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Generate impression based on findings. | Male 83 years old; Reason: obstruction? History: constipation Multiple nonspecific gaseous distended loops of bowel. Normal amount of gas in the colon. No evidence of obstruction. Normal amount of stool. Suture wires are visualized the pelvis. | Nonobstructive bowel pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Three standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A partially obscured subcentimeter mass is present in the right upper outer quadrant. No suspicious microcalcifications or areas of architectural distortion are present. | Right breast mass. Spot compression imaging and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Call back from screening mammogram for a mass in the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A partially circumscribed mass seen in the screening mammogram is not well visualized on the compression views.Focused ultrasound of the left breast was performed. Detected are clustered cysts at 7 o'clock position in the left breast. The largest cystic lesion measures 6 x 3 mm. There is a questionable solid component in one of the cystic lesion with possible blood flow. | Clustered cysts with possible solid component and blood flow. Ultrasound guided aspiration is recommended.Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 53-year-old female with history of rheumatoid arthritis, evaluate for progression Right hand: A new plate and screw device affixes the distal radius in near-anatomic alignment. Moderate to severe osteoarthritis affects the basilar joint. Small lucencies within the scaphoid, lunate, and capitate may represent cysts or chronic erosions, but appear similar to the prior exam accounting for technical differences. Minimal osteoarthritis affects the distal interphalangeal joints.Left hand: Severe osteoarthritis affects the basilar joint. Mild osteoarthritis affects the distal interphalangeal joints. We see no erosions.Right foot: Postoperative and degenerative arthritic changes appear similar to the prior exam. No erosions are noted.Left foot: Again seen is a pes planovalgus deformity. Mild osteoarthritis affects the interphalangeal joint of the great toe. No erosions are evident. Osteoarthritis affects the midfoot. | Findings consistent with arthritis as detailed above, which appears predominantly degenerative in etiology without evidence of progression. |
Generate impression based on findings. | 66-year-old male with right alveolar squamous cell carcinoma. Status post resection with right-sided facial weakness. LUNGS AND PLEURA: There is interval development of multiple ground glass nodules and airspace opacities along the posterior aspect of the right lower lobe. No pleural effusion or pneumothorax. Scattered pulmonary micronodules, unchanged. Reference left lower lobe pulmonary nodule measures 5 mm, previously 5 mm (83; series 4).MEDIASTINUM AND HILA: Moderate to severe coronary artery calcifications. No pericardial effusion. Vascular calcifications of the aorta and its branches. No mediastinal or hilar lymphadenopathy. Prominent right cardiophrenic lymph node, unchanged.CHEST WALL: Right chest port tip terminates in the right brachiocephalic vein. Multilevel degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hypodensity in the dome of the liver is too small to characterize, but likely represents a benign simple cyst, unchanged. | 1. Interval development of multiple ground glass nodules and airspace opacities along the posterior aspect of the right lower lobe compatible with aspiration with some degree of organization and partial resolution. 2. No evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Three MLO and 5 CC standard digital views (for a total of 16 images) of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Calcifications in the central left breast have lucent centers and are most likely in the skin. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Left breast skin calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 68-year-old with history of left breast cyst aspiration presents for follow-up study. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A known cyst is again seen in the left upper outer quadrant without significant changes. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Ultrasound for left breast was performed. The known simple cyst in the left 2 o'clock position measures 6 x 6 mm. No suspicious findings are associated this cyst. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 53-year-old female status post fall with left shoulder pain Four suture anchors are noted in the humeral head. Small foci of mineralization lateral to the humeral head may represent posttraumatic heterotopic ossification from prior surgery or calcific tendinosis, but are not typical of fracture fragments. Glenohumeral alignment is within normal limits. | Postoperative and degenerative changes as described above without evidence of fracture. |
Generate impression based on findings. | 74-year-old with history of benign right breast biopsy. Patient sister was diagnosed with ovarian cancer at 29. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing calcifications within both breasts are not significantly changed from prior. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: Assess lung transplant History: None LUNGS AND PLEURA: Interval resolution of multifocal subpleural consolidation in the right lung, with residual areas of scarring and rounded atelectasis.Partial clearing of right basilar ground glass opacity with residual fine nodular and tree in bud pattern consistent with bronchiolitis.Small right pleural effusion, slightly increased.New stent in the bronchus intermedius.Focal stenosis at the origin off the right upper lobe bronchus, slightly increased.Focal small scar like opacity in the left posterior costophrenic angle, unchanged.MEDIASTINUM AND HILA: Mildly enlarged mediastinal and right hilar lymph nodes, without significant change.Mild coronary artery calcification.Moderately enlargement pulmonary artery, measuring 34 mm, suggestive of pulmonary hypertension.No pericardial effusion.CHEST WALL: Port catheter with its tip in the SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Interval clearing of right lung air space opacities with residual scarring, atelectasis and pleural effusion.2. New stent in the bronchus intermedius and increased stenosis at the origin of the right upper lobe bronchus. |
Generate impression based on findings. | Right lower quadrant abdominal pain, evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No intraperitoneal free air, free fluid, or evidence of obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No intraperitoneal free air, free fluid, or evidence of obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No appendicitis or other findings to account for the patient's pain. |
Generate impression based on findings. | 34 years old, Male, Reason: pt with metastatic melanoma s/p 4 cycles of chemotherapy please assess response to therapy and compare to previous imaging History: met melanoma CHEST:LUNGS AND PLEURA: Reference left lower lobe nodule is stable in size measuring 4 mm (series 4, image 57), previously measuring 4 mm in greatest dimension. No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Reference pretracheal lymph node is unchanged measuring 1.1 x 0.7 cm (series 3, image 43), previously measuring 1.1 x 0.7 cm.CHEST WALL: Reference left axillary lymph node is minimally smaller in size now measuring 1.0 x 0.7 cm (series 3, image 31), previously measuring 1.1 x 0.9 cm.ABDOMEN:LIVER, BILIARY TRACT: No focal parenchymal liver lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Soft tissue at the level of left adrenal gland has further decreased in size (series 3, image 92).KIDNEYS, URETERS: Soft tissue implant the level of the superior pole of the right kidney has further decreased in size (series 3, image 107).RETROPERITONEUM, LYMPH NODES: Decrease in previously described aortocaval lymphadenopathy. Reference right aortocaval lymph node measures 2.1 x 1.0 cm (series 3, image 137), previously measuring 2.4 x 1.5 cm. Other reference smaller aortocaval lymph node is no longer measurable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple soft tissue lesions in the anterior abdominal wall bilaterally, paraspinal muscles, right gluteal region, and iliopsoas muscle. Many of the lesions appear stable to smaller in size. Lesion in the right iliopsoas appears smaller in size.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mass within the right inguinal region appear slightly smaller in size measuring 11.9 x 10.6 cm (series 3, image 216), previously measuring 12.3 x 11.5 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Avascular necrosis of the bilateral femoral heads.OTHER: No significant abnormality noted | Metastatic disease in the chest, abdomen, and pelvis is overall decreased in size compared to prior study. |
Generate impression based on findings. | follow up for left cerebellar ischemic infarction. Re-demonstration of the left cerebellar and vermian acute ischemic infarction.No change of the lesion extent since prior exam.No evidence of hemorrhagic conversion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No interval change of the extent and configuration of the left cerebellar acute ischemic infarction.2. No evidence of hemorrhagic transformation. |
Generate impression based on findings. | 32 year old female. Please evaluate for delayed gastric emptying. Visually there was significantly delayed gastric emptying with minimal progression of radiotracer into the bowel.Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:60 mins: 95 % of peak activity remaining. | Markedly delayed gastric emptying of liquid meal. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 70-year-old male with hypercalcemia and hyperparathyroidism. Please evaluate for parathyroid adenoma for localization for second surgery. Previous history of parathyroidectomy. In the subcutaneous soft tissues of the anterior midline neck slightly above the isthmus, there is a small to medium sized markedly sestamibi-avid lesion. The focus is seen on early imaging and persists on delayed imaging, while the remainder of the thyroid tissue washes out. This lesion is new from previous parathyroid scan in 2004 and corresponds to the soft tissue density lesion seen on CT and hypoechoic structure visualized on recent ultrasound. Given the patient's history, this lesion may represent a parathyroid adenoma. However, given its unusual location, other etiologies are possible including a nonspecific neoplastic or even inflammatory process.Today's CT portion grossly demonstrates an approximately 2 cm soft tissue density lesion in the anterior neck soft tissues above the isthmus. There is also bilateral maxillary sinusitis noted. | 1.Significantly sestamibi-avid lesion as described above which may represent an unusually located parathyroid adenoma, neoplastic lesion, or inflammatory process. 2.No additional abnormal sestamibi-avid lesion is identified. |
Generate impression based on findings. | History of right T4N2bM0 right maxillary sinus cancer s/p chemoradiation completed September 2014 with right facial pain and swelling. Redemonstration of ill-defined infiltration of the right cheek soft tissues with overlying skin retraction. No discrete mass, abnormal fluid collection, or new lesion is identified. There is persistent hypoattenuating, non-enhancing material within the right maxillary sinus with erosion of the orbital floor and the maxillary alveolar ridge with fistulous connection to the oral cavity, which is stable. There is minimal mucosal thickening of the left maxillary sinus and right ethmoid sinus. The orbits are otherwise unremarkable. There is atherosclerotic calcification of the bilateral carotid bifurcations and cavernous/clinoid portions of the internal carotid arteries. The right internal jugular vein is not visualized, which is unchanged. There is improvement in aeration of partially opacified bilateral mastoid air cells. There moderate multilevel degenerative changes of the cervical spine. | 1. No evidence of progression of disease. 2. Stable rind of non-enhancing tissue in the right maxillary sinus. The floor of the sinus remains eroded, the severity of which is stable. |
Generate impression based on findings. | Metastatic melanoma status post 4 cycles of chemotherapy. There has been interval decrease in size of a cystic right supraclavicular lymph node, which now measures 29 x 26 mm, previously 31 x 32 mm in the axial plane. There are no other significantly enlarged lymph nodes in the neck based on size criteria. In addition, the subcutaneous nodules appear to have essentially resolved and the mass in the left posterior paraspinal muscles is no longer discernible. The salivary glands are unremarkable. There is an unchanged punctate hypoattenuating nodule in the left thyroid nodule. The major cervical vessels are patent. There is mild degenerative spondylosis of the cervical spine and there are degenerative changes in the right temporomandibular joint. The airways are patent. | Interval decrease in size of the right supraclavicular lymphadenopathy and resolution of the subcutaneous and left posterior paraspinal muscle nodules. |
Generate impression based on findings. | 75 years old, Female, Reason: 75 yo f w/ h/o divertyiculosis p/w brbpr and hemoglobing drop, EGD negative History: GIB ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse Hepatic steatosis. Evidence of cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, some of which are complex appearing on the right. Nonobstructing nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No large mass or acute inflammation. No evidence of active bleeding. Extensive colonic diverticulosis without evidence of diverticulitis. In the proximal sigmoid colon there is a 1.0 x 0.2-cm nodular focus (series 3, image 32), which may represent a polyp. No evidence of active bleeding from this questionable lesion.Due to technical error, the arterial and portal venous phase of the pelvis are not included. Small enhancing masses could be missed and if there is clinical concern for this, a repeat enterography after rehydration, given patient's renal function, is recommended.Ventral widemouthed hernia with colonic involvement without evidence of bowel wall edema or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See abdomen sectionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No large mass, acute inflammation, or active bleeding. 2.Nodular focus in the proximal sigmoid colon may represent a polyp. Due to technical error, the arterial and portal venous phase of the pelvis were not performed. Small enhancing masses could be missed and if there is clinical concern for this, a repeat enterography of the pelvis with contrast after rehydration, given patient's renal function, is recommended.3.Widemouthed ventral hernia without evidence of bowel wall edema or obstruction. |
Generate impression based on findings. | 59-year-old male with fall, pain, decreased range of motion There is volar dislocation of the middle phalanx of the fifth finger relative to the proximal phalanx. There is also radial angulation and rotational deformity of the middle and distal phalanges relative to the proximal phalanx. A 4-mm crescentic density seen on the oblique view overlying the dislocated joint may represent a fracture fragment, but this is equivocal. | Fifth PIP joint dislocation and possible fracture fragment as described above. |
Generate impression based on findings. | 90 year old woman presents for cardiac CT for evalution prior to possible TAVR CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with pseudo-bovine (normal variant) brachiocephalic branching pattern. There is minimal atherosclerosis of the proximal brachiocephalic vessels. No thoracic aortic aneurysm is noted. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is a small penetrating aortic ulcer (7mm wide, 3mm deep) in the descending thoracic aorta at the level of the diaphragm. There is no significant calcification in the ascending aorta. There is mild calcification of the aortic arch. There is moderate calcification of the descending aorta. No aortic coarctation is noted. Aortic Annulus: Dimension: 26mm x 23mm Circumferance:7.9cm Area: 4.6cm2Sinus of Valsalva: Width: 32 mm x 31mm x 31mm Height: 17mmSinotubular Junction: 26 x25 mmAscending Aorta (4cm from annulus): 28 x 25 mmMid Aortic Arch: 24 x 23 mmDescending Aorta: 23 x 23 mmAnnulus to LM Height: 14 mmAnnulus to RCA Height: 16 mmAortic Leaflet Length: 11 mmOptimal fluoroscopic angle for annulus: LAO5CAU6Aortic Valve: The aortic valve is trileaflet. There is severe aortic valve calcification; non-coronary and left aortic cusps > right aortic cusp. Mitral Valve: Severe mitral annular calcification is noted. The calcification is extensive and involves both the anterior and posterior leaflets.Left Ventricle: The left ventricular end-systolic volume is increased. There is mild left ventricular hypertrophy. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is mildly sigmoid in shape.Right Ventricle: Visually the right ventricular end-systolic volume is within normal limits. Pacemaker wire is present.Left Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is dilated in size. The superior and inferior vena cavae are grossly normal. There is a pacemaker wire present in the SVC and right atrium. The coronary sinus is normal in size. Pulmonary Artery: Main pulmonary artery is normal in size. The RPA and LPA are dilated.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is no significant calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is no significant calcification of the LCx. RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is no calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Severe aortic valve calcification2. Thoracic aorta anatomy and measurements as above. A small penetrating aortic ulcer is noted in the descending thoracic aorta at the level of the diaphragm.3. Severe mitral annular calcification with significant extension onto anterior and posterior leaflets.4. Severe left atrial dilation5. Dilation of the branch pulmonary arteries.6. Mild left ventricular hypertrophy with increased end-systolic volumes.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvic aorta/ CTA will be reported separately. |
Generate impression based on findings. | Metastatic lung carcinoma ABDOMEN:LUNG BASES: Progression of multiple left lower rib metastasis with increase in surrounding soft tissue metastatic component. Left basilar pleural thickening unchanged.LIVER, BILIARY TRACT: Accounting for differences in technique, probably no significant change in left hepatic lobe metastatic focus best seen on image 16 measuring 3 x 3.3 cm.Cholelithiasis without acute inflammation or ductal dilatationSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal atrophy again noted. Stable nonobstructing subcentimeter left renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval increase in size of the T10 vertebral body lytic lesion with possible cortical disruption. Interval increase in multiple lower left rib metastasis with increase in size of soft tissue component. Interval increase in size of lytic lesion involving L4 vertebral body now with anterior cortical disruption.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: New right ischial lytic metastasisOTHER: No significant abnormality noted | Progression of multifocal lytic bony metastases with cortical disruption as described. Probably no significant change in hepatic metastasis. |
Generate impression based on findings. | Male, 47 years old.History of malignant neoplasm of the vertebral column. Retroperitoneal spinal exposure and paraspinal tumor removal.Trigger: Elevated BMI and multiple surgical teams. Counts are correct. Two lateral views of the abdomen are provided. Posterior spinal fusion hardware, intervertebral spacer device, prevertebral surgical clips, and an IVC filter are noted. A single skin staple or towel clip is projected over the anterior abdomen. Enteric tube partially visualized at the superior margin of the image, tip may be in distal esophagus or proximal stomach. No unexpected radiopaque foreign objects. | No unexpected radiopaque foreign objects in the field of view. Possible high-riding enteric tube. These findings were discussed by telephone with Dr. Milner, the attending surgeon, on 1/2/2014 at 14:33. |
Generate impression based on findings. | Multiple myeloma status post chemotherapy, last December 2014. Increasing pain including hips. Evaluate for acute injury and/or disease progression.RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 98 mg/dL. Today's CT portion grossly demonstrates numerous lytic lesions throughout the skeleton. Cholecystectomy clips are noted.Today's PET examination demonstrates complete interval resolution of tumor activity in the right iliac wing. There has been significant reduction sternal lesion activity (SUV max = 5.6 previously, = 3.9 currently). The mild residual activity may reflect persistent healing bone remodeling or conceivably residual tumor metabolism.At the right 6th costovertebral junction, a new small mildly hypermetabolic focus is identified (SUV max = 3.7). This is considered more likely to represent focal degenerative change although new tumor activity cannot be entirely excluded.No additional suspicious FDG avid lesion is identified. Mild mottled activity of both proximal femurs is stable and consistent with benign marrow heterogeneity. A punctate soft tissue subcutaneous nodule in the right anterior chest is stable and also most likely benign. Mild to moderate curvilinear soft tissue activity seen surrounding both hips is stable and consistent with inflammatory bursitis. | 1.Interval improvement in previous hypermetabolic foci without convincing FDG avid tumor currently. Mild residual sternal activity may be remodeling bone from a treated metastasis. New small right 6th costovertebral focus considered more likely degenerative than tumor.2.Hypermetabolic soft tissue inflammatory activity surrounding both hips is stable although may be contributing to the patient's symptoms. |
Generate impression based on findings. | altered mental status Now the right PCA territorial acute ischemic infarction involving right occipital lobe, right posterior temporal lobe, and right thalami with effacement of sulci is very conspicuous.No evidence of hemorrhagic conversion.No change of non specific small vessel disease on bilateral periventricular white matter since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. Acute ischemic stroke involving right PCA territory including right occipital lobe, right posterior temporal lobe and right postero-lateral thalami as described above.2. No evidence of hemorrhagic conversion.3. No change of non specific small vessel disease since prior exam. |
Generate impression based on findings. | History of stem cell transplant with chronic sinusitis who presents with neck tenderness and left ear pain. There appears to be mild mucosal swelling and hypoattenuation in the oropharynx, particularly in the region of the left tongue base with effacement of the left vallecula. Otherwise, there is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. The right lobe of the thyroid is absent. The major cervical vessels are patent. There is a right internal jugular venous catheter. There are postoperative findings related to endoscopic sinus surgery with diffuse sinonasal opacification. The imaged intracranial structures are unremarkable. There are partially-imaged bilateral pleural effusions and patchy ground glass opacities in the lungs. There is opacification within the left mastoid air cells and middle ear. There is a carious tooth #22. | 1. Apparent mild mucosal swelling in the oropharynx may represent an upper respiratory infection, but no evidence of mass or significant lymphadenopathy in the neck.2. Fluid within the left mastoid air cells and middle ear may represent otomastoiditis.3. Diffuse sinonasal opacification may represent represents acute upon chronic sinusitis and perhaps nasal polyposis. 4. Carious tooth #22.5. Partially-imaged bilateral pleural effusions and patchy ground glass opacities in the lungs. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Female 19 years old Reason: assess for video capsule History: abdominal painVIEW: Abdomen AP (one view) 1/2/15 at 1415 hrs Mild amount of fecal accumulation with no evidence of obstruction or free air. Video capsule is no longer visualized. | Video capsule no longer visualized. No evidence of obstruction or free air. |
Generate impression based on findings. | Abdominal pain, evaluate for obstruction. ABDOMEN:LUNG BASES: Emphysema and mild basilar atelectasis. Right upper lobe pleural based mass not included in field of view.LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Delayed contrast equilibrium within the bilateral kidneys consistent with medical renal disease.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No free air, free fluid, or bowel obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Mild symmetric adnexal nodularity, likely benign.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No free air, free fluid, or bowel obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No acute findings to account for patient's pain.2.Cholelithiasis without cholecystitis.3.Medical renal disease. |
Generate impression based on findings. | History of abdominal pain and gram-negative sepsis, evaluate for abscess or typhlitis. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with associated atelectasis/consolidation.LIVER, BILIARY TRACT: The gallbladder is mildly distended. There is new pericholecystic fluid, mild gallbladder wall thickening, and right upper quadrant stranding concerning for acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction or intraperitoneal free air. There is submucosal fat deposition within the ascending colon which may reflect chronic inflammation. Trace abdominopelvic fluid is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel obstruction or intraperitoneal free air. There is submucosal fat deposition within the ascending colon which may reflect chronic inflammation. Trace abdominopelvic fluid is present.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings concerning for acute cholecystitis. Recommend ultrasound for further evaluation. Findings communicated to to Blummer, Stefanie at 2:45 p.m. 2.Possible chronic inflammation of the ascending colon.3.Bilateral small pleural effusions and associated atelectasis/consolidation. |
Generate impression based on findings. | 55-year-old male with metastatic lung cancer LUNGS AND PLEURA: Please note comparisons are made with attenuation CT with significant motion artifact from recent PET/CT.Reference left paramediastinal mass measures 19 x 12 millimeters (series 5, image 25), not significantly changed when compared to recent PET/CT.Linear scarring along the medial aspect of the left upper lobe is compatible with postradiation changes.Stable left basilar pleural thickening.Left lower lobe reference subpleural nodule is not well visualized.No significant change of subpleural nodules in the lateral aspect of the left lower lobe (series 5, image 80; series 3, image 86), which display hypermetabolic activity on recent PET, and are confluent with adjacent rib metastases.Previously described subcentimeter left perihilar nodule is no longer visualized.MEDIASTINUM AND HILA: The heart size is within normal limits, no significant pericardial effusion. The main pulmonary artery is of normal caliber. Mild coronary artery calcifications.Previously described left internal mammary lymph node is no longer appreciated.CHEST WALL: Nonenlarged bilateral axillary lymph nodes, which are abnormal in multiplicity.Lytic lesions are present in the T5 and T10 vertebral bodies, which display hypermetabolic activity in recent PET.Redemonstration of multiple osseous and associated soft tissue metastases on the left, including the lateral third rib, anterior fourth rib, lateral eighth rib, and posterior 11th rib. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left hepatic lobe metastatic lesion, not significantly changed.Please refer to CT of the abdomen and pelvis from the same date for abdominal findings. | 1. Reference left paramediastinal mass and adjacent postradiation changes are not significantly changed when compared to recent PET/CT.2. Redemonstration of multiple osseous and pleural based metastatic lesions, which have not substantially changed in the short interval.3. No new nodule/mass. |
Generate impression based on findings. | 60-year-old with history of pituitary tumor status post resection presenting with right breast mass (retroareolar 9 o'clock position) and nipple discharge. MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Bilateral retroareolar flame-shaped focal asymmetries with feathered posterior margins compatible with gynecomastia. Note is made of benign parenchymal calcifications bilaterally. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND: Targeted ultrasound of the right breast was performed in the region of the palpable abnormality. Sonography demonstrated retroareolar glandular tissue without suspicious mass lesion. | Bilateral gynecomastia without focal mass lesion. As long as the patient's exam remain stable, no further imaging is required.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Metastatic lung carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty liver again noted. Stable hepatic cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable right adrenal nodule best seen on image 46 of series 7 measuring 2.1 x 1.7 cm. Stable left adrenal hyperplasiaKIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination. |
Generate impression based on findings. | PICC lineVIEW: Chest AP (one view) 1/2/15 1325 Right PICC line tip at the superior cavoatrial junction.The cardiac silhouette is mildly enlarged.There is pulmonary vascular redistribution, without focal lung opacities or specific evidence of edema. | Mild cardiomegaly without edema. |
Generate impression based on findings. | Two year old female with ventricular shunt experiencing vomiting A right parietal ventricular catheter is present with tip terminating in the adjacent to the left lateral ventricle frontal horn, unchanged in position. The lateral and third ventricles are smaller than the comparison. Hypodensity is present throughout the white matter without associated mass effect, which appears more prominent than the comparison study, however this may be due to a background of some interval white matter myelination maturation. Previously demonstrated effacement of the fourth ventricle and crowding of the posterior fossa with cerebellar tonsillar herniation is no longer apparent. Cerebellar tonsils now lie above the foramen magnum, and the fourth ventricle is now evident, although dysmorphic in appearance. There is no acute intracranial hemorrhage. Orbits, paranasal sinuses, and mastoid air cells appear clear. | The lateral and third ventricles are smaller than the comparison.1.Hypodensity is present throughout the white matter without associated mass effect, which appears more prominent than the comparison study, however this may be due to a background of some interval white matter myelination maturation.2.Previously demonstrated effacement of the fourth ventricle and crowding of the posterior fossa with cerebellar tonsillar herniation is no longer apparent. Cerebellar tonsils now lie above the foramen magnum, and the fourth ventricle is now evident, although dysmorphic in appearance. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. SPECIFICALLY, there are no CT findings to explain the patient's symptoms. If there remains a high clinical suspicion for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | 49-year-old male with knee pain Small osteophytes indicate mild osteoarthritis. There is slight varus deformity of the knee. Similar findings are seen affecting the left knee on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | 64 year-old female with tachycardia. History of recent hip fracture repair and immobility. The examination was terminated early due to the patient's inability to cooperate with the examination. Limited images were provided from the contrast bolus timing sequence. No diagnostic images were provided/obtained to evaluate for pulmonary embolus or other cardiopulmonary abnormalities. Within the confines of the provided images, there are severe coronary artery calcifications. Incompletely visualized post therapeutic changes affecting the left upper lobe. Vascular calcifications of the aorta. | Nondiagnostic examination which was terminated early secondary to the patient's inability to cooperate with the examination. |
Generate impression based on findings. | 40-year-old male with history of colon cancer presenting with right breast palpable lump at the 3 o'clock position. Clinical suspicion of a sebaceous cyst, but evaluate for metastasis. MAMMOGRAPHY: Three standard views of both breasts as well as CC and mediolateral spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. A marker overlies the lateral left breast in the 2 o'clock radian indicating the site of the patient's palpable abnormality. No underlying lesion is evident. Note is made of scattered benign calcifications bilaterally. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND: Targeted ultrasound of the left breast was performed at the site of the patient's palpable abnormality. Sonography revealed a 7 mm hypoechoic, circumscribed cutaneous lesion compatible with a sebaceous cyst. No suspicious mass lesions identified. | Sebaceous cyst corresponding to the site of the patient's palpable abnormality. No mammographic evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 30 year-old male with low back pain Mild to moderate degenerative disk disease affects L5/S1. Alignment is within normal limits. Vertebral body heights are maintained. | Degenerative disk disease. |
Generate impression based on findings. | 57 year old female with history of intracranial hemorrhage experiencing headache. Previously demonstrated hematoma in the right head of caudate nucleus with extension to the right lateral ventricle and choroid has resolved. There is no evidence of rehemorrhage. The ventricles are unchanged in size or shape without evidence of obstruction or hydrocephalus. No evidence of midline shift. Moderate advanced small vessel chronic ischemic disease is again noted. The visualized paranasal sinuses and mastoid air cells are clear. | Resolution of previously demonstrated right caudate-centered hematoma without CT evidence of rehemorrhage. |
Generate impression based on findings. | Reason: evaluate for evidence of DAH History: hemoptysis LUNGS AND PLEURA: Moderate bilateral pleural effusions, larger on the right, with associated basilar compressive atelectasis. Mild dependent atelectasis and a posterior upper lobes.No evidence of diffuse alveolar hemorrhage. Interstitial edema which was evident on a chest radiograph of the previous day has resolved.MEDIASTINUM AND HILA: Increased opacity and stranding of the mediastinal fat consistent with edema.No significant lymphadenopathy.No visible coronary artery calcification.Minimal pericardial thickening or effusion.Catheter tip in SVC.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Minimal perihepatic ascites. | Bilateral pleural effusions and atelectasis. No evidence of pulmonary edema, which has apparently resolved, or diffuse alveolar hemorrhage. |
Generate impression based on findings. | The patient submitted outside digital mammogram dated 12/15/2011 from AHC Beverly in Chicago IL. Submitted outside study was compared to the current mammogram dated 12/2/2014. Breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. There has been benign progression of arterial calcifications. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination is unremarkable, annual right unilateral diagnostic mammogram is recommended. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 64 year-old male with a history of metastatic lung carcinoma. LUNGS AND PLEURA: Note is made of paraseptal emphysema with an upper lobe predominance. Right apical bulla, unchanged. Postsurgical changes of prior left upper lobectomy and post radiation therapy changes, appearing similar to the prior study. Multiple bilateral pulmonary nodules are identified some of which are calcified, suggestive of prior granulomatous disease. No pleural effusion or pneumothorax. No new or suspicious pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: Calcified hilar and mediastinal lymph nodes suggestive of prior granulomatous disease. Severe coronary artery calcifications. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Dilation of the main pulmonary artery, measuring 4.1 cm in diameter, is nonspecific, but can be seen in pulmonary artery hypertension. Vascular calcifications of aorta.CHEST WALL: The reference left lateral chest wall mass measures 3.7 x 2.3 cm (74; series 4), unchanged when compared to prior abdominal CT examination dated 11/17/2014. The previously described reference left supraclavicular lymph node is not definitively visualized on this examination. No evidence of axillary lymphadenopathy. Multilevel degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Fatty infiltration of the liver. Hypodensity in the right lobe of the liver, most consistent with a simple cyst, unchanged. No significant interval change in right adrenal nodule which is incompletely characterized/indeterminate, measuring 25 HU. Nodular thickening of the left adrenal gland, consistent with an adrenal hyperplasia. Small subcentimeter splenule's. Exophytic simple cyst along the interpolar region of the right kidney. | No significant interval change in reference left lateral chest wall mass, consistent with a biopsy proven history of metastatic disease. No new foci of metastatic disease are identified. Please refer to the accompanying CT abdomen and pelvis report for additional details. |
Generate impression based on findings. | The patient submitted outside digital mammogram dated 12/15/2011 from AHC Beverly in Chicago IL. Submitted outside study was compared to the current mammogram dated 12/2/2014. Breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. There has been benign progression of arterial calcifications. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination is unremarkable, annual right unilateral diagnostic mammogram is recommended. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Focal asymmetry is present in the medial superior left breast. No suspicious microcalcifications or areas of architectural distortion are present. | Focal left breast asymmetry. Spot compression views and ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female 56 years old Reason: Active small bowel crohn's disease ? History: Abdominal pain and diarrhea ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild thickening of short segment of terminal ileum without any striation or fat stranding suggestive of quiescent disease. No MR evidence of active inflammation involving the small bowel loops.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large, right ovarian cystic mass measuring 7.6 by 6 cm suspicious for a cystic neoplasm. No definite solid component is noted. Left ovary is unremarkable except for a 1.6-cm follicle. The uterus is unremarkable.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Large cystic mass arising from the right ovary suspicious for an ovarian neoplasm without a definite solid components, more likely to be benign. Further evaluation with pelvic ultrasound is recommended.No MR evidence of active inflammation involving the small bowel segments. |
Generate impression based on findings. | Female 15 years old; Reason: 15y/o h/o perf appy, now w hematuria/CVA tenderness LIVER: 14.2 cm in length. Normal hepatic echotexture, without focal lesions. Patent portal vein with hepatopetal flow.GALLBLADDER, BILIARY TRACT: Laying gallbladder sludge, without wall thickening or biliary ductal dilation.PANCREAS: No significant abnormality noted in the visualized head and body.SPLEEN: No significant abnormality noted. 11 cm in length.KIDNEYS: The kidneys are normal in appearance, without stones evident or hydroureteronephrosis. The right kidney measures 9.8 cm in length. The left kidney measures 9.8 cm in length. BLADDER: Distended, without wall thickening or debris. ABDOMINAL AORTA: Patent, without significant abnormality noted.INFERIOR VENA CAVA: Patent, without significant abnormality noted.OTHER: No significant abnormality noted in the periumbilical region at the site of the patient's stated pain. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral breast reduction. History of breast cancer in mother diagnosed at age 78. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable benign masses are present bilaterally. A new ill-defined focal asymmetry is present in the anterior depth of the right breast near the 3 o'clock position.No suspicious microcalcifications or areas of architectural distortion are present. | Stable bilateral benign masses. New focal right breast asymmetry. Spot compression imaging and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Right paratracheal lung mass. Evaluate for lung cancer/initial staging.RADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion grossly demonstrates an approximately 3.5 cm right paratracheal soft tissue mass containing punctate calcification, stable. Left hilar calcified lymph node is also noted. A small linear scarlike opacity is seen in the right middle lobe.Today's PET examination demonstrates a medium sized markedly hypermetabolic right upper paratracheal mass (SUV max = 14.8), highly suspicious for malignancy such as primary lung cancer.No suspicious FDG avid lesion is identified elsewhere in the neck, chest, abdomen or pelvis to indicate metastatic disease.Decreased activity in the region the right cerebellum and/or possibly inferior right occipital lobe suggestive of prior infarct, incompletely evaluated. | 1.Markedly hypermetabolic right paratracheal mass, highly suspicious for malignancy such as primary lung cancer.2.No FDG avid metastatic disease identified.3.Probable prior right posterior brain infarct would be better evaluated on dedicated brain CT or MR imaging as clinically warranted. |
Generate impression based on findings. | 49 years old, Male, Reason: Evaluate for possible occult maligancy History: 49 yo M w/ NICM, s/p ICD, with VF arrest and ICD lead clot and possible PE Lack of IV contrast limits the ability to assess vascular patency and abdominal parenchyma. Within these limitations the following observations are made:CHEST:LUNGS AND PLEURA: No focal consolidations. No suspicious nodules or masses.MEDIASTINUM AND HILA: Cardiomegaly with ICD leads present. No evidence of pericardial effusion.CHEST WALL: No significant abnormality noted. Mild induration of the soft tissues above the sternum, likely related to recent arrest. ABDOMEN:LIVER, BILIARY TRACT: No focal lesion identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing nephrolithiasis in the left kidney. Right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of occult malignancy. Please note lack of IV contrast limits the ability to assess vascular patency and abdominal parenchyma. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in mother diagnosed at age 43. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | History of pancreatitis and peripancreatic fluid collections, evaluate for interval change. ABDOMEN:LUNG BASES: Moderate bilateral pleural effusions with associated compressive atelectasis/consolidation appearing similar to prior.LIVER, BILIARY TRACT: Status post cholecystectomy. There is mild dilatation of the intra and extrahepatic biliary ducts appearing similar to prior. There is extensive thrombus formation within the main portal vein extending throughout much of the right portal vein as well as into the proximal left portal vein which was not appreciated on prior noncontrast examinations.SPLEEN: Splenomegaly.PANCREAS: Much of the pancreas does not enhance compatible with necrotizing pancreatitis with some residual enhancing parenchyma present in the body and tail. Several peripancreatic loculated fluid collections are present. The reference lesser sac component (series 3, 52) measures 4.5 x 6.9 cm and has slightly decreased in size and no longer contains gas. There is diffuse stranding of the omentum suggesting saponification, particularly in the left upper quadrant.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A gastrojejunostomy tube is in place with tip in the proximal jejunum. No evidence of bowel obstruction. There are scattered prominent mesenteric lymph nodes, which are nonspecific in the setting of inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small to moderate abdominopelvic ascites is present. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small to moderate abdominopelvic ascites is present. | 1.Extensive necrotizing pancreatitis with some residual enhancing parenchyma in the body and tail. Peripancreatic loculated fluid collections with slight interval decrease in size of lesser sac component which no longer contains gas.2.Extensive main portal vein thrombus with extension into much of the right portal vein as well as into the proximal left portal vein which was not appreciated on previous noncontrast examinations. |
Generate impression based on findings. | Male 63 years old; Reason: obstruction? 63M prostrate ca; no BM x 3 weeks History: no BM x 3 weeks Nonobstructive bowel gas pattern. Improvement in the stool burden. Diffuse sclerotic osseous metastases again seen. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female 18 years old; Reason: Evaluate hepatic vessels and flow. r/o VOD History: increased bilirubin LIVER: Liver echogenicity is normal. No intrahepatic biliary ductal dilatation is seen. The liver measures 18.8 cm in length.GALLBLADDER, BILIARY TRACT: The gallbladder is distended and normal in appearance. No gallbladder wall thickening is present. The common bile duct is normal.PANCREAS: The visualized head and body are normal in appearance.SPLEEN: Normal in echogenicity. Spleen measures 14 cm in length, unchanged. KIDNEYS: Normal in appearance. No hydronephrosis is present. Right kidney measures 12.1 cm in length. Left kidney measures 11.0 cm in length. ABDOMINAL AORTA: Normal in appearance.INFERIOR VENA CAVA: Normal in appearance.BLADDER: Distended, without wall thickening.DOPPLER | No evidence of venoocclusive disease. |
Generate impression based on findings. | Male 3 months old Reason: eval for PNA, infiltrate History: Hypoxia, cough, feverVIEW: Chest AP (one view) 1/2/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Left lower lobe opacity, likely atelectasis or pneumonia. No effusions or pneumothorax. | Left lower lobe opacity, likely atelectasis or pneumonia. |
Generate impression based on findings. | History of ORIF with pins palpable on exam. Please assess for hardware stability/migration. A side plate and screws affix the distal fibula in near-anatomic alignment. I see no hardware complications; specifically, I see no radiographic evidence of loosening or migration. I see no fracture. Tibiotalar joint osteophytes indicate mild osteoarthritis. | Orthopedic fixation of the distal fibula and mild osteoarthritis as described above. |
Generate impression based on findings. | Solitary pulmonary nodule right upper lobe.RADIOPHARMACEUTICAL: 15.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates an approximately 17-mm nodule in the periphery of the right upper lobe. There is a subtle approximately 5-mm nodule in the left upper lobe. Degenerative changes are seen throughout the thoracolumbar spine and sacroiliac joints.Today's PET examination demonstrates the right upper lobe pulmonary nodule to be markedly hypermetabolic (SUV max = 8.2). This is highly suspicious for malignancy, likely primary lung cancer.The subcentimeter left upper lobe pulmonary nodule is only slightly FDG avid (SUV max = 1.9). This may represent an inflammatory nodule although additional tumor cannot be entirely excluded.No suspicious mediastinal or hilar FDG avid lesion is identified.No abnormal FDG avid focus is seen within the abdomen, pelvis, or visualized skeleton. | 1.Markedly hypermetabolic right upper lobe pulmonary nodule, highly suspicious for malignancy, likely primary lung cancer.2.Weakly FDG avid subcentimeter left upper lobe pulmonary nodule may be inflammatory although an additional tumor focus cannot be entirely excluded.3.No suspicious FDG avid lesion to indicate tumor activity elsewhere in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | Female 2 years old Reason: emesis w shunt VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 1/2/15 Cranial deformities are again noted. Intracranial portion of the VP shunts system is unchanged in position. The extracranial VP shunt catheter does not show any evidence of kinking or discontinuities. Intraperitoneal VP shunt catheter terminates at the right upper abdomen quadrant. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. Mild nonspecific bowel distention. No obstruction or free air . | No evidence of VP shunt malfunction. |
Generate impression based on findings. | Male 67 years old; Reason: NG first line check placement History: NG first line check placement Note that the pelvis was not included in the exam. The nasogastric tube tip is in the body of the stomach with the sidehole at or above the gastroesophageal junction. Multiple persistently dilated and gaseous loops of bowel again noted and appearing similar to previous exam. Contrast is visualized in the colon. A pelvic catheter is partially seen. | The nasogastric tube tip is in the body of the stomach with the sidehole at or above the gastroesophageal junction. |
Generate impression based on findings. | 39 year old with 5 years of intermittent yellowish nipple discharge. Mammogram: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND: Bilateral targeted breast ultrasound was performed of the retroareolar regions. Sonography demonstrated normal glandular tissue. No focal mass lesion or ductal ectasia is present. | No mammographic or sonographic evidence of malignancy. Clinical follow up is recommended for the nipple discharge. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 52 years old, Male, Reason: Recent peritoneal hematoma, cecal pneumatosis History: incresed abd pain CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions with a loculated left pleural effusion that is mildly increased in size. Bibasilar atelectasis and scarring. Paraseptal emphysema.MEDIASTINUM AND HILA: Calcification of the thoracic aorta.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large left perinephric and retroperitoneal hematoma which is not significantly changed in size. In the setting of possible spontaneous hemorrhage overlying neoplasm such as angiomyolipoma or renal cell carcinoma cannot be excluded. Unchanged soft tissue densities in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant near complete resolution of benign cecal pneumatosis with residual small pockets of air. No evidence of obstruction, bowel wall edema, or free air on this examination. No evidence of portal venous gas.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Near complete resolution of benign cecal pneumatosis with residual small pockets of intramural air. 2.Left perinephric hematoma is not significantly changed in size. In the setting of spontaneous hemorrhage, underlying neoplasm such as angiomyolipoma or renal cell carcinoma cannot be excluded. |
Generate impression based on findings. | 49-year-old male with history of rheumatoid arthritis and pain Right hand: There is nonuniform narrowing of the second metacarpophalangeal joint with small osteophytes and mild deformity of the underlying second metacarpal head, which could represent chronic erosive remodeling from rheumatoid arthritis. Round lucency in the second metacarpal head may represent a degenerative cyst or erosion. There is also mild narrowing of the third metacarpophalangeal joint with a lucency within the metacarpal head which could represent a degenerative cyst or erosion. A small defect of the tuft of the distal phalanx of the index finger with loss of the overlying soft tissue may reflect old trauma.Left hand: There is mild narrowing of the triscaphe joint. A small defect along the base of the proximal phalanx of the index finger could represent a small erosion, but this is equivocal.Right foot: There is a chronic erosion along the medial aspect of the head of the proximal phalanx of the great toe. There is also deformity of the second and third metatarsal diaphyses which may represent old trauma. Lucencies within the fourth metatarsal head may represent chronic erosions. There is mild diffuse soft tissue swelling.Left foot: Focal prominence of the bone of the medial aspect of the proximal phalanx of the great toe may reflect a healed erosion. Mild deformity of the second metatarsal head may reflect chronic erosive remodeling. | Arthritic changes as described above, likely representing a combination of osteoarthritis and mild chronic inflammatory arthritis such as rheumatoid arthritis, albeit with somewhat atypical radiographic features. |
Generate impression based on findings. | 83-year-old female status post fall with rib pain Right hip: No fracture or malalignment. Mild osteoarthritis affects the hip. Arterial calcifications are noted in the soft tissues.Ribs: The bones are demineralized. No rib fracture is evident. Compression deformity of the seventh thoracic vertebral body with approximately 40 to 50% loss of height is of indeterminate age but new compared with chest radiograph from 2011. Severe osteoarthritis affects the left glenohumeral joint. There is mild dextroscoliosis of the lumbar spine. Osteoarthritis affects the lower lumbar facet joints. There is mild multilevel degenerative disk disease. | 1. Mild osteoarthritis affecting the right hip.2. T7 vertebral body compression fracture which is age indeterminate but new from prior chest radiographic dated 3/15/2011. Additional arthritic changes as detailed above. No rib fracture is evident. |
Generate impression based on findings. | Male, 64 years old, with stroke. Hypoattenuation involving the left caudate head and extending into the left basal ganglia is seen compatible with ischemic injury of indeterminate but potentially chronic time course. Also noted is patchy periventricular hypodensity which also likely reflects microvascular ischemic disease of indeterminate age. Questionable hypoattenuation is also seen in the left lateral cerebellum versus artifact.No evidence of significant parenchymal edema or mass effect is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. Ventricles and sulci are mildly prominent compatible with a mild degree of parenchymal volume loss.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear. | 1. Hypoattenuation involving the left caudate head and adjacent basal ganglia is compatible with ischemic injury. This is probably chronic given the CT appearance, but CT is insensitive in this regard and if clinical concern exists for acute ischemia, further evaluation with MRI is recommended.2. Elsewhere, patchy microvascular ischemic disease of indeterminate age is also seen. No definite additional acute abnormalities are detected. |
Generate impression based on findings. | Female 12 months old Reason: r/o pna History: crackles, fever, tachypneaVIEWS: Chest AP/lateral (two views) 1/2/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening and left lower lobe opacity, likely atelectasis or pneumonia . No effusions or pneumothorax. | Peribronchial thickening and left lower lobe opacity, likely atelectasis or pneumonia |
Generate impression based on findings. | Female 4 years old Reason: r/o pna History: cough, fever, cracklesVIEWS: Chest AP/lateral (two views) 1/2/15 Cardiac silhouette size is normal. Peribronchial thickening, left lower lobe and lingular opacity, likely atelectasis or pneumonia. | Peribronchial thickening, left lower lobe and lingular opacity, likely atelectasis or pneumonia. |
Generate impression based on findings. | 60 year old male with metastatic thyroid cancer. Please evaluate for bone metastases prior to treatment.RADIOPHARMACEUTICAL: 15.5 mCi F-18 NaF Today's CT portion grossly demonstrates innumerable bilateral metastatic lung nodules. There is a small to medium left pleural effusion. Tracheostomy is in place. Postsurgical changes from median sternotomy are noted. Numerous gallstones are seen without evidence of cholecystitis. Left scrotal hydrocele is visualized. There are scattered, sclerotic osseous lesions in the pelvis and spine.Today's PET examination demonstrates multiple abnormal osseous lesions consistent with metastatic disease. Increased activity is noted in the left frontal skull, left scapula, left fifth posterior rib, and right 10th posterior rib. In addition, increased activity is seen in the right transverse process of L1, which corresponds to FDG PET findings, and the right anterior vertebral body of L5. In the pelvis, there is increased activity in the left ischium, bilateral iliac wings, and sacrum. For reference, the maximum SUV is seen in the right L5 lesion and measures 44.7. Several of these lesions correspond with sclerotic foci on CT portion.Degenerative changes of the cervical spine and the bilateral acromioclavicular joints and knees are noted. | Multifocal osseous metastases. |
Generate impression based on findings. | Male 51 years old Reason: r/o obstruction History: abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes have not significantly changed. Index upper retroperitoneal node measures 1.8 x 1.7 cm on image number 31, series number 3. The etiology is unknown.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's abdominal pain. Borderline enlarged retroperitoneal lymph nodes and left inguinal hernia are unchanged. |
Generate impression based on findings. | 27-year-old male status post fall with knee and ankle pain, rule out fracture Knee: No fracture or dislocation is evident. Ankle: Mild soft tissue swelling is present about the ankle without fracture evident. There may be a small tibiotalar joint effusion. | 1. No knee fracture.2. Mild soft tissue swelling about the ankle without fracture evident. |
Generate impression based on findings. | Male 65 years old Reason: evaluate for bladder rectal fistula, r/o intra-abdominal abscess History: feculent material from urethra ABDOMEN:LUNG BASES: Bilateral small pleural effusions and atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple appearing right renal cyst. Subcentimeter complex right lower pole renal cyst. Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube is in place. Mild distention of the small bowel loops may be secondary to ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is a fistula between the sigmoid colon and the bladder, best seen on image number 115, series number 6. Significant amount of fecal material is noted within the bladder. Bladder wall is thickened. There may also be a collection between the bladder and the sigmoid colon.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fistulous commutation between the sigmoid colon and the bladder.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Large fistula between the sigmoid colon and the bladder. Significant amount of fecal material is noted within the bladder. |
Generate impression based on findings. | Male 38 years old Reason: r/o abscess History: sepsis ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis and small amount of pleural effusions. Pneumonia cannot be excluded in the lung bases.LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter is in place.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat containing left inguinal hernia.OTHER: No significant abnormality noted | Dependent atelectasis and small amount of pleural effusion at the lung bases. Pneumonia cannot be excluded. Fat containing left inguinal hernia.Fatty infiltration of the liver. |
Generate impression based on findings. | Female 84 years old Reason: pt w/ sacral abscess question of abscess vs osteo History: febrile UTERUS, ADNEXA: Ossified leiomyoma.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sacrum decubitus ulcer involving a large area of the posterior skin. There is likely a fistulous communication between the anus, extending to the skin, best seen on image number 57, series number 3. Correlation of this finding with clinical findings and if necessary MRI may be helpful. Soft tissue density encases the coccyx and distal sacrum. Osteomyelitis is likely present. MRI may be helpful for more definitive evaluation of the bones.OTHER: No significant abnormality noted | Extensive decubitus ulcer with possible perianal fistula. Inflammation encases the coccyx and distal sacrum and osteomyelitis is likely. MRI may be helpful for further evaluation of the bones and possible perianal fistula.Calcified fibroid. |
Generate impression based on findings. | Recurrent cervical cancer status post 3 cycles of chemotherapy. Assess response.RADIOPHARMACEUTICAL: 15.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates multiple thoracic calcifications involving parenchymal and mediastinal granulomas as well as involving the left pleura. Right chest Port-A-Cath with tip in the SVC. A large layering gallstone is noted.Today's PET examination demonstrates interval reduction in hypermetabolic activity in the region of the cervix/vagina. The previously present focal masslike accumulation has been replaced by a milder more linear uptake (SUV max = 8.9 previously, = 6.8 currently). The current activity may reflect inflammation or some residual tumor metabolism.In the medial left inguinal region, a punctate mildly hypermetabolic focus (SUV max = 1.9) corresponds to an 8-mm lymph node. This lymph node has slightly increased in size from prior CT portion and is newly, albeit mildly, FDG avid. This may simply reflect an inflammatory lymph node although progressive tumor activity cannot be entirely excluded. No additional suspicious FDG avid lesion is identified. Extensive benign brown fat hypermetabolism is seen in the neck, thorax, and upper abdomen. Decreased marrow activity of the lower lumbar spine and pelvis is consistent with prior radiation therapy. | 1.Significant interval decrease in the previous hypermetabolic cervical/vaginal lesion with milder residual activity currently suggestive of inflammation or some residual tumor metabolism.2.While there is no definitive FDG avid tumor elsewhere, a subcentimeter mildly hypermetabolic left inguinal lymph node has progressed slightly from previous. This may reflect inflammation although tumor activity cannot be entirely excluded. Attention to this region on follow up exams can be made. |
Generate impression based on findings. | Female 9 months old Reason: DHT placement History: replacement of DHTVIEW: Abdomen AP (one view) 1/2/15 at 1704 hrs. Feeding tube terminates at the antral pyloric region. Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Feeding tube positioning as described. |
Generate impression based on findings. | 48 years old, Male, Reason: ? AAA, dissection History: chest pain, BLE paresthesias Angiogram: No evidence of dissection, aortic aneurysm, or significant stenosis. The origins of the great vessels from the celiac axis, SMA, renal arteries, and IMA are all patent.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No evidence of obstruction, free fluid, or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of dissection, aortic aneurysm, or significant stenosis. No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Male 15 days old Reason: NG position / Foley position History: psot op bowel resection /ileostomy.VIEW: Abdomen AP (one view) 1/2/15 at 1704 hrs. Feeding tube terminates about GE junction. A urinary bladder catheter is noted. Contrast material in bowel loops is no longer visualized. Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced NG tube. |
Generate impression based on findings. | Reason: r/o PE History: SOB, tachycardia PULMONARY ARTERIES: Technically adequate study. No acute pulmonary embolism to the segmental level. The main pulmonary artery is of normal caliber.LUNGS AND PLEURA: Minimal dependent atelectasis.MEDIASTINUM AND HILA: Multiple large thyroid nodules, the largest of which measures up to 2.8 cm, similar in size to previous thyroid ultrasound.A heterogeneous, soft tissue density mass within the prevascular space extends along the left hilum, measuring approximately 71 x 35 mm (series 4, image 119).Heart size is normal without significant pericardial effusion.Mild coronary artery calcifications.CHEST WALL: No significant axillary lymphadenopathy.Mild degenerative disease of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Peripheral right hepatic lobe hypoattenuating lesion is too small to characterize, nonspecific, but likely benign. | 1. No evidence of pulmonary embolism to the segmental level.2. Large heterogeneous anterior mediastinal mass, which extends along the left hilum, is concerning for neoplastic process. Differential diagnosis includes lymphoma, germ cell tumor, and although atypical for patient's age, thymic neoplasm should also be considered.3. Multiple thyroid nodules.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 10 years old Reason: 10 yo F ADHD, speech delay p/w status epilepticus now intubated. Evaluate lung fields and ETT position. History: intubatedVIEW: Chest AP (one view) 1/3/15 at 619 hours. Central line tip is at the RA/SVC junction. ET tube terminates in the thoracic inlet. Proximal side port of NG tube is above the junction. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Interval retraction of NG tube. |
Generate impression based on findings. | Respiratory distress of the newborn.VIEW: Chest AP (one view) 1/2/15 at 2328 hrs. Tracheostomy tube tip is at the thoracic inlet. NG tube is present. Cardiac silhouette size is top normal. No change in large lung volumes, right lung hyperinflation and left lower lobe atelectasis on a background of diffuse haziness. No effusions or pneumothorax. | Interval retraction of tracheostomy tube.Persistent right lung hyperinflation and left lower lobe atelectasis. |
Generate impression based on findings. | 92 years old, Male, Reason: infection? appy? cancer? History: AMS, diffusely tender abdomen. IV only; Patient is altered and will not be able to drink PO contrast. ABDOMEN:LUNG BASES: Images of the lungs are somewhat degraded by motion. Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: Interval progression of diffuse hepatic metastases. Reference left hepatic lobe lesion measures 8.7 x 6.5 cm (series 4, image 35), previously measuring 4.6 x 6.5 cm. Numerous other hepatic metastases also appear larger in size. Cholelithiasis without evidence cholecystitis.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: Left common iliac artery aneurysm appearing similar to prior exam. Severe calcification of the abdominal aorta and bilateral iliac vessels. Upper abdominal lymphadenopathy.BOWEL, MESENTERY: Bilateral inguinal hernia are present. Left hernia contains loops of small bowel, mesentery and vessels there is some adjacent fluid within the hernia sac. Small bowel loops within the hernia sac are mildly dilated containing fecal material concerning for partial small bowel obstruction. Ischemia of the bowel cannot be excluded. No definite evidence of pneumatosis or free air. Upper abdominal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: See abdomen section.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval progression of diffuse hepatic metastases.2.Left inguinal hernia containing multiple dilated loops of small bowel concerning for partial small bowel obstruction. |
Generate impression based on findings. | 59-year-old male status post reduction A splint now overlies the fifth digit. Interval reduction of the fifth DIP joint, now in near-anatomic alignment. A small osseous fragment adjacent to the ulnar aspect of the head of the fifth phalanx likely represents a small fracture fragment. There is soft tissue swelling about the fifth digit. Mild ulnar negative variance is again noted. | Status fifth DIP joint reduction, now in near-anatomic alignment. |
Generate impression based on findings. | Male 7 years old Reason: eval fracture History: prior fractureVIEWS: Left hand AP, lateral and oblique 1/3/15 (3 views) There is a Salter-Harris two fracture of the proximal phalanx of the left fifth finger with medial angulation. | Salter-Harris two fracture of the proximal phalanx of the left fifth finger as described. |
Generate impression based on findings. | Female 14 years old Reason: R/O fracture History: pain along 5th metatarsal and heelVIEWS: Right foot AP, lateral and oblique 1/3/15 (3 views) There is a nondisplaced fracture of the base of the fourth metatarsal. | Nondisplaced fracture of the right fourth metatarsal. |
Generate impression based on findings. | Right frontal approach Rickham catheter has been exchanged for EVD with the tip at the midline at the level of the frontal horns. Right parietal approach ventricular catheter, tip in the body of the right lateral ventricle, unchanged. No change in the orphaned left sided intraventricular catheter.The ventricular system is enlarged but perhaps slightly decreased in size compared to the prior study. The temporal horn measures 17 mm on the current study, previously 20 mm. There has been instillation of intraventricular contrast which layers within the right lateral ventricle and within the third ventricle. No contrast is seen in the fourth ventricle or the left lateral ventricle. Small amounts of air are seen within the lateral ventricles, likely related to the procedure. There are no masses or areas of abnormal attenuation or pathological enhancement. No evidence of intracranial abscess, intracranial hemorrhage, subdural hematomas, or loss of gray-white distinction. There is minimal mucosal thickening in the ethmoid air cells and sphenoid sinuses and opacification of a few dependent mastoid air cells. | 1.Perhaps a slight decrease in ventriculomegaly.2.No evidence of intracranial abscess or intracranial hemorrhage. |
Generate impression based on findings. | Male 12 years old; Reason: evaluate for fracture or dislocation History: dog bite with lacerations to 3rd and 4th digitVIEWS: Right hand PA/lateral (2 views) 1/2/15 Soft tissue defects are noted at the distal aspects of the middle and ring fingers. No underlying fracture or malalignment is present. No radiopaque foreign body is evident in the soft tissues. | No fracture or malalignment. |
Generate impression based on findings. | 91 year-old female status post toe amputation, rule out osteomyelitis The bones are diffusely demineralized. Status post amputation of the majority of the third toe except for the base of the proximal phalanx. The distal margins of this osseous fragment are somewhat indistinct, which is nonspecific, but could be postoperative in etiology or secondary to osteomyelitis. Mild hallux valgus deformity. There is deformity of the fifth metatarsal, presumably post traumatic. | Status post third toe amputation with indistinct margins of the residual base of the proximal phalanx, which may be postoperative in etiology or due to osteomyelitis. If further evaluation is clinically warranted serial imaging should be considered. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial bleed. |
Generate impression based on findings. | 48-year-old female post splint placement Interval splint placement about a comminuted spiral humerus fracture. There is approximately 1.3 cm persistent medial displacement of a medial fracture fragment. | Splinted humerus fracture as detailed above. |
Generate impression based on findings. | HypoxiaVIEW: Chest AP (one view) 1/2/15 2305 Surgical sutures and Penrose drain again noted.Normal cardiac silhouette.Post-surgical changes in the left lung. Small left pleural effusion, similar to prior. Decreased left lower lobe atelectasis. No focal lung opacities or pneumothorax. | Decreased LLL atelectasis. |
Generate impression based on findings. | 48-year-old female, evaluate for fracture Humerus: There is a comminuted spiral fracture of the mid diaphysis of the right humerus with medial angulation of the distal fragment as well as medial displacement of an additional osseous fragment by up to 1.5 cmShoulder: Glenohumeral alignment is within normal limits. No fracture about the shoulder. The comminuted humeral fracture as described above is again visualized.Elbow: No joint effusion or fracture about the elbow. The distal aspect of the comminuted humerus fracture as described above is again visualized. | Comminuted spiral fracture of the humeral diaphysis. |
Generate impression based on findings. | 15 y/o F hx Crohn's with severe draining fistulae c/f abscess History: labial pain and swelling, purulent drainage.EXAMINATION: MRI of the pelvis without and with IV contrast. 1/2/15 1718 UTERUS, ADNEXA: Normal in appearance. BLADDER: Normal in appearance.LYMPH NODES: Enlarged bilateral inguinal lymph nodes.BOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: Again seen is the fistulous tract extending from the posterior rectal wall to the superior gluteal cleft, with sinus tract branching laterally to the right (series 401, image 41). This tract now extends minimally more cranially along the sacral soft tissues to the S4/S5 level (series 601, image 28). More inferiorly, a right sinus tract and left fistulous tract are again seen extending from the posterior rectal wall along either side of the gluteal cleft, with the left tract now extending to the skin surface (series 401, image 47). There is interval increase in overall perineal soft tissue edema extending to the labia majora bilaterally, right significantly greater than left, with suspected tracts (series 401, image 53) extending through the labia majora bilaterally. No drainable fluid collection is evident. The right labial edema extends to the previously-seen cutaneous edema (series 401, image 48), which may indicate fistulization. The rim enhancing collection of fluid in the superficial soft tissues anterior to and to the right of the pubic symphysis (series 401, image 41) measures 11 x 5 mm, previously 14 x 6 mm. | Multiple complex fistulous and sinus tracts extending from the posterior wall of the rectum and through the perineum, which are increased in extent compared to the prior examination. Particularly, there is increased extent of edema in the labia major bilaterally with possible fistulous tract in the right labia majora. |
Generate impression based on findings. | Redemonstrated is chronic ischemic injury in the right basal ganglia and medial temporal lobe. There are also scattered foci of hypoattenuation in the periventricular white matter.No evidence of parenchymal edema or loss of gray-white distinction is seen. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. The right temporal horn shows mild ex vacuo dilatation, but the remainder of the ventricular system is normal in size and morphology.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear. | 1. No acute intracranial hemorrhage.2. Evidence of extensive prior ischemic injury in the right basal ganglia and medial temporal lobe. |
Generate impression based on findings. | Reason: Eval R lung abscess, necrotizing pneumonia History: Septic, known R lung infiltrate/abscess, s/p L lung transplant and R lung volume reduction and endobronchial valves LUNGS AND PLEURA: Status post left lung transplant. Small interval decrease of left basilar opacity, with residual consolidation/atelectasis and small loculated left pleural effusion.Interval resolution of left upper lobe centrilobular ground-glass nodules.Persistent large loculated fluid/air collection in the right lung, with complete collapse of the right upper lobe; interval drainage/resolution of the majority of the fluid, which has been largely replaced by a loculated pneumothorax, with some residual pleural fluid/thickening. Severe emphysema with large bullae at the superior segment of the right lower lobe and right-sided bronchial valves are not significantly changed.Extensive right basilar consolidation/atelectasis appears similar to prior exam.MEDIASTINUM AND HILA: Tracheostomy tube in expected position. Bilateral central venous catheters in the SVC/RA.Cardiac enlargement and small pericardial effusion, similar to prior.The main pulmonary artery is enlarged, measuring 35 mm in diameter, suggesting pulmonary arterial hypertension.Moderate coronary artery calcification, as well as dense calcification of the aortic arch.Heterogeneous thyroid nodules.Multiple prominent mediastinal lymph nodes, likely reactive.CHEST WALL: Unchanged intramuscular lipoma in the right chest wall.Stable compression deformities of T6 and L1 vertebral bodies.Stable appearance of old rib fractures and previous sternotomy.Persistent anasarca.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Interval improvement of perihepatic fluid and peripancreatic fat stranding/edema.G-J tube in expected position. | 1. Persistent large, loculated collection of fluid and air in the right lung; there has been interval resolution/drainage of the majority of the fluid, which has been replaced with air, with a small residual component of pleural fluid/thickening. The extensive right basilar consolidation/atelectasis is similar to prior, likely infectious etiology. No definitive abscess as clinically queried.2. Status post left lung transplant. Mild interval improvement of dense left basilar consolidation/atelectasis and loculated pleural effusion.3. Stable cardiomegaly and small pericardial effusion. |
Generate impression based on findings. | 37 year-old female in motor vehicle collision Humerus: No fracture of the humerus. Alignment is anatomic. Mild degenerative changes affect the pubic symphysis.Ankle: Minimal soft tissue swelling about the ankle without fracture visualized. Alignment is anatomic.Lumbar spine: Small anterior osteophytes indicate minimal degenerative changes. Alignment is anatomic. Vertebral body heights are maintained.Knee: Alignment is anatomic. No fracture is evident. Small tibiofemoral osteophytes indicate mild degenerative arthritic changes. Small effusion joint effusion. | Mild degenerative changes without fracture or malalignment. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial process. If there remains clinical concern for an acute ischemic event and no contraindication to MR, MRI of the brain is recommended. |
Generate impression based on findings. | 66-year-old male status post reduction of clinical anterior shoulder dislocation Minimal osteoarthritis affects the shoulder. The glenohumeral joint is in near-anatomic alignment. No fracture is visualized. | Status post shoulder reduction with no fracture visualized. |
Generate impression based on findings. | 57 years old, Female, Reason: eval progression of RCC History: cough, wheezing CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules bilaterally compatible with metastases. Largest nodule in the left upper lobe measures 1.9 x 1.6 cm (series 5, image 23). There is a bulky confluent mass in the right suprahilar/hilar region which appears to encase and invade the right main pulmonary bronchus. There are also scattered ground glass opacities which may represent superimposed infection or additional tumor involvement. MEDIASTINUM AND HILA: See above for right hilar mass description.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of a left nephrectomy. Right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: Left periaortic lymph nodes are enlarged adjacent to surgical clips which may represent lymph node metastasis or less likely local recurrence.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Injection granulomas seen in the superior left buttock.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Large right perihilar mass encasing vessels and bronchus with endobronchial invasion of the right main stem bronchus. Multiple bilateral pulmonary nodules consistent with metastasis.2.Left periaortic lymph nodes adjacent to the left nephrectomy surgical bed may represent metastasis or local recurrence. |
Generate impression based on findings. | 65-year-old male with history of osteoarthritis, fall on right knee Tricompartmental osteophytes and medial greater than lateral joint space narrowing without fracture visualized. There is a small joint effusion. | Moderate osteoarthritis without fracture. |
Generate impression based on findings. | 57-year-old female with history of lower extremity ulcer There is marked diffuse reticulation of the subcutaneous fat about the leg. Soft tissue ulceration is noted along the lateral aspect of the distal fibula. There is chronic appearing periosteal reaction about the distal fibula without osteolysis, which is new from the prior exam. | Soft tissue swelling, ulceration, and chronic appearing periosteal reaction about the distal fibula which may represent chronic osteomyelitis, but there is no bone destruction. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas.The ventricles and sulci are prominent compatible with volume loss, not significantly changed. There are no masses, mass effect or midline shift. Again seen is prominent periventricular hypoattenuation and areas of encephalomalacia in the left temporal and occipital lobes which is not significantly changed. There is extensive atherosclerotic calcification of the intracranial ICAs and the M1 segment of the left MCA, unchanged.There is a chronic deformity of the left lamina papyracea. No calvarial fracture. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No evidence of acute intracranial hemorrhage.2.No change in the extensive age indeterminant small vessel ischemic disease and encephalomalacia. No definite evidence of acute ischemia. Please note that CT is insensitive for the detection of early nonhemorrhagic stroke. If clinical concern remains high, further evaluation with MRI can be considered. |