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Generate impression based on findings. | view for retained catheter History: s/p LD placement with shearing of catheter during placementVIEW: Chest AP and Abdomen AP 1/5/15 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal lung opacities or pleural effusions are seen. Intraspinal catheter noted, with tip at the T12 level. No kink or discontinuity noted in the radiopaque portions of the shunt catheter. An additional 4-5 cm of looped catheter tubing projects over the spine at the L3/L4 level.Nonobstructive bowel gas pattern. | 1. No kink or discontinuity noted in the radiopaque portions of the shunt catheter. 2. Retained shunt catheter tubing noted at the L3/4 level. |
Generate impression based on findings. | 56 year old female with history of worsening shortness of breath and weight loss. Evaluate for aspergillosis. LUNGS AND PLEURA: Unchanged mild to moderate centrilobular and paraseptal emphysema with scattered cysts. No significant pleural effusion. Previously described tree in bud opacities in the right upper, middle and lower lobe appear similar to prior, but there has been an interval increase in the right upper lobe over the interval (4/32).The right upper lobe cavitary lesion (4/24) measures approximately 67 x 86 mm, previously 64 x 89 mm. The necrotic tissue wall thickness measures approximately 10 mm, previously 17 mm.The reference smallest anterior cavitary lesion (4/31) is similar in size but now clearly communicates with the larger more posterior right upper lobe cavity.MEDIASTINUM AND HILA: Mediastinal and hilar lymph nodes are unchanged in size, with reference precarinal lymph node measuring approximately 8 mm (3/43). Lack of intravenous contrast limits evaluation, however there is no significant pericardial effusion. Heart size within normal limits. No appreciable coronary artery calcifications. Atherosclerosis affects the aorta and its branches.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Previously seen cavitary lung lesions are grossly unchanged in size, with a slightly decreased soft tissue component of the wall of the largest right apical lesion, however increased intracavitary contents. Still consistent with chronic semi-invasive aspergillosis, and possible associated infectious etiology such as MAI.2.Slightly increased tree in bud opacities in the right apical anterior lung as above, may represent aspiration/endobronchial infection. |
Generate impression based on findings. | 77-year-old male with Dobbhoff tube placement. Nonspecific distended loops of bowel without evidence of obstruction. The feeding tube tip is in the fundus of the stomach. | The feeding tube tip is in the fundus of the stomach. |
Generate impression based on findings. | Reason: mets lung cancer, s/p chemo and bhx of brain mets. pls c/w previous study and evaluate dx status. History: lung ca CHEST:LUNGS AND PLEURA: Reference left apical nodule stable to marginally increased, now measuring 6 mm on image 13/111. Aspirated debris in central airways. Right perihilar scarring and architectural distortion consistent with previous surgery and radiation therapy.MEDIASTINUM AND HILA: Right thyroid nodule, unchanged.Continued decrease in right prevascular lymph node (series 3/38) now 4 mm in short axis.No other significant lymphadenopathy.Moderate coronary artery calcifications.CHEST WALL: Stable small sclerotic lesion in the T7 vertebra which is suspicious for a metastasis.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal nodule (image 99/139) unchanged.KIDNEYS, URETERS: Stable renal cysts.PANCREAS: Stable 15 mm hypodense lesion in head of pancreas (image 109/139).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. | 1. Stable to marginally increased left apex nodule.2. Stable to marginally decreased prevascular lymph node.3. Stable nonspecific pancreatic mass.4. Stable T7 sclerotic lesion.5. Stable left adrenal nodule. |
Generate impression based on findings. | Reason: history of aspergillus pna History: eval pna LUNGS AND PLEURA: Upper predominant paraseptal and centrilobular emphysema.Residual scarring is identified in left apex without evidence of cavity formation.6-mm right middle lobe subpleural nodule unchanged.No new pulmonary nodules.Mild bronchial wall thickening.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: Degenerative changes of the thoracic spineUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Residual left apical scarring with resolution of the subpleural cavitation and associated consolidation. |
Generate impression based on findings. | t-lymphoblastic lymphoma s/p induction therapy LUNGS AND PLEURA: The pleural effusions and atelectasis have resolved. Minimal atelectasis in the right middle lobe.MEDIASTINUM AND HILA: The anterior mediastinal mass measures approximately 5.6 x 2.6 x 2.8 cm markedly decreased in size in the interval. The major airways are patent. The previously noted mass effect to the adjacent vascular structures are no longer identified. The pericardial effusion has markedly decreased in size.CHEST WALL: The subcutaneous emphysema has resolved in the right lateral chest wall. Right chest port with tip in the SVC.UPPER ABDOMEN: The upper abdomen is normal. | Marked interval decrease in size of the anterior mediastinal mass with no evidence of compression to the major airways as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A round marker has been placed on a cutaneous lesion overlying the upper outer 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. | 63-year-old male. Reason: check gastric tube placement History: nausea, vomiting Percutaneous feeding tube, with balloon inflated in the stomach with tip in the proximal jejunum.Nonobstructive bowel gas pattern. Surgical clips in the right upper quadrant. | Gastrojejunostomy tube with tip in proximal jejunum. |
Generate impression based on findings. | Female 65 years old; Reason: H/O DLBCL s/p 6 cycles of R CHOP in need of end of treatment imaging. Please compare to prior. History: DLBCL CHEST:LUNGS AND PLEURA: Right lower lobe calcified granuloma. No dominant lung lesion. There are a few scattered pulmonary nodules. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.Left thoracic inlet lymph node measures 0.9 x 0.7 cm (image 4/series 3) previously, 1.0 x 0.9 cm.Right paratracheal lymph node measures 8 millimeters (image 27/series 3) previously 11 millimetersCHEST WALL: Right chest wall port terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypodensities in the liver. The hepatic and portal veins are patent.SPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node measures 0.7 x 0.6 cm (image 106/series 3) previously, 1.5 x 0.8 cm.Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Stable soft tissue thickening about the mesenteric vessels.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: Sclerotic changes in the left posterior acetabulum are unchanged.OTHER: No significant abnormality noted. | 1.Decrease in size of the referenced lymph nodes with no new sites of disease. |
Generate impression based on findings. | 77-year-old male with stool burden on previous XR now s/p enema, please check repeat XR for stool. Nonobstructive bowel gas pattern. No visible stool in the abdomen or pelvis. A gastrostomy tube overlies the body of the stomach. Again seen is a left basilar opacity and bilateral small pleural effusions. | Nonobstructive bowel gas pattern without visible stool. |
Generate impression based on findings. | 47-year-old female with history of a focal asymmetry corresponding to a probable simple cyst at the 12-1 o'clock upon sonographic exam, presenting for annual mammogram. No current breast 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, unchanged in pattern and distribution. A focal asymmetry seen in the right two o'clock position is no longer present. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 52 year-old male, left wrist/elbow pain Limited examination due to patient's inability to move arm.Elbow: The bones are demineralized. The AP and oblique views are markedly limited but there is no evidence of acute fracture or malalignment.Wrist: The bones are diffusely demineralized. Alignment is anatomic. No fracture is evident. | Diffuse demineralization without acute abnormality evident. |
Generate impression based on findings. | Subdural hemorrhage and low platelet due to ALL. There has been interval decrease in size and attenuation of the right cerebral convexity subdural hematoma, which measures up to 5 mm in thickness, previously 9 mm. There is no midline shift or herniation.There is unchanged non-specific patchy cerebral white matter hypoattenuation. There is unchanged punctate area of encephalomalacia in the left inferior cerebellar hemisphere, which likely represents a chronic infarct. The ventricles are unchanged in size and configuration, with a subcentimeter focus of fat within the glomus of the right lateral ventricle choroid plexus. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | Interval decrease in size of the right cerebral convexity subdural hematoma. |
Generate impression based on findings. | Reason: eval for progression History: prostate cancer, rising PSA Innumerable foci of activity are again seen throughout the axial and proximal appendicular skeleton, decreased in size and number, however new foci are seen in the lower thoracic and lumbar spine.Activity in the right femoral neck now appears now confluent. | 1. Widespread osseous metastases, overall decreased in size and number, but several new foci. This likely represents a mixed response.2. Right femoral neck activity appears more confluent and an impending fracture cannot be excluded. Consider orthopedic consultation. |
Generate impression based on findings. | 38-year-old female with back pain Alignment is within normal limits without evidence of instability on flexion or extension views. Vertebral body heights are maintained. Mild degenerative disk disease affects L5/S1 | Normal lumbar spine alignment. |
Generate impression based on findings. | 57-year-old with partially calcified mass in the left breast noted on screening mammography. Presents for additional evaluation. No family history of breast cancer. MAMMOGRAM: An ML view and two spot magnification 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. Within left upper central outer quadrant posterior depth is a focal mass that contains grouped coarse calcifications. There is no associated architectural distortion. No additional suspicious microcalcifications.ULTRASOUND: Targeted ultrasound was performed of the left breast at the site of the patient's mammographic abnormality. In the 3 o'clock position in the left breast 1 cm from the nipple there is an ovoid predominantly hypoechoic mass containing calcifications that measures 7 x 4 x 5 mm. There is no significant internal vascularity. No additional mass lesions are identified. | Partially calcified mass lesion in the left lateral breast likely represents a fibroadenoma, however close interval follow-up with repeat diagnostic mammogram and possible ultrasound in 6 months is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | 74 year old female with history of chest pain and breast cancer. Evaluate for pulmonary embolus. PULMONARY ARTERIES: No pulmonary embolus.LUNGS AND PLEURA: Scattered bilateral pulmonary nodules, not significantly changed from prior. Reference right apical nodule (10/24) measures 9 x 7 mm, previously 9 x 8 mm. No new suspicious pulmonary nodules or masses, no significant pleural effusions, and no consolidation or pneumothorax.MEDIASTINUM AND HILA: No significant pericardial effusion, no cardiomegaly. Evaluation of the mediastinum is limited due to phase of contrast, however no new lymphadenopathy is appreciated.CHEST WALL: Stable scattered sclerotic foci within the visualized spine and ribs.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hypoattenuating foci within the liver, consistent with known history of liver metastases. Left renal cysts are partially visualized. | 1.No pulmonary embolus.2.Scattered bilateral pulmonary micronodules, and other findings of metastatic breast cancer, are unchanged when compared to prior.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 54-year-old female with history of reversed Bennett fracture Deformity of the base of the fifth metacarpal is consistent with the patient's history of fracture. Interval decrease in soft tissue swelling about the hand. | Unchanged deformity of the base of the fifth metacarpal. |
Generate impression based on findings. | Reason: h/o met thyroid ca, compare to previous, measurements pls, eval response to therapy History: none CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules stable in size and number.Reference nodule in the right upper lobe measures 4-mm, unchanged (image 35/100).MEDIASTINUM AND HILA: Mass in thyroid resection bed contiguous with enhancing, centrally necrotic lymphadenopathy in the mediastinum measures 3.8 x 5.2 cm (image 20/150), unchanged.Stable to marginally increased left hilar/prevascular node now measuring 13 mm on image 38/150 (12 mm on previous).CHEST WALL: Scoliosis. Tumor/lymphadenopathy above the thoracic inlet will be discussed in separately reported neck CT..Soft tissue metastasis at the level of the clavicular heads (image 14/150) stable at 23-mm. T4 vertebral body lucent lesion is most suggestive of a hemangioma and is unchanged compared to 2011.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypoattenuating focus in the posterior right hepatic lobe, too small to characterize but stable and presumably benign..SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: Bilateral hypoattenuating renal lesions stable and most likely represent cysts..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.. | Reference measurements grossly stable with no new sites of disease. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is likely an incidental cavum vellum interpositum with slight splaying of the internal cerebral veins just inferiorly. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Unremarkable noncontrast MRI brain. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. There is no extra-axial fluid collection. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. Mild patchy hypoattenuation in the periventricular and subcortical white matter and a more focal area of hypoattenuation in the left insula is nonspecific but most compatible with age indeterminate small vessel ischemic disease. There is been surgical reconstruction of the inferior orbital wall on the right. There is moderate mucosal thickening within the right maxillary sinus and opacification of the mastoid air cells bilaterally. The remaining imaged portions of the paranasal sinuses and middle ears are grossly clear. | No evidence of acute intracranial hemorrhage or acute intracranial abnormality. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | 57-year-old male with history of emphysema and fibrosis. Evaluate for interstitial lung disease. "...PMHx of HTN, developmental delay, pulmonary fibrosis, pulmonary hypertension who presented from an OSH as a transfer for further evaluation/treatment of his ILD and treatment of his acute exacerbation. " LUNGS AND PLEURA: Diffuse severe emphysema is grossly similar to prior. New scarlike opacities are predominantly in the lung bases. Pertinent negatives are no honeycombing or architectural distortion. No significant groundglass opacities or septal thickening. No pleural effusion. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. No pericardial effusion. Heart size is within normal limits. Pulmonary trunk measures 3.5 cm, compatible with given history of pulmonary artery hypertension.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited evaluation of the upper abdomen reveals no significant abnormality. Mild atherosclerosis of the aorta and its branches. | 1.Diffuse severe emphysema, similar to prior.2.New scarlike opacities and subsegmental atelectasis in the lower lungs bilaterally, may represent sequela of prior infection or inflammation.3.No findings of interstitial lung disease/pulmonary fibrosis. |
Generate impression based on findings. | Evaluate for foreign bodyVIEWS: Right foot AP and lateral The radiopaque foreign body in the subcutaneous tissue at the plantar aspect of the calcaneus again noted and unchanged. | Radiopaque foreign body at the plantar aspect of the calcaneus unchanged. |
Generate impression based on findings. | Male 53 years old; Reason: metastatic prostate cancer, evaluation of disease after 3 cycles of investigational therapy. History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Visualized lung fields without significant change, no suspicious lung nodule or mass delineated. No pleural effusion.MEDIASTINUM AND HILA: Mild to moderate calcified coronary artery disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal hypoattenuating lesion, too small to characterize.RETROPERITONEUM, LYMPH NODES: Ectatic abdominal aorta again seen, aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Normal appendix.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pathologically enlarged nodes.BONES, SOFT TISSUES: Again seen numerous sclerotic lesions, subjectively similar appearance to prior study. Bilateral L5/S1 pars defects with associated anterolisthesis. Multilevel degenerative changes of spine. Please refer to concomitant nuclear medicine bone scan from same day for additional findings. | 1. Diffuse skeletal sclerotic foci compatible with metastatic disease. Please refer to concomitant nuclear medicine bone scan from same day for additional findings. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | 71-year-old female. Reason: recurrent aspiration. Evaluate for structural abnormality. Exam was severely limited due to patient's inability to tolerate lying flat for extended period of time, and inability to stand. Unable to ingest sufficient quantity of barium for complete exam.Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Median sternotomy and mediastinal surgical clips. Single contrast evaluation of the esophagus revealed a moderate to severe narrow stricture at the level of the hypopharyngeal-esophageal junction, measuring up to 8.7 cm in diameter. Moderate diffuse dilatation proximal to the stricture. No diverticulum is seen. Left directed swallow.No other morphologic abnormalities of the mucosal surfaces or mural contours. No other strictures were seen during limited evaluation of the more distal esophagus. Limited fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 4:34 minutes | High grade stricture at the level of the hypopharyngeal-esophageal junction with mild diffuse bulging proximal to the stricture. No Zenker's diverticulum.Findings discussed via telephone with Dr. Merling at 2:40 PM. |
Generate impression based on findings. | metastatic Prostate cancer, evaluation of disease after 3 cycles of investigational therapy. Please complete PCWG2 form Increased foci of activity in the humeri, bilateral ribs, spine, and pelvis are again compatible with osseous metastases. New foci of activity in the right L1 pedicle, right T3 transverse process, and left ilium/sacrum are compatible with new metastases.Activity around the knees is likely due to degenerative changes. | Diffuse osseous metastases with several new metastases in the spine and left ilium/sacrum. |
Generate impression based on findings. | Reason: patient with known pulmonar nodule LUL 5mm, needs complete 2 year follow up History: none LUNGS AND PLEURA: Left upper lobe pulmonary nodule measures 5 mm (image 25, series 4), unchanged in size. MEDIASTINUM AND HILA: Calcified right thyroid nodule.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable 5mm left upper lobe pulmonary nodule consistent with a benign etiology such as a granuloma or hamartoma. |
Generate impression based on findings. | 72-year-old male. Reason: s/p DHT placement History: eval placement DHT Compared with CT exam from 04/22/2013, there is a partial intrathoracic stomach. The Dobbhoff tube is curled within the intrathoracic stomach, with the tip oriented superiorly.Nonobstructive bowel gas pattern. Surgical clips in the right upper quadrant. | Dobbhoff tube is curled within the intrathoracic portion of the stomach, with the tip oriented superiorly. As this puts the patient at an increased risk of aspiration, recommend the tube is adjusted/advanced so the tip lies intra-abdominally.Findings discussed via telephone with Dr. Yesensky at 4:03 PM. |
Generate impression based on findings. | Metastatic melanoma s/p 4 cycles of Ipilimumab please evaluate disease status and compare to previous imaging.RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 90 mg/dL. Today's CT portion grossly demonstrates nodularity along the inferior aspect of the left major fissure, unchanged from prior study. A lytic lesion is seen in the right glenoid. Status post cholecystectomy with a soft tissue mass in the gallbladder fossa. This mass has increased in size. Pneumobilia is now present, likely related to prior sphincterotomy.Subcutaneous nodules are seen anteromedial to the right tibia contiguous with subcutaneous vessels, likely representing varicose veins.Today's PET examination demonstrates hypermetabolic activity associated with the gallbladder fossa mass, increased from the prior study, now with an SUVmax of 27.3, previously 23.3. Increased activity is seen with the lytic right glenoid lesion, now with an SUVmax of 2.7, previously 1.8. Minimal activity associated with pulmonary nodularity is again noted, likely due to inflammation rather than tumor.Increased activity around the left knee is likely degenerative. Previously noted activity along the midline abdominal incision are no longer seen. | 1.Increase in size and activity of gallbladder fossa mass compatible with melanoma metastasis.2.Increase in activity of a right glenoid lytic lesion which may represent metastatic disease. |
Generate impression based on findings. | 34-year-old female. Reason: eval for obstruction, stool burden History: SBO Paucity of small bowel gas without specific evidence of obstruction. Average stool burden. Enteric contrast within the colon from prior examination. No free air seen on upright imaging. | No evidence of small bowel obstruction. Average stool burden. No free air seen on upright imaging. |
Generate impression based on findings. | Frontal sinus: The frontal sinuses are not well pneumatized but are clear. The frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: Bilateral interosseous are present, and remain patent. The ostiomeatal units are clear.Posterior ethmoids: There been partial bilateral ethmoidectomies.Sphenoid sinus: There is trace mucosal thickening in the left sphenoid sinus. The right sphenoid sinus and sphenoethmoidal recesses are clear. There is minimal rightward nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.Incidental fat density is suggested associated with the glomus of choroid plexus in the left atrium, likely representing a xanthogranuloma. There is scattered atherosclerotic calcification along the intracranial internal carotid arteries. | No CT evidence of acute sinusitis, with evidence of postoperative changes. |
Generate impression based on findings. | 46-year-old female with metastatic breast cancer. This study was performed for restaging.RADIOPHARMACEUTICAL: 12.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion again shows postsurgical changes in the right axilla and a right breast implant. There are hyperattenuating foci in bilateral kidneys compatible with renal stones. There is a renal cyst in the inferior pole of the left kidney. There is minimal sclerosis in the right iliac bone and right sacrum. Streaky opacities seen in the right middle lobe are unchanged. There is a nodule in the right lower lobe (series 4, image 89).Today's PET examination demonstrates two FDG avid lesions in the right hemipelvis. One lesion is located in the right iliac, SUV max 3.3, previously 5.3. A second lesion is located in the right sacrum, SUV max 3.4, previously 4.3.There is hypermetabolic activity in the subcutaneous tissue over the gluteal muscles bilaterally corresponding with fat stranding that may be related to injections. There is stable mild activity of the capsule of the right breast implant, likely postsurgical in etiology. | 1.Two hypermetabolic osseous lesions in the right side of the pelvis as described above appear decreased in activity.2.No new FDG avid tumors are identified. |
Generate impression based on findings. | Male 56 years old; Reason: pt with hx of anal cancer s/p 2 cycles of chemo and XRT; needs surveillance imaging CHEST:LUNGS AND PLEURA: Visualized lung fields stable in appearance with emphysematous disease present. Small air space disease, seen in right lower lobe medially, may reflect scarring but nonspecific, similar to prior study. Small fat containing defect seen in right posterior thorax, similar to earlier exam.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip in right atrium. Mild interval decrease in size of right-sided retrocrural lymph node, measuring 1.4 x 0.7 cm, previously measured 1.5 x 1.2 cm. Heart normal in size.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right renal hypoattenuating lesion, too small to characterize, image 119 series 3.RETROPERITONEUM, LYMPH NODES: Bi-iliac atherosclerotic disease.BOWEL, MESENTERY: Circumferential wall thickening seen at level of anorectal junction/anal verge, appears mildly improved, for example, measures up to 2 cm in thickness posteriorly, image 193 series 3, previously measured 2.5 cm at this level. Colonic diverticulosis without evidence of acute diverticulitis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Improving pelvic and inguinal lymphadenopathy. Reference right external iliac lymph node measures 1.2 x 0.9 cm, image 154 series 3, previously measured 1.6 x 1.4 cm. Reference right inguinal lymph node measures 2.4 x 2.2 cm, image 194 series 3, previously measured 3.5 x 3.1 cm. Mildly prominent perirectal and mesenteric lymph nodes again seen.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance, multilevel degenerative changes of spine. | 1. Interval decrease in size of inguinal and pelvic lymphadenopathy.2. Mild improvement in degree of circumferential wall thickening at level of anal verge, may reflect patient's reported primary anal malignancy. |
Generate impression based on findings. | Female 64 years old Reason: status post small bowel resection 12/18, and lysis of adhesions and g-tube placement 12/29 with rising WBC ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. Unchanged punctate hypodensities in the hepatic parenchyma are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant change with respect to kidneys, including a large simple cyst arising from the inferior pole the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical findings related to small bowel resection again identified. There is persistent dilatation of the small bowel and multiple areas of luminal narrowing suggestive of adhesive disease. Additional more focal tethering and narrowing noted at the distal aspect of the small bowel anastomosis suggest partial small bowel obstruction as previously administered contrast progressed to the colon. Small bowel feces sign is noted in the area of the prior resection suggesting stasis. The colon is mostly collapsed. Duodenal mass again seen in the third portion of the duodenum, now measuring 2.3 x 2.1 cm (image 68, series 3). Small volume ascites, decreased from the prior exam. No drainable intra-abdominal fluid collection is evident. There is colonic diverticulosis without evidence of diverticulitis. Gastrostomy tube in place, position unchangedBONES, SOFT TISSUES: Gas within the subcutaneous fat of the bilateral inguinal regions presumably postprocedural in etiology.PELVIS:UTERUS, ADNEXA: Uterus not identified.BLADDER: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Gas within the subcutaneous fat of the bilateral inguinal regions presumably postprocedural in etiology.OTHER: Partially loculated ascites within the pelvis. | 1.Diffuse dilatation of the small bowel with narrowing at the distal aspect of the small bowel anastomosis with associated small bowel feces sign suggestive of partial small bowel obstruction, likely secondary to adhesive disease given the adjacent tethering.2.Duodenal mass as detailed above.3.Partially loculated ascites within the pelvis. |
Generate impression based on findings. | 53 years old Male. Reason: IgG kappa, ISS stage II, multiple myeloma, pt in complete response hematologically, f/u on large plasmacytoma in spine and pelvis. History: IgG kappa, ISS stage II, multiple myeloma, pt in complete response hematologically, f/u on large plasmacytoma in spine and pelvis.. RADIOPHARMACEUTICAL: 15.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion grossly demonstrates multifocal stable lytic osseous lesions, most notably in the right ischium. Healing rib fractures are seen in the left third anteriorly and right 10th postero-laterally. Compression fractures are noted at T4 and T9. Linear atelectasis is seen in the left lung base.Today's PET examination demonstrates two new foci of increased activity in the T4 and and T9 vertebral bodies. The SUV Max in the T4 vertebral body lesion is 4.6. There are multiple hypermetabolic lymph nodes in both sides of the neck at the level 2, 3 and 5. The SUVmax in the right level 2 lymph nodes is 7.3. The SUVmax in the posterior cervical triangle on the left with SUV Max of 3.3. A new small normal-sized lymph node is seen in the right inguinal region with maximal SUV of 2.5.A new focus of increased activity is seen in the subcutaneous tissue right face near the base of the nose or in the maxillary bone, with SUV Max of 5.2. There is no definite CT correlation for this finding. This finding is non-specific.Stable two rib lesions with the mildly increased activity are seen in the right lower ribs.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Two new hypermetabolic osseous lesions in the thoracic spine and multiple new hypermetabolic lymph nodes in the neck and the right inguinal regions are suspicious for tumor recurrence.2.Nonspecific focus of increased activity in the right face without CT correlation.3.Two stable rib lesions with increased metabolic activity. |
Generate impression based on findings. | 40 year-old with history of pain and discomfort in left breast for two months. Palpable abnormality on recent clinical exam, however the patient cannot locate abnormality today. Family history of breast carcinoma in her sister diagnosed at 34 years of age. 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Note is made of scattered benign calcifications bilaterally. Benign appearing lymph nodes are projected over both axillae.ULTRASOUND: Targeted ultrasound was performed of the left axilla at the site of the patient's previously palpable abnormality. Physical exam revealed several subcentimeter, soft, mobile, palpable densities in the deep axillary soft tissues. Sonography of the left axilla revealed 4 normal appearing lymph nodes. No suspicious mass lesion is evident. | Normal axillary lymph nodes at the site of the patient's palpable abnormality. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage.There is slight increased conspicuity of confluent abnormal low density in the right parietal centrum semiovale. In addition, there is interval development of a new area of abnormal low density in the posterior left frontal lobe in the precentral gyrus extending into the left frontal subcortical and deep white matter, with mild gyral expansion suggestive of edema. There are questioned areas of loss of gray white differentiation suggested more cranially, although it appears preserved more caudally. On sagittal and coronal reformatted images, there is likely a rounded pseudo-lesion formed from abutment of adjacent cortical margins when compared to the prior exam, rather than an identifiable underlying lesion. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. New area of abnormal low density in the left precentral gyrus extending into adjacent subcortical and deep white matter, with slight associated gyral expansion. MRI with without contrast recommended for further evaluation, for a suspected underlying lesion.2. No acute intracranial hemorrhage, as clinically questioned.3. Increased conspicuity of abnormal low density in the right parietal centrum semiovale which is nonspecific but may represent progressive age indeterminate small vessel ischemic changes. |
Generate impression based on findings. | Pain, trauma to the fifth metatarsalVIEWS: Right foot AP, oblique and lateral There is mild widening to the apophysis at the base of the fifth metatarsal and likely to represent a fracture at this site. There is associated soft tissue swelling. The remainder of the examination is normal. | Probable fracture through the apophysis at the base of the fifth metatarsal. |
Generate impression based on findings. | Feeding tube placementVIEW: Abdomen AP Feeding tube tip at the pylorus of the stomach. Disorganized nonobstructive bowel gas pattern. Left lower lobe opacity noted. | Feeding tube tip at the pylorus of the stomach. |
Generate impression based on findings. | 73-year-old female status post coiling of left internal carotid artery aneurysm To maximize sensitivity of the supratentorial structures, the infratentorial structures were not omitted form the field of view given the patients size. There is mild, persistent, relatively asymmetric decreased activity in the left frontoparietal region. | Mild, relative, asymmetrically decreased activity in the left frontoparietal region is unchanged from prior post-occlusion perfusion examination 5/16/2011. |
Generate impression based on findings. | Female 39 years old; Reason: Evaluate for aortic dissection History: severe chest pain, SOB CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Ascending thoracic aorta measures 2.7 cm. No evidence of aortic dissection. No evidence of curvilinear hyperdensity on noncontrast imaging to suggest intramural hematoma. Main pulmonary artery prominent, measuring 2.8 cm in transverse dimension. Small soft tissue attenuation seen in anterior mediastinal area, may reflect residual thymic tissue. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Common bile duct at upper limits in size, measuring up to 6 mm but tapers distally. No radiopaque choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of aortic dissection or curvilinear hyperdensity on noncontrast imaging to suggest intramural hematoma.BOWEL, MESENTERY: Colonic diverticulosis without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: Lobulated uterus, may be related to underlying leiomyomatous disease. Small simple pelvic free fluid, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative disease of spine. | 1. No aortic dissection. 2. Lobulated uterus, may be related to underlying leiomyomatous disease. Dedicated pelvic sonographic imaging may be pursued for confirmation.3. Small simple pelvic free fluid, likely physiologic. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two 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 marker was placed on a skin lesion overlying 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. | 23-year-old female with knee pain after motor vehicle collision Knee: Alignment is within normal limits. No fracture is identified.Lumbar spine: Vertebral body heights and alignment are maintained. No fracture is visualized. | No acute fracture or dislocation. |
Generate impression based on findings. | 60 year-old female status post curettage of right proximal tibia giant cell tumor Sideplate and screws affix the proximal tibia with cement again noted at the site of curettage and packing within the proximal tibial metaphysis and epiphysis without evidence of complication. Lucency along the anterior aspect of the cement bone interface is unchanged from the prior exam. Moderate osteoarthritis affects the knee. | Postoperative changes of giant cell tumor curettage and packing without evidence of recurrence. |
Generate impression based on findings. | 20 year-old female with lateral pain after injury Alignment is within normal limits. No fracture is identified. Possible small joint effusion. | No fracture or dislocation. |
Generate impression based on findings. | Female 51 years old Reason: 51 yr old patient with fallopian tube cancer, s/p 6 cycles of Gemzar/Carboplatin, evaluate disease process compare to 7-25-14 scan CHEST:LUNGS AND PLEURA: Previously described right lower lobe nodule not identified on today's examination.MEDIASTINUM AND HILA: Thyroid nodules unchanged. Marked interval decrease in size of the reference cardiophrenic node, now measuring 0.9 x 1.5 cm (image 69, series 3), previously 1.7 x 2.6 cm.CHEST WALL: Right chest wall Port-A-Cath with tip terminating in the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Subcapsular hypoattenuating foci unchanged and compatible with simple hepatic cyst. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion in the left kidney is too small to characterize.RETROPERITONEUM, LYMPH NODES: Marked interval decrease in size in the reference retroperitoneal lymphadenopathy. Aortocaval node now measures 1.0 x 1.6 cm (image 121, series 3), previously 1.8 x 2.4 cm. The left para-aortic lymph node now measures 0.7 x 1.1 cm (image 121, series 3), previously 1.9 x 2.1 cm.BOWEL, MESENTERY: Postoperative changes within the large bowel. Wide mouth ventral hernia containing small bowel without significant interval change.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left lower quadrant peritoneal nodule now measures 0.6 x 0.7 cm (image 29, series 3), previously 1.4 x 1.4 cm. interval decrease in size of multiple non-reference pelvic lymph nodes.BOWEL, MESENTERY: Postoperative changes within the large bowel. Wide mouth ventral hernia containing small bowel without significant interval change.BONES, SOFT TISSUES: No significant abnormality noted. | Treatment response with interval decrease in size of all index and non-index lesions. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral cyst aspirations. Two standard digital views of both breasts were performed with tomosynthesis 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. | Female 55 years old; Reason: Metastatic pancreas cancer please assess extent of disease and provide index lesion measurements for RECIST as required by study CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary lesions seen compatible with metastatic disease, stable and enlarging, additional new lesions also present. Reference left lower lobe lesion without significant change, measuring approximately 2.4 x 2 .2 cm, image 60 series 5. New small left pleural effusion and trace right pleural fluid. Another lesion is submitted for reference, which demonstrates interval increase in size, pleural-based and located in right lower lobe, measuring 2.5 x 1.9 cm, image 65 series 5, previously measured 2 x 1.5 cm.MEDIASTINUM AND HILA: Mild interval decrease in size of adherent thrombus in the left innominate vein, image 20 series 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Improved pneumobilia. Status post cholecystectomy. Liver stable in appearance, for example, hepatic segment 7 subcentimeter focus, image 76 series 3, too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes related to Whipple procedure with resection of pancreatic head, upper abdominal surgical clips. Remainder pancreatic parenchyma somewhat atrophic with parenchymal calcifications. No ductal dilatation. Stable portacaval adenopathy. Subcentimeter retroperitoneal including aortocaval lymph nodes.ADRENAL GLANDS: Unchanged hyperplastic appearing left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive aortobiiliac atherosclerotic disease. Interval enlargement of peripancreatic mesenteric lymph node, measuring 2.5 x 1.8 cm, image 113 series 3, previously measured 1.8 x 1.7 cm. Additional smaller mesenteric lymph nodes also seen.BOWEL, MESENTERY: Small to moderate stool burden.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Decreased osseous mineralization. Multilevel degenerative changes of spine. | 1. Numerous bilateral pulmonary metastatic lesions, stable and enlarging as well as new lesions. New small left pleural effusion and trace right pleural fluid. 2. Portacaval, peripancreatic and mesenteric lymph nodes as described with interval enlargement of peripancreatic mesenteric lymph node as described, suspicious for metastatic disease. |
Generate impression based on findings. | 46 showed female with neck pain radiating to head Cervical spine: Alignment is within normal limits. No fracture is identified. There is no evidence of instability on flexion and extension views.Lumbar spine: Vertebral body heights and alignment are maintained. Small anterior osteophytes are noted along the lower thoracic and lumbar spine. No fracture. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Male 5 years old; Reason: s/p attempted left subclavian central line, femoral port placed VIEW: Chest AP (one view) 1/5/15 1447 Lower extremity central venous catheter tip in the superior cavoatrial junction. The cardiothymic silhouette is normal.The lung volumes are low, similar to prior. No focal lung opacity or pleural effusion is present. Apparent lucency along the left cardiac border may represent a pneumothorax. | 1. Lower extremity central venous catheter tip at the superior cavoatrial junction.2. Apparent lucency along the left cardiac border may represent a pneumothorax. A cross-table lateral may be helpful to differentiate this. Findings were discussed with Dr. Carlisle at 330pm on 1/5/15. |
Generate impression based on findings. | 27-year-old male with history of comminuted, intra-articular fracture of the base of the fifth metacarpal. A comminuted, intra-articular fracture of the base of fifth metacarpal is again identified with fragments in near anatomic alignment appearing similar to the prior exam. There is mild soft tissue swelling about the base of the fifth metacarpal. | Base of the fifth metacarpal fracture appearing similar to the prior exam. |
Generate impression based on findings. | Male 55 years old Reason: Left cheek cancer s/p RT, evaluate for metastases LUNGS AND PLEURA: New Ill-defined, spiculated subpleural nodule measuring 3.1 x 1.7 cm in the left lower lobe (image 62 series 4). Smaller surrounding centrilobular nodules and groundglass opacity also noted. Few scattered nonspecific subcentimeter centrilobular nodules are noted in the left upper lobe (image 40 series 4).MEDIASTINUM AND HILA: Mildly enlarged right hilar lymph node measuring 1.3 x 1.0 cm (image 45 series 3). Trace pericardial fluid.CHEST WALL: Degenerative changes in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Post op change. | New 3cm subpleural nodular opacity in left lower lobe. The appearance and relatively rapid growth are more typical of an infarct, aspirate or infection, though metastatic disease cannot be excluded and follow up to resolution is recommended. |
Generate impression based on findings. | Male 61 years old; Reason: History of t4 mucinous appendiceal cancer evaluating for peritoneal recurrence history: Appendiceal cancer ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal in morphology. The hepatic and portal veins are patent. No new solid hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measures 1.0 x 0.7 cm (image 41/series 3) previously, 1.0 x 0.7 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from an appendectomy. No bowel obstruction. No mesenteric lymphadenopathy.Postsurgical changes in the omentum. No focal mass is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: Tubular structure extending from the dome of the bladder likely represent a residual patent urachus.LYMPH NODES: Right pelvic lymph node adjacent to the urinary bladder measures 1.2 x 1.0 cm (image 140/series 3) and is slightly prominent from prior.There is a similar smaller lymph node on the left.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Right pelvic lymph node, slightly more prominent than prior exam. Follow up is suggested. |
Generate impression based on findings. | PainVIEWS: Right middle finger AP, oblique and lateral Again noted an oblique fracture involving the distal phalanx of the middle finger. The appearance is not significantly changed from prior study. There is an overlying splint in place. Diffuse osteopenia noted. | Fracture through the distal phalanx of the middle finger not significantly changed. |
Generate impression based on findings. | Fracture painVIEWS: Right elbow AP, oblique and lateral, right forearm AP and lateral Multiple fractures of the radius, ulna, and humerus remain fixed in near anatomic alignment. The metallic hardware at the proximal radius is unchanged. Two anchor sutures are present at the distal humeral epiphysis not significantly change. Two screws affixing the ulnar diaphysis have been removed in the interval. There is interval healing at the ulnar diaphysis fracture site as evidenced by callus formation and periosteal reaction. Bullet fragments are again noted. | Postoperative changes as described above. |
Generate impression based on findings. | Male 68 years old Reason: assess for sbo History: significant ileus, intubated for emphysematous bullae ABDOMEN: Evaluation suboptimal secondary to severe respiratory motion artifact.LUNG BASES: Severe centrilobular emphysema with bibasilar atelectasis/consolidation.LIVER, BILIARY TRACT: Hypoattenuating lesions in the hepatic parenchyma are incompletely characterized on this examination.SPLEEN: Indeterminate hypoattenuating splenic lesion.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: There is marked colonic distention, predominantly affecting the transverse and proximal descending colon with stool present within the rectum and cecum. These findings are consistent with colonic ileus as no definite transition point is identified. There is colonic diverticulosis with mild associated wall thickening suggesting chronic diverticulitis. There is an enteric feeding tube in place with the tip terminating in the gastric fundus.BONES, SOFT TISSUES: Right hip arthroplasty device in place.PELVIS: Evaluation of the pelvis is limited by respiratory artifact and streak artifact from the patient's right hip arthroplasty device.PROSTATE, SEMINAL VESICLES: Amorphous high density within the prostate is nonspecific and incompletely characterized. Dense adjacent prostatic calcifications are evident.BLADDER: Nonspecific high-density fluid within the bladder lumen. There is a Foley catheter in place.BONES, SOFT TISSUES: Compression deformity of L2 vertebral body is of indeterminate age. | Examination severely limited by motion artifact.1.Findings compatible with colonic ileus as detailed above. 2.Severe emphysema and bibasilar atelectasis/consolidation. |
Generate impression based on findings. | Reason: ILD possible Fibrotic NSIP History: DOE LUNGS AND PLEURA: Patchy bilateral predominantly interstitial abnormality with traction bronchiectasis and probable honeycombing at a few locations is unchanged. No significant air trapping and expiratory phase imaging.MEDIASTINUM AND HILA: Scattered small nodes are unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatic calcified granuloma. | Chronic interstitial lung disease stable in severity and distribution. The imaging findings are consistent with known fibrotic NSIP. |
Generate impression based on findings. | 19 year-old male with sickle cell anemia. Abnormal LFTs. LIMITED ABDOMEN | 1. Normal liver Doppler study.2. Mildly coarse liver parenchyma may represent diffuse fatty infiltration and/or parenchymal dysfunction. |
Generate impression based on findings. | 19 year-old female with right middle finger pain Interval removal of surgical pins with healed deformity of the dorsal base of the distal phalanx. Alignment is anatomic. No new fracture identified. | Healed fifth finger fracture without acute abnormality. |
Generate impression based on findings. | 61-year-old female history of left leg weakness. There is no evidence of intracranial hemorrhage or mass. There is mild confluent subcortical and periventricular white matter hypoattenuation compatible with age indeterminate ischemic small vessel disease. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is opacification of the left mastoid air cells. The skull and scalp soft tissues are unremarkable. | 1. Mild age-indeterminant ischemic small vessel disease, but no evidence of acute intracranial hemorrhage. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Opacification of the left mastoid air cells may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 81 years old; Reason: breast cancer History: breast cancer per protocol CHEST:LUNGS AND PLEURA: Reference right middle lobe subpleural nodule unchanged, measuring 1.6 x 0.8 cm, image 57 series 4, previously measured 1.6 x 0.8 cm. Another index nodule seen in right upper lobe near fissure without significant change, measuring approximately 6 mm, image 36 series 4. Not as well seen on earlier exam is pleural-based focal nodularity in region of left major fissure peripherally, measuring 1.3 x 1 cm, image 45 series 4, nonspecific, may be related to round atelectasis or scarring, attention on follow-up recommended. Additional micronodules without significant change. Peripheral pulmonary scarring, post radiation sequela particularly on the left suggested and sequela of chronic interstitial lung disease visualized.MEDIASTINUM AND HILA: Mild coronary artery calcifications. Stable to minimal interval decrease in size of right axillary lymph node, measuring 1.7 x 1.1 cm, image 26 series 3, previously measured 1.8 x 1.2 cm.CHEST WALL: Right chest wall port seen with tip in right atrium. Status post left mastectomy with associated surgical clips seen in chest wall and axillary area.ABDOMEN:LIVER, BILIARY TRACT: Relatively decreased hepatic parenchymal hypoattenuation seen in hepatic segment IVb, image 99 series 3, similar to prior exam, may reflect focal hepatic steatosis but nonspecific.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided and right-sided extrarenal pelvises. RETROPERITONEUM, LYMPH NODES: Moderate to severe aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Small hiatal hernia. Descending and sigmoid colon diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: Underdistended bladder, marking evaluation suboptimal.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. Not as well seen on earlier exam is pleural-based focal nodularity in region of left major fissure peripherally, nonspecific, may be related to round atelectasis or scarring but attention on follow-up recommended. Additional stable pulmonary lesions. 2. Stable to minimal interval decrease in size of right axillary lymph node. |
Generate impression based on findings. | Female 62 years old; Reason: 62yo G3P1 s/p optimal debulking for cervical ca f/u for recurrence/mets History: none CHEST:LUNGS AND PLEURA: Subcentimeter left lower lobe pulmonary nodule. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.CHEST WALL: Bilateral breast prosthesis.ABDOMEN:LIVER, BILIARY TRACT: Probable cyst in segment 7 of the liver. The lesion in segment 6/7 of the liver measuring 1.4 x 1.0 CM does not meet criteria for a simple cyst. It has some minimal enhancement and cannot be further characterized by single phase CT.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathyBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No pelvic lymphadenopathy. 2.Nonspecific right hepatic lobe lesion which was present on the prior PET/CT and cannot be further characterized on a single phase CT. |
Generate impression based on findings. | Metastatic breast cancer with progression of several lines of therapy now on the lucitinib trial. There has been overall interval decrease in size of the extensive infiltrative lymphadenopathy in the neck and partially-imaged mediastinum. For example, a right level 5 lymph node measures 30 x 36 mm, previously 40 x 37 mm and a left level 5 lymph node measures 34 x 26 mm, previously 36 x 29 mm. In addition, there appears to be a greater degree degree of necrosis in the affected lymph nodes. The thyroid and major salivary glands are unchanged. There is persistent encasement of the left common carotid artery. There is absent opacification of the left internal jugular vein. There is minimal degenerative cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Overall interval decrease in size of the extensive lymphadenopathy in the neck and partially-imaged mediastinum. |
Generate impression based on findings. | Male 59 years old Reason: adenoid cystic carcinoma with lung mets. Please measure reference RML lung lesion and compare to last CT History: post 2 cycles of therapy CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules consistent with metastases are not significantly changed in size. Reference right middle lobe nodule measures 3.7 x 3.3 cm (image 55 series 5) previously 3.8 x 3.3 cm.MEDIASTINUM AND HILA: No adenopathy.CHEST WALL: Right chest wall intramuscular lipoma is unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable right hepatic hemangioma.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. | No change in pulmonary metastases. |
Generate impression based on findings. | Metastatic lung cancer status post neck radiation therapy and 4 cycles of chemotherapy. There is continued interval decrease in the lymphadenopathy in the neck. The lymph nodes within the neck are no longer significantly enlarged. For example, a left level 2A lymph node measures 4 mm in short axis, previously 16 mm. Likewise, subcutaneous mass in the right supraclavicular region is also no longer discernible. The thyroid and major salivary glands are unchanged. There is a left internal jugular venous catheter. The carotid arteries are grossly patent. The imaged paranasal sinuses and mastoid air cells are clear. There are multiple left upper lobe pulmonary nodules, which appear to have decreased in size, but there is a persistent right upper lobe consolidation with traction bronchiectasis. There is a partially imaged small pericardial effusion. | 1. Interval decrease in size of numerous cervical lymph nodes, which are no longer significantly enlarged.2. Interval decrease in size of a right supraclavicular subcutaneous mass, without measurable residual tumor.3. Interval decrease in size of metastases in the imaged portions of the lungs and a partially imaged small pericardial effusion. Please refer to the separate CT chest report for additional details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 23 years old; Reason: 23 yo with AML, imaging for fever of unknown origin and pre SCT work-up. CHEST:LUNGS AND PLEURA: Small right pleural effusion. Bibasilar subsegmental atelectasis, right greater than left.MEDIASTINUM AND HILA: Normal sized heart without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right PICC tip in the right atrium. No axillary lymphadenopathy. No soft tissue fluid collections.ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance without focal lesions or biliary ductal dilation. Normal appearance of the gallbladder.SPLEEN: Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: Normal in appearance.KIDNEYS, URETERS: Normal in appearance without focal lesions, radiopaque stones, or hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: Normal appearing bowel loops, without wall thickening, mesenteric stranding, or associated fluid collections.BONES, SOFT TISSUES: Lytic appearing regions of the lumbar spine and sacrum likely reflect bone marrow changes seen on the prior MRI.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Subcentimeter peripherally calcified foci about the cecum likely represent prior torsed epiploic appendages. Otherwise normal appearing bowel loops, without wall thickening, mesenteric stranding, or associated fluid collections.BONES, SOFT TISSUES: Lytic appearing regions of the lumbar spine and sacrum likely reflect bone marrow changes seen on the prior MRI. Haziness of the right groin subcutaneous fat may reflect prior procedure or possible soft tissue edema. | 1. Small right pleural effusion with overlying subsegmental atelectasis.2. Lytic appearing regions of the lumbar spine and sacrum likely reflect bone marrow changes seen on the prior MRI.3. Haziness of the right groin subcutaneous fat may reflect prior procedure or possible soft tissue edema. Correlation with physical exam findings and history may be helpful. |
Generate impression based on findings. | Male 58 years old Reason: Please eval for progression or improvement in presumed fungal pneumonia. History: Pneumonia (likely fungal) in immunocompromised patient (AML) LUNGS AND PLEURA: Interval decrease in right pleural effusion, with small residual. Masslike consolidation in the superior segment of the right lower lobe has decreased in size since prior examination. No centrally hypoattenuating area is identified on this examination to suggest necrosis. Left upper lobe subpleural nodule is unchanged (Image 50 series 5). Mild centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Moderate to severe coronary artery calcifications. Central venous catheter tip at the cavoatrial junction. No lymphadenopathy.CHEST WALL: Degenerative changes in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval decrease in the masslike consolidation in the superior segment of the right lower lobe, with interval improvement of central necrosis. Interval decrease in size of right pleural effusion, with small residual pleural effusion. |
Generate impression based on findings. | 68y/o female with Right breast cancer; please page Dr. Jaskowiak-2440 prior to injecting patient; surgery 1/6/15 at 710am for Right SNBx, mast with recon RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | Female 49 years old Reason: metastatic breast cancer - evaluate response to treatment, compare to baseline exam uploaded in system with measurements per recist 1.1 History: lymphadenopathy - patient also having CT of neck CHEST:LUNGS AND PLEURA: Nonspecific 4-mm left lower lobe nodule unchanged.MEDIASTINUM AND HILA: Prevascular soft tissue mass measures 1.4 x 2.1 cm (image 22, series 3), previously 1.6 x 2.1 cm. The heart size is normal as is the caliber the great vessels. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: Large incompletely imaged amorphous left axillary mass encases the subclavian vessels, which are attenuated. Additional amorphous right axillary mass measures 4.2 x 7.7 cm (image 8, series 3), previously 4.2 x 8.7 cm. Additional soft tissue seen along the anterior aspect of the left clavicular head, measuring 2.0 x 3.0 cm (image 12, series 3), previously 1.9 x 3.2 cm. There are postsurgical changes related to left mastectomy and reconstruction.ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is the upper limit normal size. No hepatic metastases are identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating renal lesions are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.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: There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: No significant abnormality noted. | Postsurgical changes related to left mastectomy with bilateral axillary masses consistent with nodal metastases. Additional soft tissue mass anterior to the left clavicular head and within the prevascular space as detailed above. |
Generate impression based on findings. | 78 years old female with a History of right lung adenocarcinoma s/p resection in 2010, please evaluate lymph nodes and lesion noted on CT chest. RADIOPHARMACEUTICAL: 15.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates a small right pleural effusion and multiple right paratracheal lymph nodes in the mediastinum. Decreased attenuation of the liver is noted.Today's PET examination demonstrates increased metabolic activity in the multiple mediastinal right paratracheal and prevascular lymph nodes with SUV Max of 7.5. Several foci of mildly increased metabolic activity are seen in the bilateral lung hila. The SUVmax in the right hilar lymph nodes is 4.7.There is a focus of increased activity in the periaortic region at the level gastric cardia, which correlates with a soft tissue densities seen on CT. A small focus increased activity is seen in the right retrocrural space at level of the right adrenal gland. Additional focus of increased activity is seen in the right pericardial lymph node with SUV Max of 3.4.Mild FDG uptake is seen in the degenerative changes in the lower lumbar spine.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Multiple hypermetabolic lymph nodes in the mediastinum in the right paratracheal, prevascular, pericardial and peri-aortic regions as well as in the right retrocrural space, suspicious for nodal metastasis.2.Bilateral hilar mildly hypermetabolic lymph nodes, which are nonspecific. |
Generate impression based on findings. | 57-year-old male with gastric cancer. This study was performed for initial staging.RADIOPHARMACEUTICAL: 14.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 69 mg/dL. Today's CT portion of the neck demonstrates enlarged, enhancing parotid glands may be inflammatory in etiology. No significant lymphadenopathy. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates increased hypermetabolic activity correlating with a mass in the gastric antrum, SUV max 19.8. There is a focus of FDG activity at the surface of the right lobe of the liver correlating with a wedge shaped defect compatible with history of recent wedge biopsy. There is hypermetabolic activity in the midline anterior abdominal wall correlating with postsurgical changes. Increased FDG activity in the bilateral parotid glands may be inflammatory in etiology. Increased minimal activity in bilateral lung bases may be due to atelectasis. FDG activity surrounding the right chest port correlating with subcutaneous emphysema likely represents post-procedural changes. | 1.FDG avid gastric antrum mass compatible with malignancy.2.Increased activity in the right lobe of the liver and midline anterior abdominal wall compatible with biopsy and postsurgical changes, respectively. However, metastasis in the right perihepatic space cannot be excluded.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 36 year old woman with 3 month history of low back pain radiating down the lateral thigh and leg. There appear to be 5 lumbar vertebrae with partial sacralization of L5. There is slight rightward curvature of the lumbar spine. The spinal curvature slightly limits assessment of intervertebral discs, but we suspect moderate degenerative disc disease affects L3/L4 and L4/L5. There is grade 1 anterolisthesis of L4 on L5 and grade 2 anterolisthesis of L5 on S1. Moderate to severe osteoarthritis affects the facet joints of the lower lumbar spine. | Degenerative arthritic changes as described above. |
Generate impression based on findings. | 65 year-old woman with history of hip pain. A single modified Dunn view of the left hip is provided. Severe osteoarthritis affects the left hip with bone-on-bone apposition superiorly. There is prominence of the anterolateral aspect of the femoral head and neck junction with an alpha angle of approximately 60 degrees. | Osteoarthritis as described above. |
Generate impression based on findings. | 23 year-old woman with history of hip pain status post arthroscopy. A single modified Dunn view of the left hip is provided. There is minimal prominence of the anterior/superior aspect of the femoral head/neck junction with a mild cam deformity and an alpha angle measuring approximately 55 degrees. The hip otherwise appears normal. | Minimal cam deformity as described above. |
Generate impression based on findings. | Reason: 53 yo male with history of AML; pre-allo SCT evaluation History: evaluate LUNGS AND PLEURA: Previously noted groundglass opacities have resolved. No acute findings.MEDIASTINUM AND HILA: Right PICC tip at RA/SVC junction.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. | No acute cardiopulmonary abnormality. |
Generate impression based on findings. | 59-year-old female with pain status post fall Wrist: Alignment is anatomic. No fracture is identified. Small metallic object volar to the metacarpals is of unclear etiology.Hip: There is marked superior joint space narrowing, subchondral sclerosis and osteophyte formation about the hip. No fracture is visualized.Knee: Alignment is anatomic. No fracture is visualized. | 1. No acute fracture or dislocation.2. Metallic object volar to the metacarpals, of unclear etiology, correlate clinically. 3. Severe degenerative changes of the left hip. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis 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. Arterial calcifications are present. 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. | 6 mo ex 24wk male with previous OPM failureEXAMINATION: Oropharyngeal motility study 1/5/15 Julia Ecclestone, speech and language therapist, supervised the examination.45 seconds of fluoroscopy was used.Thin liquids were administered via medium flow nipple. Half strength nectar was administered via slow flow nipple. Nectar thick liquids were administered via slow flow in standard flow nipples.Oral deficits included increased suck ratio.Pharyngeal deficits included penetration with nectar thick liquids via standard flow nipple and aspiration with thin liquids via standard flow nipple and half strength nectar via slow flow nipple. No cough reflex was evident.The patient tolerated nectar thick liquid via clear rim standard flow nipple. | Aspiration identified.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | 49-year-old female, evaluate for left fifth toe osteomyelitis There is osseous destruction about the distal aspect of the proximal phalanx, which extends distally to the DIP and PIP joints. There is deformity and postoperative changes/amputations of the second through fourth digits. Marked soft tissue swelling. | Osseous destruction involving the fifth digit as described above, highly suggestive of osteomyelitis. |
Generate impression based on findings. | 60-year-old female with history of pain and swelling Alignment is anatomic. No significant joint space narrowing or erosions involving either knee. Ossification is partially visualized along the distal aspect of the right femoral diaphysis, suggestive of heterotopic ossification. | Partially visualized focus of likely heterotopic ossification along the distal right femoral diaphysis and additional findings as above. |
Generate impression based on findings. | 83-year-old male with bruising and tenderness Alignment is anatomic. No fracture is visualized. Degenerative arthritic changes affect the knee. | No fracture or dislocation. |
Generate impression based on findings. | LUNGS AND PLEURA: Significant interval decrease in the size and number left upper lobe lesions.Left apical nodule (image 15 series 6) now measures 9 mm x 8 mm previously measuring 12 mm x 7 mm.Additional left upper lobe lesion (image 17 series 6) now measuring 6 mm x 10 mm previously measuring 10 mm x 13 mm.Left superior segment lower lobe cavitary nodule (image 23 series 6) now measures 8 mm x 7 mm previously measuring 12 mm x 13 mm.No new pulmonary nodules or masses.No pleural effusions.Stable right upper lobe paramediastinal and right perihilar post radiation fibrotic changes.MEDIASTINUM AND HILA: Right supraclavicular adenopathy not measurable on this exam.Progressive interval decrease in mediastinal lymphadenopathy.Prevascular lymph node (image 25 series 5) measures 5 mm image in its short axis previously measuring 10 mm.Cardiac size is normal with stable small anteriorly located pericardial effusion.Mild coronary artery calcifications.CHEST WALL: Degenerative changes in the thoracic spine.No axillary lymphadenopathy.Surgical absent right breast and right axilla.Left chest port with its catheter tip in the SVC.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Retained contrast within the colon. | Continued interval decrease in the pulmonary nodules and mediastinal lymphadenopathy. |
Generate impression based on findings. | T2N0M0 squamous cell carcinoma of the tongue status post right partial glossectomy and bilateral selective neck dissection on 6/21/12. New suspicious 1 cm x 1 cm left lateral tongue lesion, indurated, slightly rough and firm. There post-treatment findings in the neck related to neck dissection and partial glossectomy. There appears to be an ill-defined lesion in the posterior left lateral tongue, although the lesion is partially obscured by dental amalgam artifact. There is no significant cervical lymphadenopathy based on size criteria. For example, a left level 1B lymph node measures 7 mm in short axis, which is unchanged. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. There is mild mucosal thickening within the maxillary sinuses. There are postoperative findings in the left temporo-occipital region with apparent encephalomalacia. The imaged portions of the lungs are clear. | 1. Post-treatment findings in the neck with an apparent ill-defined lesion in the posterior left lateral tongue that may represent recurrent tumor, although the lesion is partially obscured by dental amalgam. 2. No significant cervical lymphadenopathy. |
Generate impression based on findings. | Left breast cancer status post mastectomy and chemo/XRT and recurrent sarcoma left neck status post excision and XRT with chronic left sided facial numbness, now with hoarseness. There is persistent in the ill-defined soft tissue in the region of the left lung apex and supraclavicular fossa, as well as the subcutaneous stranding in the left chest wall. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. | 1. Persistent nonspecific soft tissue in the left supraclavicular fossa region and anterior left chest wall may be treatment-related. Nevertheless, underlying tumor recurrence cannot be entirely excluded and FDG-PET or MRI with contrast may be useful for further evaluation, if clinically warranted. 2. The upper airways are patent. |
Generate impression based on findings. | New left-sided weakness. Question of stroke. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. There is mild to moderate periventricular white matter hypoattenuation which is nonspecific but may represent small vessel ischemic disease. There is a partially empty sella. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a left lens implant. The skull and scalp soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage.2. Probable age indeterminate small vessel ischemic disease. CT is insensitive for the detection of nonhemorrhagic, acute ischemic infarcts. If clinical concern for ischemia persists, MRI may be obtained. |
Generate impression based on findings. | 59-year-old woman status post spinal stimulator placement. A spinal stimulator device is seen posterior to the left ilium with wires entering the spinal cord at the level of T12. The terminal leads of one wire lie at T7-T9 and the terminal leads of the other wire lie at T8-T10, appearing similar to the CT from 4/25/14. Severe degenerative disc disease and facet joint osteoarthritis affects the lumbar spine. Moderate to severe degenerative disc disease affects the lower thoracic spine with relatively mild degenerative disc disease affecting the upper thoracic spine. A plate and screw device is seen affixing C6 and C7 in fusion. | Spinal cord stimulator placement and degenerative arthritic changes as described above. |
Generate impression based on findings. | Corresponding to the area of abnormal low density on CT, there is T2/FLAIR hyperintensity within a mildly expanded left precentral gyrus. There is an underlying irregularly-shaped T1 hypointense and T2 hyperintense lesion, which does not suppress on FLAIR and remains isointense to white matter. This corresponds to the questioned rounded finding in this location on prior CT. There is corresponding smooth peripheral enhancement as well as linear internal enhancement cranially. There is a slightly more eccentric nodule of enhancement along its lateral aspect. This measures 12 x 10 mm in greatest dimensions, by 12 mm in greatest CC dimension.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are other scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no diffusion abnormality. There is a single focus of susceptibility along the lateral margin of the posterior body of the right lateral ventricle. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is incidental slightly prominent empty sella. The midline structures and craniocervical junction are otherwise within normal limits. The orbital lenses are surgically absent. There is mild mucosal thickening in the left maxillary sinus. | 1. Confirmation of parenchymal lesion centered at the gray-white junction in the left precentral gyrus with associated vasogenic edema and mild gyral expansion. This is a peripheral enhancement and possible internal septation. This is suspicious for a metastasis, although the differential diagnosis includes a primary brain neoplasm, and clinical correlation should also be made to exclude the possibility of neurocysticercosis, although there is only a single focus of nonspecific susceptibility along the right lateral ventricular margin without mineralization on CT.2. No acute infarct. Mild chronic small vessel ischemic changes. |
Generate impression based on findings. | 20 year-old male with midline spinal pain after MVC, rule out fracture Lumbar and thoracic vertebral body heights and alignment are maintained. No fracture is evident. | No fracture or malalignment. |
Generate impression based on findings. | 62-year-old male with knee pain Alignment is anatomic. No fracture is evident. Small osteophytes are noted along the tibiofemoral joint compartments. A focus of ossification adjacent to the proximal fibular diaphysis likely represents heterotopic ossification | No fracture or dislocation. |
Generate impression based on findings. | 76-year-old female with lung cancer. Follow up after chemotherapy. Clinical trial. ABDOMEN:LUNG BASES: Small pericardial effusion, unchanged.LIVER, BILIARY TRACT: Slightly nodular contour. No focal mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No adenopathy. Vascular calcification.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable exam. No evidence for metastatic disease in the abdomen or pelvis. |
Generate impression based on findings. | ET placementVIEW: Chest AP ET tube tip in the right mainstem bronchus. NG tube and left central line unchanged. Cardiothymic silhouette normal. Left lower lobe atelectasis new from prior study. Minimal atelectasis in the right lower lobe. | Malpositioned ET tube. |
Generate impression based on findings. | 12-year-old boy with history of fracture and pain. An orthopedic pin affixes the Salter-Harris type II fracture of the proximal phalanx of the right fifth finger in near anatomic alignment. The pin extends across the fifth metacarpophalangeal joint and through the physis of the fifth metacarpal head. There is callus formation along the proximal phalanx indicating some interval healing. | Orthopedic fixation of a healing proximal phalanx fracture. |
Generate impression based on findings. | Male 71 years old; Reason: right thigh mass History: mass CHEST:LUNGS AND PLEURA: Left upper lobe pulmonary lesion measures 1.3 x 1.1 cm (image 14/series 4). There a few scattered micronodules in the right lung (image 36 series 4)MEDIASTINUM AND HILA: Heart size is normal. Small right hilar and mediastinal lymph nodes.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Subcentimeter hypodensity focus in the pancreatic head/uncinate process (image 107/series 3) is too small to characterize.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes. Preaortic lymph node measures 1.1 x 1.0 cm (image 128/series 3). BOWEL, MESENTERY: A right peritoneal nodule measures 2.1 x 1.5 cm (image 153/series 4). There are chronic changes adjacent cecum. Including a peripherally calcified structure possibly representing a calcified diverticula.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple small right inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Heterogeneous mass involving the medial compartment of the right thigh. There is right thigh swelling.OTHER: No significant abnormality noted | 1.Lesions in the lung, retroperitoneum and right peritoneum suspicious for metastatic disease |
Generate impression based on findings. | Rhabdomyosarcoma, off therapy for 3 yearsVIEWS: Chest PA/lateral (two views) 1/5/15 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal.No focal lung opacities or pleural effusions are present. | No evidence of metastatic disease. |
Generate impression based on findings. | 67 year-old female with abdominal pain and fatty liver on an outside hospital study. Concern for mesenteric ischemia. LIMITED ABDOMENLIVER: The liver is normal in morphology, echogenicity and size, measuring 19 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. The hepatic veins are markedly prominent.BILIARY TRACT: A normally distended gallbladder is present with sludge and mild diffuse gallbladder wall thickening up to 4 mm which may be related to the patient's increased volume status. Evaluation for focal tenderness was limited by the patient's altered mental state. No extrahepatic biliary ductal dilatation with common duct measuring 3 mm.PANCREAS: The visualized pancreatic body and head are normal. There is mild nonspecific prominence of the pancreatic duct up to 3 mm.SPLEEN: The spleen is normal in morphology, echogenicity and size measuring 11.1 cm in length. RIGHT KIDNEY: The right kidney measures 10.6 cm in length without hydronephrosis or shadowing calculus. The renal cortex is mildly hyperechogenic.OTHER: The left kidney measures 10.2 cm in length without hydronephrosis or shadowing calculus. The renal cortex is mildly hyperechogenic.Note is made of bilateral pleural effusions. Moderate volume ascites. | 1. Patent hepatic vasculature with diminished diastolic flow with corresponding increased resistive indices which is nonspecific, but may be seen in the setting of hepatic venous congestion due to heart failure.2. Moderate volume ascites and bilateral pleural effusions.3. Echogenic renal cortices, compatible with medical renal disease.4. Gallbladder sludge and nonspecific wall thickening, may be seen in fluid overload states. Evaluation for focal tenderness was limited by the patient's decreased mental state. |
Generate impression based on findings. | Female 70 years old Reason: r/o PE History: shortness of breath PULMONARY ARTERIES: Technically adequate exam without evidence of pulmonary embolus.LUNGS AND PLEURA: Biapical scarring is again noted. Elevation of the left hemidiaphragm, with persistent left basilar atelectasis/consolidation.MEDIASTINUM AND HILA: Right chest port with tip in the right atrium. Reference paratracheal lymph node measures 0.9 cm in short access, previously 0.8 cm (image 74 series 7). Reference prevascular lymph node measures 0.5 cm (image 80 series 7) unchanged.CHEST WALL: Post op changes status post left mastectomy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of PE.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 71-year-old female with multiple past surgeries, prior abdominal fluid collection drainage and acute renal failure. Evaluate stability. Evaluation of the abdomen and pelvis is limited by lack of IV contrast as well as body habitus.ABDOMEN:LUNG BASES: Bilateral pleural effusions with atelectasis appears slightly increased. Severe coronary artery calcification.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Presumed vascular calcification in the renal hila bilaterally.RETROPERITONEUM, LYMPH NODES: No change in multiple small and borderline retroperitoneal lymph nodes.BOWEL, MESENTERY: There is small- moderate ascites within the abdomen without significant change. A drainage catheter in the left lower quadrant is not surrounded by significant fluid with the tip in the right lower quadrant. No free intraperitoneal gas.There is significant wall thickening involving a loop of small bowel in the left pelvis is noted on image 113/167. This cannot be well compared to prior exam which was performed without oral contrast.Stable wall thickening involving stomach which cannot be well separated from perigastric fluid.. There is a G-tube with balloon in the region of the body -- antrum.Ostomy in the right lower quadrant.BONES, SOFT TISSUES: Dehiscent wound involving the anterior abdominal wall. Small amount of gas adjacent to the G-tube in left upper quadrant soft tissues. Anasarca. SmallOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is mild, bilateral pelvic adenopathy without change.BOWEL, MESENTERY: There is small- moderate ascites within the abdomen without significant change. A drainage catheter in the left lower quadrant is not surrounded by significant fluid with the tip in the right lower quadrant. No free intraperitoneal gas.There is significant wall thickening involving a loop of small bowel in the left pelvis is noted on image 113/167. This cannot be well compared to prior exam which was performed without oral contrast.Diffuse, presumed fluid surrounding the stomach, although I cannot exclude gastric wall thickening. There is a G-tube with balloon in the region of the body -- antrum.Ostomy in the right lower quadrant.BONES, SOFT TISSUES: Dehiscent wound involving the anterior abdominal wall. Small amount of gas adjacent to the G-tube in left upper quadrant soft tissues. Anasarca.OTHER: Tip of the right femoral venous catheter at the level of the right common iliac vein. Tip of the left femoral venous catheter in the left common femoral region. | Further regression of a small amount of right lower quadrant fluid with drainage catheter.No significant change in ascites.Slight increase in pleural effusions.Stable abdominal/pelvic adenopathy.Small bowel wall thickening as well as gastric wall thickening. |
Generate impression based on findings. | Reason: right tongue with a new lesion on the left tongue History: r/o lung mets LUNGS AND PLEURA: Linear scarring and atelectasis at the lung bases. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Degenerative change involving thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary metastases. |
Generate impression based on findings. | 83 male with history of chest pain and arm numbness. LUNGS AND PLEURA: Minimal right lower lobe subsegmental atelectasis or scarring. Left lower lobe groundglass nodule (image 35/94), nonspecific and may be postinflammatory/infectious in etiology.MEDIASTINUM AND HILA: Small precarinal lymph node measures approximately 10 mm (3/35). Moderate coronary artery calcifications. Large hiatal hernia. Heterogeneous multinodular thyroid. Brachiocephalic and subclavian vessels course through the right sided mass though appear patent. The veins, however, are attenuated and are poorly evaluated. Doppler US would provide better characterization.CHEST WALL: Partially visualized 5.3 x 13 x 10-cm right anterior chest wall soft tissue mass which extends superiorly beyond the margin of this exam into the right neck base. There is associated permeative rib destruction of the at least right first through third ribs. "Nonpathologic" right lower rib fractures are also noted separate from the mass. Asymmetry in left rotator cuff soft tissue with probable permeative osseous changes in the humeral head and glenoid incompletely evaluated but suspicious for tumor involvement/metastatic disease.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hypoattenuating focus in the left kidney, nonspecific and incompletely violated on this exam. Additionally, a subcentimeter focus of hypoattenuation in the right hepatic lobe (series 3 image 89) may also be further evaluated on subsequent staging CT. Gallbladder incompletely evaluated though has equivocal wall thickening. | Right superior sulcus tumor highly suggestive of malignancy. Multiple other findings described above.Findings discussed with Dr Vinci at the time of report. |