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Generate impression based on findings. | Tooth pain and swelling. Question of abscess in right lower molar with possible tracking in potential space. There is minimal periapical lucency involving the right mandibular first molar tooth (ADA #3) with minimal overlying soft tissue thickening measuring up to 3 mm (image 90, series 3 and image 60, series 80387). There is mild soft tissue stranding overlying the right mandible. No discrete fluid collection is identified. There are prominent bilateral level Ib lymph nodes. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is mucosal thickening of the imaged paranasal sinuses. The mastoid air cells are clear. The imaged portions of the lungs are clear. | Periapical lucency involving the first right mandibular molar (ADA #3) with overlying soft tissue thickening may represent a phlegmonous collection though no discrete fluid collection is identified; correlate with direct examination. |
Generate impression based on findings. | Evaluate lung expansionVIEW: Chest AP 1/4/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left upper extremity PICC with tip in the left brachiocephalic vein. Cardiothymic silhouette normal. Patchy atelectasis in the left lung unchanged. New large right pneumothorax with mediastinal shift from right-to-left. Marked body wall edema. | New large right pneumothorax with mediastinal shift from right-to-left. |
Generate impression based on findings. | Increased work of breathingVIEW: Chest AP 1/4/15 NG tube has been removed in the interval. Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. |
Generate impression based on findings. | Central line placementVIEW: Chest AP (one view) 1/4/15 1640 ET tube tip is at the carina. Left central venous catheter tip is curled at the left brachiocephalic vein, with tip directed cranially. Enteric tube tip is in the distal esophagus.The cardiothymic silhouette is normal.No focal pulmonary opacity, pleural effusion, or pneumothorax is present. | Misplaced left central venous catheter. Findings were discussed with the covering PICU resident by the radiology resident on call at 6 p.m. on 1/4/15. |
Generate impression based on findings. | ET placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis bilaterally increased in the right lung. No pleural effusion or pneumothorax. | ET tube tip below thoracic inlet and above the carina. |
Generate impression based on findings. | Endotracheal tube placementVIEW: Chest AP ET tube tip at the level of the thoracic inlet. Left upper extremity PICC with tip in the left subclavian vein. NG tube removed in the interval. Cardiothymic silhouette normal. Patchy atelectasis bilaterally increased in the interval. No pleural effusion or pneumothorax. | ET tube tip at the level of the thoracic inlet. |
Generate impression based on findings. | 83-year-old male with new onset severe ankle pain. Right ankle: There is mild soft tissue swelling about the lateral ankle without underlying fracture visualized. There has been an osteotomy of the fifth metatarsal which is incompletely visualized. Soft tissue swelling is noted about the distal Achilles tendon.Left ankle: Mild soft tissue swelling about the lateral ankle without underlying fracture. There is deformity of the fifth metatarsal, which may relate to prior trauma. There is soft tissue swelling about the distal Achilles tendon. | Mild soft tissue swelling and finding suggestive of distal Achilles tendinopathy. |
Generate impression based on findings. | TraumaVIEWS: Pelvis AP (one views) 1/4/15 1406 The femoral heads are well directed into normal appearing acetabula. No fracture or malalignment is present. | No fracture or malalignment. |
Generate impression based on findings. | Pain status post fallVIEWS: Left elbow AP/oblique/lateral (3 views) 1/4/15 There is a supracondylar fracture of the humerus with moderate posterior angulation of the distal fracture fragment. Soft tissue swelling and elbow joint effusion are noted. | Supracondylar humeral fracture. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage. There is no extra-axial fluid collection. The ventricles and sulci are within normal limits for age. There is no midline shift or mass effect. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Advanced degenerative changes at the right temporomandibular joint. No appreciable orbital masses. | No intracranial hemorrhage or evidence of mass effect. No hydrocephalus. Please note MRI would be more sensitive for evaluation of small lesions along the sixth cranial nerve. |
Generate impression based on findings. | Increased work of breathingVIEW: Chest AP 1/4/15 NG tube tip at the GE junction. Cardiothymic silhouette normal. Patchy atelectasis right lower lobe in a background of chronic lung disease. No pleural effusion or pneumothorax. | Patchy atelectasis right lower lobe in a background of chronic lung disease. |
Generate impression based on findings. | Bony growth. Swelling.VIEWS: Right knee AP/oblique/lateral (3 views) 1/4/15 An unchanged broad-based exostosis extends anteriorly and medially from the anterior aspect of the proximal tibia, just inferior to the apophysis. No fracture or malalignment is present. No joint effusion is evident. | Unchanged proximal tibial exostosis. |
Generate impression based on findings. | The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with a normal cervical lordosis. The vertebral body and disk space heights are well-maintained.There is no acute fracture.At C1-C2, there is a normal relationship of the dens with the arch of C1.At C2-C3, there is no significant spinal canal or neural foraminal stenosis. There is mild left facet arthropathy.At C3-C4, there is no significant spinal canal or neural foraminal stenosis.At C4-C5, there is no significant spinal canal or neural foraminal stenosis.At C5-C6, there is a tiny central disk protrusion with no significant spinal canal or neural foraminal stenosis.At C6-C7, there is a tiny central disk protrusion with no significant spinal canal or neural foraminal stenosis.At C7-T1, there is no significant spinal canal or neural foraminal stenosis.There is mild left facet arthropathy at T2-3 with left neural foraminal stenosis.The visualized intracranial structures appear normal. The lung apices show fibrotic changes. | 1.No acute fracture or traumatic subluxation.2.Mild left neural foraminal stenosis at T2-3 from left facet arthropathy. |
Generate impression based on findings. | Female 42 years old; Reason: Assess etiology of hemoperitoneum History: s/p bilateral retroperitoneal nephrectomies with blood in dialysate fluid The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Moderate bilateral atelectasis with superimposed consolidation, left greater than right.LIVER, BILIARY TRACT: Moderate sludge within the gallbladder.SPLEEN: Extensive calcified granulomata throughout the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomies. Bilateral hyperdense retroperitoneal collections with air locules extending inferiorly along the bilateral psoas muscles. The appearance is most compatible with postsurgical hematoma formation, slightly larger on the right side and measuring 8.9 x 6.3 cm (series 3, image 52).RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Additional hematoma is identified in the left paracolic gutter and extending along the pancreatic tail and splenic hilum. Perihepatic and pericolonic hyperdense fluid is noted. Free air is identified within the abdomen likely relating to a combination of recent surgery and peritoneal dialysis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Abnormal intramuscular air along the left lateral abdominal wall and anterior pelvic wall bilaterally, which likely relates to recent surgery. Mild body wall edema.OTHER: Peritoneal dialysis catheter coiled within the pelvis. Peritoneal dialysis fluid within the pelvis. Free air is identified within the pelvis, likely relating to a combination of recent surgery and peritoneal dialysis. | 1.Postsurgical changes relating to recent bilateral nephrectomies. Bilateral hematomas within the nephrectomy beds. Additional hematoma identified within the left upper quadrant.2.Perihepatic, perisplenic and pelvic hyperdense fluid. This is compatible with peritoneal dialysate with hyperdensity likely relating to recent surgery. It is not possible to assess for active bleed in the absence of intravenous contrast. 3.Moderate bilateral atelectasis with superimposed consolidation, left greater than right. |
Generate impression based on findings. | 42-year-old with history of architectural distortion on prior mammogram. Short interval follow-up. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal architectural distortion seen previously in the left lower inner quadrant is no longer present. No dominant mass or suspicious microcalcifications are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: eval for aneurysm and progression of ICH/IVH/SAH History: unresponsive, ICH Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Atherosclerotic calcifications are present the origins of the vertebral arteries bilaterally. Atherosclerotic calcifications are present at the carotid bifurcations.There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at see 45, C5-6 and C6-7 as well as C7-T1 worse at C5-6 where there are findings suspicious for spinal stenosis. There is bilateral neural foramen encroachment at C4-5, C5-6 and C6-7.There are airspace opacities present in the upper lung fields.A hypodense foci present in the thyroid gland lobes bilaterally.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the left posterior communicating arteries are identified and are intact. The right posterior communicating artery has a fetal origin. The right P1 segment is small.CT head:There is a 34 by 58 millimeter hemorrhage located in the right frontal lobe along the right orbital gyrus and gyrus rectus which abuts the right sylvian fissure and is associated with a significant amount of subarachnoid blood centered at the expected location of the right internal carotid artery bifurcation. Additionally, there is intraventricular blood present in the right lateral ventricle more than the left but also present in the fourth and third ventricles. The adjacent anterior falx is shifted towards the left by approximately 4 mm , however, the septum pellucidum and third ventricle are nearly midline.A ventriculostomy tube courses through the left frontal lobe into the left lateral ventricle and has its tip in the body of the left lateral ventricle. The temporal horns of the lateral ventricles are dilated. Sulci appear to be effaced. There is subgaleal air present adjacent to the entry point of the ventriculostomy tube.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is a large right frontal lobe intraparenchymal hematoma associated with subarachnoid and intraventricular blood in the mass effect. No underlying source is appreciated on this exam. 2.There is mild ventriculomegaly present associated with sulcal effacement. This raises the question of hydrocephalus. Please correlate with clinical symptoms.3.No evidence for aneurysm.4.No evidence for cervicocerebral occlusive disease5.findings are suspicious for cervical spinal stenosis6.air space opacities suggest lung consolidations . Please correalate with chest x-ray findings.7.Multiple hypodense lesions in the thyroid gland are nonspecific but could represent multiple thyroid nodules |
Generate impression based on findings. | Reason: Metastatic lung cancer. History: Metastatic lung cancer. CHEST:LUNGS AND PLEURA: Pleural thickening on the left (image 59/104) with basilar scarring unchanged. Previous referenced subpleural nodules and pericardial masses remain resolved. No new pulmonary nodules.MEDIASTINUM AND HILA: Reference prevascular lymph node (series 3, 34) unchanged at 4 mm. Reference cardiophrenic lymph node (series 3, 67) unchanged at 6 mm. Subcentimeter right thyroid nodule too small to characterize but stable.CHEST WALL: Small axillary lymph nodes, similar to priorSmall punctate sclerotic focus in the T6 vertebrae, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodensity in the left lobe measuring 26 mm (image 81/139), 25 mm on prior. No new lesions identified.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable CT with no new sites of disease. |
Generate impression based on findings. | 39 year old female with left breast cancer status post chemoRADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A foci of increased activity is noted in the left axilla, representing the sentinel node. This region was marked with an indelible marker. | Sentinel node identified in the left axilla. |
Generate impression based on findings. | Cerebral palsy tachypneaVIEW: Chest AP Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette normal. Left lower lobe opacity likely atelectasis minimally improved in the interval. No pleural effusion or pneumothorax. Multiple surgical clips in the upper abdomen. | Left lower lobe atelectasis minimally improved in the interval. |
Generate impression based on findings. | Female 12 years old; Reason: 12yo F with SLE, respiratory failure, pancreatitis, eval lung opacities (?alveolar vs interstitial) , r/o splenic thrombosis, pancreatic pseudocyst History: intubated, pancreatitis CHEST:LUNGS AND PLEURA: Extensive dense bilateral perihilar pulmonary opacities with surrounding patchy groundglass opacities. Very small bilateral pleural effusions.MEDIASTINUM AND HILA: Mild cardiomegaly, without pericardial effusion. No mediastinal or hilar lymphadenopathy by CT size criteria.CHEST WALL: The ET tube tip is below the thoracic inlet and above the carina. Right central venous catheter tip in the SVC. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Normal appearance, without focal lesions or biliary ductal dilation. Patent main, right, and left portal veins.SPLEEN: Normal in appearance. Patent splenic vein and artery.PANCREAS: Edematous in appearance, without focal areas of hypoattenuation to suggest necrosis. No pancreatic ductal dilation.ADRENAL GLANDS: Normal in appearance. KIDNEYS, URETERS: Normal in appearance, without focal lesions or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate amount of diffuse abdominopelvic ascites, without distinct loculated fluid collections.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted. Bladder catheter in place.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of diffuse abdominopelvic ascites, without distinct loculated fluid collections. | 1. Dense bilateral perihilar pulmonary opacities. The differential for this appearance includes hemorrhage, ARDS, or drug reaction.2. Edematous pancreas with ascites, compatible with pancreatitis. |
Generate impression based on findings. | Female; 75 years old. Reason: evaluate for acute causes of suprapubic/periumbilical abdominal pain History: periumbilical/suprapubic crampy abdominal pain, ESRD. ABDOMEN:LUNG BASES: Mild basilar interstitial opacities, pleural thickening, subpleural blebs, and bronchiectasis which are compatible with chronic interstitial lung disease.LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute gallbladder inflammation. Scattered liver hypodensities are too small to definitively characterize (e.g. series 80264, image 71). SPLEEN: Incidental note is made of a calcified splenic granuloma. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Lobulated renal contours with nonobstructive calcifications. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Dense atherosclerotic calcifications of the abdominal aorta and its major branches. BOWEL, MESENTERY: Evaluation of intraluminal pathology is limited by lack of oral contrast. However, there is circumferential wall thickening involving the ascending colon which measures up to 2 cm in thickness (series 3, image 78) and approximately 7 cm in length (coronal series 80264, image 64). Mild associated paracolic fat stranding is also noted.Scattered colonic diverticula. No bowel obstruction or free air. Normal appendix. PELVIS:UTERUS, ADNEXA: Enlarged heterogeneous fibroid uterus.BLADDER: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Extensive wall thickening involving the ascending colon as described above. Appearance worrisome for acute colitis, possibly infectious/inflammatory in etiology, but follow-up imaging is recommended to document resolution and exclude malignancy. 2.Cholelithiasis without CT evidence of cholecystitis.3.Findings compatible with mild interstitial lung disease. |
Generate impression based on findings. | 18 year-old male with history of decreased breath sounds at the bases. Evaluate for consolidation/effusions. History of heart transplant. LUNGS AND PLEURA: Minimal bilateral patchy groundglass opacities, worse on the left. Right lower lung pleural based small foci of atelectasis/consolidation. No significant pleural effusion or pneumothorax. No significant bronchial wall thickening, scarring or bronchiectasis.MEDIASTINUM AND HILA: Postoperative findings of sternotomy and heart transplant. No significant pericardial effusion.CHEST WALL: Retained cuff on the left presumably from prior IABP.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Minimal patchy bilateral ground glass opacities, left greater than right, which have increased. These are nonspecific but may be infectious in etiology. |
Generate impression based on findings. | 56-year-old female with left foot gangrene, concern for osteomyelitis There is diffuse soft tissue swelling about the medial foot with multiple foci of gas extending within the soft tissues. Diffuse osteopenia with indistinct margin of the cortex along the medial base of the first phalanx suggesting osteomyelitis. | Soft tissue swelling and multiple foci of gas concerning infection with indistinct cortical margin of the base of the first proximal phalanx raising the question of osteomyelitis. Further evaluation with MRI may be considered clinically warranted. |
Generate impression based on findings. | FractureVIEWS: Right wrist AP and lateral The previously described Salter-Harris type III fracture involving the distal radius is obscured by the overlying cast. The alignment is anatomic. | Fracture of the distal radius in anatomic alignment. |
Generate impression based on findings. | 59-year-old male evaluate for left femoral neck fracture There is a lucent lesion in the left femoral neck seen on this single view of the pelvis, which, given the patient's history of malignancy, could represent a metastasis. No acute fracture is visualized. | Lucent lesion of the left femoral neck raising the possibility of a lytic metastasis. |
Generate impression based on findings. | Male 72 years old Reason: Evaluate for post obstructive pneumonia History: mass on bronchoscopy LUNGS AND PLEURA: Severe apical predominant centrilobular emphysema. Atelectasis/consolidation in the superior segment of the right lower lobe consistent with infection. Multiple pulmonary nodules. Spiculated, lobular right lower lobe pulmonary nodule measures 2.5 x 1.0 cm (image 62 series 4). Spiculated right lower lobe pulmonary nodule measures 1.7 x 1.6 cm (image 84 series 4). Spiculated right upper lobe pulmonary nodule is also noted (image 33 series 4). Left upper lobe subpleural nodule containing calcification is noted (image 47 series 4).MEDIASTINUM AND HILA: Bronchial stent is noted (image 56 series 3) in the right mainstem bronchus. The stent partially obstructs the right upper lobe bronchus, with possible tumor growth of the distal end of the stent. There is soft tissue infiltration of the right hilum presumably due to tumor, but no distinct enlarged mediastinal lymph nodes are present. Lobulated lipomatous hypertrophy is noted into the intra-atrial septum. No adenopathy. Atherosclerotic calcification of the coronary arteries and aorta.CHEST WALL: Age indeterminate compression fracture of T7 vertebral body.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Bilateral renal cysts. | 1.Consolidation consistent with infection in the superior segment right lower lobe.2.Multiple spiculated pulmonary nodules, as well as soft tissue surrounding the right mainstem bronchus consistent with history of NSCLC. 3.Right mainstem bronchus stent, with partial obstruction of the right upper lobe bronchus, and possible tumor overgrowth of the distal end of the stent.4.Age indeterminate compression fracture of T7 vertebral body. |
Generate impression based on findings. | FractureVIEWS: Right thumb AP and lateral Healing Salter II fracture of the proximal phalanx of the thumb again noted. There is periosteal reaction reflecting interval healing. Alignment is near anatomic. The overlying cast obscures fine bony detail. | Healing fracture of the right thumb as described above. |
Generate impression based on findings. | 48-year-old female with difficulty swallowing. Please evaluate for anatomical abnormality. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Cholecystectomy clips noted in the right upper quadrant.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. AP and lateral fluoroscopic video examination of the pharyngeal/hypopharyngeal region demonstrated no webs, stricture or other abnormalities in this region to explain the patient's symptoms (series 8 and series 9).Fluoroscopic evaluation of esophageal peristalsis demonstrated very transient minor breakup of the primary wave initially. This cleared immediately with the second swallow and is likely within normal limits.During the exam, spontaneous gastroesophageal reflux was observed extending up to the thoracic inlet. No provoked reflux was observed. During tablet swallow, the pill remained transiently in the lower esophageal junction before passing into the stomach with a small single swallow of water. This was within normal limits.TOTAL FLUOROSCOPY TIME: 6 minutes and 11 seconds | Findings compatible with gastroesophageal reflux which likely explain the patient's symptoms. |
Generate impression based on findings. | Evaluate chest tube adjustmentVIEW: Chest AP 1/4/15 Endotracheal tube, NG tube and left PICC unchanged. The right chest tube has been retracted and the tip at the right mid lung. There is a small right pneumothorax unchanged. Cardiothymic silhouette normal. Probable small pneumothorax at the left costophrenic angle. Patchy atelectasis left upper lobe and lingula. Marked body wall edema. | Retraction of right chest tube with tip in the right midlung. |
Generate impression based on findings. | Chest tube placementVIEW: Chest AP ET tube, NG tube and left PICC unchanged. Interval placement of a right chest tube with interval decrease in size of the large pneumothorax. The tip of the right chest tube is projected over the left upper lobe. Cystic lung changes are present at the left lower lobe. Patchy atelectasis left upper lobe and lingula. Cardiothymic silhouette normal. Marked body wall edema. | Placement of a right chest tube with tip projected over the left upper lobe with interval decrease in size of the large right pneumothorax. |
Generate impression based on findings. | 66-year-old female with history of worsening hypoxia, bilateral lower lung crackles. Also history of sarcoid. LUNGS AND PLEURA: Persistent apical predominant pulmonary fibrosis with traction bronchiectasis and architectural distortion. Interval increased groundglass nodular opacities diffusely. No significant pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Marked bihilar lymphadenopathy, with additional enlarged mediastinal lymph nodes. Small amount of pericardial fluid, similar to prior. Mild coronary artery calcifications. Central venous catheter tip is at the level of the right atrium.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right upper quadrant cholecystectomy clips. | 1. Apical predominant pulmonary fibrosis consistent with history of sarcoid. 2. Diffuse ground glass nodular opacities are new, without significant pleural effusions, could be due to infection, progression of pulmonary sarcoidosis or superimposed edema. |
Generate impression based on findings. | 61-year-old male with history of lung and pharyngeal cancer with cough and congestion. There is mild mucosal thickening of the left frontal, scattered ethmoid, sphenoid, and right greater than left maxillary sinuses. There are no air-fluid levels present to suggest acute sinusitis. The right frontal sinus is hypoplastic. There is narrowing of bilateral maxillary infundibulum and sphenoethmoidal recesses. There is mild rightward deviation of the nasal septum with a prominent spur. The roof of the ethmoid sinuses is symmetric. The lamina papyracea are intact bilaterally. The mastoid air cells are clear. The visualized intracranial structures are unremarkable. | 1.Mild paranasal sinus mucosal thickening as above.2.Narrowing of the osteomeatal complexes and sphenoethmoidal recesses. |
Generate impression based on findings. | Abdominal distentionVIEW: Chest AP and abdomen AP Tracheostomy tube in place. NG tube tip in the stomach. Cardiothymic silhouette normal. Left lower lobe atelectasis not significantly changed. There is also atelectasis in the left upper lobe. No pleural effusion or pneumothorax. Multiple dilated bowel loops in the abdomen not significantly changed. No pneumatosis or pneumoperitoneum. There are bowel loops projected over the lower pelvis and represent inguinal hernias bilaterally. | Multiple dilated bowel loops not significantly changed. |
Generate impression based on findings. | 51 year-old woman with history of trauma and pain in the left shoulder. Left shoulder: There is no acute fracture. Glenohumeral joint alignment is within normal limits.Left humerus: There is no acute fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | 83-year-old man with history of pain, fall. Left hip: There is severe joint space narrowing of the left hip with subchondral sclerosis and cyst formation. Mild chondrocalcinosis is noted. A penile prosthesis is also noted. There is no acute fracture or malalignment.Right hip: There is mild joint space narrowing of the right hip with osteophyte formation. The penile prosthesis is again noted. There is no acute fracture or malalignment. | No acute fracture or malalignment. Degenerative changes as described above. |
Generate impression based on findings. | 80 year-old woman with history of fall, right hip fracture. Right hip: There is a comminuted, intertrochanteric fracture of the right femur with mild medial displacement of the lesser trochanter and mild superior displacement of the distal femoral fracture fragment. The hip joint alignment is anatomic.Right femur: The intertrochanteric fracture is again noted. The patient has a total right knee arthroplasty device in near anatomic alignment. Arterial calcifications are noted. | Comminuted intertrochanteric fracture of the right femur. |
Generate impression based on findings. | 54-year-old with history of calcifications in the right upper outer breast. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing coarse calcifications in the right upper outer breast, are not significantly changed since 8/26/2011. Benign appearing lymph nodes are projected over both axillae. | 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: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 73-year-old man with history of low back pain after fall. Pelvis: There is no acute fracture or malalignment.Lumbar spine: Anterior wedge deformity of T12 appears unchanged from CT on 12/5/2014. There is disc space narrowing suggestive of degenerative disc disease at T12/T1 and L3/L4. Additionally, small anterior osteophytes project from multiple lumbar vertebral bodies. Lumbar spine alignment is anatomic. | Degenerative disease of the lumbar spine and old compression deformity of T12 without acute fracture or malalignment. |
Generate impression based on findings. | 46-year-old man with history of right ankle fracture status post reduction and external fixation. Again seen is a comminuted fracture of the distal tibia with fracture lines extending to the tibiotalar articulation. There is minimal displacement and the fracture fragments are grossly in anatomic alignment. Additionally, there is a comminuted fracture of the distal fibula with slight lateral displacement of the distal fracture fragment. There is been interval placement of an external fixation device with screws anchored in the calcaneus and first metatarsal. Areas of serpentine sclerosis are seen in the first metatarsal, calcaneus, and distal tibia, compatible with bone infarct. There is edema in the subcutaneous soft tissues surrounding the ankle. | Comminuted fractures of the distal tibia and fibula in gross anatomic alignment status post external fixation. |
Generate impression based on findings. | Reason: hx of head and neck cancer, compare to previous with measurments. History: as above CHEST:LUNGS AND PLEURA: Multiple pulmonary metastases not significantly changed. The reference right lower lobe pulmonary nodule measures 8 mm on image 80/115 (9 mm on prior).MEDIASTINUM AND HILA: Reference right paratracheal lymph node unchanged at 20 mm (image 39/143). Reference right hilar lymph node measures 23 mm on image 52/143 (25 mm on prior).Right thyroid bed soft tissue densities incompletely evaluated. Please see dedicated neck CT report for further details.Coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Diffuse skeletal metastases, most notably a destructive lesion in the left glenoid, not significantly changed. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Presumed hemangioma in dome of liver (image 87/143). Calcified granulomas unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 9-mm upper abdominal lymph node (image 101/143) unchangedBOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Diffuse skeletal metastases unchanged.OTHER: No significant abnormality noted. | 1. Stable pulmonary nodule.2. Stable intrathoracic lymphadenopathy. Stable small upper abdominal node which was PET+ in the past.3. Stable osseous metastases.4. Mass in the neck is incompletely evaluated. Please see dedicated neck CT report. |
Generate impression based on findings. | Status post 28 cycles of treatment for metastatic thyroid cancer. There are postoperative findings related to total thyroidectomy and neck dissection. Overall, there is no significant interval change in the size of some of the suprasternal and bilateral supraclavicular subcutaneous tissues lesions. There is stable to minimal interval enlargement of a partially necrotic mass anterior to the left sternocleidomastoid muscle measuring 15 x 21 x 24 mm (AP x TR x CC), previously 15 x 21 x 22 mm. A right upper paratracheal soft tissue lesion measures 18 x 12 mm (AP x TR), previously 18 x 10 mm. There is no significant interval change in size of bilateral lung apex nodules. There is an unchanged 6 mm sialolith within the right submandibular gland. There is unchanged appearance of the larynx. The major cervical vessels are patent. There is scattered opacification of the bilateral ethmoid air cells. There is degenerative spondylosis. There are bilateral lens implants. | 1. Overall, largely stable size of the multiple foci of metastatic tumor in the suprasternal and bilateral supraclavicular subcutaneous tissues, with stable to minimal interval enlargement of the dominant necrotic mass anterior to the left sternocleidomastoid muscle.2. No significant interval change in size of bilateral lung apices metastases. Please refer to the separate chest CT report for additional details.3. Unchanged sialolith within the right submandibular gland. |
Generate impression based on findings. | Female 47 years old; Reason: Bilious emesis after retroperitoneal dissection, JJ anastomosis; h/o lap band ABDOMEN:LUNG BASES: Right basilar atelectasis and trace effusion, not significantly changed compared to prior. Left basilar micronodules are nonspecific. Enlarged cardiophrenic lymph node is not significantly changed compared to prior study.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in the posterior right hepatic lobe is nonspecific and unchanged compared to prior study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: Status post resection of right retroperitoneal mass. Within the resection bed there is a 10.5 x 4.5 cm (series 3, image 51) collection of loculated fluid containing small air locules, insinuating through the right lateral abdominal wall defect, most likely representing postsurgical fluid. Continued follow-up is recommended as superimposed infection/developing abscess is not excluded.BOWEL, MESENTERY: New jejunojejunal anastomosis in the right lower quadrant. There is a single loop of jejunum proximal to the anastomosis which is dilated. This may represent a focal postsurgical ileus. No evidence of obstruction with enteric contrast identified opacifying distal small bowel and colon.Gastric band in situ.PELVIS:UTERUS, ADNEXA: Fibroid uterus.BLADDER: Small air locules within the bladder likely relating to recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.OTHER: Pelvic ascites. | 1.Postsurgical changes relating to retroperitoneal mass resection. Loculated fluid collection within the surgical bed likely represents postsurgical fluid. Continued follow-up is recommended as developing superimposed infection is not excluded.2.New jejunojejunal anastomosis with mildly prominent proximal dilatation, may reflect focal postsurgical ileus, continued follow-up suggested. |
Generate impression based on findings. | Male; 53 years old. Reason: Pre-kidney Transplant evaluation, assess aorta and iliacs for potential kidney transplant. History: Smoking and 8 years of HD. Evaluation of solid organ pathology and lymphadenopathy is limited by lack of intravenous contrast. ABDOMEN:LUNG BASES: Moderate pericardial effusion. No pleural effusions or focal areas of consolidation. Scattered bullous changes are noted in the lung bases. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous hypodensities are noted in both kidneys, some of which are calcified. These lesions are not fully assessed due to lack of IV contrast but many likely represent cysts given simple fluid attenuation. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Dense atherosclerotic calcifications involving the aorta, which also extend into the bilateral renal arteries, superior mesenteric artery, bilateral common iliac arteries, and external/internal iliac branches. No evidence of aneurysmal dilatation in the visualized aorta. BOWEL, MESENTERY: Mild diffuse mesenteric induration. No bowel obstruction or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mild bladder wall thickening, likely secondary to underdistention. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of left pelvic free fluid, nonspecific and best seen on coronal series, image 51. | 1.Numerous bilateral renal hypodensities, which are incompletely assessed without IV contrast but may reflect acquired cystic disease of dialysis. Please correlate with patient history. 2.Extensive aortobiiliac atherosclerotic disease as detailed above. |
Generate impression based on findings. | Female 68 years old Reason: question of pancreatitis, please use pancreas protocol. rising lipase, emesis. ABDOMEN:LUNG BASES: New patchy partially solid appearing/ground glass opacities consistent with pneumonia. Persistent bilateral pleural effusions with associated compressive atelectasis, increased from the prior.LIVER, BILIARY TRACT: Status post cholecystectomy. There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: New wedge-shaped areas of hypoattenuation in the periphery of the splenic parenchyma compatible with infarcts. Findings discussed with Scott from ICU team at 8:58 a.m. on 1/5/2015.PANCREAS: Mild peripancreatic haziness is nonspecific in the setting of ascites. The pancreatic parenchyma enhances homogeneously without evidence of necrosis. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: New small/moderate volume ascites.BONES, SOFT TISSUES: Significant anasarca. | 1.Bibasilar partially solid/groundglass opacities consistent with multifocal pneumonia.2.New wedge-shaped areas of hypoattenuation in the splenic parenchyma consistent with new splenic infarcts.3.Anasarca, with associated new ascites and increased pleural effusions.4.Mild peripancreatic haziness is nonspecific in the setting ascites, underlying pancreatitis not entirely excluded but no evidence of pancreatic parenchymal necrosis. |
Generate impression based on findings. | 86 year old woman with history of knee pain. There is mild joint space narrowing on this nonweightbearing view with small tricompartmental osteophytes and mild to moderate chondrocalcinosis. There is no acute fracture, malalignment, or joint effusion. | Degenerative changes without acute fracture or malalignment. |
Generate impression based on findings. | 22 year-old woman with history of pain over the dorsum of the foot after being run over by car. Left ankle: There is no acute fracture or malalignment. There is no significant soft tissue swelling or joint effusion.Left foot: There is no acute fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | 48 year-old woman with history of right fourth digit pain. There is no acute fracture or malalignment. Note is made of a short fourth metacarpal, a finding that has a long differential but may be a normal variant. Additionally, there is negative ulnar variance and a questionable, small erosion of the ulnar styloid. Moderate osteoarthritis affects the basilar joint. | 1.No acute fracture or malalignment.2.Questionable erosion of the ulnar styloid, correlate to history of inflammatory arthritis. |
Generate impression based on findings. | Female 79 years old Reason: Rule out SBO History: constipation ABDOMEN:LUNG BASES: Small bilateral pleural effusions with associated compressive atelectasis, right greater than left.LIVER, BILIARY TRACT: Scattered hypoattenuating lesions in the right hepatic lobe are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: There is a 1.7 x 1.6 cm cystic focus near the pancreatic head/neck junction, which is nonspecific, but could represent a sidebranch intraductal papillary mucinous neoplasm or serous cystadenoma. Nondilated main pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is thrombus within the left renal vein, which appears acute and may be related to compression by the cecal volvulus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The cecum is markedly distended with gas and is displaced in the right upper quadrant, in a configuration consistent with a cecal volvulus. The transverse, descending and sigmoid colon are decompressed. There is diffuse dilatation of the small bowel. Moderate volume ascites is worrisome for ischemia in the setting of obstruction.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Findings compatible with cecal volvulus with associated dilatation of the small bowel. Associated ascites is worrisome for ischemia.2.Thrombus in the left renal vein likely related to compression secondary to the cecal volvulus.3.Nonspecific cystic focus in the pancreatic head/neck junction area, may represent a sidebranch intraductal papillary mucinous neoplasm or serous cystadenoma. |
Generate impression based on findings. | History of aortic stenosis, pre-operative planning. Please see accompanying cardiac CT report for description of heart and thoracic aorta. Evaluation of solid organs somewhat limited by arterial phase of contrast. VESSELS:SUPRARENAL ABDOMINAL AORTA: 2.2 X 2.4 cmINFRARENAL ABDOMINAL AORTA: 1.23 X 1.31 cmRIGHT COMMON ILIAC ARTERY: 7.7 X 9.3 mmRIGHT EXTERNAL ILIAC ARTERY: 5.6 X 7.8 mmRIGHT COMMON FEMORAL ARTERY: 7.2 X 7.9 mmLEFT COMMON ILIAC ARTERY: 6.3 X 6.7 mmLEFT EXTERNAL ILIAC ARTERY: 5.8 X 7.1 mmLEFT COMMON FEMORAL ARTERY: 7.6 X 8.2 mmANGIOGRAM: Please see accompanying cardiac CT report for description of thoracic aorta. A small aortic penetrating ulcer is present at the level of the diaphragmatic hiatus (series 5, 66). There is no evidence of abdominal aortic aneurysm. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent. Moderate atherosclerotic disease is present. The right common and external iliac arteries are mildly tortuous. A site of luminal irregularity (series 5, 307) involving the right external iliac artery only seen on the axial images may be related to this tortuosity. ABDOMEN:LUNG BASES: Please see accompanying cardiac CT report for description of pulmonary findings. Small pleural effusions with basilar atelectasis. Large hiatal hernia with possible gastric wall thickening and small amount of surrounding fluid. 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: Multiple left renal cysts are present. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of complicated diverticulitis. BONES, SOFT TISSUES: Scoliosis and severe degenerative changes of the thoracolumbar spine. 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: Colonic diverticulosis without evidence of complicated diverticulitis. BONES, SOFT TISSUES: Scoliosis and severe degenerative changes of the thoracolumbar spine. Mild soft tissue stranding surrounds the right external iliac and femoral vessels which may be related to prior procedure. A right lower quadrant anterior abdominal wall soft tissue defect is present. | 1.Please see cardiac CT from same day for description of thorax including heart and thoracic aorta.2.Atherosclerotic disease of the abdominal aorta with measurements as above. |
Generate impression based on findings. | Reason: 67 yo with right sided heart failure of uncler cause, assess lungs History: right sided heart failure LUNGS AND PLEURA: Very small right pleural effusion. No evidence of pulmonary fibrosis are significant emphysema.MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Coronary calcification. Cardiomegaly.CHEST WALL: Small axillary lymph nodes bilaterally.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Very small right pleural effusion. No evidence of pulmonary fibrosis are significant emphysema. |
Generate impression based on findings. | There is no suspicious intracranial enhancement, acute intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild left maxillary sinus mucosal thickening. The imaged mastoid air cells are clear. The patient is status post right parietal craniotomy. The skull and extracranial soft tissues are otherwise unremarkable. | No evidence of intracranial metastases. |
Generate impression based on findings. | No bowel movement evaluate for obstructionVIEWS: Abdomen AP and left lateral decubitus There is a urinary catheter in place. Gastrostomy tube in place. There appears to be contrast within the collecting systems bilaterally. Multiple dilated bowel loops in the right hemi-abdomen without pneumatosis or pneumoperitoneum. No bowel gas seen within the distal rectum. | Multiple dilated bowel loops in the right hemi-abdomen may represent partial bowel obstruction and follow-up recommended. |
Generate impression based on findings. | 67-year-old male with Dobbhoff tube placement. Note that the pelvis was not included in the exam. Two right upper quadrant abdominal pigtail catheters are visualized. The multi-sidehole feeding tube tip overlies the proximal jejunum corresponding to the anatomy seen on CT. Nonobstructive bowel gas pattern. Abdominal wound closure assist tubing overlies the midline. | The feeding tube tip terminates in the jejunum. |
Generate impression based on findings. | Reason: please eval for signs of infection History: fever, leukocytosis, AMS LUNGS AND PLEURA: Small pleural effusions identified.Mild basilar atelectasis.No focal areas of consolidationMEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Mild cardiac enlargement without evidence of the pericardial effusion.Moderate coronary artery calcification.Enteric tube with its tip in the stomach.CHEST WALL: Mild degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Small bilateral pleural effusions with underlying atelectasis. No specific evidence of infection. |
Generate impression based on findings. | Female 43 years old Reason: Nephrolithiasis, pyelonephritis History: Sepsis likely uro source, back pain ABDOMEN:LUNG BASES: Incidental left fat containing Bochdalek hernia.LIVER, BILIARY TRACT: The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is nonspecific bilateral mild perinephric fat stranding. There is no evidence of hydronephrosis, hydroureter, nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The gastric band has a somewhat more horizontal configuration than expected, which could reflect slippage. There is no evidence of distention of the gastric pouch.BONES, SOFT TISSUES: There are severe degenerative changes of the L5-S1 disc space.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: Air within the bladder presumably reflects recent instrumentation, although clinical correlation is recommended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The gastric band has a somewhat more horizontal configuration than expected, which could reflect slippage. There is no evidence of distention of the gastric pouch.BONES, SOFT TISSUES: There are severe degenerative changes of the L5-S1 disc space.OTHER: No significant abnormality noted | 1.No evidence of nephrolithiasis or ureterolithiasis as clinically questioned.2.Gastric band with a somewhat more horizontal configuration than expected, which could reflect slippage. Evaluation with fluoroscopy may be considered as clinically indicated.3.Air within the bladder presumably reflects recent instrumentation, although clinical correlation is recommended. |
Generate impression based on findings. | chest pain s/p marijuana now with periumbilical abdominal painVIEW: Abdomen AP Disorganized nonobstructive bowel gas pattern. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: Eval emypema and loculated pleural effusions History: Eval empyema and loculated pleural effusions LUNGS AND PLEURA: Significant interval decrease in the large right pleural effusion previously identified.Scattered foci of air are noted within the effusion with demonstration of a loculated hydropneumothorax.Previous right -sided chest tube has been removed with a new tube placed more posteriorly.Pleural fluid is primarily water density with scattered areas of stranding most likely representing the residual of patient's prior empyema.Mild right basilar atelectasis without focal areas of consolidation.Severe upper lobe predominant emphysema and bronchial wall thickening similar to the prior exam..MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Prominent right retrocrural lymph node (image 7 series 3) is unchanged from prior exam.Cardiac size is normal without evidence of pericardial effusion.Marked coronary artery calcification.CHEST WALL: Subcutaneous emphysema along the right lateral chest wall.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable hypoattenuating hepatic lesions . | Significant interval decrease in the right pleural effusion with scattered foci of pleural air and loculated hydropneumothorax related to placement of a new right-sided chest tube. |
Generate impression based on findings. | Evaluate pneumothoraxVIEW: Chest AP 1/4/15 2202 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. There are now two chest tubes on the right. The superior most chest tube has its sidehole in the subcutaneous tissue. The large right pneumothorax with mediastinal shift from right to left is unchanged. Patchy atelectasis in the left upper lobe and lingula. Cardiothymic silhouette normal. Cystic lung changes in the left lower lobe. Marked body wall edema. | Placement of a new right chest tube with its side hole in the subcutaneous tissue. |
Generate impression based on findings. | Male 66 years old Reason: history of metastatic renal cancer, s/p resection all metastatic cancer, assess for recurrence CHEST:LUNGS AND PLEURA: 1.6-cm calcified right upper lobe nodule unchanged. Additional smaller calcified and noncalcified pulmonary nodules are not significantly changed.MEDIASTINUM AND HILA: Retrosternal goiter unchanged. Reference right paratracheal node now measures 0.9 x 1.1 cm (image 42, series 3), previously 1.0 x 1.2 cm.CHEST WALL: There is no evidence of axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria.ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation, which is stable from the prior exam. The patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The patient is status post right nephrectomy. There is no soft tissue within the nephrectomy bed to suggest local recurrence. Punctate hypodensity in the superior pole of the left kidney is too small to characterize.RETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. Extensive atheromatous plaque, some of which is ulcerated, affects the abdominal aorta and its branches.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Mild thickening of the sigmoid colon wall may reflect sequelae of chronic diverticulitis.BONES, SOFT TISSUES: Sclerotic lesions in the right pubic symphysis, sacrum and posterior right seventh rib are unchanged. Given the lack of radioisotope accumulation on the prior bone scan and interval stability, a benign etiology is favored. The left L5 transverse process articulates with the underlying sacrum.PELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneous prostatic parenchyma.BLADDER: No significant abnormality notedLYMPH NODES: There is no evidence of pelvic lymphadenopathy on the basis of size criteria.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Mild thickening of the sigmoid colon wall may reflect sequelae of chronic diverticulitis.BONES, SOFT TISSUES: Sclerotic lesions in the right pubic symphysis, sacrum and posterior right seventh rib are unchanged. Given the lack of radioisotope accumulation on the prior bone scan and interval stability, a benign etiology is favored. The left L5 transverse process articulates with the underlying sacrum. | 1.Postsurgical changes related to right nephrectomy without evidence of locoregional disease recurrence or distant metastatic disease.2.Sclerotic bone lesions as detailed above, likely benign in etiology given the lack of radioisotope accumulation on the prior bone scan and interval stability. |
Generate impression based on findings. | Pneumothorax desaturationVIEW: Chest AP 1/4/15 2028 ET tube, NG tube and left PICC unchanged. The right chest tube is unchanged. The large right pneumothorax has increased in size with mediastinal shift from right to left. Patchy atelectasis in the left upper lobe and lingula. Cardiothymic silhouette normal. Marked body wall edema. | Recurrence of the large right pneumothorax with mediastinal shift from right to left. |
Generate impression based on findings. | 56-year-old female with nausea and vomiting. Rule out SBO or ileus. Nonobstructive bowel gas pattern. Average amount of stool. Right vascular access catheter is again noted. | No evidence of obstruction or ileus. |
Generate impression based on findings. | Female 53 years old Reason: hx of hep B carrier. Asym. R/o liver changes History: asymptomatic LIVER: The liver measures 13.4 cm in length. Stable coarse hepatic echotexture without focal liver lesion. The main portal vein is patent and demonstrates normal directional flow. GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder. The gallbladder polyp previously identified is not clearly seen on today's study. There is no biliary dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 10.0 cm. The left kidney measures 10.0 cm. There is no hydronephrosis or shadowing renal calculus.OTHER: The spleen measures 8.0 cm in length. There is no ascites. | Stable coarse liver echotexture without suspicious liver lesion. No ascites. |
Generate impression based on findings. | FractureVIEWS: Left forearm AP and lateral Healing fracture involving the distal ulna in near anatomic alignment. There is periosteal reaction and sclerosis at the fracture site reflecting interval healing. Again noted periosteal reaction along the posterior aspect of the mid radius unchanged. | Healing forearm fractures as described above. |
Generate impression based on findings. | Reason: SAH with clipping day 6. to evaluate for cerebral vasculature History: comatose Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. There is approximately 75% stenosis at the ophthalmic segment of the left internal carotid artery. There is a wide necked left posterior communicating artery aneurysm measuring 4 mm just distal to the stenosis.There is 75% stenosis present along the cavernous segment of the right internal carotid artery.Metal artifact from the basilar tip aneurysm coiling obscures visualization of the distal basilar artery as well as the proximal posterior cerebral arteries and the proximal anterior and middle cerebral arteries. A stent is present which courses from the basilar artery to the left P1 segment.The left vertebral artery is larger than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebral arteryCT head:There is redemonstration of intraventricular blood as well as subarachnoid blood and hypodensities involving basal ganglia and thalami and left and right cerebellar hemispheres. A 24 x 21 mm hypodense focus in the right cerebellar hemisphere inferiorly has slowly evolved since the 12/30/14 exam.A ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with tip in the frontal horn of the right lateral ventricle. It is in stable position compared to the prior exam. The temporal horns of the lateral ventricles do not appear to be symmetrically dilated. The sulci are not effaced.The visualized portions of the paranasal sinuses demonstrate hyperdense opacities in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.The patient is status post recent embolic coil occlusion of basilar tip aneurysm. There is obscuration for visualization of the proximal anterior, middle and posterior cerebral arteries. Vasospasm cannot be excluded.2.Finding suggests a small subacute infarction along the right posterior inferior cerebellar artery territory.3.75% stenosis at the ophthalmic segment of the left internal carotid artery .4.75% stenosis of the cavernous segment of the right internal carotid artery.5.4-mm left posterior communicating artery aneurysm.6.Subarachnoid and intraventricular blood is redemonstrated and stable when compared to prior exams.7.There is redemonstration of hypodensities involving deep gray nuclei and thalami which are stable when compared with prior exams and most likely vascular related.8.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. | Negative noncontrast brain MRI. |
Generate impression based on findings. | Evaluate trach tubeVIEW: Chest AP 1/5/15 Tracheostomy tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Cardiothymic silhouette normal. Patchy atelectasis in the right lower lobe and left lower lobe. Hyperinflated right lung with no pleural effusion or pneumothorax. | Tracheostomy tube tip below thoracic inlet and above the carina. |
Generate impression based on findings. | Reason: 44 y.o with AML with neutropenic fever History: neutropenic fever LUNGS AND PLEURA: Right-sided nodules with surrounding ground glass (images 25 and 43 series 4) compatible with atypical infections including fungal etiologies.No pleural effusions.MEDIASTINUM AND HILA: Cardiac size is normal evidence of pericardial effusion.Hypoattenuating blood pool compatible with anemia.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Right-sided pulmonary nodules with surrounding ground glass opacities compatible with atypical infection including fungal etiologies. |
Generate impression based on findings. | Male 72 years old Reason: metastatic colon cancer s/p hepatic resection in August 2014, evaluate disease status History: colon cancer CHEST:LUNGS AND PLEURA: Reference left basilar nodule now measures 9 mm (image 41, series 5), previously 5 mm. Additional non-reference right basilar nodule now measures 6 mm, previously 3 mm. Additional non-referenced nodules also increased in size.MEDIASTINUM AND HILA: Nonspecific hypoattenuating collection in the prevascular space now measures 1.9 x 2.6 cm (image 34, series 3), previously 1.8 x 2.6 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Postoperative changes related to bilobar partial hepatic lobe resections. There has been resolution of the previously seen pneumoperitoneum and improvement in the persistent left subcapsular fluid collection. Hepatic segment two hemangiomas are unchanged. Postsurgical changes related to cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged nodular thickening of the left adrenal gland.KIDNEYS, URETERS: Hypoattenuating lesion in the inferior pole of the right kidney is consistent with a simple renal cyst.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: Postsurgical changes related to partial large bowel resection as well as appendectomy. Scattered mesenteric lymph nodes are not pathologically enlarged by size criteria. Soft tissue lesion along the colonic resection bed appears slightly more solid compared to the prior examination and may be postprocedural in etiology; however, attention at follow-up is recommended (image 122, series 3).PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Interval increase in size of multiple pulmonary nodules concerning for metastatic disease.2.Postsurgical changes related to bilobar hepatic wedge resections, without new metastatic lesions identified.3.Resolution of the previously seen pneumobilia and improvement of the subcapsular fluid along the left hepatic lobe.4.Postsurgical changes related to partial large bowel resection with soft tissue seen along the resection bed, presumably postoperative in etiology, but attention at follow-up is recommended. |
Generate impression based on findings. | 19 year-old boy with history of left fifth finger pain. There is a partially visualized, oblique fracture of the left fifth metacarpal diaphysis which appears in near anatomic alignment but extends beyond the inferior margin of the study. Associated soft tissue swelling is noted. | Oblique fracture of the left fifth metacarpal diaphysis, partially visualized. Finding was text paged to pager number 9036 at 11:35 on 1/5/2015. |
Generate impression based on findings. | Female 37 years old Reason: elevated LFT's, cholestasis History: jaundice. Additional history from prior M.R.C.P. of orthotopic liver transplant. LIVER: Mildly coarse echogenic liver echotexture suggestive of chronic liver disease. The main portal vein is patent and demonstrates normal directional flow.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. There is no intra-or extrahepatic biliary ductal dilatation.PANCREAS: The pancreas appears heterogeneous, enlarged and hypoechoic. The appearance is not significantly changed compared to prior studies and is therefore likely within normal limits however correlation with serum markers is recommended as acute pancreatitis could have this appearance.KIDNEYS: The right kidney measures 7.3 cm. The left kidney measures 10.0 cm. There is no hydronephrosis.OTHER: The spleen is enlarged measuring 16.0 cm. Abdominal ascites noted. | 1. Status post orthotopic liver transplant and cholecystectomy. There is no intra-or extrahepatic biliary duct dilatation. There is splenomegaly and ascites.2. Heterogeneous, enlarged and hypoechoic pancreas. As the appearance is not significantly changed compared to prior studies this is likely within normal limits however correlation with serum markers is recommended as acute pancreatitis could have this appearance. |
Generate impression based on findings. | Male 67 years old Reason: heart transplant evaluation LUNGS AND PLEURA: Right basilar subsegmental atelectasis/scarring. No pleural effusion or pneumothorax. Non-specific left apical micronodule measuring 4 mm (image 16, series 5) which was negative on recent PET CT. Calcified left basilar micronodule which may be due to prior granulomatous disease.MEDIASTINUM AND HILA: Right central venous catheter tip in the SVC. Left central venous catheter in the left subclavian vein. Nonspecific, small, nonenlarged mediastinal lymph nodes. No pericardial effusion.CHEST WALL: Degenerative changes in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Surgical clips noted in the upper abdomen. | Right basilar atelectasis. No specific evidence of acute infection. Non specific 4 mm left apical micronodule. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast cyst removal. 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, unchanged in pattern and distribution. Round markers were on skin lesions overlying both breasts. Scattered benign calcifications are seen, including an oil cyst in the right breast. 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. | There are no pathologically enlarged cervical lymph nodes.The thyroid gland is enlarged and nodular containing calcification, these findings appear unchanged since 2004. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement. The postcontrast appearance of the salivary glands is unremarkable. Evaluation of the oral cavity is limited by artifact from dental amalgam, within this limitation the oral tongue and floor of mouth are unremarkable.There is mild mucosal thickening within the right maxillary sinus. The imaged paranasal sinuses are otherwise unremarkable. Degenerative changes affect the spine, most prominently from C5-6 to C7-T1. The osseous structures are otherwise unremarkable.Limited views of the chest are unremarkable. | 1.No pathologically enlarged lymph nodes, abnormal soft tissue mass or pathologic enhancement.2.The thyroid gland remains heterogeneous but stable for the past years. |
Generate impression based on findings. | Male 64 years old Reason: recurrent fevers, had CT abdomen that showed pulmonary opacities in the lung bases History: SOB Patient motion artifact limits optimal evaluation.LUNGS AND PLEURA: Patchy right lower lobe nodular opacities, which may be due to infection. Smaller left lower lobe focus of nodular opacities. Lingular atelectasis/consolidation, with adjacent cystic focus, most likely due to pre-existing cyst formation, although cavitary lesion cannot be entirely excluded. Right apical scarring/atelectasis. Faint foci of groundglass opacities in the right lobe.MEDIASTINUM AND HILA: Moderate atherosclerotic calcification of coronary arteries and the aorta. No adenopathy. Widened mediastinum due to fat deposition. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cirrhotic liver morphology. Trace ascites. | 1.Multifocal nodular pulmonary opacities, as well as ground glass opacities, which could be due to infectious/inflammatory process.2.Lingular atelectasis/consolidation, with adjacent cystic focus, most likely due to pre-existing cyst formation, although cavitary lesion cannot be entirely excluded. |
Generate impression based on findings. | 52-year-old with history of multiple breast cysts. History of bilateral benign cyst aspirations. No family history of breast cancer. MAMMOGRAM: 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. In the left breast along the 11 o'clock radian, posterior depth is a new partially circumscribed mass like opacity. Benign calcifications are present bilaterally. A percutaneous biopsy clip in the right upper outer breast is unchanged in position. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND:Targeted ultrasound of the left breast performed in the region of the patient's mammographic abnormality. In the left breast 11 o'clock radian 7 cm from the nipple there is a circumscribed, anechoic cyst with through transmission that measures 2.3 x 1.0 x 2.0 cm. No mural nodularity or internal vascularity. No suspicious mass lesions. | New simple cyst in the left breast upper inner quadrant as described. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: interval worsening of diffuse bilateral interstitial and air space History: worsening cough LUNGS AND PLEURA: Moderate bilateral pleural effusions. Patchy bilateral groundglass, alveolar, and interstitial opacity with a few areas of traction bronchiectasis, most notably in the inferior lingula. Background mild centrilobular emphysema.MEDIASTINUM AND HILA: Mild intrathoracic lymphadenopathy. Severe coronary calcification. Atherosclerotic calcification of the aorta and its branches.CHEST WALL: Degenerative change involving the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Moderate bilateral pleural effusions. Patchy bilateral groundglass, alveolar, and interstitial opacity with a few areas of traction bronchiectasis, most notably in the inferior lingula. Background mild centrilobular emphysema. The findings are nonspecific. In the acute setting this may be due to pneumonia or hemorrhage; a more chronic presentation (suggested by areas of traction bronchiectasis) raises the possibility of NSIP. Continued follow-up is recommended as underlying nodules or masses could be of obscured by the opacities. |
Generate impression based on findings. | 73-year-old male with history of COPD, spontaneous pneumothorax and chest tube placement. May require pleurodesis. LUNGS AND PLEURA: Left lateral chest tube, with tip pointing anteriorly at the level of the mid thorax, and associated subcutaneous emphysema tracking along the left chest wall. Small left anterior pneumothorax, and an approximately 5 cm left perifissural airspace cyst. No significant pleural effusion. Minimal dependent atelectasis bilaterally.MEDIASTINUM AND HILA: No significant pericardial effusion. Heart size within normal limits. Minimal valvular calcifications, and no appreciable coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia. | Left chest tube, with small anterior residual pneumothorax. |
Generate impression based on findings. | Previously demonstrated mild left ventriculomegaly is no longer evident. There are no findings of ventricular dilatation or hydrocephalus. Foci of susceptibility can be found within the left cerebellar hemisphere, left paramedian vermis, and tips of bilateral occipital horns (left greater than right) consistent with hemosiderin from prior hemorrhage. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within bilateral mastoid air cells and middle air cavities. | 1.Previously demonstrated mild left ventriculomegaly is no longer evident. 2.Foci of susceptibility can be found within the left cerebellar hemisphere, left paramedian vermis, and tips of bilateral occipital horns (left greater than right) consistent with hemosiderin from prior hemorrhage. 3.Fluid is present within bilateral mastoid air cells and middle air cavities. |
Generate impression based on findings. | 79-year-old woman with history of basilar joint arthropathy status post fusion, evaluate for foreign body. There are postoperative findings of first metacarpophalangeal joint fusion with osseous clips affixing the first metacarpal to the proximal phalanx. Deformities of the tuft of the second distal phalanx and the third distal phalanx are likely chronic and posttraumatic. There is narrowing of the second, third, and fifth metacarpal phalangeal joints along with degenerative changes affecting the basilar joint and DIP joints. There is no unexpected radiopaque foreign body within the field of view. | Postoperative, posttraumatic, and degenerative changes as described above without unexpected radiopaque foreign body. |
Generate impression based on findings. | Female 82 years old Reason: 82F with bladder cancer, s/p neoadjuvant chemo and cystectomy/ileal conduit. Surveillance imaging History: bladder cancer ABDOMEN:LUNG BASES: Reference left basilar partially semisolid/groundglass nodule now measures 1.1 x 1.3 cm (image 10, series 6), previously measuring 0.9 x 1.5 cm. Adjacent spiculated nodule does not appear significantly changed. These lesions may represent indolent primary pulmonary malignancies as described on the prior chest CT examination.There are multiple new left lower lobe solid pulmonary nodules, most consistent with metastases. For reference purposes, a new left lower lobe nodule measures 0.9 x 1.2 cm (image 4, series 6).LIVER, BILIARY TRACT: The patient is status post cholecystectomy and there is unchanged prominence of the intrahepatic and extrahepatic biliary ducts, presumably postoperative in etiology.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion in the inferior pole of the left kidney consistent with a simple renal cyst. Interval resolution of the previously seen left hydroureter. The patient is status post cystectomy with ileal conduit formation. The ureters are well opacified with contrast on the delayed phase imaging and there is no evidence of filling defect to suggest metachronous urothelial lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. There is no evidence of retroperitoneal lymphadenopathy on the basis of size criteria. There are severe atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There are postsurgical changes related to cystectomy and right lower quadrant ileal conduit formation.BONES, SOFT TISSUES: There are severe degenerative changes of the lower lumbar spine. Left hip arthroplasty device in place.PELVIS: Beam hardening artifact from the patient's arthroplasty device slightly limits evaluation of the pelvis.UTERUS, ADNEXA: The patient is status post hysterectomy. There is a fluid collection in the distal right vaginal wall, which is incompletely imaged, but may be postoperative in etiology (Image 128, series 3).BLADDER: The patient is status post cystectomy. There is a multiloculated fluid collection along the right pelvic sidewall, which measures up to approximately 2.2 x 4.0 cm (image 114, series 7) and demonstrates an enhancing rim. There is an additional single rounded loculated fluid collection along the left pelvic sidewall, which measures approximately 1.7 x 2.0 cm (image 108, series 7), which also demonstrates an enhancing rim. These collections are nonspecific, but are presumably postoperative in etiology; however, infection cannot be excluded, although the foci of gas are evident.BONES, SOFT TISSUES: There is severe degenerative changes of the lower lumbar spine. Left hip arthroplasty device in place. | 1.New solid left basilar pulmonary nodules are most consistent with metastatic disease.2.Stable semisolid/groundglass nodules, which could represent additional indolent primary pulmonary malignancy.3.Postsurgical changes related to cystectomy and ileal conduit formation, with fluid collections along the bilateral pelvic sidewalls, which are likely postoperative in etiology. However, infection cannot be excluded and clinical correlation is recommended. |
Generate impression based on findings. | Male 3 days old; History: prenatal diagnosis left multicystic dysplastic kidney; right pelviectasis BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: The left kidney consists primarily of cysts, without connection to the collecting system. The right cortical echogenicity is normal. Medullary Echogenicity: The left kidney consists primarily of cysts, without connection to the collecting system. The right medullary echogenicity is normal. Pelvicaliceal System -- SFU Grade* Right: 2 Left: 0 Length*** Right: 5.2 cm Left: 2.1 cm Mean for age: 4 cm Range for age: 3.5 - 5.5 cmADDITIONAL OBSERVATIONS: The left kidney is pelvic in location. | 1. Multicystic dysplastic left kidney located in the pelvis.2. Grade 2 right hydronephrosis.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Reason: newly diagnosed retromolar trigone cancer History: r/o lung mets LUNGS AND PLEURA: No evidence of pulmonary metastases.MEDIASTINUM AND HILA: Enlarged central pulmonary arteries and mild enlargement of the right ventricle, suggestive of pulmonary hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary metastases.2. Enlarged central pulmonary arteries and mild enlargement of the right ventricle, suggestive of pulmonary hypertension. |
Generate impression based on findings. | 54-year-old man with history of right knee pain. Moderate osteoarthritis affects the right knee with medial joint space narrowing to near bone-on-bone apposition and small tricompartmental osteophytes. | Moderate osteoarthritis of the right knee. |
Generate impression based on findings. | 77-year-old male with history of recurrent right ear squamous cell carcinoma. Status post surgery. Postop evaluation. LUNGS AND PLEURA: Minimal dependent atelectasis/scarring. 4-mm right upper lobe micronodule (6/23) is unchanged. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Heart size within normal limits, and there is no pericardial effusion. Mild coronary artery calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative changes affect the spine, shoulders and sternum.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Right renal hypoattenuating focus, likely a benign cyst. | Unchanged right upper lobe nodule, nonspecific. No new suspicious nodules or masses, or other findings of metastases. |
Generate impression based on findings. | 82 year-old woman status post right hip arthroplasty revision. Right hip: Hardware components of a right total hip arthroplasty device are seen in near anatomic alignment. Acetabular protrusio is again noted. There is no evidence of hardware complication.Pelvis: Bilateral total hip arthroplasty devices are seen in near anatomic alignment. There is bilateral acetabular protrusio. Degenerative changes are seen affecting the lower lumbar spine. | Right total hip arthroplasty without evidence of complication. |
Generate impression based on findings. | Please see accompanying CTA abdomen/pelvis for description of abdominal findings. CHEST:LUNGS AND PLEURA: Trace bilateral pleural effusions. Scattered scarring and subsegmental atelectasis. No suspicious nodules or masses. MEDIASTINUM AND HILA: Please see accompanying cardiac CT report for description of heart and vasculature. Large hiatal hernia with possible gastric wall thickening and small amount of adjacent fluid. CHEST WALL: Left sided pacemaker device is present. Degenerative disease of the spine. | Large hiatal hernia. Trace pleural effusions and scattered scarring/atelectasis. Please see accompanying cardiac CT report for description of heart and vasculature. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of ovarian cancer in paternal grandmother and paternal aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. Tomosynthesis was performed. The breast parenchyma is heterogeneously dense, which may obscure small masses. 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. | Diarrhea abdominal distentionVIEW: Abdomen AP Disorganized nonobstructive bowel gas pattern. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 32 year-old woman with history of elbow pain, evaluate for fracture. There is a lucency with cortical step-off involving the articular surface of the radial head indicating a nondisplaced fracture. The joint effusion has decreased compared to the prior examination. | Nondisplaced, intra-articular radial head fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional right MLO view 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. | 57-year-old man with history of right total hip arthroplasty, postoperative evaluation. Right hip: Hardware components of a right total hip arthroplasty device are seen in near anatomic alignment. Heterotopic bone formation is noted about the acetabular component, but there is no evidence of complication.Pelvis: Bilateral total hip arthroplasty devices are noted in near anatomic alignment. Although the distal stem of the left total hip arthroplasty is not visualized, there are no acute fractures or evidence of complication. | Right total hip arthroplasty without evidence of complication. |
Generate impression based on findings. | Metastatic breast cancer to lung and liver. Left chest wall pain. Status of pulmonary nodules, liver. CHEST:LUNGS AND PLEURA: Left upper lobe nodule now measures 33 x 18 mm on image 35/124 (9 x 21 mm on prior). Some of this measurement includes atelectasis.The previously referenced left lower lobe subpleural nodule has marginally increased and now measures 10 mm on image 88/124 (8 mm on prior).Third reference measurement of a right lower lobe nodule is now increased to 7 mm on image 55/124 (6 mm previously). Other scattered smaller nodules are stable to marginally increased.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Status post left axillary lymph node dissection. Multiple surgical clips are seen within the left breast compatible with prior lumpectomy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Reference hepatic metastasis has increased to 62 x 56 mm on image 102/161 (42 x 35 mm on prior)SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval increase in size of reference pulmonary and hepatic metastases. |
Generate impression based on findings. | 65-year-old male with history of amiodarone induced lung injury. Cough. LUNGS AND PLEURA: Lower lobe predominant diffuse groundglass opacities. Minimal septal thickening at the periphery, and minimal dependent atelectasis. No architectural distortion, no honeycombing. Scattered micronodules, some of which are calcified. No consolidation. No pleural effusion.MEDIASTINUM AND HILA: Left chest cardiac assist device with lead in right ventricle. No significant pericardial effusion. Moderate coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. | Diffuse lower lobe predominant ground glass opacities, with minimal septal thickening and no architectural distortion or honeycombing. These findings are nonspecific, but may be seen in cases of amiodarone related lung disease. |
Generate impression based on findings. | Female 52 years old; Reason: 52 F with metastatic gallbladder cancer, please evaluate for interval change. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with tip in right atrium. ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Continued decrease in size of reference segment 5 hypoattenuating focus, nearly inconspicuous on current study, lesion measures 0.9 x 0.5 cm, image 118 series 3, previously measured 1.8 x 0.9 cm. Status post cholecystectomy, with adjacent mild stranding/soft tissue thickening seen, without significant change. Stable prominent liver, measuring up to 23 cm in craniocaudal dimension, may reflect a Reidel lobe, a normal variant.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic parenchymal atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered sigmoid and descending colon diverticula. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. Diastases of rectus abdominis muscles, with fat and small bowel loops herniating through defect is widemouthed and measures up to 9 cm. | 1. Continued decrease in size and conspicuity of right hepatic lesion. |
Generate impression based on findings. | 77 year old with history of right mastectomy for carcinoma in 1993 followed by adjuvant chemotherapy. No new breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable benign calcifications are present. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Evaluate pneumothoraxVIEW: Chest AP 1/5/15 ET tube, NG tube and left PICC unchanged. There are two chest tubes on the right side with a moderate size right pneumothorax with midline shift from right to left not significantly changed. Patchy atelectasis in the lingula unchanged. Cardiothymic silhouette normal. Marked body wall edema. | Moderate size right pneumothorax not significantly changed. |
Generate impression based on findings. | 55-year-old man with history of right knee pain. Severe osteoarthritis affects the right knee with medial joint space narrowing and small tricompartmental osteophyte formation. | Severe osteoarthritis of the right knee. |
Generate impression based on findings. | Female 51 years old; Reason: metastatic breast cancer - evaluate response to treatment. Compare with previous with measurements per recist 1.1 History: adenopathy CHEST:LUNGS AND PLEURA: Nonspecific subpleural nodularity in the right upper lobe likely related to prior radiation therapy.MEDIASTINUM AND HILA: Reference enlarged prevascular lymph node has decreased in size and measures 1.4 x 0.6 cm (series 3, image 27), previously 2.1 x 1.2 cm. Reference low pretracheal lymph node has increased and measures 1.4 x 1.2 cm (series 3, image 34), previously 1.1 x 0.8 cm. Reference subcarinal lymph node has increased and measures 1.7 x 0.9 cm (series 3, image 40), previously 1.3 x 0.8 cm. Non reference paraesophageal lymph nodes are subjectively increased in size.Trace pericardial effusion.CHEST WALL: Status post bilateral mastectomy with left prosthesis in situ. Right subpectoral fluid collection has reduced in size and measures 7.3 x 1.5 cm (series 3, image 53), previously 6.8 x 1.4 cm. Persistent overlying skin thickening. No significant axillary lymphadenopathy. Left-sided Port-A-Cath with tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: 1.3 x 1.2 cm hypoattenuating lesion within the anterior right hepatic lobe (series 3, image 75) was present on prior PET study of 07/31/14 and is most compatible with hepatic metastasis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Non obstructing punctate bilateral renal calculi. Subcentimeter hypoattenuating focus within the mid pole of the left kidney is too small characterize.RETROPERITONEUM, LYMPH NODES: New porta hepatis, peripancreatic and retroperitoneal lymphadenopathy. A reference left periaortic node measures 1.9 x 0.9 cm (series 3, image 119).BOWEL, MESENTERY: Stable mildly prominent mesenteric lymph nodes with mild associated stranding.BONES, SOFT TISSUES: No significant abnormality noted.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: Nonspecific sclerotic focus in the right femoral head.OTHER: No significant abnormality noted. | 1.Status post bilateral mastectomy. Reducing right subpectoral fluid collection.2.Mixed response of mediastinal lymphadenopathy.3.New retroperitoneal, porta hepatis and peripancreatic lymphadenopathy.4.Hypoattenuating right hepatic lesion, previously identified on outside hospital PET study is highly suspicious for metastatic disease.Overall the appearance is suggestive of disease progression. |
Generate impression based on findings. | 77-year-old male with ileostomy formation. Evaluate DLI for takedown. The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Surgical clips are noted bilaterally within the pelvis. Postsurgical changes from the anastomosis are seen within the right lower quadrant. Degenerative changes are noted of the lower lumbosacral spine.The Omnipaque contrast which was diluted 50/50 with water flowed freely from the rectum to the cecum without evidence of stricture or leak. The colonic mucosa demonstrated innumerable diverticula about the rectosigmoid colon. Scattered diverticula are noted elsewhere within the colon. Mucus and debris noted. The exam was not sensitive for detection of polyps or masses, although no large masses or strictures were seen.Small amounts of contrast and air were refluxed into the terminal ileum. Spot films of the terminal ileum were normal. Note that contrast did extend to the small bowel site of anastomosis for evaluation. The appendix was visualized and is normal in appearance. | Diverticulosis of the colon, greatest in the rectosigmoid region, without stricture or leak. No large masses. Exam not designed to evaluate for polyps. |
Generate impression based on findings. | 72 year-old woman with history of low back pain. Lumbar spine alignment is within normal limits. Vertebral body heights are preserved. Small anterior osteophytes project from the vertebral bodies and there is mild narrowing at L3/L4 and L4/L5 with vacuum disc phenomenon. | Degenerative disc disease without acute fracture or malalignment. |