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.\n\nVASCULAR: 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 lumbar spine with loss of disc space\nheight and formation of osteophytes.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.  No\ninguinal hernia.",
            "output": "1. There is no evidence of an inguinal hernia but there are prominent vascular\nstructures along the spermatic cord most likely representing large\nvaricoceles.\n2. Gross prostatomegaly.\n3. Bladder calculi and mild generalized bladder wall thickening most likely\nsequelae of chronic bladder outflow obstruction.\n4. Uncomplicated sigmoid diverticulosis.\n5. Multiple hepatic cysts."
        },
        {
            "input": "CHEST: The visualized lung bases are clear.  There is no pleural or\npericardial effusion. Considerable coronary artery calcifications are\npartially imaged. The heart is normal in size.\n\nABDOMEN:\nThe liver is normal in attenuation with no focal lesions.  There is marked\natrophy of the left lobe of the liver, versus hepatectomy.  The gallbladder is\nnormal with no radio-opaque gallstones.  The pancreas is normal with no\nperipancreatic fat stranding or fluid collections.  The spleen is normal in\nsize and homogeneous in attenuation.  The adrenal glands are normal in size\nand morphology. The kidneys enhance symmetrically and display prompt contrast\nexcretion with no focal lesions, hydronephrosis, or radio-opaque stones.\n\nThe distal esophagus and stomach are normal. The small and large bowel are\nnormal in caliber with no wall thickening. The appendix isnormal (2:52). \nThere is no intraabdominal free air or free fluid.\n\nOf note, there is mild haziness within the mesentery associated with mildly\nprominent but subcentimeter prominent mesenteric lymph nodes (02:36-43)\nconsistent with mesenteric panniculitis.  This has increased over ___ years,\nalthough already present before, and is a common incidental finding which is\nrarely significant clinically.\n\nPELVIS: The distal ureters and urinary bladder are normal.  The prostate is\nmildly enlarged and seminal vesicles are unremarkable.  There is no pelvic\nside-wall or inguinal lymphadenopathy by CT size criteria. No free pelvic\nfluid is identified.\n\nVESSELS: The aorta is normal in caliber and its major branches are patent. \nThere is significant atherosclerosis at the origin of the celiac axis, SMA,\nand left renal artery, with no post stenotic dilatation.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.  Bilateral sacroiliac joint fusion is noted.  Prior thoracolumbar\nsclerotic changes have resolved for the most part although lateral briding\nosteophytes are more prominent.",
            "output": "1.  No evidence of acute intra-abdominal process.\n\n2.  Waxing and waning endplate sclerotic changes.  This is seen in the setting\nof sacroiliac fusion and large bridging osteophytes.  Most likely the\nappearance is due to degenerative changes superimposed on a background of\nprior inflammatory arthropathy such as reactive or potentially psoriatic\narthritis.  Findings are not typical for ankylosing spondylitis.\n\n3.  SMA atherosclerosis seen as mixed plaque with degree of stenosis difficult\nto discern, but possibly mild to moderate, but new over ___ years.  No\nassociate bowel abnormalities identified.  If chronic vascular insufficiency\nis suspected clinically then CT or MR angiography could be considered in\nfollow-up."
        },
        {
            "input": "The examination is limited secondary to the lack of intravenous contrast.\n\nCHEST:  Limited assessment of the lung bases are clear.  No pleural effusion\nor large pneumothorax. The visualized heart is normal in size without\npericardial effusion.\n\nABDOMEN:\n\nThe liver is homogeneous and without gross focal lesion. The gallbladder is\nnormal without calcified gallstones.\n\nThe spleen is normal. There is pancreas divisum with the main pancreatic duct\nappearing mildly dilated measuring up to 5 mm.  No peripancreatic stranding or\nfluid collection is noted.\n\nThe adrenal glands are unremarkable.The kidneys are symmetric in size. No\nfocal renal lesions. No hydronephrosis or hydroureter identified. No renal or\nproximal ureter calculi.\n\nThe distal esophagus is normal without hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small bowel is normal in caliber without wall\nthickening. The large bowel is normal in caliber without wall thickening, fat\nstranding, or focal mass lesion. The appendix is visualized in the right lower\nquadrant and appears normal..\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation.  Small\namount of atherosclerotic calcification noted. The iliac arteries are normal\nin course and caliber.\n\nNo retroperitoneal or mesenteric lymph node enlargement by CT size criteria.\nNo free abdominal fluid, abdominal wall hernia, or pneumoperitoneum.\n\nSoft tissues:  There is minimal fat stranding in the anterior abdominal wall\nsoft tissues (series 2, image 25).\n\nPELVIS: The bladder is well distended and normal. No pelvic side-wall or\ninguinal lymph node enlargement by CT size criteria. No free pelvic fluid\nseen.\n\nOSSEOUS STRUCTURES: No fracture identified.  Degenerative changes are most\npronounced at the L5-S1 level with intervertebral disc vacuum phenomenon. No\nfocal lytic or sclerotic lesion concerning for malignancy.",
            "output": "1. Fat stranding in the anterior abdominal wall may be posttraumatic and\nclinical correlation is recommended.\n2. Pancreas divisum with mild dilatation of the main pancreatic duct.\n\nRECOMMENDATION(S):  Dedicated MRCP is recommended on a non-urgent basis for\nfurther evaluation of the main pancreatic duct dilatation.\n\nNOTIFICATION:   The findings, recommendations and updates to the wet read were\ndiscussed by Dr. ___ with Dr. ___ on the telephone on ___ at\n9:39 ___, 10 minutes after discovery of the findings."
        },
        {
            "input": "CHEST: The visualized lung bases are clear. The heart is normal in size and\nthere is no evidence of pericardial effusion.\n\nABDOMEN:\n\nThe liver enhances homogeneously. There are a few scattered subcentimeter\nhypodensities within the liver, which are too small to characterize. The\nportal venous system is patent. There is no evidence of intrahepatic or\nextrahepatic biliary dilatation. The gallbladder is normal and without\ngallstones.\n\nThe spleen and adrenal glands are unremarkable.  The pancreas enhances\nhomogenously and is without focal lesions.\n\nThe kidneys display symmetric nephrograms and excretion of contrast. There are\nno focal renal lesions. There is no hydronephrosis. The ureters are normal in\ncaliber and course to the bladder.\n\nThe distal esophagus is normal without a hiatal hernia. The stomach is grossly\nunremarkable in appearance. The small and large bowel are normal in caliber\nand without evidence of wall thickening.  A candidate structure for the\nappendix is seen in the right lower quadrant (601b:20) with no surrounding\ninflammatory changes.\n\nThe abdominal aorta and its major branches are patent . The aorta and iliac\nbranches are normal in course and caliber. There is no retroperitoneal or\nmesenteric lymphadenopathy by CT size criteria. There is no free abdominal\nfluid or pneumoperitoneum.\n\nPELVIS:\n\nThe bladder is well distended and normal.  There is no pelvic side-wall or\ninguinal lymphadenopathy by CT size criteria. No free pelvic fluid is\nidentified. Right-sided hydrosalpinx has increased since ___ (02:57).\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1. No acute intra-abdominal process.\n2. Right hydrosalpinx has increased in size from prior ultrasound in ___, and\na pelvic ultrasound can be obtained for further assessment."
        },
        {
            "input": "CHEST: The visualized lung bases demonstrate a small left pleural effusion and\nbibasilar atelectasis. The lungs are otherwise clear. The heart is moderately\nenlarged with a small amount of pericardial fluid.\n\nABDOMEN:\nEvaluation of the intra-abdominal solid organs is limited by lack of\nintravenous contrast. The liver and gallbladder are normal appearing. The\nspleen is top normal in size. The pancreas is normal in attenuation. The\nadrenal glands are normal bilaterally. The left kidney is enlarged with\nsignificant amount of perinephric stranding, but no hydronephrosis. At the\nlower pole of left kidney there is a nonobstructive renal calculus measuring 5\nmm. The ureter demonstrates periureteral stranding and there is a 4 mm stone\nat the left UPJ. Calcified density in the mid to distal ureter (02:53) may\nrepresent a second ureteral calculus, measuring 2 mm. The stomach and small\nbowel are normal in caliber. The large bowel contains a considerable amount of\nstool, particularly in the rectum. There is no intra-abdominal free air or\nfree fluid.\n\nPELVIS: The urinary bladder is decompressed and contains a Foley catheter. \nThe uterus and adnexae are unremarkable.  There is no pelvic free fluid or\nlymphadenopathy. Large amount of stool in the rectum appears impacted.\n\nVESSELS: The aorta demonstrates considerable atherosclerotic calcification\nwithout aneurysmal dilatation.\n\nOSSEOUS STRUCTURES: Bones are diffusely demineralized. There is grade 1\nanterolisthesis of L3 on L4 and L4 on L5. There is grade 1 retrolisthesis of\nL5 on S1. Compression deformity of the superior endplate of the L2 vertebral\nbody is of uncertain chronicity. No retropulsed fragments are seen in the\nspinal canal, however there is considerable disk osteophyte complex at the\nL1-L2 level resulting in moderate canal stenosis at this level.",
            "output": "1.  Multiple left-sided nephroureteral calculi, with considerable perinephric\nand periureteral stranding compatible with upper urinary tract infection. 4 mm\nleft UPJ stone does not appear obstructive, as there is no hydronephrosis.\nNonobstructive 5 mm lower pole left renal calculus is noted.\n2. Compression deformity of the L2 vertebral body appears chronic.\nMalalignment in lower lumbar spine as noted related to spondylolysis.\n3. Moderate cardiomegaly with a small amount of pericardial fluid, and a small\nleft pleural effusion.\n4. Probable rectal fecal impaction"
        },
        {
            "input": "LOWER 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 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 has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.  There is no peripancreatic\nstranding.\n\nSPLEEN: The spleen shows normal size and attenuation throughout, without\nevidence of focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of 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 nasogastric tube in place.  Again seen is left\nperiumbilical incisional hernia with a 4.2 cm neck (series 2, image 85)\ncontaining multiple loops of small bowel with upstream small bowel dilatation\nmeasuring up to 3.4 cm slightly improved from prior exam.  The oral contrast\nmaterial has passed through the trapped loops of small-bowel extending to the\ntransverse colon.  There is no evidence of strangulation or ischemia.  There\nis no pneumoperitoneum.\n\nPELVIS: The urinary bladder and distal ureters are unremarkable.  There is no\nfree fluid in the pelvis.\n\nREPRODUCTIVE ORGANS: The endometrium is thickhead measuring 0.9 cm as noted on\npelvic ultrasound dated ___.  There is right hydrosalpinx as seen\non 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.  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: In addition to aforementioned left periumbilical incisional\nhernia there is a smaller right ventral abdominal wall hernia containing\nmesenteric fat with aperture measuring 15 mm (series 2, image 73) similar to\nprior exam.",
            "output": "1. Left periumbilical incisional hernia with a 4.2 cm neck containing loops of\nsmall bowel with interval slight improvement of upstream small bowel\ndilatation.  The oral contrast material has passed through the trapped loops\nof small-bowel in the incisional hernia, however, given the continued upstream\ndilation, there appears to be an element of persisting partial obstruction.\n2. Thickened endometrium measures 0.9 cm as noted on pelvic ultrasound dated ___.  Please correlate with prior endometrial biopsy.\n3. Unchanged right hydrosalpinx.\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 homogenous attenuation throughout. \nThere is diffuse 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 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. 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: A right-sided adnexal cystic lesion previously\ncharacterized as a hydrosalpinx on ultrasound measures 8.5 x 7 cm compared\nwith 8 x 5.2 cm on the 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 no evidence of worrisome osseous lesions or acute fracture.\n\nSOFT TISSUES: The abdominal and pelvic wall is within normal limits.\nThere is a large paraumbilical hernia to the left of the umbilicus with\nherniation of multiple loops of unobstructed small bowel and mesenteric fat\nthrough a 6 x 5 cm defect in the anterior abdominal wall.  The hernial sac\nmeasures approximately 6 x 8 cm in cross-section and 12.5 cm longitudinally\nwith the sac extending caudally in the anterior abdominal wall.\n\nAt least 4 other hernias are seen in the upper abdomen/epigastric region with\nherniation of mesenteric fat only through small defects.  These are seen on\nseries 5 image 57 (right paramedian epigastric region), 68 (midline), 72  (\nright-side), 75 (left side).",
            "output": "1. No evidence of recurrence of lymphoma.\n2. Multiple anterior abdominal wall hernias.  The largest hernia contains\nmultiple loops of non-obstructed small bowel while other smaller hernias\ncontaining mesenteric fat only.\n3. Right adnexa lesion previously characterized as a right hydrosalpinx is\nslightly larger in size.\n4. Diffuse hepatic steatosis."
        },
        {
            "input": "LOWER CHEST: Bibasilar atelectasis.  There is no evidence of pleural or\npericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post hepatic transplant.  The liver\ndemonstrates homogenous attenuation throughout.  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 is mildly atrophic, without evidence of focal lesions\nor pancreatic ductal dilatation.  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14 cm and shows 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 right upper pole.  A subcentimeter hypodensity arising from the right\nlower pole is too small to characterize, but is likely simple cyst.  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. Submucosal fat is\nseen in the sigmoid colon, consistent with the patient's diagnosis of Crohn's\ndisease.  There is lipomatosis of the ileocecal valve.  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 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.  There is suboptimal evaluation of the hepatic arterial vasculature\non this non angiogram study.  The transplant main hepatic artery appears to\narise from the SMA and is patent to level of the hilum.\n\nBONES: Bones are osteopenic.  There is no evidence of worrisome osseous\nlesions or acute fracture.  Schmorl's nodes are seen along the superior\nendplates T12 and L1.  There is a chronic/healed right L2 transverse process\nfracture.\n\nSOFT TISSUES: An umbilical hernia containing fat is noted.",
            "output": "1. No acute intra-abdominal process.\n2. Unremarkable appearance of the liver transplant.  The transplant main\nhepatic artery appears patent to level of the liver hilum.  Suboptimal\nevaluation of the hepatic arterial vasculature on this non dedicated study.\n3. Splenomegaly."
        },
        {
            "input": "VASCULAR:\n\nThe main hepatic artery arises from the SMA and is widely patent.  The left\nand right hepatic arteries are relatively small caliber but appear similar to\nprior CTA chest from ___.  There is no evidence of focal stenosis. \nThere is stable postsurgical change along the course of the main hepatic\nartery.\n\nMajor portal and hepatic veins are patent.  The celiac and SMA are widely\npatent.  There is mild atherosclerotic plaque in the visualized abdominal\naorta.\n\nLOWER CHEST: There is mild scarring at the left lung base.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout and\nshows normal enhancement on all phases.  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 demonstrates normal attenuation throughout.  A 13 x 8\nmm cystic lesion in the pancreatic head (303:55) is unchanged from MRCP ___ and likely represents a side-branch IPMN.  There is no main duct\ndilation.\n\nSPLEEN: This plane is mildly enlarged at 14.8 cm in the sagittal plane.  The\nparenchyma enhances homogeneously.\n\nADRENALS: The bilateral adrenals are unremarkable.\n\nURINARY: There is mild cortical scarring in the right kidney.  Adjacent\npunctate calcifications could represent stones or parenchymal calcifications. \nThere are multiple small cortical hypodensities in the right kidney,\nincompletely characterized but likely cysts.  There is no hydronephrosis.\n\nGASTROINTESTINAL: Visualized bowel is grossly unremarkable.  No ascites in the\nfield of view.\n\nLYMPH NODES: A 1 cm upper abdominal node is stable from ___ (303:28).  No new\nenlarged nodes.\n\nBONES: There is stable mild anterior wedge compression deformity of T12 and\nL1.  Nonacute right L1-L3 transverse process fractures are again noted.  No\naggressive bone lesions.\n\nSOFT TISSUES: The abdominal wall is within normal limits aside from a tiny fat\ncontaining periumbilical hernia.",
            "output": "1. Main, left and right hepatic arteries are patent and appear similar to CTA\nfrom ___ with no evidence of focal stenosis.\n2. Stable pancreatic cystic lesion is likely a side-branch IPMN and can be\nre-evaluated at next follow-up."
        },
        {
            "input": "CHEST: The visualized lung bases demonstrate dependent bibasilar atelectasis,\nbut no large consolidation or pleural effusion. The heart is normal in caliber\nand there is no pericardial effusion.\n\nABDOMEN:\nThe transplanted liver is normal in attenuation with no focal lesions. The\nportal vein is patent. The gallbladder is surgically absent. The common bile\nduct is normal in caliber, and contains a punctate hyperdensity which may\nrepresent a common bile duct stone, which is nonobstructive. The pancreas\nmildly atrophic, but with no peripancreatic stranding. The spleen is enlarged,\nmeasuring 18 cm. The adrenal glands are normal in size and morphology. The\nkidneys enhance symmetrically and display normal contrast excretion. Again\ndemonstrated is a focal area of scarring at the lower pole of the right\nkidney. There is no evidence of hydronephrosis.\n\nA small hiatal hernia is seen of the distal esophagus. The stomach and small\nbowel are normal in caliber with no evidence of obstruction. Large bowel is\nfilled with stool and air, with no evidence of wall thickening.  The appendix\nisnot clearly seen, however there are no secondary signs for appendicitis.\nThere is no retroperitoneal or mesenteric lymphadenopathy by CT size criteria.\nThere is no intraabdominal free air or free fluid.\n\nPELVIS: The distal ureters and urinary bladder are normal. The prostate and\nseminal vesicles are unremarkable. There is no pelvic side-wall or inguinal\nlymphadenopathy by CT size criteria. No free pelvic fluid is identified.\n\nVESSELS: The aorta demonstrates mixed calcified and noncalcified\natherosclerotic calcification, without aneurysmal dilatation and its major\nbranches are patent.\n\nOSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for\nmalignancy.",
            "output": "1.  Status post liver transplant with normal appearance of the post transplant\nliver.\n2.  Stable splenomegaly.\n3. Unchanged focal right lower pole renal cortical scarring.\n4.  No evidence of colitis.\n5. Non obstructive common bile duct stone."
        },
        {
            "input": "LOWER CHEST: There is mild bibasilar atelectasis.\n\nABDOMEN:\n\nHEPATOBILIARY: The patient is status post liver transplant.  The transplant is\nunremarkable in appearance.  The portal vein is patent.  There is no evidence\nof focal lesions.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  A punctate calcification is seen adjacent to the distal\ncommon bile duct, unchanged since prior examination.  The gallbladder is\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 is prominent, measuring up to 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.  There is\nstable focal scarring in 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.  The rectum and\ndistal colon are decompressed.  The appendix is not definitively visualized,\nhowever, there is no evidence of appendicitis.\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 diverticulosis or diverticulitis.\n2. Status post liver transplant with normal appearance of the transplanted\nliver.\n3. Stable splenomegaly."
        },
        {
            "input": "VASCULAR:\n\nPatent abdominopelvic vasculature.  Please refer to separately dictated CT\ntorso report from the same day for full description of vascular findings.\n\nLOWER CHEST: Partially imaged small bilateral pleural effusions with\nassociated compressive atelectasis.  Otherwise, please refer to the separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates decreased attenuation throughout.  There\nis a 1.3 cm segment 7 peripherally arterially enhancing lesion likely\nrepresenting a hemangioma (04:13).  There is a tiny hypodensity at the liver\ntip in segment 6 with punctate calcifications which may dropped gallstones or\ncalcified granulomas.  Otherwise, there is no evidence of focal lesions. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation.  The\ngallbladder is is resected.  There is a millimetric soft tissue nodule in the\nperihepatic abdominal fat and adjacent to segment 6 which is nonspecific,\nindeterminate in likely of no clinical significance (4:68).\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 9 mm calcified granuloma in the spleen.  Otherwise, the\nspleen shows normal size and attenuation throughout, without evidence of\nsuspicious focal lesions.\n\nADRENALS: The right and left adrenal glands are normal in size and shape.\n\nURINARY: There is mild cortical renal scarring bilaterally.  Otherwise, the\nkidneys are of normal and symmetric size with normal nephrogram.  There is a\nsmall simple cyst in the upper pole of the left kidney.  There is no evidence\nof stones, solid renal lesions, or hydronephrosis. There are no urothelial\nlesions in 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. Colonic\ndiverticulosis without evidence of acute diverticulitis.  The rectum is within\nnormal 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 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: There are soft tissue nodules in the right anterior abdominal\nwall, likely from injections (4:64).  Otherwise, the abdominal and pelvic wall\nis within normal limits.",
            "output": "1. No acute abdominopelvic process.\n2. 1.3 cm right hepatic lobe lesion likely representing a hemangioma.\n3. Hepatic steatosis.\n4. Partially imaged small bilateral pleural effusions with associated\ncompressive atelectasis.  Otherwise, please refer to separately dictated CT\ntorso report from the same day for full description of vascular findings.\n5. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings."
        },
        {
            "input": "There is no evidence of fracture or dislocation.  There is mild to moderate\nbilateral femoroacetabular joint degenerative change.  There is no symphysis\npubis or sacroiliac joints diastasis.  Mild lumbosacral spine degenerative\nchanges noted.  Grade 1 L4-5 anterolisthesis is likely degenerative.  No focal\nlytic or sclerotic osseous lesions are seen.\n\nEnlargement of the right vastus lateralis and rectus femoris muscular\ncompartments is suggestive of proximal right anterior thigh intramuscular\nhematoma.  There is diffuse soft tissue subcutaneous edema.  A moderate to\nseverely calcified infrarenal abdominal aorta and mildly ectatic, tortuous\niliac arterial vasculature is demonstrated. Otherwise, the imaged soft tissues\nand intra-abdominal and intrapelvic solid and hollow viscous organs are\nunremarkable.  There is mild diffuse subcutaneous soft tissue edema,\npredominantly dependent in nature.",
            "output": "1. No evidence of fracture or dislocation.\n2. Intramuscular hematoma (that is too diffuse to measure) involving the\nanterior right thigh flexor musculature, likely the vastus lateralis and\nrectus femoris.\n3. Mild to moderate bilateral femoroacetabular joint and lumbosacral spine\ndegenerative change, as above."
        },
        {
            "input": "Lung Bases: The imaged lung bases are clear.  The imaged portion of the heart\nis notable for mitral annular calcification.  Partially imaged heart appears\nnormal in size.\n\nAbdomen: The liver contains a subtle hypodensity within segment 4B best seen\non series 2, image 21 measuring approximately 10 x 10 mm, similar to that on\nprior.  Please correlate with result from prior MRI report.  Main portal vein\nis patent.  No biliary ductal dilation.  Gallbladder is normal.  Spleen is\nnormal.  Adrenals are normal.  Pancreas is normal.  Kidneys enhance\nsymmetrically.  The abdominal aorta is mildly calcified and normal in caliber.\nNo retroperitoneal lymphadenopathy.  Stomach is normal.  A periampullary\nduodenal diverticulum noted.  Duodenum otherwise unremarkable.\n\nPelvis: Proximal small bowel is decompressed.  There is progressive dilation\nof bowel loops which can be traced to the point of abrupt caliber transition\nin the right lower quadrant which is best seen on series 601, image 24 and 25.\nJust distal to the transition point, the decompressed bowel appears to take a\nposterior course behind the small bowel mesentery, series 2, image 51 and then\ntakes a hairpin turn into the right lower quadrant, series 2, image 57.  The\nanatomy is distorted in this region in the possibility of an internal hernia\nis raised.  There is mesenteric congestion involving bowel just proximal to\nthe abrupt transition point.  Distal small bowel is entirely decompressed. \nDistal to this point there is an enteroenteric anastomosis which appears\npatent.  The appendix is normal.  The colon contains a minimal fecal load is\nmostly there is a small amount of free fluid in the left lower quadrant,\nseries 601, image 27..  No free air.  Urinary bladder is decompressed around a\nFoley catheter.  Suture at the level of the rectum indicates prior site of\nLAR.  No pelvic sidewall or inguinal adenopathy.\n\nBones: No worrisome lytic or blastic osseous lesion is seen.",
            "output": "High-grade small-bowel obstruction with abrupt transition point in the right\nlower quadrant.  Possible internal hernia, as described above.  Small volume\nfree fluid and mesenteric edema as described.\n\nNOTIFICATION:  Findings were discussed with Medical ___ the time\nof initial review."
        },
        {
            "input": "LOWER CHEST: Posterior bibasilar consolidation with air bronchograms is\nworrisome for aspiration/pneumonia.  There is mild cardiomegaly.  There is no\nevidence of pleural or pericardial effusion.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver demonstrates diffusely decreased homogenous\nattenuation throughout.  There is hepatomegaly.  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.\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, measuring 12.2 cm in AP diameter.  There is\nnormal 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: Enteric tube descends into the body of the stomach.  There\nis a large amount of ingested material throughout the decompressed stomach. \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.\n\nPELVIS: The urinary bladder is decompressed about a Foley catheter.  Small\nfocus of intraluminal air is likely secondary to catheterization.  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.  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. Bibasilar pulmonary consolidations worrisome for aspiration/pneumonia.\n2. No evidence of acute cholecystitis.\n3. Hepatomegaly with diffuse decrease in parenchymal attenuation could suggest\nsteatosis or acute hepatitis."
        },
        {
            "input": "LOWER 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 in contour compatible with\ncirrhosis.  There is no evidence of focal lesions on this contrast enhanced\nstudy, however evaluation for HCC is limited as this is not a dedicated\ntriphasic liver study.  There is no evidence of intrahepatic or extrahepatic\nbiliary dilatation.  The gallbladder is under distended.  There is large\nvolume ascites.\n\nPANCREAS: The pancreas is atrophic.  Multiple hypodensities in the pancreas\nmeasuring up to 1.8 cm (601:36), likely side branch IPMNs, better evaluated on\nMR from ___. there is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14.3 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. \nMultiple bilateral renal cysts the largest in the left kidney measuring 5.3\ncm.  Multiple subcentimeter hypodensities are seen in bilateral kidneys, too\nsmall to characterize, likely simple cysts.  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 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 portal vein is patent.  Splenic and gastric varices are noted. \nThere is no abdominal aortic aneurysm.  Mild atherosclerotic disease is noted.\n\nBONES: Bilateral rounded lucencies the anterosuperior aspect of the femoral\nnecks compatible with synovial herniation pits.  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. Cirrhotic liver without focal liver lesions.  Evaluation for ___ is limited\non this portal venous phase contrast-enhanced study.  Recommend further\nevaluation a dedicated liver CT which includes the noncontrast, arterial, and\n3 minutes delayed phases.  The portal venous phase does not need to be\nrepeated.\n2. Large volume ascites, splenomegaly, and portosystemic varices compatible\nwith sequela of portal hypertension.\n3. Multiple pancreatic cystic lesions better evaluated on MR, likely represent\nside branch IPMNs.  Recommend attention on follow-up imaging.\n4. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings.\n\nRECOMMENDATION(S):  Evaluation for HCC is limited on this portal venous phase\ncontrast-enhanced study. Recommend further evaluation a dedicated liver CT\nwhich includes the noncontrast, arterial, and 3 minute delayed phases. The\nportal venous phase does not need to be repeated.\n\nNOTIFICATION:   The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 2:39 pm, 15 minutes after\ndiscovery of the findings."
        },
        {
            "input": "LOWER CHEST: Interval increase in bibasilar dependent consolidations, possibly\nreflecting pneumonia particularly within the lingula and left lower lobe.  The\nascending aorta measures up to 4.4 cm, previously characterized on the CT\nchest dated ___.\n\nABDOMEN:\n\nHEPATOBILIARY: The liver is shrunken and nodular in contour compatible with\ncirrhosis.  No evidence of focal lesions on this single-phase study.  No intra\nor extrahepatic biliary ductal dilatation.  The gallbladder is collapsed.\n\nPANCREAS: The pancreas has normal attenuation throughout.  Multiple\nhypodensities are again seen measuring up to 1.5 cm in the pancreatic head\nregion (06:30).  There is no peripancreatic stranding.\n\nSPLEEN: The spleen is enlarged measuring 14.4 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.  Multiple bilateral\ncysts are unchanged measuring up to 5.3 cm in the left kidney.  Other\nhypodensities are too small to characterize.  No hydronephrosis or perinephric\nabnormality.\n\nGASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate\nnormal caliber, wall thickness, and enhancement throughout.  A rectal tube is\npresent.  There is a large amount of stool within the rectum and distal\nsigmoid colon.  Air and fluid filled colonic loops are seen throughout\nmeasuring up to 7.4 cm in the transverse colon.  No evidence of\npneumoperitoneum, pneumatosis or mesenteric venous gas.  No abnormal bowel\nwall thickening.\n\nPELVIS: The urinary bladder is decompressed around a Foley catheter.  There is\nsmall to moderate volume ascites, decreased in extent since prior.\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: The TIPS is patent.  The portal vein, SMV and splenic vein are also\npatent.  Multiple varices are present throughout the upper abdomen.  Mild\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. No evidence of perforation.  Air and fluid filled mildly dilated colon.\n2. Patent TIPS\n3. Cirrhosis and findings compatible with portal hypertension.  Interval\ndecrease in extent of abdominopelvic ascites.\n4. Unchanged pancreatic hypodensities, presumably reflecting IPMNs."
        },
        {
            "input": "The patient has apparently undergone TACE and RFA x2 previously at an outside\ninstitution.  Prior imaging is not available for review.\n\nLOWER CHEST: Unremarkable.\n\nABDOMEN:\n\nHEPATOBILIARY:\n\nThe liver demonstrates cirrhotic morphology with lobar redistribution and\nsurface nodularity.  There are multiple small portosystemic collaterals and\nthere is moderate ascites.\n\nThere is a 2.5 x 4.2 cm nonenhancing region in the left lobe, presumably an\nRFA ablation zone.\n\nThere is a 5.7 x 6.2 x 7.3 cm heterogeneously enhancing mass in segment 6 with\nan exophytic component.  This does not show significant arterial\nhyperenhancement and may represent a previously treated lesion, though the\npresence of persistent nodular enhancement suggests residual active tumor.\n\nThere is moderate biliary dilation within segment 8, associated with an\nill-defined region of arterial hyperenhancement measuring approximately 4 cm\n(301:31).  This shows areas of mild delayed phase washout and is concerning\nfor ___.\n\nA 1.3 cm arterially enhancing lesion at the interface of segments 8 and 4A \n(301:23) shows questionable portal venous washout and may represent HCC. \nThere is a similar 1.4 cm lesion in segment 5.  There are numerous additional\nround arterially enhancing lesions throughout the liver, most of which show\nnormalization on the delayed phases and are nonspecific but may represent\ndysplastic nodules.\n\nThe gall bladder is unremarkable aside from cholelithiasis.  There is no\ncentral/extrahepatic biliary dilation.  There are a few mildly prominent porta\nhepatis lymph nodes measuring up to 1 cm, likely benign.\n\nVASCULAR:\n\nThere is conventional hepatic arterial anatomy.  There is normal contrast\nopacification of portal and hepatic veins.  There is moderate calcified plaque\nin the abdominal aorta.  No AAA is demonstrated.  There is mild\natherosclerotic stenosis at the celiac and SMA origins.  The bilateral renal\nartery origins are widely patent.\n\nPANCREAS: The pancreas has normal attenuation throughout, without evidence of\nfocal lesions or pancreatic ductal dilatation.\n\nSPLEEN: The spleen is borderline enlarged at 14 cm in coronal dimension.  Any\nmm hypodensity at the inferior aspect is nonspecific but likely benign\nhemangioma or cyst..\n\nADRENALS: Unremarkable.\n\nURINARY: Both kidneys are unremarkable aside from a few subcentimeter cortical\nhypodensities on the left, incompletely characterized due to size but likely\ncysts.\n\nGASTROINTESTINAL: There is a periumbilical hernia containing ascites fluid and\na loop of fluid filled small bowel, with no evidence of obstruction.  The\nbowel is otherwise grossly unremarkable.\n\nRETROPERITONEUM: There is mild diffuse retroperitoneal stranding.  There is no\nsignificant adenopathy.\n\nPELVIS: Evaluation of the pelvic structures is limited due to metal artifact\nfrom bilateral hip arthroplasties.  The visualized portion of the bladder is\ngrossly unremarkable.\n\nBONES: No aggressive bone lesions.\n\nSOFT TISSUES: Bilateral inguinal hernias, containing fat on the right and\nascites fluid on the left.",
            "output": "1. Cirrhotic liver morphology with findings of portal hypertension.  Moderate\nascites.\n2. Dominant, heterogeneously enhancing mass in segment 6 is likely HCC,\npresumably previously treated.  There is residual nodular enhancement\nsuggesting active tumor.\n3. Ill-defined arterial enhancement in segment 8 associated with localized\nbiliary dilation, incompletely characterized but concerning for HCC.\n4. Numerous arterially enhancing nodular foci throughout the liver, a few of\nwhich demonstrate mild portal venous washout but no definite capsular\nenhancement.\n5. MRI could be considered for further evaluation of the above abnormalities,\nif there is not a recent outside MRI study for review."
        },
        {
            "input": "LOWER CHEST: Visualized lung 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.  Trace perihepatic free fluid noted at\nedge of the left lobe of the liver.  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 enlarged measuring up to 14.8 cm with normal 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 with normal nephrogram. \nThere is no evidence of focal renal lesions 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 sigmoid colectomy.  Scattered colonic diverticula are noted without\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 and bilateral adnexae are within normal\nlimits.\n\nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There\nis no pelvic or inguinal lymphadenopathy.  Multiple surgical clips are\nvisualized throughout the lower abdomen and pelvis may relate to prior\nmesenteric surgery or lymph node dissection and correlation with records of\nprior surgery is recommended\n\nVASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease\nis noted.\n\nBONES: Multilevel degenerative changes are visualized throughout the\nthoracolumbar spine notable for posterior disc bulging at multiple levels in\nthe lumbar spine.  There is no evidence of worrisome osseous lesions or acute\nfracture.\n\nSOFT TISSUES: Patient status post ventral hernia repair with skin defect\noverlying the mid to lower abdomen with peritoneal exposure measuring up to\n14.5 x 16.1 cm with moderate soft tissue thickening along the lateral borders\nof the open wound.  Subcutaneous air tracks superiorly along the right\nhemiabdomen superiorly to the level of the L1-L2 suggesting increasing wound\nextension.  No enterocutaneous fistula is identified.  Of note laxity in the\nlower aspect of the ventral hernia results in protrusion of fat and loops of\nsmall bowel though no entrapment or obstruction is identified.",
            "output": "1. No enterocutaneous fistula or small-bowel obstruction identified.\n2. Open anterior abdominal wall wound measuring up to 14.5 x 16.1 cm with\nmoderate soft tissue thickening along the lateral borders.  Small focus of\nsubcutaneous air tracking along the right superior border suggests increasing\nwound extension."
        }
    ]
}