{
    "Contributors": "MIMIC",
    "Source": "MIMIC-IV",
    "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/",
    "Categories": [
        "Summarization"
    ],
    "Definition": [
        "Summarize the MRI imaging diagnostics' detailed findings for the Chest into a concise conclusion."
    ],
    "Reasoning": [],
    "Input_language": [
        "English"
    ],
    "Output_language": [
        "English"
    ],
    "Instruction_language": [
        "English"
    ],
    "Domains": [
        "Medicine",
        "Clinical Reports",
        "MRI",
        "Chest"
    ],
    "Positive Examples": [],
    "Negative Examples": [],
    "Instances": [
        {
            "input": "LUNGS: The visualized portions of the lungs do not demonstrate any obvious\nmasses, given the limitations of MRI.  There is abnormal right pleural\nthickening which enhances post gadolinium administration, concerning for\nmetastatic disease.  Associated trace right pleural effusion.\n\nVASCULATURE: Visualized portions of the thoracic aorta and pulmonary arteries\nare unremarkable.\n\nHEART AND MEDIASTINUM: There is no lower mediastinal lymphadenopathy.  No\npericardial effusion.\n\nUPPER ABDOMEN: Visualized cuts through the upper abdomen demonstrate few T2\nhyperintense foci in the liver, measuring up to 1 cm in segment 2, likely\ncysts.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: Multiple thoracic vertebral body\nmetastatic lesions are again demonstrated, involving the T2, T3, T6, T10 and\nT12 vertebral bodies.  There is abnormal enhancement extending into the\nposterior right transverse processes and ribs in the mid thoracic spine. \nThere are also foci of abnormal enhancement along the anterior chest wall,\npossibly within the ribs, which are also concerning for metastatic disease.",
            "output": "1.  Re-demonstration of diffuse metastatic bone disease involving multiple\nthoracic vertebral bodies and posterior right ribs.  For comparison of extent\nis difficult, versus prior thoracic spine MRI given differences in planes of\nimaging.\n\n2.  Small of abnormal enhancement within the soft tissues of the right\nanterior and lateral chest wall, possibly within the ribs, which are\nconcerning for metastatic disease.\n\n3.  Right pleural thickening and enhancement with associated trace right\npleural effusion, also concerning for metastatic disease.\n\nRECOMMENDATION(S):  A bone scan is may be considered as clinically indicated\nfor further evaluation of the possible rib metastases if clinically suspicious\nfor progression since bone scan of ___."
        },
        {
            "input": "LUNGS: Within limits of MRI, the lungs are clear.  Please refer to the\ndedicated CT chest from ___ for details.\n\nVASCULATURE: Patient is status post right chest wall infusion port placement\nwith tip at the cavoatrial junction, unchanged from prior exam.  Please note\nthat the evaluation for pulmonary embolism is limited on the current\ntechnique.  The ascending and descending aorta are not dilated.  The pulmonary\nartery appears well opacified centrally.\n\nHEART AND MEDIASTINUM: The heart is normal in size.  There is no pericardial\neffusion.  As previously, again seen is a soft tissue density in the anterior\nmediastinum measuring 1.9 x 4.0 cm.  There is evidence of dropout in signal on\nin and imaging, suggestive of intravoxel fat.  The ratio between in and out of\nphase images when compared to the paraspinal muscles measure 0.86 ___ et\nal.  AJNR ___ Jul;197(1):W15-20).  The enhancement is mostly homogeneous. \nThere is no lymphadenopathy in the mediastinum.\n\nUPPER ABDOMEN: The imaged portion of the upper abdomen is unremarkable.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: The imaged osseous structures and soft\ntissues are within normal limits.",
            "output": "Soft tissue in the anterior mediastinum, most likely representing thymic\nhyperplasia given clinical history and signal characteristics.  No suspicious\nenhancement within the thymus.  No new lymphadenopathy."
        },
        {
            "input": "LUNGS: Within limits of an MRI examination, no significant pulmonary\nabnormality seen.\n\nVASCULATURE: Again seen is a right sided Port-A-Cath with tip in the proximal\nright atrium.  The aorta is normal in caliber.  The main and central pulmonary\narteries are normally opacified.  Please note limitation of MRI for assessment\nof distal pulmonary arterial vessels.\n\nHEART AND MEDIASTINUM: Heart is normal in size.  There is no pericardial\neffusion.  Again seen is the mildly enhancing soft tissue density in the\nanterior superior mediastinum showing evidence of signal dropout on the out of\nphase images measuring approximately 3.5 x 2.0 cm (previously 4.0 x 1.9 cm). \nThe ratio between in and out of phase images compared to the paraspinal\nmuscles measures 0.5, which is in keeping with normal thymus/thymic\nhyperplasia ___ et al ___ AJNR).  No significantly enlarged mediastinal\nlymph nodes seen.\n\nUPPER ABDOMEN: No significant abnormality seen in the visualized upper\nabdomen.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No abnormal marrow signal or soft tissue\nabnormality.",
            "output": "Mild interval decrease in size of the thymic hyperplasia in the anterior\nmediastinum.  No suspicious mass or lymphadenopathy seen."
        },
        {
            "input": "LUNGS: Postsurgical changes are again seen at the left lung base with a small\nleft pleural effusion.  Multiple nodules are seen along the left major fissure\nmeasuring up to 5 mm, unchanged and likely benign lymph nodes (8:26). \nMultiple enhancing T1 isointense and T2 hyperintense nodules are seen along\nthe posterior left pleura at the apex measuring 1.3 x 1.2 cm (10:11) and at\nthe left lung base measuring up to 1.5 x 0.7 cm, more conspicuous compared to\nprior exam (8:51, 52, 55).  A 3.4 x 2.6 cm T2 hyperintense enhancing mass is\nseen in the left costophrenic angle, previously measuring 3.9 x 2 cm, grossly\nsimilar to prior given difference in modality (11:11).\n\nVASCULATURE: No aortic aneurysm or significant atherosclerotic disease.\n\nHEART AND MEDIASTINUM: Heart size is normal.  No mediastinal lymphadenopathy\nor mass.\n\nUPPER ABDOMEN: The visualized portion of the upper abdomen is unremarkable.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: Postsurgical changes are seen along the\nleft chest wall.  Mild degenerative changes are seen in the thoracic spine. \nNo aggressive osseous lesion.  The thyroid gland is without concerning focal\nlesion.  A right chest Port-A-Cath is visualized terminating in the mid SVC.",
            "output": "1. Multiple enhancing nodules along the left pleura, concerning for metastatic\ndisease.\n2. Left costophrenic angle mass is stable in size but avidly enhancing.  While\nthis may represent postsurgical sequela, metastatic disease can have a similar\nappearance.\n\nNOTIFICATION:   The impression and recommendation above was entered by Dr.\n___  ___ on ___ at 18:26 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider."
        },
        {
            "input": "There is marked, necrotic-appearing lymphadenopathy identified within the\nanterior mediastinum, prevascular area, left paratracheal, left suprahilar and\nright paratracheal stations.  The largest lymph nodes is seen in the left\nanterior lateral mediastinum and measures 2.4 cm.  The largest left\nparatracheal lymph node measures 1.6 cm.  The left largest suprahilar lymph\nnode measures 2.1 cm.  There is bilateral moderate-sized pleural effusions\nwhich are new compared to the prior study.  There is also significant increase\nin the consolidation in left upper lung lobe with bronchial wall thickening of\nthe upper lobe bronchi consistent with post obstructive bronchitis.\n\nPostcontrast administration there appears to be central hypervascularity of\nthe lymph nodes suggesting a more atypical source such as an a typical\ninfection, and based on the age of the patient less likely a neoplastic\nprocess.  Further characterization by means of biopsy is recommended.",
            "output": "There is marked, necrotic-appearing lymphadenopathy identified within the\nanterior mediastinum, prevascular area, left paratracheal, left suprahilar and\nright paratracheal stations. Postcontrast administration there appears to be\ncentral hypervascularity of the lymph nodes suggesting a more atypical source\nsuch as an a typical infection, and based on the age of the patient less\nlikely a neoplastic process.\n\nRECOMMENDATION(S):  Further characterization by means of biopsy is\nrecommended."
        },
        {
            "input": "AORTA: The patient is status post resection and grafting of the ascending and\nhemi-arch of the aorta for previous type A aortic dissection.\n\nAgain demonstrated is an anterior outpouching of the anterior aortic root,\nsuperior to the right coronary cusp (15b:61), and is unchanged since the most\nrecent prior study of ___.\n\nAgain identified is an aortic dissection extending from the distal thoracic\naorta at the level of the diaphragmatic hiatus (16b:53) into the proximal left\ncommon iliac artery (18b:72). The configuration and appearance of the\ndissection is unchanged since the most recent prior study. The celiac artery,\nSMA and right renal artery originate from the true lumen and are patent. \nThere is severe narrowing of the origin of the celiac axis with marked\npoststenotic aneurysmal dilation of the proximal celiac artery measuring up to\n16 mm in diameter (17b:5), which is unchanged from the prior study. The left\nrenal artery arises from both the true and false lumen, with the dissection\nflap extending into the left renal artery (17b:25). There is aneurysmal\ndilatation of the distal left renal artery which measures 15 x 13 mm and is\nunchanged since previous (17b:24). The inferior mesenteric artery arises from\nthe false lumen and fills retrograde.\n\nThe left common iliac artery is again dilated measuring 2.7 x 2.4 cm and is\nunchanged since previous (previously 2.6 x 2.5 cm).\n\nAortic measurements (all are unchanged since the most recent prior study):\n\nAortic root: 4.2 cm (10:6).\nAscending aorta: 2.7 cm (15b:40).\nAortic arch: 3.6 cm (15b:23).\nDescending aorta:  3.6 x 3.1 cm (15b:50).\nDescending aorta at the esophageal hiatus:  4.0 x 3.6 cm (16b:45).\nAbdominal aorta at the level of SMA:  4.0 x 3.4 cm (17b:14).\nInfrarenal abdominal aorta:  4.3 x 3.7 cm (17b:64).\n\nCHEST: There is evidence of prior sternotomy. No mediastinal, axillary or\nhilar lymphadenopathy is appreciated. There is minimal dependent atelectasis\nin the bilateral lung bases. No pericardial or pleural effusions are present.\n\nABDOMEN:  A few subcentimeter T2 hyperintense cystic lesions within the liver\n(6:34, 35, 37) are consistent with biliary hamartomas. The liver is otherwise\nunremarkable. The portal and hepatic veins are patent.  Incidental note is\nmade of a replaced right hepatic artery arising from the SMA. No intra or\nextrahepatic biliary duct dilatation is seen. There are multiple small\ngallstones within the gallbladder, which is nondistended and nonedematous.\n\nThere are multiple T2 hyperintense cystic lesions within both kidneys, the\nlargest of which measures 5.1 x 4.5 cm within the upper pole of the right\nkidney, consistent with a simple cyst.  A 6 mm T1 hyperintense lesion in the\nright upper pole renal cortex ___: 104) is compatible with a\nhemorrhagic/proteinaceous renal cyst. Both kidneys enhance symmetrically and\nexcrete contrast normally without hydronephrosis or suspicious renal mass. The\nbilateral adrenal glands and spleen are within normal limits. The pancreas\nshows normal signal intensity and homogeneous enhancement without pancreatic\nduct dilation.\n\nThere is a small axial hiatal hernia.  The stomach, duodenum and\nintra-abdominal loops of bowel are unremarkable except to note a few colonic\ndiverticula. There is a small fat-containing umbilical hernia. No\nlymphadenopathy or ascites is seen.\n\nPELVIS:  The urinary bladder and seminal vesicles are unremarkable.  The\nprostate is not well-visualized and is likely surgically absent. The rectum is\nwithin normal limits. No free pelvic fluid or pelvic lymphadenopathy is seen. \nUncomplicated bilateral small fat containing inguinal hernias are noted.\n\nThere is no bone marrow signal abnormality concerning for infection or\nmalignancy.",
            "output": "1. Stable extent and appearance of distal thoracic and abdominal aortic\ndissection involving the left common iliac and left renal arteries. Aneurysmal\ndilatation of the abdominal aorta, left common iliac artery and distal left\nrenal artery are unchanged from the prior examination. Unchanged postsurgical\noutpouching of the anterior aortic root.\n\n2. Unchanged severe stenosis of the origin of the celiac artery with market\npost stenotic aneurysmal dilatation.\n\n3. Cholelithiasis without evidence of cholecystitis.\n\n4. Small axial hiatal hernia."
        },
        {
            "input": "AORTA: The patient is status post resection and grafting of the ascending and\nhemi-arch of the aorta for previous type A aortic dissection.\n\nAgain demonstrated is an anterior outpouching of the anterior aortic root,\nsuperior to the right coronary cusp (15b:61), and is unchanged since the most\nrecent prior study of ___.\n\nAgain identified is an aortic dissection extending from the distal thoracic\naorta at the level of the diaphragmatic hiatus (16b:53) into the proximal left\ncommon iliac artery (18b:72). The configuration and appearance of the\ndissection is unchanged since the most recent prior study. The celiac artery,\nSMA and right renal artery originate from the true lumen and are patent. \nThere is severe narrowing of the origin of the celiac axis with marked\npoststenotic aneurysmal dilation of the proximal celiac artery measuring up to\n16 mm in diameter (17b:5), which is unchanged from the prior study. The left\nrenal artery arises from both the true and false lumen, with the dissection\nflap extending into the left renal artery (17b:25). There is aneurysmal\ndilatation of the distal left renal artery which measures 15 x 13 mm and is\nunchanged since previous (17b:24). The inferior mesenteric artery arises from\nthe false lumen and fills retrograde.\n\nThe left common iliac artery is again dilated measuring 2.7 x 2.4 cm and is\nunchanged since previous (previously 2.6 x 2.5 cm).\n\nAortic measurements (all are unchanged since the most recent prior study):\n\nAortic root: 4.2 cm (10:6).\nAscending aorta: 2.7 cm (15b:40).\nAortic arch: 3.6 cm (15b:23).\nDescending aorta:  3.6 x 3.1 cm (15b:50).\nDescending aorta at the esophageal hiatus:  4.0 x 3.6 cm (16b:45).\nAbdominal aorta at the level of SMA:  4.0 x 3.4 cm (17b:14).\nInfrarenal abdominal aorta:  4.3 x 3.7 cm (17b:64).\n\nCHEST: There is evidence of prior sternotomy. No mediastinal, axillary or\nhilar lymphadenopathy is appreciated. There is minimal dependent atelectasis\nin the bilateral lung bases. No pericardial or pleural effusions are present.\n\nABDOMEN:  A few subcentimeter T2 hyperintense cystic lesions within the liver\n(6:34, 35, 37) are consistent with biliary hamartomas. The liver is otherwise\nunremarkable. The portal and hepatic veins are patent.  Incidental note is\nmade of a replaced right hepatic artery arising from the SMA. No intra or\nextrahepatic biliary duct dilatation is seen. There are multiple small\ngallstones within the gallbladder, which is nondistended and nonedematous.\n\nThere are multiple T2 hyperintense cystic lesions within both kidneys, the\nlargest of which measures 5.1 x 4.5 cm within the upper pole of the right\nkidney, consistent with a simple cyst.  A 6 mm T1 hyperintense lesion in the\nright upper pole renal cortex ___: 104) is compatible with a\nhemorrhagic/proteinaceous renal cyst. Both kidneys enhance symmetrically and\nexcrete contrast normally without hydronephrosis or suspicious renal mass. The\nbilateral adrenal glands and spleen are within normal limits. The pancreas\nshows normal signal intensity and homogeneous enhancement without pancreatic\nduct dilation.\n\nThere is a small axial hiatal hernia.  The stomach, duodenum and\nintra-abdominal loops of bowel are unremarkable except to note a few colonic\ndiverticula. There is a small fat-containing umbilical hernia. No\nlymphadenopathy or ascites is seen.\n\nPELVIS:  The urinary bladder and seminal vesicles are unremarkable.  The\nprostate is not well-visualized and is likely surgically absent. The rectum is\nwithin normal limits. No free pelvic fluid or pelvic lymphadenopathy is seen. \nUncomplicated bilateral small fat containing inguinal hernias are noted.\n\nThere is no bone marrow signal abnormality concerning for infection or\nmalignancy.",
            "output": "1. Stable extent and appearance of distal thoracic and abdominal aortic\ndissection involving the left common iliac and left renal arteries. Aneurysmal\ndilatation of the abdominal aorta, left common iliac artery and distal left\nrenal artery are unchanged from the prior examination. Unchanged postsurgical\noutpouching of the anterior aortic root.\n\n2. Unchanged severe stenosis of the origin of the celiac artery with market\npost stenotic aneurysmal dilatation.\n\n3. Cholelithiasis without evidence of cholecystitis.\n\n4. Small axial hiatal hernia."
        },
        {
            "input": "MR ANGIOGRAM: Postsurgical changes related to prior repair ___ type A\ndissection are again noted, with persistent anterior outpouching of the aortic\nroot, unchanged in appearance (25:50).  The origins of the great vessels\narising from the aortic arch are patent.\n\nA ___ type B aortic dissection arises at the level of the diaphragmatic\nhiatus common extends into the left common iliac artery.  The overall\nconfiguration extent of the dissection appears similar compared to the prior\nexamination.  There is stable degree of concentric variability of the\nthrombosis in the false lumen.  There is persistent severe stenosis of the\nceliac artery, poststenotic dilatation measuring up to 14 mm (26:30),\nunchanged.  The celiac artery, superior mesenteric artery, and right renal\nartery arise from the true lumen.  The inferior mesenteric artery arises from\nthe false lumen and fills via retrograde flow.  Slight irregular thrombosis\nwithin the superior mesenteric artery near the origin is unchanged.  There is\nre- demonstration of a replaced right hepatic artery, arising from the\nsuperior mesenteric artery.\n\nThe aortic dissection flap extends into the left renal artery (2700, 22:74),\nwith predominant filling by the true lumen.  There is likely fenestration in\nthe proximal left renal artery. The false lumen of the left renal artery is\nopacified for only approximately 1.5 cm.  The distal left renal artery is\naneurysmal, spanning approximately 13 mm (27:79), unchanged.   Left common\niliac artery aneurysm is also noted (measured below).\n\nMeasurements include:\nAortic root:  3.9 x 4.4 cm\nAscending thoracic aorta at the level of the main pulmonary artery:  4.2 x 3.4\ncm\nProximal arch:  3.4 x 3.6 cm\nDistal arch:  3.6 x 3.6 cm\nMid descending:  3.8 x 3.8 cm\nDistal descending:  3.9 x 3.6 cm\nSuprarenal abdominal aorta:  4.1 x 3.7 cm\nInfrarenal abdominal aorta:  4.1 x 3.6\nLeft common iliac artery:  2.8 x 2.2 cm\n\n\nLUNGS:  A 6mm pulmonary nodule in the right middle lobe is stable since the\nchest CT from ___ (25:13).  There is no pleural effusion.\n\nHEART AND MEDIASTINUM: The heart and mediastinum are unremarkable.  There is\nno mediastinal or hilar lymphadenopathy.  No pericardial effusion is\nidentified.\n\nABDOMEN:  There is a small hiatal hernia.  The liver is unremarkable with\nexception of small cysts or biliary hamartomas, unchanged (5:5).  The\npancreas, spleen, and bilateral adrenal glands are normal in appearance. \nThere are several simple cysts in the bilateral kidneys, unchanged.  The\ngastrointestinal tract is within normal limits.  There is no free fluid in the\nabdomen.  No retroperitoneal or mesenteric lymphadenopathy is present.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No osseous lesion worrisome for\nmalignancy or infection is identified.",
            "output": "1. Overall stable appearance of Type B aortic dissection.\n2. Graft repair of prior Type A dissection is unchanged.\n3. Aneurysmal dilation of the left common iliac artery, distal left renal\nartery, and celiac artery just beyond celiac origin stenosis are overall\nunchanged.\n4. Hepatic and renal cysts."
        },
        {
            "input": "There are bilateral pleural effusions, left greater than right\nside.  There is a large anterior and middle mediastinal mass which extends\nanterior to the branch vessels of the aorta.  It extends inferiorly anterior\nto the arch and posterior to the sternum and involves the sternum.  It extends\nfurther inferiorly to surround the main pulmonary artery and the proximal\npericardium.  It encases the left brachiocephalic vein.  It encases the\ninternal mammary arteries.  The mass extends down to the aortopulmonary window\nand the subcarinal space.  The mass encases the branch vessels of the aorta\nextending posteriorly between the SVC and trachea and abutting the azygos\nvein.  Anteriorly, it elevates the left pectoralis muscle.\n\nNo evidence of any occlusion of any of the vasculature.  No evidence of any\nemboli.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.",
            "output": "1.  Large anterior and middle mediastinal mass which surrounds and abuts the\naorta and pulmonary artery as well as the branch vessels of the aorta,\ninvolves the sternum and elevates and slightly invadses the left pectoralis\nanteriorly and inferiorly involves the pericardium.  The appearance is most\nlikely that of an aggressive thymoma.\n\n2.  Bilateral pleural effusions with associated atelectasis, left more than\nright side."
        },
        {
            "input": "Motion artifact degrades the quality of the study.\n\nIn the anterior mediastinum prevascular space extending inferiorly anterior to\nthe heart, there is lobulated soft tissue lesion in a triangular configuration\nwhich is mildly hyperintense on the T2 weighted images.   There is signal loss\non the out of phase sequence as opposed to the in phase sequence consistent\nwith intravoxel fat.  This area measures approximately 2.0 x 4.6 cm and is\nunchanged compared to the prior exam. This area is most consistent with thymic\nhyperplasia.  There are no discrete masses.\n\nThere are bilateral simple appearing 4 and 2 mm cysts in the right and left\nlobes of the thyroid respectively.\n\nNo supraclavicular or axillary lymphadenopathy by size criteria.\n\nThe great vessels are of normal caliber throughout.  Heart size is normal.  No\npericardial effusion.\n\nAlthough the study is not optimized for assessment of the lung parenchyma.  No\ngross masses.  No areas of consolidation.  No mediastinal or hilar\nlymphadenopathy by size criteria.\n\nThe visualized portion of the abdomen is not well assessed due to motion\nartifact.\n\nThe bone marrow demonstrates normal signal characteristics.  No concerning\nosseous lesions.",
            "output": "Soft tissue in the anterior mediastinum appears unchanged from CT chest ___ and is compatible with thymic hyperplasia."
        },
        {
            "input": "The study is mildly limited by motion.\n\nLUNGS: The study is not targeted for evaluation of lung parenchyma.  Within\nthis limitation, there is no focal consolidation or mass.  No pleural\neffusion.\n\nVASCULATURE: The thoracic aorta appears normal in caliber.\n\nHEART AND MEDIASTINUM: Visualized thyroid appears unremarkable.  Visualized\nportion of the base of the neck appears unremarkable.  There is no axillary\nlymphadenopathy or supraclavicular lymphadenopathy.  In the anterior\nmediastinum, there is significant decrease in soft tissue with again loss of\nsignal on out of phase imaging suggesting intravoxel fat now measuring\napproximately 3.7 x 1.8 cm, previously measuring at least 7.3 x 2.0 cm (4; 21)\nconsistent with thymic hyperplasia.  There is no mediastinal lymphadenopathy. \nThe heart is not enlarged.  There is no pericardial effusion.\n\nUPPER ABDOMEN: Visualized portion of the upper abdomen appears unremarkable.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No suspicious osseous lesion is\nidentified.",
            "output": "Interval decrease in anterior mediastinal soft tissue which again drops in\nsignal on out of phase imaging consistent with thymic hyperplasia, decreased\ncompared to prior."
        },
        {
            "input": "Within the skin and subcutaneous tissues of the anterior right chest wall\nthere is a STIR hyperintense and T1 hypo intense lesion, which measures\napproximately 1.7 x 4.4 x 5.3 cm (AP, transverse, cc dimension).  There are\nmultiple hypo intense curvilinear flow voids within the lesion and within the\nsurrounding subcutaneous fat.  There is a large tortuous artery that leads\nfrom the right internal mammary artery to the lesion, better delineated on\nprior CT.  No definite nidus identified, however, this study was not tailored\nto evaluate the vasculature.  The associated T1 hypointense and STIR\nhypointense signal is non mass like, suggesting this may represent a vascular\nmalformation.  Difficult to definitively exclude a highly vascularized soft\ntissue tumor.  There is thickening of the overlying skin.  In addition, there\nis a smaller ill defined nodular T1 hypointense and STIR hyperintense area\ndeep the dominant lesion measuring up 1.3 x 0.8 x 1.5 cm (series 6, image 15).\nThere are flow voids leading to and within this area as well.  This second\nportion of the lesion abuts the fascia overlying the pectoralis muscle.  No\nevidence of definite involvement of the pectoralis muscle.  Postcontrast\nimaging demonstrates enhancement within both lesions.\n\nNo axillary lymphadenopathy.\n\nNo suspicious bone marrow signal.",
            "output": "T1 and STIR hypointense lesion in the right anterior chest wall subcutaneous\ntissues involving the overlying skin with multiple large flow voids.  The\nabnormal signal intensity is non mass like in configuration and likely\nrepresents a vascular malformation, however, a highly vascular tumor cannot be\nexcluded.\n\nNOTIFICATION:  The findings were discussed with Dr.  ___, M.D. by\n___, M.D. on the telephone on ___ at 8:22AM, 5 minutes\nafter discovery of the findings."
        },
        {
            "input": "In the anterior mediastinum, there is soft tissue measuring 19 x 11 mm which\nis triangular in configuration and demonstrates signal loss on the out of\nphase sequence as opposed to the in phase sequence consistent with intravoxel\nfat.  This constellation of finding is most in keeping with thymic\nhyperplasia.  There are no masses.\n\nNo mediastinal or hilar lymphadenopathy by size criteria.\n\nThere is conventional 3 arch anatomy.  The great vessels are normal in\ncaliber.  Heart size is normal.  No pericardial effusion.\n\nThe lungs are clear.  No pleural effusion.\n\nThe thyroid gland is within normal limits.\n\n The bone marrow demonstrates normal signal characteristics.  No concerning\nosseous lesions.",
            "output": "1.  Thymic hyperplasia\n2.  No thymic masses."
        },
        {
            "input": "MRA:  The superior vena cava, bilateral subclavian veins and axillary veins\nare patent and contrast opacified.  Superficial venous branches of the\ndraining from the anterior aspect of the right upper arm are also contrast\nopacified, although course immediately adjacent to the soft tissue mass\ndescribed below.\n\nMRI: There is extensive soft tissue abnormality centered anterior to the right\nshoulder joint.  This material spans 6.7 cm caudocranially, 8.4 cm\ntransversely and 3.1 cm anterior to posterior. This is soft tissue is slightly\nhyperintense has to skeletal muscle on T2 weighted imaging, isointense to\nskeletal muscle on T1 weighted imaging and is avidly and progressively\nenhancing. The margins are irregular and infiltrative, involving multiple\nmyofascial planes.  There is infiltration of the medial aspect of the right \ndeltoid, lateral aspect of the pectoralis, and anterior biceps muscles.  The\nnoninvolved muscle maintains normal signal without identified edema or\ninflammation. Along the medial aspect there is deeper infiltration to the\nthoracic chest wall, with abnormal enhancement involving the intercostal\nmuscles surrounding the first rib (17:55). There is no extension into the\nthoracic cavity. No pleural effusion or airspace opacity is seen.\n\nInnumerable osseous metastases are seen throughout the visualized spine,\ncorrelating with appearance on the prior CT.\n\nLimited evaluation of the upper abdomen is notable for a T2 hyperintense,\nnonenhancing cysts scattered throughout the liver and bilateral kidneys.\n\nNote is made of bilateral mastectomies and reconstructions.\n\nThe arms beyond the shoulders are not included in the field of view and are\nnot assessed for edema.",
            "output": "Extensive abnormal enhancing soft tissue process infiltrating anterior right\nchest wall and proximal arm musculature and extending towards but not into the\nright thoracic cavity.  While this could represent recurrence of known\nmetastatic breast cancer, the infiltrative appearance and progressive\nenhancement is atypical, and can also be seen with other tumors such as\nlymphoma or desmoid tumor.  Lack of surrounding edema argues against an\ninflammatory myositis and contours are not typical for radiation myositis. The\ndeep venous structures of the thorax remain patent at this time.\n\nNOTIFICATION:  Findings were discussed with person between Dr ___ Dr\n___ at approximately 16:30 on ___."
        },
        {
            "input": "Study is severely degraded by motion despite repeating sequences.\n\nThere is no definite lesion visualized at the right eleventh costochondral\njunction corresponding to the increased SUV uptake in the previous PET-CT. \nNoting that there is motion artifact.\n\nThe evaluation of the intra-abdominal structures are significantly limited due\nto severe motion artifact.  There are multiple high T2 lesions in the liver\nwith no internal enhancement poorly characterized at the current study likely\nrepresenting previously described cysts and better assessed on the dedicated\nprior liver MRI studies..\n\nThere are also bilateral renal high T2 lesions obscured by the significant\nmotion artifact with grossly no internal enhancement likely representing the\npreviously described cysts.  There are severe degenerative changes and\nscoliosis throughout the thoracolumbar spine.\n\nThere bilateral trace pleural effusion.  There is small ascites visualized.",
            "output": "No definite lesion visualized at the right eleventh costochondral junction\ncorresponding to the increased SUV uptake in the previous PET-CT.  Noting that\nsignificantly limited evaluation due to severe motion artifact."
        },
        {
            "input": "LUNGS: There is a 3.7 x 2.4 x 3.0 cm oval, predominantly T2 hyperintense, T1\nhypointense, well-circumscribed lesion with peripheral enhancement including\nfocal enhancing nodularity located along the posterior-lateral left upper lung\npleura (series 3, image 24; series 4, image 30; series 11, image 27).  The\ndominant nodular component measures 1.0 x 0.6 cm, located along the\nposterolateral aspect of the lesion (series 11, image 28).  There is no\nmicroscopic or macroscopic fat within this lesion.  There appears to be a\ncurvilinear line of subpleural fat between the margins of the lesion and the\nadjacent lung. The lesion does not appear to extend beyond the lateral margins\nof the intercostal structures.  The remainder of the imaged lungs is\nunremarkable.  No pleural effusion.\n\nVASCULATURE: The thoracic aorta is normal in caliber.  No evidence of\ndissection.  Incidental common origin of the left common carotid and\ninnominate arteries.  The main pulmonary artery is normal in caliber.  No\ncentral pulmonary embolism.\n\nHEART AND MEDIASTINUM: No cardiomegaly.  No upper mediastinal lymphadenopathy.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No suspicious osseous lesions.  The\nabdominal wall is unremarkable.",
            "output": "A cystic lesion with peripheral enhancing nodularity located along the\nposterolateral left upper lung pleura is probably a cystic neurogenic tumor\nrelated to the intercostal nerve or a branch of the intercostal nerve.  Less\nlikely considerations include a solitary fibrous tumor of the pleura given the\nrelatively small amount of solid tissue and probable extra pleural location,\nor cystic/necrotic malignancy such as mesothelioma or primary lung cancer\ngiven probable extra pleural location."
        },
        {
            "input": "MRI OF THE CHEST WITH AND WITHOUT IV CONTRAST:\n\nA 3.1 x 2.5 cm retrosternal goiter arising from the lower pole of the right\nthyroid lobe is again seen (series 4, image 7), unchanged in size since the CT\nexamination from ___, demonstrating intermediate signal intensity on\nT2 weighted sequences with moderate contrast enhancement (series 15, image\n40). At least three left supraclavicular lesions demonstrate high signal\nintensity on T2 weighted sequences, with avid contrast enhancement, the\nlargest measuring 3.2 x 2.3 cm (series 9, image 9). T1 and T2 signal\ncharacters are slightly different from the thryoid, making it less likely to\nbe ectopic thyroid tissue, and are most likely enlarged lymph nodes. Only the\ntwo lower nodes are visualized on the CT examination from ___,\nappearing similar in size.\n\nA paraesophageal nodule measuring 16 x 9 mm appears stable (series 9, image\n12). There is no hilar lymphadenopathy. No pulmonary mass or nodule is\ndetected.\n\nProminent triangular-shaped anterior mediastinal tissue demonstrates moderate\nsignal drop-off on T1 weighted out of phase images in comparison to in phase\nsequences (series 11 image 43), compatible with hyperplastic thymic tissue.\n\nThe left common carotid and innominate arteries arise from a common trunk\n(series 15, image 49). The thoracic aorta and pulmonary arteries are patent\nand normal in caliber. The subclavian and carotid arteries are patent and\nnormal in caliber. No pulmonary embolus is detected at the proximal\nsubsegmental levels.\n\nThe heart size is normal. There is no pericardial effusion.\n\nThere is mild bibasilar dependent atelectasis (series 1403, image 106). There\nis no pleural effusion.\n\nIncluded views of the liver, spleen, kidneys, spleen, adrenal glands, stomach,\nand splenic flexure are within normal limits.\n\nThere are no bony lesions concerning for malignancy or infection.",
            "output": "1. Multiple abnormally-enlarged left supraclavicular lymph nodes, measuring up\nto 3.2 cm. Ultrasound-guided biopsy/FNA recommended, assuming the cause is not\nalready known.\n2. Very large right-sided low cervical/retrosternal goiter.  Based on it size,\nadvise biopsy/FNA which can also be performed at the time of lymph node FNA.\n3. Enlarged paraesophageal lymph node remains stable since ___\nexamination.\n4. Hyperplastic thymic tissue."
        },
        {
            "input": "Motion artifact from breathing, inhomogeneous fat saturation and the lack of\nintravenous contrast limits interpretation of the study.\n\nLUNGS: There are moderate-sized bilateral pleural effusions, increased in size\nfrom the prior study.  No large lung mass is identified.\n\nVASCULATURE: Limited evaluation but no obvious abnormality.\n\nHEART AND MEDIASTINUM: Limited evaluation but no obvious abnormality.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No definite abnormal signal or edema is\nseen in the region of the left sternoclavicular joint or manubrium.  No fluid\nseen in the sternoclavicular joints.  However, as noted above, there is marked\nmotion artifact.",
            "output": "Technically limited study as outlined above.  Allowing for the limitations of\nthis study, there is no evidence of edema in the left sternoclavicular joint. \nPlease note that prior chest CT demonstrates normal appearing sternoclavicular\njoint and  manubrium without evidence of effusion."
        },
        {
            "input": "Patient is intubated.  Orogastric tube passes into the stomach.\n\nThe great arch vessels and the thoracic aorta appears normal in contour and\ncaliber.  Arteries of the chest are widely patent without stenoses.  There is\nno wall thickening, hyperenhancement or edema in the wall of the aorta or the\nproximal great arch vessels of the chest.\n\nThe heart is normal in size.  There are trace bilateral pleural effusions. \nThere is no significant pericardial effusion.",
            "output": "No evidence for vasculitis in the chest."
        },
        {
            "input": "Within the anterior costophrenic angle of the right hemithorax is a triangular\ncystic structure. This is T2 hyperintense, T1 hypointense and nonenhancing. It\nhas smooth, rounded contour with subtle, thin septations anteriorly. This has\n___ of 6 cm anterior to posterior, 3 cm caudocranially and 11 cm\ntransversely. This conforms to its space, respecting the anterior margin of\nthe major fissure. It abuts the free wall of the right atrium and right\nventricle, without mass effect on the heart. This structure is unchanged in\nshape, size and signal/enhancement characteristics, and is consistent with a\nbenign pericardial cyst.\n\nNo additional mediastinal mass is identified. Cardiac function is not assessed\non this examination. The morphology of the heart is normal. There is\nconventional vascular anatomy of the chest.\n\nThere is mild consolidative change within the dependent portions of each lung,\npresumably from hypo ventilation.\n\nLimited evaluation the upper abdomen reveals no additional incidental\nabnormality.  There is no evidence of hepatic steatosis.",
            "output": "Unchanged benign pericardial cyst within the anterior costophrenic angle of\nthe right hemithorax."
        },
        {
            "input": "At the level of the pulmonary artery, the ascending aorta measures\n3.5 cm in maximum dimension and the descending aorta measures 3 cm in maximum\ndimension.  In the anterior mediastinum in the prevascular area, note is made\nof a lesion of high signal intensity on both FIESTA and T2-weighted imaging,\nwhich measures 13 mm and may represent a thymic cyst.  This was also seen on\nthe previous CT from ___ and ___ and is unchanged.  At the level of\nthe diaphragmatic hiatus, the suprarenal aorta measures 2.5 cm.\n\nNo evidence of any dissection.  No evidence of any pulmonary embolus.\n\nThe lungs where visualized are normal.  The origins of the brachiocephalic,\nleft carotid, and left subclavian arteries are normal.\n\nThe lungs where visualized are normal.\n\nNote is made of a gastric pull-up in the right side of the chest in this\npatient status post esophagectomy.\n\nUpper cuts of the abdomen reveal a cyst in the upper pole of the right kidney\nmeasuring 17 mm.  Visualized images of the liver and spleen appear\nunremarkable.\n\nThe osseous structures where visualized are normal.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.",
            "output": "1.  No evidence of any aortic dissection.\n2.  Gastric pull-up in patient status post esophagectomy.\n3.  Incidental right renal cyst noted."
        },
        {
            "input": "Four markers denote the area of clinical concern.\n\nImmediately deep to the right upper trapezius muscle, there is a\nwell-circumscribed 5.1 cm CC by 1.3 cm AP by 5.4 cm transverse T1 hyperintense\nlesion which demonstrates loss of signal on fat saturated sequences.  There is\na single enhancing septation--although this appears thin, it measures up to 2\nmm in thickness.  No evidence of nodular soft tissue component.  No other\nseptations identified.  Otherwise, no convincing internal enhancement.\n\nThe mass lies deep to the right trapezius muscle, overlying the rhomboid\nmuscles.  Surrounding muscles and overlying subcutaneous fat are within normal\nlimits.\n\nNo other focal mass fluid collection is detected in this area.  No overlying\nsoft tissue edema.\n\nVisualized muscles and bones about the upper chest are otherwise grossly\nunremarkable.\n\nThis examination is not diagnostic for evaluation of the lung parenchyma. \nHowever, bibasilar dependent atelectasis is noted.",
            "output": "Palpable abnormality corresponds to a 5.1 x 1.3 x 5.4 cm fat containing lesion\ndeep to the right upper trapezius muscle, likely representing a lipoma. Note\nis made of a single internal septation that is at the upper limits of normal\nin thickness.  No evidence of nodular soft tissue thickening or focus of\nnodular enhancement to suggest malignancy.\n\nRecommend follow-up MRI in ___ year to confirm expected stability.  Also\nrecommend re-imaging if there is a change in symptoms or interval growth\nrelated to this lesion.\n\nRECOMMENDATION(S):  Recommend follow-up MRI in ___ year to confirm expected\nstability.\n\nAlso recommend re-imaging if there is a change in symptoms or interval growth\nrelated to this lesion."
        },
        {
            "input": "A external marker overlies the right upper posterior chest wall, in the area\nof patient's palpable abnormality.  Compared with ___, a\nwell-circumscribed 5.4 x 1.4 (TRV x AP) fat density lesion immediately deep to\nthe right trapezius muscle is not significantly changed in size, previously\nmeasuring 5.4 x 1.3 cm.  Although the mass appears slightly longer in the CC\ndirection, spanning approximately 5.7 cm compared with 5.1 cm previously, the\npatient is slightly oblique, likely accounting for this difference.  This mass\nagain contains a single septation measuring up to 2 mm in thickness.  No new\nthick septal or nodular enhancement.\n\nThe bone marrow intensity appears isointense to muscle on T1 weighted imaging,\nslightly lower in signal than normally seen, however unchanged and may be\nrelated to red marrow conversion.  There is a 5 mm T1 hyperintense enhancing\nlesion in a midthoracic vertebral body, only included on the axial images,\nsaturates out on fat sat precontrast images and is not well seen on STIR\nweighted imaging (09:33; 03:33).",
            "output": "1. A fat density lesion in the right posterior chest wall with a single thin\ninternal enhancing septation is not significantly changed compared with\n___, with slight increase in the length of the mass in the CC\ndirection accounted for by differences in obliquity of the patient, favored a\nlipoma.  No new thick septal or nodular enhancement.\n2. The signal intensity of the bone marrow on T1 weighted imaging is\nrelatively hypointense, however is unchanged and may be related to red marrow\nconversion. Correlate clinically.\n3. A 5 mm enhancing lesion in a midthoracic vertebral body is favored a\nhemangioma, however given the history of pheochromocytoma, metastasis\ndifficult to exclude.  MIBG nuclear medicine imaging could be performed if\nthere is clinical concern for metastases."
        }
    ]
}